Statewide Collaboration Process Protocol and Services Work Group HEAL 5 Kick Off Mtg May 12, 2008 DRAFT
Vision to Implementation: NYHII and SHIN-NY • • • Today RHIOs in early stages CHITAs nascent; NYC roll out Statewide infrastructure efforts in planning (common policies approaches) – bottom up and state-level approach • • • The Road SCP coordinates planning process Decisions and schedules created ASAP SCP manages integration of policy, technical, operational plans and implementation • • • Vision Robust efforts operational at local, regional, state levels Statewide infrastructure ubiquitous to achieve critical quality/pubh goals and drive regs. CHIx. P Protocols used at all levels
Today’s Discussion • Scope of Interoperable EHRs for Medicaid/Medication Management Use Case • Straw dog proposal and objectives • Key work streams/next steps
Scope of Medication Management • Medication Management is: – Across the continuum of care, complete access to medication history and other clinical information for clinicians and consumers to have the right information at right time to improve care – Electronic prescribing, including: formulary, eligibility, administrative authorization and clinical decision support functions to improve quality and safety and reduce costs • Medication Management requires the following system components: – Data Sources • • Medicaid data is leading the way Surescripts for e. RX network and medication history Rx. Hub formulary, medication history Other hospital, mom n’ pop retail pharmacies, long term care pharmacies • Laboratory information to support clinical decision support – HIE Services • Patient uniform id and identity reconciliation • 4 As • Secure physical connection
Medication Management Straw dog and Objectives • State level Medicaid service – Most projects are participating (ubiquity) – Strategic integration vs. point-to-point; consistent with MITA principles and ability to leverage other services – Clinically effective and cost effective • Additional state level data services to achieve medication management goals – Good potential for horizontal integration and standardization with other medication information services (e. g. – Rx. HUB, Sure. Scripts) – Economies of scope are realized if the aforementioned integrations occur, as one interface will now yield multiple feeds – Ability to drive key services for data quality and utility • Prerequisite HIE services
Medication Management A View From the Top Logical Physical? TODAY - Point-point proprietary EMR 1 1 Medicaid get. Rx (PUID*) VISION – Many Physical Architectures, Uniform CHIx. P EMR 1 Rx Object Medicaid, Sure. Scripts, Rx. Hub, … Local CHIx. P EMR 1 CHIx. P SHIN-NY *PUID - Positive, Uniform ID EMR 1 CHIx. P Medicaid
Breaking it Down 2 Before we can request the history we need a PUID… get. PUID (identifying attributes*) PUID System EMR 1 PUID Object *identifying attributes can be demographics, biometrics, etc. 3 Before we can get a PUID we need to connect and login… secure. Connect (credentials) 4 A’s System EMR 1 Security Object
Diving down Before we can login we need to authenticate… 3. 1 Requester PUID (provider) Authenticate (PUID, telephone #) EMR 1 Verify(PUID, telephone #) PUID System 4 a’s System PUID Object - verified Authenticate (PUID, telephone #) Security Object 3. 1. 1 Authentifying System Security Object Before we finish authenticating we need to record an audit log… Audit (transaction) 4 A’s System Audit Object Audit System
Infrastructure Before we can invoke many of the services described we need underlying infrastructure support… • Secure connection – Transport: HTTPS, TLS – Discovery: SHIN-NY DNS – Encryption: digital certificates, certificate authority • PUID System – Enrollment: IDs (self selected? ), phone numbers? , pictures? – Management: Additions, Verification, Removal ( death) – Implementation: high availability system
Protocols from the Pictures The needed protocols fall out from the diagrams • High Level – Services • • • get. RX get. PUID secure. Connect Authenticate Audit … • • • Rx. Object PUID Object Security Object Audit Object … – Structures • Further refinement (lots) will get us to UML diagrams or whatever final form we prefer • Issues begin to surface – PUID? Do we want this? Can we do it? – Do the protocols go all the way to the EMR? – Do we create protocols for infrastructure? – Do we provide implementations for statewide services or just protocol definitions?
Work Stream Process • Create P&S subgroup on Medication Management if needed • Assess NY, National efforts for leverage, compatibility considerations • Choose Exchange Architecture – Geographic with technologic exceptions (local EHR integration strategy) • Choose Extent – Base Standards (NCPDP, …) – Constrained Standards? – Common Instantiations? • Develop proposed CHIx. P – Draft and review – Plan for testing (instantiation or higher level extents if needed) • Coordinate with other groups – Plans for policy, adoption, evaluation
Straw Dog Work Streams • Identity Management – PUID System? • Identity Reconciliation – ‘MPI’ services: subject matching, … • 4 A’s – Authentication, Authorization, Access, Audit • Connection – Physical transport – Dynamic discovery • Medication Management – – Medication history protocol: Medicaid exemplar e. Rx Clinical information protocols related to medication management Clinical services: de-duping, interactions, …
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