Infrastructure Updates for Beacon Roundtable 9-15-2011

Infrastructure updates for Beacon Roundtable 9-15-2011

Clinical Data Repository : Regenstrief

Context: RI told us in a phone call that they would not do data normalization which meant we had to normalize data in the form they wanted. By this time Rochester ADT/labs, MCHS, Winona and PH were all sending test data feeds.

This was a show stopper for an RI CDR for Beacon. While exploring other options, operationally the best tactical route was through RI and the best method to explore that was a face-to-face meeting.

Beacon team visited Regenstrief on Sep 6 2011

The goal was to determine certain responsibilities regarding normalizing the data that are expected to flow into the Repository from 14 data feeds ( Mayo/Rochester, MCHS, Olmsted, Winona and 11 PH counties)

Decisions:

Beacon communities will provide the cross walks (mapping tables) from local codes (from EMRs) to LOINC codes. These will then be mapped to a dictionary of RI codes (which are more granular for clinical specimens) normalized and persisted. A set of standardized queries will be designed for all Beacon communities (each site can decide on queries as required).

Backload of three years data is considered.

Mayo data will be filtered at the query stage to only three states (IA, WI, and MN) to avoid international and other patient data to be prevented from queried for SEMN. MCHS all data will be included and for other sites they can determine what they want. (Expected to include all data)

Medications feed will be from CCDs if they are parsable for December timeline. If not Medications will not be included for December. Generating from source feeds will be complex. Survey of communities will be held for drug formularies used.

Data Feeds in order of priority:

1. ADT- HL-7

2. Labs-LOINC

3. ICD/CPT: Billing codes – CSV over FTP

4. Medications- HL-7 from CCD or backload from EDT for Mayo

The next steps are

1. Provide cross walks to Regenstrief from all Beacon participants

2. Restart the data feeds ( test data) from Rochester ADT/Labs, MCHS, Winona, Olmsted and Public Health

3. Completion of contractual legal framework

of 5 4. Production data

The timelines have been shifted from September to end of 2011.

A proof of functionality CDR is expected by end of 2011.

1. Mayo

 ADT transactions are transmitted  Currently close to 10,000 transactions are transmitted with minimal errors.  First cut of LOINC cross walk tables sent to RI today. Labs are from Websphere  Exploring if EDT backloads of medications can be fed into the Repository for Dec timeline. 2. MCHS  Lab and ADT Cross walks will be given to Regenstrief  Cerner lab codes are currently mapped to SOFT (PH-Dict) codes to get to MICS. MICS/SOFT ( PH Dict) codes are already mapped to LOINC from SOFT 3. OMC:  VPN Connectivity established  ADT testing underway  Lab data ( LOINC crosswalk ) – Kris to confirm  Backload to commence upon execution of Data Agreement  Meeting on September 27th 4. Winona  HL7 connectivity has been established- HL-7 test message transmitted.  Working on sending CCD and other clinical data to the repository. We’re still working on the HL7 piece. I worked with Cerner resources yesterday on some ADT transactions. So, were still plugging along. I am waiting on Amanda Smiley now for times that will work for our next call.  9-15-2011 update from Gail: I am happy to report that we have been successful at transmitting a document (not CCD) to the Cerner Hub. Here’s an email that I received from Jonathan(Cerner interface resource) this morning regarding the connectivity. We are waiting for Larry Lemmon to complete the CernerWorks VPN form for the CCD VPN tunnel. Then, CernerWorks will bring up the tunnel, and we can send test CCD’s.  Work in progress on parsable CCD to Regenstrief ( for medications)  Labs will be from CCD. LOINC cross walks given on 9-16-2011 5. Public Health  Mirth appliance has been set up and CCD consumption of patient Winona CCD, parsing and medication reconciliation on PH Doc will be demonstrated during ONC visit  PH is currently focused on CCD consumption and parsing.  PH will determine a relevant CDA format which may not be a typical CCD (as required by MU). PH Doc is a nurse only EMR which is not by any licensed or mid-level providers hence there is no medication, and no ICD generated by PH-Doc. In general, Public Health is focused on sending ADT and QOL data to Regenstrief

 ACS has completed the programming/testing of the nightly ADT push to Regenstrief (using LLP and the appliance)  ACS has completed the programming of the one-time ADT push to Regenstrief for backload of data (using SFTP and the appliance)  ACS is waiting for the SFTP URL from Regenstrief to test the one-time ADT push.

of 5  ACS will install the nightly ADT push and one-time backload at OLMSTED COUNTY at end of October 2011  ACS will soon be working with Dan Jensen on implementing the QOL assessment form within PH-Doc  ACS will be installing the QOL assessment form in the Beacon counties by end of 2011  ACS will be developing the ability to push QOL data elements (probably LOINC codes) to Regenstrief  ACS will be installing the ability to push QOL data elements to Regenstrief in 2012  ACS will be working on requesting and receiving other CDA documents in 2012

 ACS will be working on creating other CDA documents in 2012

Health Information Exchange

1. Mayo/MCHS

Mayo and MCHS are part of an enterprise wide HIE effort independent of Beacon

Phase I: Custom CCD in 2011 from GE only in Rochester from a CCD generator; generate a readable document, CDA compatible, not coded and parsable and viewable in synthesis.

