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Your Healthcare Standards Conformance Partner

Accelerating Adoption of Health
Information Exchange Standards
AbdulMalik Shakir
President and Chief Informatics Scientist
Electronic Health Information
The use of Electronic Health
Records and the demand for
electronic exchange of health
information from one health
care professional to another is
growing along with national
efforts to improve the quality,
safety and efficiency of health
care delivery.

2 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
National Health Programs


Meaningful use requirements,
new payment approaches,
and federal financial
incentives are all driving the
interest and demand for
health information exchange.



Similar initiatives are
underway in other nations
throughout the world.

3 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Healthcare Informatics Standards


Healthcare organizations have
found it advantageous to
collaborate in the pursuit of
solutions to healthcare
information management issues.



Healthcare provider, payer, vendor,
consulting, and regulatory
organizations have formed
industry groups to study
information management issues
and develop standard solutions to
their common problems.

4 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Electronic Health Information Exchange
Claims/Prescriptions
Referral Process

Eligibility
Claim Status
Referral Process

Eligibility
Claim/Status

Payors

Pharmacies

Physicians

Public Health
Medical Society

Medical Records
Patient Data

Family Planning

Lab results

Mental Health

Hospitals

County/Community
Entities
Enrollment

Orders

Insurance Updates
Health Information

Results
Images

Testing Organizations
Lab/Images
5 of 32

Employers
Government
Medicare/Medicaid

Patients/Consumers

Accelerating Adoption of Health
Information Exchange Standards

October 14, 2013
Healthcare Data Interchange Standards
HL7
X12N
X12N / HL7 (Non-US only)
NCPDP

Healthcare
Information
System

HL7

HL7

HL7, X12N

DICOM
IEEE MIB,
ASTM

6 of 32

HL7

Accelerating Adoption of Health
Information Exchange Standards

HL7, X12N

October 14, 2013
Leading U.S. Healthcare Data Interchange SDOs
IEEE
Institute of Electrical and Electronic
Engineers

NCPDP
National Council for Prescription Drug
Programs

X12N
Insurance Subcommittee of X12

7 of 32

ASTM
American Society for Testing and
Materials
DICOM
Digital Imaging and Communications in
Medicine

HL7
Health Level Seven

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Leading U.S. Healthcare Data Interchange SDOs
IEEE
Instrumentation communication standards
and generalized information interchange
standards

ASTM
Lab reporting standards and standard guide
for content and structure of computerbased patient records

NCPDP
DICOM

Standards for communication of
prescription, billing, and other pharmacy
material

Standards for exchanging digital radiology
images

X12N

HL7

Standards for exchange of healthcare
insurance and billing information

Inter-application interoperability standards
for healthcare

8 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
HL7 and X12N




HL7
Insurance / Billing

X12N

Clinical / Administrative





9 of 32

HL7 and X12N are standards
development organizations
accredited by the American
National Standards Institute
(ANSI).
Each organization adheres to a
strict and well-defined set of
operating procedures that ensures
consensus, openness and balance
of interest.
HL7 develops standards that
enable disparate healthcare
applications to exchange key sets
of clinical and administrative data.
X12N develops specification that
enable the electronic interchange
of healthcare insurance and claims
processing data.

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
An X12N Data Interchange Scenario
Patient Billing
Application
System

Dataset

Program
Module

Outbound
Transformation

Inbound
Transformation

A to B
Transformation

10 of 32

Dataset

Patient Billing
Application
System

B to A
Transformation

Inbound
Transformation

Claims Processing
Application
System

User Interface

Outbound
Transformation

Program
Module

User Interface

Accelerating Adoption of Health Information Exchange Standards

Claims Processing
Application
System
October 14, 2013
An HL7 Data Interchange Scenario
Order Entry
Application
System

Dataset

Program
Module

Outbound
Transformation

Inbound
Transformation

A to B
Transformation

11 of 32

Dataset

Order Entry
Application
System

B to A
Transformation

Inbound
Transformation

Laboratory
Application
System

User Interface

Outbound
Transformation

Program
Module

User Interface

Accelerating Adoption of Health Information Exchange Standards

Laboratory
Application
System
October 14, 2013
Reaching the Limits of Application
Interfaces
Decision
Support

Electronic
Health Record

Lab

Radiology

Pharmacy

?
External
Systems

?
Order Entry

ADT

?

Administrative
Systems

Enterprise
Systems
12 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
HIE Standards: Why

• The number of interfaces between N systems is given by the formula (N2-N)/2.
• Linking 2 systems only needs 1 interface, (22 – 2) / 2 = 1;
• Linking 6 systems needs as many as 15 interfaces, (62 – 6) / 2 = 15
• The benefits of using standard increase rapidly with the number of systems involved.

