Presenter(s): Dave Venier. Topic Rosetta Interoperability (C-CDA and IHE) Level 200

Transcription

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2 Presenter(s): Dave Venier Topic Rosetta Interoperability (C-CDA and IHE) Level 200

3 Safe Harbor Provisions/Legal Disclaimer This presentation may contain forward-looking statements within the meaning of the federal securities laws, including statements concerning future prospects, events, developments, the Company s future performance, management s expectations, intentions, estimates, beliefs, projections and plans, business outlook and product availability. These forward-looking statements do not represent a commitment, promise or legal obligation to deliver any material, code or functionality. The development, release and timing of any features or functionality described for our products remains at our sole discretion. Future products developed beyond what is contemplated by existing maintenance agreements, will be priced separately. This roadmap does not constitute an offer to sell any product or technology. We believe that these forward-looking statements are reasonable and are based on reasonable assumptions and forecasts, however, undue reliance should not be placed on such statements that speak only as of the date hereof. Moreover, these forward-looking statements are subject to a number of risks and uncertainties, some of which are outlined below. As a result, actual results may vary materially from those anticipated by the forward-looking statements. Among the important factors that could cause actual results to differ materially from those indicated by such forward-looking statements are: the volume and timing of systems sales and installations; the possibility that products will not achieve or sustain market acceptance; the impact of incentive payments under The American Recovery and Reinvestment Act on sales and the ability of the Company to meet continued certification requirements; the development by competitors of new or superior technologies; the timing, cost and success or failure of new product and service introductions, development and product upgrade releases; undetected errors or bugs in software; changing economic, political or regulatory influences in the health-care industry or applicable to our business; changes in product-pricing policies; availability of third-party products and components; competitive pressures including product offerings, pricing and promotional activities; the Company's ability or inability to attract and retain qualified personnel; uncertainties concerning threatened, pending and new litigation against the Company; general economic conditions; and the risk factors detailed from time to time in the Company s periodic reports and registration statements filed with the Securities and Exchange Commission.

4 Agenda C-CDA Exchange Functional Overview New functionality for 5.8 UD2 New functionality coming in 5.8 UD3 C-CDA Nightly Export via the Background Business Processor (BBP) Immunizations import from the C-CDA C-CDA content collection and generation filtering Consent-based PIX integration What s in the Pipeline?

5 C-CDA Exchange Functional Overview

6 Required Interoperability Environments PCMH Beacon Grants Regional Extension Centers EHRs & Providers ACO Meaningful Use Hospitals Labs Radiology Public Health

7 Building Blocks of Exchange Vocab Content ICD 9/10, CPT, SNOMED-CT CDA, HL7, X12 Transport Security / Trust Underlying Services User Workflows Web-Services (SOAP), SMTP, MLLP X.509, SAML CERTIFICATE AUTHORITIES, PROVIDER DIRECTORIES Usability, Automation

8 Rosetta EHR Connect Interfaces Rosetta EHR Connect is the bundle of Interfaces which connect the NextGen EHR to 3rd parties and providers.

9 Interoperability and Why it Matters Access to actionable data which resides in external systems Support of data exchange using industry standards Ability to export / import data to support a variety of workflows: Encounter creation (automated import) Locked encounter (automated export) Template triggers (workflow triggered) BBP (automated nightly processing import & export) Manual (Medical Summary Utility & EHR) Integration with provider workflows Interoperability delivers the promise of EHR efficiencies, reduces duplication of services, and access to data

10 Current State NextGen Share EHR Connect Clients In Production 700 (74,000 Addresses!) 100 Clients In Test

11 Rosetta EHR Connect A bundle of interfaces allowing NextGen EHR to connect to HIEs and 3 rd parties Uses Components of Rosetta Including the HIE Gateway Distributed via the Rosetta installer Managed via the Rosetta Management Console Rosetta EHR Connect IS NOT required for MU2

12 Rosetta EHR Connect Services EMPI, Patient Identification Bi-directional document exchange with an HIE Patient consent Secure Transport Content generation for Medical Summaries (C-CDA) Workflow integration Enhanced workflow Sensitive data stripping Discrete data import

