COHIE:Colorado Health Information Exchange

“The road to CORHIO”David Kaplan, MD

Matt MadisonArt Davidson, MD

March 6, 2005

Funded in part through a contract with Agency for Health Care Research and Quality (AHRQ), and the Foundation for eHealth Initiative (FeHI) and their cooperative agreement with HRSA, Office for the Advancement for Telehealth (OAT). 

The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official view of AHRQ, HRSA/OAT or FeHI.

COHIE & the road to CORHIO

Where did we start COHIE partners Organizing the trip The primary scenario Work groups & lessons learned Evolution of a vision

Where did we start?

Colorado Health Outcomes Program UCHSC Denver Health Kaiser Permanente

Colorado The Children’s

Hospital University of

Colorado Hospital Complementary HIT

projects: Boulder County El Paso County Larimer County Mesa County Weld County

COHIE Initial PartnersBuilding upon what exists

Denver Health (DH)150,000 residents (25% of population)

Kaiser Permanente of Colorado (KPC)3rd largest CO HMO (350,000 members)

The Children’s Hospital (TCH)Largest pediatric specialty care provider

University of Colorado Hospital (UCH)Largest Metro area teaching hospital

Shared communities and patient care:

Pediatrics AdultsDH⇔TCH UCH⇔DH TCH⇔KPC KPC ⇔ (& Exempla)

UCHSC health professional training sites

Technical: advanced IS and IT at four initial partner institutions with strong health information systems vendors (e.g., Epic, Siemens)

COHIE Initial PartnersBuilding upon existing relationships

COHIE Initial Partners

Initial / Potential Partners

Organizing the Trip

Enthusiasm and support quickly generated questions

COHIE established Steering Committee with “Expert” Working Groups

Community Advisory Council is exploring RHIO

Learning LaboratoryCOHIE SteeringCommittee

Community AdvisoryCouncil

COHIE WorkingGroups

Legal Technical Clinical Organizational Research & Evaluation

Colorado's Regional Health Information Organization (RHIO)

A sharing, self-sustaining, non-profit structure that:

September 2009

October 2004

Vision:

Project:

Promotes legalagreements for

participation andaccess

Maintains arobust

technologyenvironment

Defines clinical -value through

policies &procedures

Manages thebudget andsustainable

business model

Supports nationalstandards andpublic health

interfaces

Learning from Others Study existing “maps”

Legal Group: reviewing “participation agreements” from Santa Barbara, CA, IN & MA

Technical Group: considering IN & MA models, “Connecting for Health”

Research Group: reviewing cost savings models from WA, MA, IN

Community Advisory Council: examining organizational models from UT & MA for RHIO business planning

The “Primary” Scenario

Clarifies the scope (common understanding)

Provides a structure to focus meetings and discussion

Creates a mechanism for logging issues and decisions

COHIE ProcessIterative review of scenario

Steering Committee Working Groups

Technical Clinical Legal Research/evaluation Organization Financial

Community Advisory Council

Colorado Health Information Exchange (COHIE): Scenario (Use Case), draft 12/22/04 - AD

a) Patient seizes, taken toThe Children's Hospital(TCH) EmergencyDepartment (ED)

c) Consent given?

b) Patient registration androutine informed consentwhich includes permision toelectronically query formatching patients acrossCOHIE partners. Patientmay "opt out".

a) Secure TCH registrationsystem message received atCOHIE; seek potentialmatches in unified masterpatient index (UMPI); uniqueUMPI identifier created;patient's consent storedcentrally with TCH identifier

e) ED Physician securelyreviews list of potentialmatches, confirms atrue match and sendsmessage to COHIE

f) COHIE receives alllaboratory, radiology,pharmacy and clinicalconsultation Information fromparticipatingpartners;organizes andpresents health history inweb page for viewing at TCH.

SCENARIO ASSUMPTION (USE CASE Pre-condition):

4 year old boy with history of prior seizures. Born prematurely at University of Colorado Hospital (UCH) with prolonged stay in NICU 1 year ago had first seizure while a Kaiser (KP) patient. Evaluated with CT scan, EEG and neurologist visit. Started on

unknown medication at that time. Patient lost health insurance coverage, transferred care to Denver Health (DH) outpatient clinic about 6 months ago. Seen at Westwood Family Health Center for blood test and change in medication about 3 days ago

STARTSCENARIO

i) ED Physician uses allhealth information toprovide best, costeffective, treatment forpatient.