13 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
HIE Standards: Why
Interfaces Requirements
120

100

Interfaces

80

60

40

20

0

2

3

4

5

6

7

8

9

10

11

12

13

14

15

W/O HL7

1

3

6

10

15

21

28

36

45

55

66

78

91

105

With HL7

2

3

4

5

6

7

8

9

10

11

12

13

14

15

System s

14 of 32

Tolerable

Painful

Accelerating Adoption of Health Information Exchange Standards

Intolerable

October 14, 2013
Health Information Exchange
Effective, meaningful health information exchange
requires that all parties involved in information
exchange adhere to predetermined transaction formats,
usage constraints, and encoding rules.

15 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Healthcare Information Integration Infrastructure
Your healthcare standards conformance partner



Product Domains



Health Information Integration





Health Information Standards Compliance

Healthcare Quality and Performance Measurement

Service Offerings


Consulting and Contracted Resources



Education and Training

16 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Health Information Standards Compliance



Hi3 Solutions’ STANDARDS CONFORMANCE VALIDATOR™ (SCV) is a
comprehensive suite of application services that validates compliance with
healthcare information exchange standard specifications and conformance
with related implementation guides and profiles.

17 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
STANDARDS CONFORMANCE VALIDATOR


Standard HIE Transaction Specifications



Standard Clinical Terminology Code Systems



Data Item Specific Value Sets



Use Case Driven Specification Profiles



Data Exchange Instance Validation

18 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Short List of HIE Standards
Standards


Exchange Structures













HL7 v2.x
HL7 v3 Messages
HL7 v3 CDA Documents
ASC X12 v5010

Code Systems


Profiles / Guides

SNOMED CT
LOINC
CPT
ICD

19 of 32

HL7







Case Notification
Laboratory Reporting
Immunization
Consolidated CDA

X12




834 Benefit Enrollment
837 Health Care Claim
835 Health Care Claim Payment

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Health Information Integration
Hi3 Solutions’ HEALTH INFORMATION INTEGRATOR™ (HII) is a
comprehensive suite of application and database services that facilitate the
transformation of data structures, translation of clinical terminologies, and
integration of health information.


20 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
HEALTH INFORMATION INTEGRATOR




Standard structure to local
structure transform



Standard structure to
standard structure transform



Coded value to coded value
translation



21 of 32

Local structure to standard
structure transform

Integrated health information
data repository

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Healthcare Quality and Performance Measurement

Hi3 Solutions’ HEALTHCARE QUALITY MONITOR™ (HQM) is a
comprehensive suite of data warehousing and business intelligence
solutions geared specifically toward monitoring quality and performance in
healthcare in accordance with established measurement standards.


22 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
HEALTHCARE QUALITY MONITOR






RIM-based Integrated
Data Repository
RIM-based Star-Schema
Business Intelligence
database
Predefine performance
measures and metrics
23 of 32






Drill-down and drillthrough capabilities
Information publication
and data export
capabilities
Data visualization and
reporting capabilities

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Quality and Performance Measures


CMS: Clinical Quality Measures



NCQA: Healthcare Effectiveness Data and Information Set



JCAHO: National Quality Core Measures



CMS: Physician Quality Reporting System



BC/BS: Pay For Performance

24 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
25 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Hi3 Solutions Products


STANDARDS CONFORMANCE VALIDATOR™ a comprehensive suite of
application services that validates compliance with healthcare information
exchange standard specifications and conformance with related
implementation guides and profiles.



HEALTH INFORMATION INTEGRATOR™ a comprehensive suite of
application and database services that facilitate the transformation of data
structures, translation of clinical terminologies, and integration of health
information.



HEALTHCARE QUALITY MONITOR™ a comprehensive suite of data
warehousing and business intelligence solutions geared specifically toward
monitoring quality and performance in healthcare in accordance with
established measurement standards.

26 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
http://54.200.52.82/
Hi3 Solutions Services


Consulting and Contracted Resources [Hi3 Consulting Group]




Consulting personnel provide advisory services and expert strategic guidance, while contracted
resources provide staffing for projects to augment internal personnel and fulfill gaps in skills or available
bandwidth.





Hi3 Solutions’ CONSULTING AND CONTRACTED SERVICES are provided by a diverse set of HIT
professionals with talent and experience in all areas of healthcare informatics, health information
exchange, and health information management in general.

Contracted services are also available to design and develop of custom turnkey solutions to meet client
specific information management needs.

Education and Training [Hi3 University]


Hi3 Solutions’ EDUCATION AND TRAINING SERVICES provide the knowledge transfer, skills
development, and skills certification required to establish an effective HIT workforce.



Education is provided in the form of instructor lead classroom tutorials, custom on-site training and
certification, and online live and pre-recorded webinars.



Hi3 educational offerings include topics in the area of health informatics standards, information
modeling and vocabulary management, and healthcare information management tools and technologies.