13 Discontinuing the Surescripts HISP Interface With the advent of NextGen Share, we have decided not to renew our Surescripts HISP connectivity This only applies to customers who purchased a Direct interface to the Surescripts HISP On July 1, 2016, the Surescripts HISP interface will no longer be available Migrate now to NextGen Share to avoid the disruption of your Direct interface The Surescripts HISP Interface will be discontinued on July 1, Migrate NOW to NextGen Share for Direct connectivity

14 New Functionality for 5.8 UD2 & UD3

15 New functionality for 5.8 UD2 Export Document Management Images (ICS) via MSU Automate On-Demand Document registration process BBP Nightly query of C-CDA Documents Filtering C-CDA documents by payer, billable/clinical indicator, and provider Allow inclusion of Sensitive data when generating a C-CDA to file for a patient Allow disabling encrypted log files in HIE Gateway

16 New functionality for 5.8 UD3 Add a HL7 v 3 Demographic Import Interface Extracting patient demographics from the C-CDA for NG Share (pushed to UD2/UD1 also) Importing Immunizations from the C-CDA with the Recon Module PIX Only MPI mode outside of the EPM/EHR person lookup screen (pushed to UD2 also) Control how many C-CDA files exported per file (applies to HL7 also) Allow the Omission of any C-CDA sections Validate C-CDA Documents Automatically

17 C-CDA Nightly Export via the BBP

18 C-CDA Nightly Export via the BBP Currently there are two ways to get C-CDA s exporting automatically including Locked encounter (most commonly used) Template triggers These options do suit most workflows but do leave gaps For example: if an encounter is locked but results are imported a day later to that encounter, an export is not triggered automatically. In 5.8 UD3 we now support tracking changes to encounters and exporting automatically as necessary.

19 C-CDA Nightly Export via the BBP The change allows users to configure the system to watch specific tables for changes on encounters When those changes occur the system adds the encounter to a tracking table A stored procedure has been created to look at the tracking table and trigger the Rosetta agent to export based on the encounters which have changed. The BBP can be configured to run this stored procedure nightly or as needed.

20 C-CDA Nightly Export via the BBP The HIE Gateway Administration Console supports the configuration of this functionality. Users can create new configurations based on system or practice level configurations. Currently the selectable events for change monitoring are: Allergies, Medications, Problems, Procedures, Diagnosis, Lab Results, and Immunizations Once an event happens the information is placed into the tracking table where it awaits export.

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23 Immunizations Import from the CDA

24 Immunizations import from the CDA Currently users can import Medications, Problems, Procedures, Diagnosis and Allergies from the C-CDA Importing data discretely into the modules allows access to actionable information As part of the UD3 HL7 Immunization Query/Response Interfaces we have also added importing them from C-CDAs The importing of immunizations works similar to the other items which can be imported Items will be automatically matched to existing immunizations if found

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28 DEMONSTRATION! Import Immunizations from a CCDA

29 C-CDA Content Collection and Generation Filtering

30 C-CDA Content Collection and Generation Filtering Currently there is limited functionality to configure what is and what is not included in the C-CDA There are some options to limit some data inclusion in specific sections For example: "Include Patient Diagnosis In Problems Section" and "Include Clinical Guidelines In Plan of Care Section Depending on the system being sent to, you may want to always exclude certain data. 5.8 UD3 provides the ability to exclude specific data types from the C-CDAs. Note: It is a common refrain that C-CDA s are not useful because of their verbosity. We hear this and are working on options to make it better.

31 C-CDA Content Collection and Generation Filtering There are two sections of options: Do we collect the data? Do we send the section or data in the C-CDA These options are Content Generation Filter and CDA Content Section Filter. The new options work together. They can compliment or seemingly contradict eachother.

32 CDA Content Section Filter Option C-CDA Content Section filtering items available are: Advanced Directives, Allergies, Chief Complaint and Reason For Visit, Care Team Members, Diagnoses, Encounters, Family History, HPI, Immunizations, Instructions, Medications, Payer Information, Physical Examination, Plan of Care, Problems, Procedures, Social History and Vital Signs. For Allergies you can choose whether to include all allergies or only unresolved allergies. For lab results you can choose whether to include all lab results or only results which have been signed off. For plan of care you can choose to include clinical guidelines in the section. For Problems you can choose whether to include patient diagnosis codes.

