Inter-institutional Data Sharing, Standards and Legal Arthur Davidson, MD, MSPH Agency for Healthcare Research and Quality, Washington, DC June 9, 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 author and do not necessarily represent the official view of AHRQ, HRSA/OAT or FeHI. Colorado Health Information Exchange
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Inter-institutional Data Sharing, Standards and Legal
Arthur Davidson, MD, MSPH
Agency for Healthcare Research and Quality, Washington, DC
June 9, 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 author and do not necessarily represent the official view of AHRQ, HRSA/OAT or FeHI.
Colorado Health Information Exchange
Goal: Create a local health information infrastructure for clinicians to access patient information across individual health care institutions
Colorado Health Information Exchange 2 Complementary Initiatives
Build 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
COHIE to CORHIO
COHIELearning
Laboratory
Steering Committee
Working groups:• Technical• Clinical• Evaluation• Legal• Organizational
Community Advisory Council
Colorado Regional Health Information OrganizationA sharing, self-sustaining non-profit structure that:
Promotes legal
agreements for
participation and access
Maintains a robust
technical environment
Defines clinical value
through policy and procedures
Manages the budget and
sustainable business
model
Supports national
standards and public
health interfaces
PROJECT(10/2004)
VISION(10/2009)
COHIE: 2005 plan
RHIO: 2005 vision
Organizational / Governance Layer
Inter-Enterprise Utility Services
Network Transport
Inter-Enterprise Business Services
Internal OperationsLayer
Operating Entity
Organizing / Convening Entity
Participating Entity
Operational / Project Sub-committee
Financing Entity
Operational / Project Sub-committee
Message Standards Validation
InternetLeased Private
Network
Message or Other Storage
Privacy / Security
Authorization
Record Locator
(MPI)
Hosted Routing Services
Customer / User Portal
Call Center
Message Translation
Message Handling
Process- / Data Content-Specific
Applications
Standard Software Applications /
Services / ToolsAdapter Adapter Adapter Adapter
Hospital Information
System
Electronic Medical Record (EMR) System
Physician OfficePractice
Management System
Lab,/ Diagnostic Imaging /
Ancillary System
Adapter Payer Claims SystemAdapter
Pharmacy / PBM
SystemAdapter
Public Health / Disease Surveillance SystemAdapter
Adapter Adapter
Adapter
The “Primary” Scenario
• Clarifies the scope (common understanding)
• Provides a structure to focus meetings and discussion
• Creates a mechanism for logging issues and decisions
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 GroupsIterative reviews
COMPONENTSLegal
ClinicalTechnical
Research/Evaluation
Timeline – October 2005• MPI prototype, record locater service (RLS)
• Data sharing agreement: based on IN• avoids multiple BAA• no research references
• Incidental disclosures: CFH Policy Group• Design modification: ? near 100% match for
disclosure (high threshold to start), role-based threshold (ED vs. referral MD), challenge to business case
• Minimum certainty before RLS returns demographic information to the requester
• Minimum number of required demographic fields supplied by the requester before the RLS returns demographic information.