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					               HIE Pilot between Military and Civilian Providers in a SOA Framework




           Lessons Learned from a Health
          Information Exchange (HIE) Pilot
      between a Military Treatment Facility and
         its Purchased Care Network (PCN)
                                                          Presented By:

                                              LTC Nhan Do, MD, MS
                                      Chief, Business Process Management,
                                       Office of the Surgeon General, USA

                                                         Huy Nguyen, MD
                                                       CEO, COGON System,

                                                            July 13, 2010

Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com           UNCLASSIFIED
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                       AGENDA

           • Current state of health information exchange in the Military
               Health System
           •   Description of Pensacola Health Information Utility Project
                   –    Technical Background
                   –    Screen Shot Demo
                   –    User Experience and Lessons Learned
                   –    Technical Challenges
                   –    Business Challenges
           • Life in the Healthcare Cloud
           • SOA What?



                                                         UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                          Slide 2
               HIE Pilot between Military and Civilian Providers in a SOA Framework




     Current State of HIE in MHS System




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                           Slide 3
               HIE Pilot between Military and Civilian Providers in a SOA Framework



              Current system for consult tracking
             for military beneficiaries in Pensacola
                                                                      Archive        Share folder

                                                AHLTA



                                                   Referral Manager         Fax
                       Primary Care                                                   Tricare Service Center
                       Manager



                                                          Fax                                     Archive
                                                                              Mail

                                                                                       Consult
                        Specialist                                                     Web site


                                                                  Patient
Slide prepared by CAPT Robert Hoyt, NOMI

                                                                UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                                                    Slide 4
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                              Changes after HIU

                                                       AHLTA
                                                                     Referral Manager


                      Primary Care Manager
                                      Consult Notes
                                                                              Fax   Tricare Service Center
                                                           Consult Notes
                            HIE


                                                                                                Archive
                                                                           Mail

                                Consult Notes
                                                                                     Consult
                                                                                     Web site

                                     Specialist                     Patient

Slide prepared by CAPT Robert Hoyt, NOMI

                                                               UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                                                Slide 5
               HIE Pilot between Military and Civilian Providers in a SOA Framework



                      BHIE/FHIE Architectural Components
DoD                                                               FHIE/BHIE Framework                      VA
                                                                      (VA AITC, Austin TX )
                   MHS Data
                   Repository                 HL7
                                              PDTS
                                                                                                                                            VistAWeb
  DMSS
                                              SADR                             FHIE                                MiCare
                                                                             Repository
                                                                                                                                                CPRS
                                              K61
                       CHCS
                                              Pre/Post
                      Sharing
                       CHCS
                      Facility                PDHRA                                             Query
                                                                                                Access                           RDV &
                                          HL7/ADT
                            CACHE’                                           FHIE/BHIE
                                                                              FHIE/BHIE        VistALink            VistA        VistAWeb
                                                       WS/XML                Framework
                                                                             Framework                             VA Host
                                                                                                                (Station 200)                      VistA
                                                                                                                                                   Local
                       DoD
                      DoD
                                                                                                                                                   VAMC
                    WebServer
                        Server                                                 HL7/ADT
   IDS              Web

                                                    WS/XML                      VA
                                                                                Vitria
                WS/XML                                                   Vitria Interface             PIDS/ Correlation
                                                                                  IE
                                                             WS/XML
                                                                              Engine                                             VA MPI
                                   CDR
 SHARE GUI
                                                                 -Correlation of Patient Identity
                                 WS/XML                          -Information Locator
                  WS/XML                       TMDS
                                                                 -Security

 BHIE-AHLTA                 BHIE-AHLTA                           -Optimization
                            Web Server                           -Adapter/Connector




Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com                         DRAFT
                                                                              UNCLASSIFIED                                      Slide 6
               HIE Pilot between Military and Civilian Providers in a SOA Framework




          Pensacola Health Information Utility
                       Project




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 7
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                       Overview
           • Congressional sponsor is Jeff Miller from Florida (FY07).
           • Cogon and the DoD entered into a Data Use Agreement, November
               2008.
           •   The Pensacola Health Information Utility (HIU) was deployed in the
               Spring of 2009, between Sacred Heart (SHH) and Naval Hospital
               Pensacola (NHP).
           •   Baptist Health System (BHH) joined the Pensacola HIU May 2010, and
               both SHH and BH can view the military health records via a common
               secure portal.
           •   Through BHIE, DoD users have access to SSH and BH health data.
           •   Pensacola HIU will migrate toward SAS 70 compliant, world-class data
               hosting center (Terremark) – ‘cloud computing’




