Redwood MedNet Established 2005
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1 Redwood MedNet Established 2005 Health information exchange (HIE) services for healthcare facilities in Northern California 40 Outpatient Practices 5 Hospitals 1 Outpatient Surgery Center 5 Independent Laboratories 2 Imaging Centers 2 Public Health Departments 1 Skilled Nursing Facility As of 31 October
2 Redwood MedNet Core Services [1] Provide health data informatics expertise for under-resourced sites [2] Focus on electronic clinical data [3] Integrate gracefully with individual user work flow at each facility [4] Establish and maintain secure data network (i.e., transport ) services [5] Establish and maintain clinically rigorous content delivery services (i.e., interfaces ) 2
3 Redwood MedNet History Community steering committee Incorporated as 501(c)(3) nonprofit Test initial data circuits in northern Sonoma County Begin clinical data delivery in northern Sonoma County Expand data services to Mendocino County Add radiology report narratives, medication history Expand data delivery to Marin County, add immunizations Expand to Lake & Humboldt Counties, add referrals 3
4 Redwood MedNet Governance Nine (9) member Board of Directors (BOD) No carve-out seats or specified BOD member categories New bylaw proposal drafted to expand BOD to 11 members BOD meets monthly in conference room at Ukiah Valley Medical Center Twelve meetings per year Special meetings called as needed One special meeting in 2011, no special meetings yet in 2012 Next meeting Friday November 16,
5 Redwood MedNet Charitable Purpose The purpose of Redwood MedNet is to investigate and support optimal workflow solutions for the secure and appropriate sharing of electronic health files and clinical data, and to develop, improve and assist in the implementation of health information technology for health care providers, their business associates, and health care consumers. Adopted by Board of Directors, February (original) charitable purpose limited business services to physicians and business operations to Lake and Mendocino Counties 2007 revision expanded territory to Northern California 2011 revision expanded service categories and removed geographic boundaries 5
6 Redwood MedNet Strategic Assumptions Traditional HIE assumes operation of a single clinical data repository (CDR) for all healthcare facilities in a single region Redwood MedNet assumes the topology of a single community data repository is a legacy artifact of early HIE experiments (e.g., Indiana Network for Patient Care, HealthBridge, etc.) Redwood MedNet assumes the single data repository model will not work in California (e.g., imagine Kaiser, Sutter, Dignity, etc. in a single repository? NOT!) Therefore Redwood MedNet assumes the strategic priority for HIE services is data transport agility between healthcare facilities in overlapping geographic territories and not data content aggregation into a single repository 6
7 Redwood MedNet Validation of Strategy Demonstrated bidirectional interoperability with Kaiser Permanente in 2009 In 2012 Dignity Health adopted the same strategy (i.e., onboarded directly with national ehealth Exchange) HealthShare Bay Area is proposing the same strategy Same lightweight gateway approach No Record Locator Service and no portal, just an MPI with clinical data transport between enterprise HIE systems Veterans Administration and other federal facilities are building for the interoperability approach to support care coordination, and are not forwarding their patient data to a community CDR 7
8 Redwood MedNet Tactical Operations Redwood MedNet operates as a business neutral clinical data network Redwood MedNet has no members, just network participants Participating facilities sign a Network Participation Agreement Agreement derived from Markle Model Agreement Functionally identical to the new CHHS Model Agreement Redwood MedNet signed the Federal DURSA, November 2011 Onboarded with national ehealth Exchange, September