28 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Hi3 University

29 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
www.hi3solutions.com

30 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
Hi3 Solutions,
3500 W. Olive Ave,
Suite 300,
Burbank, CA 91505
ww.hi3solutions.com
+1 800 918-6520

31 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013
32 of 32

Accelerating Adoption of Health Information Exchange Standards

October 14, 2013

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Hi3 Solutions: Accelerating HIE standards conformance

  • 1. Your Healthcare Standards Conformance Partner Accelerating Adoption of Health Information Exchange Standards AbdulMalik Shakir President and Chief Informatics Scientist
  • 2. Electronic Health Information The use of Electronic Health Records and the demand for electronic exchange of health information from one health care professional to another is growing along with national efforts to improve the quality, safety and efficiency of health care delivery. 2 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 3. National Health Programs  Meaningful use requirements, new payment approaches, and federal financial incentives are all driving the interest and demand for health information exchange.  Similar initiatives are underway in other nations throughout the world. 3 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 4. Healthcare Informatics Standards  Healthcare organizations have found it advantageous to collaborate in the pursuit of solutions to healthcare information management issues.  Healthcare provider, payer, vendor, consulting, and regulatory organizations have formed industry groups to study information management issues and develop standard solutions to their common problems. 4 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 5. Electronic Health Information Exchange Claims/Prescriptions Referral Process Eligibility Claim Status Referral Process Eligibility Claim/Status Payors Pharmacies Physicians Public Health Medical Society Medical Records Patient Data Family Planning Lab results Mental Health Hospitals County/Community Entities Enrollment Orders Insurance Updates Health Information Results Images Testing Organizations Lab/Images 5 of 32 Employers Government Medicare/Medicaid Patients/Consumers Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 6. Healthcare Data Interchange Standards HL7 X12N X12N / HL7 (Non-US only) NCPDP Healthcare Information System HL7 HL7 HL7, X12N DICOM IEEE MIB, ASTM 6 of 32 HL7 Accelerating Adoption of Health Information Exchange Standards HL7, X12N October 14, 2013
  • 7. Leading U.S. Healthcare Data Interchange SDOs IEEE Institute of Electrical and Electronic Engineers NCPDP National Council for Prescription Drug Programs X12N Insurance Subcommittee of X12 7 of 32 ASTM American Society for Testing and Materials DICOM Digital Imaging and Communications in Medicine HL7 Health Level Seven Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 8. Leading U.S. Healthcare Data Interchange SDOs IEEE Instrumentation communication standards and generalized information interchange standards ASTM Lab reporting standards and standard guide for content and structure of computerbased patient records NCPDP DICOM Standards for communication of prescription, billing, and other pharmacy material Standards for exchanging digital radiology images X12N HL7 Standards for exchange of healthcare insurance and billing information Inter-application interoperability standards for healthcare 8 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 9. HL7 and X12N   HL7 Insurance / Billing X12N Clinical / Administrative   9 of 32 HL7 and X12N are standards development organizations accredited by the American National Standards Institute (ANSI). Each organization adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest. HL7 develops standards that enable disparate healthcare applications to exchange key sets of clinical and administrative data. X12N develops specification that enable the electronic interchange of healthcare insurance and claims processing data. Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 10. An X12N Data Interchange Scenario Patient Billing Application System Dataset Program Module Outbound Transformation Inbound Transformation A to B Transformation 10 of 32 Dataset Patient Billing Application System B to A Transformation Inbound Transformation Claims Processing Application System User Interface Outbound Transformation Program Module User Interface Accelerating Adoption of Health Information Exchange Standards Claims Processing Application System October 14, 2013
  • 11. An HL7 Data Interchange Scenario Order Entry Application System Dataset Program Module Outbound Transformation Inbound Transformation A to B Transformation 11 of 32 Dataset Order Entry Application System B to A Transformation Inbound Transformation Laboratory Application System User Interface Outbound Transformation Program Module User Interface Accelerating Adoption of Health Information Exchange Standards Laboratory Application System October 14, 2013
  • 12. Reaching the Limits of Application Interfaces Decision Support Electronic Health Record Lab Radiology Pharmacy ? External Systems ? Order Entry ADT ? Administrative Systems Enterprise Systems 12 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 13. HIE Standards: Why • The number of interfaces between N systems is given by the formula (N2-N)/2. • Linking 2 systems only needs 1 interface, (22 – 2) / 2 = 1; • Linking 6 systems needs as many as 15 interfaces, (62 – 6) / 2 = 15 • The benefits of using standard increase rapidly with the number of systems involved. 13 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 14. HIE Standards: Why Interfaces Requirements 120 100 Interfaces 80 60 40 20 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 W/O HL7 1 3 6 10 15 21 28 36 45 55 66 78 91 105 With HL7 2 3 4 5 6 7 8 9 10 11 12 13 14 15 System s 14 of 32 Tolerable Painful Accelerating Adoption of Health Information Exchange Standards Intolerable October 14, 2013
