Each year the “Connecting California to Improve Patient Care” conference features a statewide interoperability showcase called California Connects. Robert (Rim) Cothren, executive director of the California Association of Health Information Exchanges, says that in 2014 attendees will see the increasing maturing of the state’s HIEs.
“If we look at California Connects from a few years ago, it really was isolated demonstrations,” Cothren says. “Unlike a few years ago, now we are really showing how all these organizations are exchanging information with each other. It shows that HIE is maturing beyond regional exchange and is starting to cross regional boundaries,” he adds. And it’s not just because technologies are maturing. “The industry is feeling more comfortable with the concept of sharing information as well as the legal requirements and policies that need to be in place.”
Cothren led me conceptually through several of the kiosks that are going to be demonstrating specific capabilities at the eighth annual conference in Santa Rosa, Calif., on Friday, July 25, and discussed their significance.
• Direct Address Discovery & Document Delivery
Organized by RAIN Live Oak HIE and Telemedicine Network.
RAIN Live Oak DIRECT will demonstrate a process for a registered ambulatory or acute healthcare provider to search the CTEN (California Trusted Exchange Network) federated provider directory to discover a Direct address and transmit medical documents and referral information.
“This is one of the real barriers to Direct messaging today,” Cothren says. “If I want to refer to you to a podiatrist, what do I do? I start by picking up the phone and calling their office and asking for their Direct address or fax number. California is launching a statewide service to help you locate providers and the means by which you can exchange data, including Direct. So that is what the address discovery part of that demonstration is: looking up a physician to refer to, and sending information in advance of that patient visit.
(When you send a Direct message to somebody else, you need to establish trust with that other health information service provider. CTEN provides the mechanism for that to happen without two organizations having to get together and work it out themselves. The CTEN Orchestrator can look through all the other directories in the state and facilitate a query for them, so they’re guaranteed to get the answer without having to know exactly who to ask for it. Think of it as a statewide phone book.)
• Query-Based Exchange via eHealth Exchange
Organized by Dignity Health and UC Davis Health System
Query-based exchange is demonstrated between Dignity Health's private HIE and the UC Davis Epic EHR via the national eHealth Exchange, allowing clinicians to access clinical information from another health system for a given patient.
This is the flip side of the Direct example, Cothren notes. Rather than the provider pushing information to another, this is a provider looking for information on a patient. In this case, they are going to be demonstrating how this would work in the Sacramento area, where UC Davis Health System and Dignity Health, both eHealth Exchange members, have a presence and patients sometimes go from one to the other. “This so a physician can request documents about a patient from another facility,” Cothren explains. “It is not part of meaningful use yet, but they are going to be using the same standard that meaningful use does for moving the content of a care summary from one facility to another.”
California is in the process of setting up a mirror of eHealth Exchange that doesn't have all the strict requirements that the federal agencies put on eHealth Exchange and therefore can be more agile, Cothren adds. “Because we don't have to drag the federal agencies into it, we can expand to other transaction patterns more rapidly,” he says.
• eHealth Exchange and Direct Secure Messaging between VA and the Private Sector
Organized by U.S. Dept. of Veterans Affairs
The VA is exchanging data 17 private-sector organizations to coordinate veterans' care. Direct secure messaging is a new protocol being piloted by VA to enable both provider-mediated and patient-mediated health information exchange. They are demonstrating pulling and pushing information using Exchange, Direct, and BlueButton download.
There will also be a demonstration of a veteran receiving care at the San Diego VA, at a private clinic, at a military treatment facility, and at the UC San Diego using the Humetrix iBlueButton app to access, display, aggregate, and store health records from the VA, Medicare, and DoD with a UC San Diego C-CDA record transmitted to the app by Direct, and then at an emergency department in Santa Cruz to the iBlueButton Professional iPad app of an ED physician.
• Coordination of Care across Disparate Systems and Care Settings
Organized by the Santa Cruz HIE
Santa Cruz HIE will be demonstrating coordination of care across disparate systems and care settings using Axesson’s ClearExchange Interoperability suite of solutions. The latest available standards and capabilities are on display including Blue Button+, Consolidated CDA, Direct Messaging, and Provider Directory.
This is sort of a “kitchen sink” demonstration of care coordination, Cothren explains. They are going to be showing Exchange and Direct as well as the exchange of information with HealthVault, and therefore a patient PHR. Humetrix’s iBlueButton app can also exchange and download information in a mobile PHR-type platform. “They are trying to show how you can support all these activities and really keep the patient and providers both engaged,” he says. “It is not a demonstration showing anything very different from the others, but it is showing how they all come together.”
• Hospital Sends Patient Visit Alerts
Organized by Alliance Medical Center, Redwood MedNet and Healdsburg District Hospital
A hospital visit is used to trigger the Redwood MedNet visit alerting service. The patient in the hospital visit registration is compared to a Patient Centered Medical Home (PCMH) registry published by Alliance Medical Center. If a patient is also on the PCMH registry, then a visit alert message is sent to the medical center, where the message is routed in their EHR to the PCMH care team for the patient.
“This one is an emerging technology being pioneered by Alliance Medical Center and Redwood MedNet,” Cothren says. If you showed up in the emergency department and registered there, it creates certain messages that normally move around the hospital. Redwood MedNet is watching those messages, picking up that you’ve registered and knows that you are also part of a medical home. It alerts your care team that you have just showed up in the emergency department. “That means your primary care physician knows he needs to follow up with you,” he says. “It takes the responsibility off of you to make sure all your doctors know what is going on with you.”
Cothren notes that the 2014 conference is concentrating a little bit more on what is going on in California than nationally. “That just reflects the fact that California has a lot going on and doesn’t always need to be looking to the national stage for where we should be headed,” he says. “We have more to talk about now in terms of what we are doing ourselves.”