END SCENARIO

YES

g) COHIE maintains a completeaudit log: who accessed thesystem, when, whatinformation was shared, and itssource

ED Physicianprovides treatmentwith limitedmedical historyfrom parent/patient

may requireadditional (andpotentiallyunnecssary ) blood tests, radiologic tests

NO

e) COHIE sends secure datarequest to retrieve patientclinical information

b) COHIE UMPI sends asecure message toparticipating partnersseeking any potentialmatches to this patient.

a) Secure message fromCOHIE received byparticipating partners(DH, KP, UCH)requesting potentialmatches .

d) ED Physician uniquelyidentified / authenticatedon the COHIE system

h) ED Physician securelyreviews clinical data inbrowser window

Desired information: medication used drug level EEG results CT scan results newborn, neurology and primary care exam findings

and diagnosis name/institution/contact method for treating MDs

b) Potential matchesidentified and messagereturned to COHIE fromeach partner.

c) Potential matches mergedand prepared as oneCOHIE web page forviewing at TCH

d) COHIE UMPI storesmatch with linking (TCH,DH, KP, UCH) identifiers

c) Secure COHIEmessage received byDH, KP/UCHrequesting clinical data

d) Clinical repositorydata identified andmessage preparedfor COHIE from DH/KP/UCH.

Partner Institutions (3)

COHIE (2)

The Children's Hospital (1)

f) Secure COHIEmessage received byTCH requesting clinicaldata

g) Clinical repositorydata identified andmessage preparedfor COHIE from TCH.

COHIE Working Groups

COMPONENTSLegal

ClinicalTechnical

Research/Evaluation

1.e) Potential matches

LegalQuestions: What are the implications of the clinician choosing the

wrong match? Clinical

Parameter: Provide a useful, small list of potential matches Technical

Issues: What logic constitutes a real match and realistic number of matches to handle? Build, buy vs. wait?

Parameter: Clinician must confirm one specific patient record to use for clinical data requests

Assumptions: Clinician’s confirmation shall persist in system and shall initiate request for patient’s clinical data

ResearchQuestion: How many is too many matches to review? What is the

clinician threshold to retain as useful?

2.g) Audits

Legal Questions: what are minimum legal/institutional audit requirements? Assumption: A “superset” of data will be valid for all entities.

Technical Assumption: Audit data will persist in COHIE logs. Question: Can COHIE build an audit query tool?

Research Question: How often do clinician abort from the system? Will the audit

tool allow us to infer reasons for leaving? How can we organize and deliver a survey for interruptions and what might identify other valuable data needed by clinicians.

Other potential use cases

Health care facility electronic data interchange Adult presenting to ED with chest pain Expanded use of decision support Continuity of care record (CCR) and skilled

nursing facility or nursing home patient Pharmacy benefits managers, large

laboratories as clinical data resources PH: registries (IZ & reportable diseases) Patients controlling access to their EHR

Learning LaboratoryCOHIE SteeringCommittee

Community AdvisoryCouncil

COHIE WorkingGroups

Legal Technical Clinical Organizational Research & Evaluation

Colorado's Regional Health Information Organization (RHIO)

A sharing, self-sustaining, non-profit structure that:

September 2009

October 2004

Vision:

Project:

Promotes legalagreements for

participation andaccess

Maintains arobust

technologyenvironment

Defines clinical -value through

policies &procedures

Manages thebudget andsustainable

business model

Supports nationalstandards andpublic health

interfaces

Going to ScaleCOHIE CORHIO

COHIE & CORHIO An Evolving Vision

COHIE – learning laboratory Purpose: provide data exchange services Goal: build a data exchange environment that promotes patient-

centric quality of care Product: generate value through data exchange

CORHIO – production environment Purpose: organize service availability/distribution Goal: sustainable, neutral (non-profit) body with balanced

representation Product(s): efficient CO data flow, standards, guidance, &

development/improvement opportunities

CORHIO Process

Colorado Health Institute Legal support Explore/define relationship COHIE ⇔ CORHIO Working Group

Business plan Articles of incorporation (501c3) Defining the board Education/public relations

Community Advisory Council

CORHIO Candidate Partners

COHIE Contact information:

Project Manager: Matt MadisonTelephone: 303-724-0334Email: matthew.madison@UCHSC.edu