33 CDA Content Section Filter Option While you can exclude these items, doing so may mean that your C-CDA is missing required information for MU requirements.

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35 Content Generation Filter Option Content Generation filtering items available are: Advanced Directives, Allergies, Care Team Members, Diagnoses, Encounters, Family History, HPI, Immunizations, Instructions, Medications, Payers, Physical Exam, Plan of Care, Problems, Procedures, Social History and Vital Signs. For Payers you can choose whether or not to collect expired payers. For Problems you can choose whether to collect all or resolved, active chronic and active acute problems. While you can choose to not collect these items, doing so may mean that your C-CDA is missing required information for MU requirements. Removing information which is not needed will increase the speed of C- CDA generation.

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37 Example Use Case Remove Lab Results Issue: C-CDA s are being sent via XDS.b to an HIE which is unable to handle lab results being included in the C-CDA. Since a longitudinal record is being sent automatically, users cannot control whether the information is sent or not. Resolution: Open the agent options in the Rosetta Management Console for the agent which is sending the C-CDA s. Open the "Content Generation Filter option and uncheck the "Lab Results" item. This will keep the result information from being included in the message but will leave the lab results section in the C-CDA itself which allows C-CDA validation but also passes the other vendors requirements.

38 Example Use Case Remove Resolved Allergies Issue: C-CDA s are being sent to another provider over Direct. The C- CDAs are being send as longitudinal and include all information on the patient including their resolved allergies. This information is not needed since they are resolved and should be removed to make the C- CDA more useful and easier for the receiving provider to read. Resolution: Open the agent options in the Rosetta Management Console for the agent which is sending the C-CDA s. Open the "CDA Content Section Filter" option and uncheck "Include Resolved Allergies under the Allergies item. This will keep the resolved allergy information from being included in the message but will leave the unresolved allergies which are useful for another provider.

39 Consent-Based PIX integration

40 Consent-Based Patient Identifier Exchange (PIX) integration Currently there are many options for Identifier (PIX) and Demographic (PDQ) queries. Currently all Master Person Index (MPI) interaction occur within the person lookup screen. There are four modes which are available: Trust Mode, Untrusted Mode, MPI Refresh (5.7) and PIX Only (5.8). There may be situations where consent must be established with the MPI system before any interaction can happen. The MPI system may be part of a Health Information Exchange (HIE) Additionally, users may not want any interaction with the HIE system in the user workflow. This functionality is only relevant when connecting with an HIE and doing XDS.b interaction

41 Consent-Based PIX integration We have added automated PIX interaction in the HIE Gateway. This functionality is available in 5.8 UD2 and 5.8 UD3. Two new options were created: Check practice level consent before query or publish Add patient to MPI, add or update patient external id when necessary before query or publish If Check practice level consent before query or publish is enabled: Before any query or publish of documents can happen in the HIE Gateway the consent for the patient is checked. If the patient does not consent no interaction occurs with the HIE.

42 Consent-Based PIX integration If Add patient to MPI, add or update patient external id when necessary before query or publish is enabled the MPI interaction automatically occurs with the HIE. If the patient does not have an external id for the HIE a new patient message is sent to the HIE then a PIX message is sent to get the identifier for that new patient. If that patient already has an external id for the HIE a PIX message is sent to retrieve the latest identifier for the patient. Once these queries have completed the query or publish can occur. This automated process happens right before a query for available documents or before a document publish. This process also enforces consent constraints. If consent is enabled a patient has not consented no interaction will happen with the HIE.

43 What s in the Pipeline?

44 What s Coming in 5.8 UD3* and Beyond EHR Inbox RHT Status Information Automatically Import Discrete Data from C-CDA FHIR Interfaces MU3 Items: C-CDA R2.1 Implantable Device Support Share Interfaces: Clinical Registry Service Cancer Registry Service Immunization Registry Service Many More Items!

45 Session Survey Please take a moment to complete a brief survey regarding this session. 1. Open your ONE UGM Mobile App (please note: you must have already logged in and accepted the Terms of Use to access this feature) 2. Click the Navigation Button at the top left of the screen 3. Select Sessions 4. Search for and select this session 5. From the sessions details screen, select Survey at the bottom right of the screen 6. Remember to hit Save at the bottom of the survey once you have answered the questions

46 Any Questions?