9 Redwood MedNet Sustainable Business Model Tactical Plan Leverage grant funding to capitalize business operations Use technical support subscription revenue to operate business Sustainability Phases 2005 to 2007 = Community needs assessment & HIE technology planning 2008 to 2011 = Build (rather than buy) prototype technology platform 2012 to 2014 = Drive operating revenue to sustainability level Revenue Model One time charges to establish interfaces Flat rate annual charges for subscription to basic HIE services Outpatient Practice: $200 per provider per year Hospital: from $6,000 to $18,000 per year Other: flat rate services quoted per participant Premium services also available 9
10 Redwood MedNet Business Operations Currently operating as a Virtual Corporation Redwood MedNet operates without employees Each capitalized business development project is contracted out Mendocino Informatics = general project management contractor Mirth Corp. for technology services Pillsbury, Winthrop, Shaw, Pittman for legal services Pam Rones, CPA for checkbook, accounting and tax returns BOD may approve hiring employees to move contract work in house after achieving sustainable revenue, or may not 10
11 Redwood MedNet Enterprise Applications Comprehensive health data integration engine to filter, transform and route clinical messages Clinical data repository (CDR) to organize and aggregate health data, with audited user access and a portal NOTE: There is little interest to date in portal functionality because participants want direct clinical data integration with their certified EHRs Specifically, over 300 physicians receive electronic clinical data via the HIE services, yet only one physician has a login account to the portal 11
12 Redwood MedNet Technology Standards CDR consumes HL7 v2.x, HL7 v3, NCPDP and DICOM messages CDR consumes CCD, C32, C37, C48 messages which adhere to the general CDA and HL7 v3 standards HIE establishes flexible and practical integration services with EMR, EHR, LIS, PACS and other clinical data sources HIE supports IHE standards for XCPD, XCA and XDS.b document submission and retrieval HIE supports ehealth Exchange (i.e. NwHIN ) Patient Discovery (PD), Document Query (DQ), Document Retrieve (DR) and Document Push (XDR) via integration with CONNECT gateway HIE supports Direct (PKI secured SMTP) transport protocol 12
13 Redwood MedNet Data Model 13
14 Redwood MedNet Interfaces 14
15 Redwood MedNet Current Expansion Projects [1] HIE Expansion (MUX-1) [2] HIE Infrastructure (MUX-2) [3] Safety Net Integration (MUX-3) [4] San Francisco VA Medical Center 15
16 Redwood MedNet Current Expansion Projects [1] HIE Expansion (MUX-1) 22 Participants (13 new participants in RWMN) 64 Deliverables (3 new data types - - IZ, CalREDIE & syndromic surveillance) Funded by contract with Cal econnect/california Health equality June 2011 to February
17 Redwood MedNet Current Expansion Projects [2] HIE Infrastructure (MUX-2) 9 Participants (3 new to RWMN) 18 Deliverables (1 new clinical data type - - visit summaries) Funded by contract with California Health equality December 2012 to May
18 Redwood MedNet Current Expansion Projects [3] Safety Net Integration (MUX-3) 3 Participants 18 Deliverables (1new clinical data type - - vitals) Funded by grant from Blue Shield of California Foundation (Alliance for Rural Community Health - ARCH - is the grantee, RWMN the technology contractor) December 2012 to May 2013 MCC MFN vitals CCD Redwood MedNet MCDH ADT CCD San Francisco VA Medical Center typical pattern for Healtheway Exchange NCMA CCD 18
19 Redwood MedNet Current Expansion Projects MUX-3 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 CSRHA Public covening MCC Technology Plan MFN Outbound - [ MCC > RWMN ] Vitals Outbound - [ MCC > RWMN ] CCD Outbound - [ MCC > RWMN ] CCD Inbound - [ MCDH > MCC ] CCD Inbound - [ NCMA > MCC ] MCDH Technology Plan ADT Outbound - [ MCDH > RWMN ] CCD Outbound - [ MCDH > RWMN ] CCD Inbound - [ RWMN > MCDH ] NCMA Technology Plan CCD Inbound - [ RWMN > NCMA ] CCD Outbound - [ NCMA > RWMN ] ARCH Integration Evaluation Technology Outline (6 ARCH sites) Publish Interfaces Milestones
20 Redwood MedNet, Inc. 216 West Perkins St Suite 206 Ukiah, California Will Ross Project Manager
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