Hot Integration Topics � 2006 Purpose : Discuss by T1u2o2L

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									     Hot Integration Topics – 2006
     Purpose:
      Discuss Integration Experiences
      Discuss Integration Interface Components
      Discuss Integration Challenges

Presenter:
Ken Hoffman
Vice President, Interface & Integration
978-805-4103
Kenh@iatric.com                              1
Meditech Integration Topics:
• Physician Practice EMR
• PACS
• Physician/Community Portal
• Emergency Department Systems
• Access Images through PCI/EMR
• Critical Care Online Documentation
• HIPAA Security Exception Reports
• RHIO’s
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      Physician Practice EMR Integration

      Meditech HCIS



Inbound Orders                                     Physician EMR
Inbound Registration           EMR Orders to HIS   Software

Outbound LAB Results
Outbound RAD Reports
Outbound OE Dept Reports   HIS Results to EMR




                                                                   3
      Physician Practice EMR Integration
Bi-directional Integrations Points:
• EMR sends HL7 ORM Order to Meditech
• EMR Order triggers a Meditech Registration, CLI or REF Short
• EMR Vendor will send Meditech MR# so new MR# is not created.
• If no MR# patient match is based on SSN, Last Name, First Name, Gender,
DOB. If still no Match patient is placed in work queue to be manual matched or
a new MR# will be created.
• EMR Orders are placed in Meditech Order Entry and flow to LAB or RAD
• Meditech Results are sent to EMR vendor
• Meditech Results contain EMR Order Number
• Meditech Orders status updates are sent to EMR
                                                                                 4
       Physician Practice EMR Integration
Uni-directional Integrations Points:
• Meditech Results are sent to EMR vendor
• Meditech Results do not contain EMR Order Number
• EMR vendor will match patient by SSN, Last Name, First Name, Gender,
DOB. If patient can not be matched results are placed in work queue to be
manually matched with EMR patient.

Additional Integration Points:
• Meditech and Physician Practice share real-time transactions via secure VPN
or other encrypted transfer method
• Most EMR vendors have HL7 capability.
• Hospitals are leveraging this type of integration to win practice business and
reference lab work.                                                                5
       Physician Practice EMR Integration
Additional Integration Points (Cont.):
• Have a “Scope of Work” agreement between practice and hospital. Can
provide sample document.
• Hospital practice liaison to facilitate communication and cooperation.
• Hospital technical staff to help physician practice with connectivity.




                                                                           6
    Physician Practice EMR Integration
Interface Components:
• EMR HL7 ORM Orders to Meditech Order Entry Orders
  NOTE: ORM must contain enough information to perform
Meditech Registration
• HL7 ORU LAB Results to EMR
• HL7 ORU RAD Reports to EMR
• HL7 ORU OE Departmental Reports to EMR
• HL7 ORM OE Orders to EMR (Status Update)
                                                         7
                    PACS Integration

  Meditech HCIS


Inbound RAD Order                                    PACS Vendor
   Status Update             PACS Orders to HIS      Or
                                                     Broker
Outbound ADT
Outbound RAD Orders
                        HIS Results to PACS Vendor
Outbound RAD Reports
Onetime Backload
Orders/Reports

PCI PACS Image Viewer


                                                                   8
                       PACS Integration
Bi-directional Integrations Points:
• HL7 ADT is not always required, but does supply patient demographic
updated information.
• Voice recognition can be integrated to PACS Vendor system and can provide
reports to PACS vendor. Still recommend RAD reports come from Meditech so
no updates or Meditech originated reports are missed.
• Inbound status updates are sent to Meditech to update the order to a taken
status.
• PACS image viewer can be launched from PCI/EMR via Web browser.
• Not all PACS Vendors require a broker (data converter).
• Need to consider back loading reports, orders, and images.

                                                                               9
                 PACS Integration
Interface/Integration Components:
• HL7 ADT to PACS Vendor or Broker
  NOTE: Not all PACS system require ADT interface.
• HL7 ORU RAD Report to PACS Vendor.
• HL7 ORM RAD Orders to PACS Vendor.
• PACS Vendor to Meditech RAD Orders Status Update.
• PACS Images access via PCI/EMR


                                                      10
Physician Portal/Web Enabled Systems

    Meditech HCIS


 Application Specific                                Portal
  Inbound Interfaces     Portal Vendor to Meditech
                                                     Vendor
 Query Interface
 or
 Application Specific   Meditech to Portal Vendor
   Interfaces




                                                              11
  Physician Portal/Web Enabled Systems
Interface/Integration Points:
• Common objective to web enable Meditech data display and data entry
• Data retrieval/storage techniques used by portal vendors:
  1) Staging Database – Portal vendor receives & stores x days worth of data
  2) EMR – Portal vendor incorporates repository/EMR for long term storage
  3) Query – Portal vendor queries Meditech as data is needed
  4) Highbred – Cache & Query: combination of query & staging.
• Replace PCI/EMR for Physicians view
• Portal vendors can provide both desktop and mobile solutions
• Community wide portals for employee, physicians, and patients