                                                          UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                           Slide 8
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                       Shared Data
           • C32 patient summary specification of CCD
           • Patient demographic and administrative information
           • Diagnoses/problem list
           • Providers
           • Allergies
           • Medications
           • Laboratory results
           • Radiology results
           • Previous procedures
           • Clinical notes such as consult notes



                                                            UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                              Slide 9
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                           Virtual Health Network (VHN)


           • Cogon’s Virtual Health Network employs a service-oriented
               architecture built upon a Java platform that provides the
               framework for healthcare data transmission, transformation,
               and transparency.
           •   Technical Guiding Principles:
           •   Security, Interoperability, Scalability, Extensibility
           •   Built to support a utility/transaction-based business model




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                            Slide 10
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                Virtual Health Network Architecture




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                         Slide 11
               HIE Pilot between Military and Civilian Providers in a SOA Framework

                                       HEALTH INFORMATION EXCHANGE
                                            Strategic Health Intelligence
                                     (Slide - courtesy of Robert Johnson- BH)
                     Baptist All                                          Navy
                                               Sacred Heart                            VA Clinic
                      Facilities                                         Hospital




                                              HIE (Health Information Exchange )




                                                                        ed
                                                                mbin ical
                 Connection to Florida                                               Connection to NHIN
                   Regional Health                          Co        log
                                                                                       (National Health

                                                             hrono tion of
                 Information Network                                                Information Network)
                                                          C
                                                                   nt a        nt
                                                          Pre se trea tm e
                                                                  t ’s          s
                                                         Pa ti en ll Fac ilitie
                                                                   a
                                                           f ro m




Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com             UNCLASSIFIED               Slide 12
               HIE Pilot between Military and Civilian Providers in a SOA Framework




                     Screen shots of health data from
                        SHH through BHIE/SHARE




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 13
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                          Laboratory Results




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                              Slide 14
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                 Detail View of Lab Result




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 15
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                            Medication Profile




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                            Slide 16
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                     Detail Medication View




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                           Slide 17
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                    Clinical Documentation




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 18
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                  C32 Summary




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                               Slide 19
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                              Cardiac Catheterization Report




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 20
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                    Cardiac Catheterization Report




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                              Slide 21
               HIE Pilot between Military and Civilian Providers in a SOA Framework




              Screen shots of health data from
                       DoD through
                 McKesson Physician Portal




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 22
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                  McKesson Physician Portal SHH




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                               Slide 23
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                     Visit Results from the Request




Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com   UNCLASSIFIED        Slide 24
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                      Lab Results from the Request:




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                            Slide 25
               HIE Pilot between Military and Civilian Providers in a SOA Framework


            Radiology Results from the Request




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                              Slide 26
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                 Patients in HIU


           • Sacred Heart Hospital currently has 290,000+ unique
               patients in the HIU system
           •   Correlations with 28,400 patients from the Pensacola Naval
               Hospital.




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                            Slide 27
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                             Lessons Learned

           • Clinical relevance
           • Clinical workflow
           • Data Critical mass
           • Marketing
           • Training



                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                            Slide 28
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                       Technical Challenges

           • BHIE data integration (not plug and play)
           • Network connectivity and maintenance
           • Two different MHS portal (BHIE SHARE, AHLTA 8viewer)
           • Multiple civilian EHR portal
           • Integration multiple disparate HIS system with multiple
               standard
           •   Integration of mental health data with multiple rule of
               governance




                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 8
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                               Life in the Cloud

           • Cost Efficiency
           • Cost Sharing and Sustainability
           • Standards-Based Commodity Business Model
           • Decreased Capital Requirement – Risk Mitigation
           • Security Recommended on a “Cloud” Level
           • Scalability and Distributive Network
           • Extensibility to technology innovation and
               collaboration



                                                       UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 30
               HIE Pilot between Military and Civilian Providers in a SOA Framework


                                                       SOA What?
                                                       (Meaningful Use)
           Clinical Transformation
             Population Health
             Disease Management
             Patient Centered Medical Home
           End User Experience
             Mobility
             Voice Technology
           Business Process Management (BPM) in Healthcare
                    Case Study: Tissue Organ Donor
                    Referral Management
                    Medication Management
                    Hospital Admissions




                                                              UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                             Slide 31
               HIE Pilot between Military and Civilian Providers in a SOA Framework




                                                       Questions?




                                                         UNCLASSIFIED
Nhan.Do@us.army.mil/ and Huy.Ngyuen@cogonsystems.com
                                                                              Slide 32

				
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