Phase II: CCD from GE and Cerner in 2012 (required for MU), integrating with external CCD and viewable in EMR and generated from the MU certified version of GE and Cerner.

 Mayo received appliance in week of 9-5-2011  Connectivity testing scheduled to be done with Intermountain Health by September 30 as part of CCC commitment. This will be done with a mock up CCD (phase I above) and include the full workflow including patient discovery.  Next phase of testing by December 2011  Production i.e. exchange with CCC, Bacon and other communities by January 15th. Timeline for NHIN connectivity is January 2012. Beacon timeline for HIE is Q1 2012

2. Winona

Generated CCD is being used for ONC demo. Cerner is yet to start CCD parsing and no date has been determined. NHIN connectivity is expected September end. Exchanging to Cerner attestation site HIE- Winona health – Pending Regenstrief completion, goal is now 1st quarter 2012.

o Producing CCD’s in production EHR. o Plan to exchange with area tertiary facilities as soon as they are ready 3. OMC

 EHR Software Generates parsable CCD  NwHIN Exchange will be used  Anticipated production HIE by 12/31/11  Update on 9-15-2011 from Call: EMR vendor ( Med 3000) does not support synchronous HIE. i.e. the process will be when a CCD request comes to HER at Olmsted as a clinical message, it is routed to a physician/nurse who approves request, CCD is generated manually, checks for patient consent and then sent out . All this is automatically done in MIRTH connect.  Exploring options with Mayo HIE team _ MIRTH Results/Match to push all CCDs to a holding area to be accessed??

of 5 4. Public health

HIE- In general, Public Health will be using the MIRTH appliance installed with the CONNECT gateway to accomplish the exchange of documents

 MIRTH Appliance is installed and running at two sites: physical appliance at ACS (developer site) and virtual appliance at Olmsted County (user site)  Gateway is installed at both sites  ACS is holding on gateway development until after MIRTH WEBEX training  This week, Dan Jensen arranged for 80 hours of additional training on the gateway for ACS ( to be held AFTER #3 training)

CCD- In general, Public Health is focused on requesting and receiving CCDs from Winona, MAYO and Olmsted Medical Center. Creating a CCD from Public Health will be analyzed in 2012

 ACS is testing/demoing the consumption of the CCD from Winona - header and medications only  ACS will distribute this work to OLMSTED COUNTY at end of March in 2012 (along with application enhancements to structured medications and allergies)  ACS is completing the gap analysis for consuming additional sections of the CCD by end of 2011

Meaningful Use

1. MCHS  October upgrade  December attestation 2. OMC  Eligible Providers to Attest 10/1/11 3. Winona  Winona Health’s stage one attestation periods are as follows. o Hospital – July – September 2011 o Eligible Provider – October – December 2011

Portals/Patient Engagement

1. OMC  Patient Portal live 7/15/11  Visit Summaries provided patients via portal 2. Winona  Winona Health Online is a free web-tool that allows you to have access to your Winona Health records anytime, anywhere you have internet connection.  Winona Health Online e-Record makes it fast and easy to view your personal medical history: o Lab results o Clinical Information o Immunization Records o Medication history

of 5 Other Updates

1. Mayo Clinic Health Systems Update  Working groups formed to specifically focus on CDR, HIE, MU and Portal. Resources are identified.  Project plan is drawn up, updated with new timelines and will include resources and efforts.  Efforts are on to align the MCHS Asthma Action Plan to a standardized template used by Mayo (new CDM). 2. QOL Technical Specification Requirements:

 Expected soon to be passed on to development at PH-Doc, CDM

3. ONC Visit Technical Presentation:

The event was at Owatonna Clinic on September 12 2011 from 5-7 PM followed by dinner (7-9 PM) at Gainey conference center.

The invitees are MCHS leadership and Beacon infrastructure team from all participants and the agenda was:

1. Beacon Progress update, lessons learned, best practices, milestones achieved and way forward

2. HIE Demo: Public health will WebEx from Owatonna to Olmsted and demonstrate consumption of CCD into PH-Doc. Part II of this the med reconciliation was demonstrated at the PH offices on Tuesday September 13th at noon.

3. MCHS presentation by Dr. Brian Bunkers who will highlight the MCHS organization and community based care delivery model that is scalable and replicable.

4. Walk around of MCHS Owatonna Clinic and Allina hospital

Owatonna location has added significance considering the interest that Allina hospitals have shown in participating in Beacon for CDR and HIE. The Owatonna Allina hospital leadership and corporate IT leadership will attend the event. They are on Epic Systems.