                                                                           12
   Physician Portal/Web Enabled Systems
Interface/Integration Components:
INBOUND to MEDITECH
• HL7 ORM OE Orders for LAB, PHA, RAD, etc…, New Order and Status
Update
• HL7 ADT Pre-registration via patient portal
• HL7 ORU RAD/ITS/OE Department Reports and Esign
• HL7 ORU NUR/PCS Assessments
• HL7 DFT Billing, Payments to apply to patient account
• HL7 User ID and Password authentication, password changes, expirations
  Portal access using Meditech User ID and Password


                                                                           13
  Physician Portal/Web Enabled Systems
Interface/Integration Components:
OUTBOUND from MEDITECH
• HL7 Query Engine for ALL Meditech Data
• HL7 ORM OE Orders for LAB, PHA, RAD, etc…, New Order and Status
Update
• HL7 ADT Patient Demographics/Visit Information
• HL7 ORU RAD/ITS/OE Department Reports, Status Updates
• HL7 ORU NUR/PCS Assessments
• HL7 ORU LAB Results, Status Updates
• HL7 RDE Pharmacy Orders, Status Updates
• HL7 DFT Billing Information
                                                                    14
• HL7 Employee Record
Emergency Department Software Integration

   Meditech HCIS


                       ED Vendor to Meditech
  Inbound ED Reg
  Inbound OE Orders                            EDS
  Inbound OE Report
                                               Vendor
  Outbound ADT
  Outbound Meditech   Meditech to ED Vendor
     Orders
  Outbound Meditech
    Results




                                                        15
Emergency Department Software Integration
Bi-directional Integrations Points:
• EDS vendor sends HL7 ORM Order to Meditech, LAB & RAD
• EDS workflow typically gets registration from Meditech, but registration can be
received from EDS
• EDS Vendor will send Meditech MR# so new MR# is not created.
• If no MR# patient is match based on SSN, Last Name, First Name, Gender,
DOB. If still no Match patient is placed in work queue to be manual matched or
a new MR# will be created.
• EDS Orders are placed in Meditech Order Entry and flow to LAB or RAD
• Meditech Results are sent to EDS vendor
• Meditech Results contain EDS Order Number
• Meditech Orders status updates are sent to EDS                               16
Emergency Department Software Integration
Interface Components:
• EDS HL7 ORM to Meditech Order Entry Orders
  NOTE: ORM must contain enough information to perform
Meditech Registration
• EDS HL7 ORU Discharge Summary to Meditech OE
Departmental
• HL7 ORU LAB Results to EDS
• HL7 ORU RAD Reports to EDS
• HL7 ORM OE Orders to EDS (Status Update)
                                                     17
          Clinical Images Via PCI/EMR




Image Server           Web Based Image Viewer   18
             Clinical Images Via PCI/EMR
Interface/Integrations Points:
• Image server to centralize most or all clinical images
• PACS images seem to be excluded from an imaging server, but can
be incorporated.
• Image examples are EKG/ECG, fetal monitor strips, endoscopy,
cardiology, etc…
• View images via URL Web access using Web Browser. Passing User
ID, Password, MR#
• Image viewer routine can be attached to an Other Data Source
routine in PCI. Meditech has yet to release an Other Data Source link in
EMR.
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Clinical Monitor Online Documentation
                            Clinician Validation Routine
            Critical Care
            Monitor




                                                Meditech HIS
                                                Validated Results
                                                Filed in
                                                NUR or PCS
Results Server
                                                                    20
   Clinical Monitor Online Documentation
Interface/Integrations Points:
• Critical care fixed monitors can send several HL7 ORU
results message per minute.
• Results servers can house this large quantity of
unvalidated, raw monitored results.
• These results can be queried, validated by clinicians, and
filed into Meditech NUR/PCS, making validated results
available via PCI/EMR.
• EKG Images can also be acquired from fixed monitors
and made available via imaging server.                     21
     HIPAA PHI Access Security Violations
Interface/Integrations Points:
• Sites are actively looking for Protected Healthcare Information (PHI)
access violations.
• Here are some exception report examples:
    • Patient and User Last Name Same
    • Address Street of User and Patient Match
    • Emulated User
    • Guarantor/Subscriber and User Name Match
    • List of Patient that are facility employees
    • Several More…..
                                                                          22
Regional Health Information Organizations (RHIO)
• Made up of
                            Stakeholde                     Stakeholde
Stakeholders and non-        r Hospital                     r Hospital
stakeholder
• Goal to improve
patient treatment,                        RHIO Trustee
                                          Authenticatio
safety, quality                              n Trust

• Level of trust must be
established – Chain of
Trust                      Stakeholde
                                                              Non-
                            r Hospital
                                                          Stakeholde
• Independent                                              r Hospital
authentication authority
• Level of information
shared
• Staged or queried
information                                                       23
Regional Health Information Organizations (RHIO)

Integration Points:
• Staging database at each point of data source – Clinical Data Repository
(CDR)
• Query at each point of data source - Query originates with RHIO Trustee
• Data exchanged on secure connection with Trustee holding the keys to all
information authentication
• Level of information shared agreed upon by stakeholders
• Query is real-time
• Clinical information
• Many models are being presented
• What is the right model for you?
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