Provider Directory Strategies John D Halamka MD March

Provider Directory Strategies John D. Halamka MD March 21, 2011

The Massachusetts HIE Procurement • Project 1 – HIE Software Components – – – Subproject 1: Direct Gateway Subproject 2: AIMS Subproject 3: Provider Directory Subproject 4: Clinical Gateway Subproject 5: Children’s Behavioral Health Initiative Interface Module – Subproject 6: Syndromic Surveillance Interface Module – Subproject 7: Healthcare Provider Portal – Subproject 8: Local Access for Network Distribution (LAND) • Project 2 Public Key Infrastructure (PKI) • Project 3 Hosting

The Massachusetts Statewide Health Information Exchange (Illustrative) Mass. Health BIDMC Partners DPH EOHHS NEHEN Nw. HIN Bay. State Health Statewide HISP Direct gateway services Web portal PKI/certificate mgmt Provider/entity directory Audit log Atrius Safe. Health MD MD MD Fallon Clinic UMass Memorial MD MD MD

Phasing defines Roadmap for Statewide HIE Program Phase 1 Information Highway • Create infrastructure to enable secure transmission (“directed exchange”) of clinical information • Will support exchange among clinicians, public health, and stand-alone registries • Focus on breadth over depth Phase 2 Analytics and Population Health • Create infrastructure to facilitate data aggregation/analysis Facilitate normalization and aggregation • Will support Medicaid CDR and quality measure infrastructure • Will support vocabulary translation services (lab, RX) Phase 3 Search and Retrieve Enable queries for • Create infrastructure for cross-institutional queries for and records retrieval of patient records Increasing cost and complexity

Statewide HIE Services Overview Network participants Phase 1: • • Hospitals (inc. labs and imaging) PCP or Specialist Health plans Long-term care facilities Other care setting Patients* Quality Reporting Service * Public health* Additional network participants Phase 2: • More providers and payers and quality reporting services • Commercial diagnostic facilities • Imaging centers • Labs Additional network participants Phase 3: More providers and payers *single-direction exchange Network functions Send/receive: • Referral/Consult • Admission notification • Post-encounter summary • Discharge Summary/Instructions • Lab Order/Results • Death Notification • Uniform Transfer Form • Public health (SS, Imm. , ELR) • Provider address search Additional network functions Send/receive: • Public Health Alerts • Quality Measure Reports • Patient-matching service • Vocabulary normalization service Additional network functions Search and retrieve: • Patient record • Patient consent/authorization

Leveraging existing and new Mass. Health infrastructure HIE Users (Medicaid and non-Medicaid) ~80 K users already using Virtual Gateway EHR (Direct enabled) Provider Online Service Center Claims Engine VG Shared Service MMISShared Service XDR or SMTP MMIS Base Application EHR (not Direct enabled) Web portal Labs (HL 7) Clinical documents (CDA) Virtual Gateway Labs (HL 7) Clinical documents (CDA) Other Existing Enterprise Shared Services MMIS AIMS* AIMS (Access and Identity Management) CBHI Syndromic Surveillance (Children’s Behavioral Health Initiative ) Clinical Gateway* Clinical Gateway (HL 7 Interfaces) Immunization PKI** Electronic Laboratory Reports (Public Key Infrastructure) No interoperable EHR Medicaid & Public Health Applications Web portal Provider Directory** Clinical documents Direct Gateway** Architecture and usage patterns identical for all users Security and Provider Directory services leveraged for Statewide HISP

Complement infrastructure with a multi-pronged Last Mile Adoption Program ONC Cooperative Agreement (last-mile services) CMS SMHP/MMIS (infrastructure) Managed procurement of interfaces Hospital/ambulatory EHR vendor LTC/BH/other vendors Managed procurements, grants, and PM/technical support Grants/technical assistance to underresourced providers Small practices VG Shared Service MMIS Shared Service Other Existing Enterprise Shared Services Virtual Gateway Statewide outreach, recruitment, and training Provider Online Service Center Claims Engine MMIS Base Application MMIS AIMS* AIMS (Access and Identity Management) Syndromic Surveillance CBHI (Children’s Behavioral Health Initiative ) Clinical Gateway* Clinical Gateway (HL 7 Interfaces) Immunization PKI** Electronic Laboratory Reports (Public Key Infrastructure) Medicaid & Public Health Applications LTC/BH/CAH Provider Directory** Synergies with Me. HI REC Direct Gateway** Web portal recruitment and training Small practices Me. HI Logo here LTC/BH/other Statewide HISP

Vendor Roundtable • EHR vendor roundtable held on December 16, 2011 – Over 20 vendors participated in 4 -hour session – Mix of ambulatory, hospital, and HIE vendors • Goal was to understand vendors current and near-future interoperability capabilities and get feedback on MA approach • Findings – There is wide variation in vendor interoperability capabilities – Few if any vendors have production Direct-enabled systems in place today – There are no standardized approaches to integration with centralized provider directories or PKI infrastructure – All of the vendors supported a centrally coordinated approach to interface development and deployment

Entity Level, Individual Level or Both? • Entity = organization, department, agency, vendor, service provider etc. • Individual = a person • We decided that the directory should have a schema within a relational database that enables lookup of entities (e. g. , Organizations, Departments, State Agencies, Payer Organizations, Patient Health Record services) AND an individual's affiliation with an entity trusted by the HIE.

Federated or Central? • Elected a Central Provider Directory given lack of proven scalable approach to federated provider directories • Elected a Federated PKI implementation based on Direct DNS specification 10

Services Approach • Chose SOAP/REST web services API for query/response, add/change, delete over the internet • Chose LDAP for intranet operations • Willing to pilot Microdata/Search engine approach but have not yet included it 11

• • • Many options to populate/maintain the directory Massachusetts Health Quality Partners dataset IDN/ACO datasets Massachusetts Medical Society dataset REC dataset Last Mile Process 12

Questions? http: //geekdoctor. blogspot. com jhalamka@caregroup. harvard. edu