  • 15. Health Information Exchange Effective, meaningful health information exchange requires that all parties involved in information exchange adhere to predetermined transaction formats, usage constraints, and encoding rules. 15 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 16. Healthcare Information Integration Infrastructure Your healthcare standards conformance partner  Product Domains   Health Information Integration   Health Information Standards Compliance Healthcare Quality and Performance Measurement Service Offerings  Consulting and Contracted Resources  Education and Training 16 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 17. Health Information Standards Compliance  Hi3 Solutions’ STANDARDS CONFORMANCE VALIDATOR™ (SCV) is a comprehensive suite of application services that validates compliance with healthcare information exchange standard specifications and conformance with related implementation guides and profiles. 17 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 18. STANDARDS CONFORMANCE VALIDATOR  Standard HIE Transaction Specifications  Standard Clinical Terminology Code Systems  Data Item Specific Value Sets  Use Case Driven Specification Profiles  Data Exchange Instance Validation 18 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 19. Short List of HIE Standards Standards  Exchange Structures          HL7 v2.x HL7 v3 Messages HL7 v3 CDA Documents ASC X12 v5010 Code Systems  Profiles / Guides SNOMED CT LOINC CPT ICD 19 of 32 HL7      Case Notification Laboratory Reporting Immunization Consolidated CDA X12    834 Benefit Enrollment 837 Health Care Claim 835 Health Care Claim Payment Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 20. Health Information Integration Hi3 Solutions’ HEALTH INFORMATION INTEGRATOR™ (HII) is a comprehensive suite of application and database services that facilitate the transformation of data structures, translation of clinical terminologies, and integration of health information.  20 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 21. HEALTH INFORMATION INTEGRATOR   Standard structure to local structure transform  Standard structure to standard structure transform  Coded value to coded value translation  21 of 32 Local structure to standard structure transform Integrated health information data repository Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 22. Healthcare Quality and Performance Measurement Hi3 Solutions’ HEALTHCARE QUALITY MONITOR™ (HQM) is a comprehensive suite of data warehousing and business intelligence solutions geared specifically toward monitoring quality and performance in healthcare in accordance with established measurement standards.  22 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 23. HEALTHCARE QUALITY MONITOR    RIM-based Integrated Data Repository RIM-based Star-Schema Business Intelligence database Predefine performance measures and metrics 23 of 32    Drill-down and drillthrough capabilities Information publication and data export capabilities Data visualization and reporting capabilities Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 24. Quality and Performance Measures  CMS: Clinical Quality Measures  NCQA: Healthcare Effectiveness Data and Information Set  JCAHO: National Quality Core Measures  CMS: Physician Quality Reporting System  BC/BS: Pay For Performance 24 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 25. 25 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 26. Hi3 Solutions Products  STANDARDS CONFORMANCE VALIDATOR™ a comprehensive suite of application services that validates compliance with healthcare information exchange standard specifications and conformance with related implementation guides and profiles.  HEALTH INFORMATION INTEGRATOR™ a comprehensive suite of application and database services that facilitate the transformation of data structures, translation of clinical terminologies, and integration of health information.  HEALTHCARE QUALITY MONITOR™ a comprehensive suite of data warehousing and business intelligence solutions geared specifically toward monitoring quality and performance in healthcare in accordance with established measurement standards. 26 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 28. Hi3 Solutions Services  Consulting and Contracted Resources [Hi3 Consulting Group]   Consulting personnel provide advisory services and expert strategic guidance, while contracted resources provide staffing for projects to augment internal personnel and fulfill gaps in skills or available bandwidth.   Hi3 Solutions’ CONSULTING AND CONTRACTED SERVICES are provided by a diverse set of HIT professionals with talent and experience in all areas of healthcare informatics, health information exchange, and health information management in general. Contracted services are also available to design and develop of custom turnkey solutions to meet client specific information management needs. Education and Training [Hi3 University]  Hi3 Solutions’ EDUCATION AND TRAINING SERVICES provide the knowledge transfer, skills development, and skills certification required to establish an effective HIT workforce.  Education is provided in the form of instructor lead classroom tutorials, custom on-site training and certification, and online live and pre-recorded webinars.  Hi3 educational offerings include topics in the area of health informatics standards, information modeling and vocabulary management, and healthcare information management tools and technologies. 28 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 29. Hi3 University 29 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 30. www.hi3solutions.com 30 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 31. Hi3 Solutions, 3500 W. Olive Ave, Suite 300, Burbank, CA 91505 ww.hi3solutions.com +1 800 918-6520 31 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013
  • 32. 32 of 32 Accelerating Adoption of Health Information Exchange Standards October 14, 2013