Direct Messaging in North Carolina: Current Capabilities & - - PowerPoint PPT Presentation
NCHICA Presents the 7 th Thought Leader Forum Direct Messaging in North Carolina: Current Capabilities & Future Directions November 4, 2015 Research Triangle Foundation Presenters Dennis Andrison , IS Project Lead II, New Hanover
November 4, 2015 Research Triangle Foundation
NCHICA Presents the 7th Thought Leader Forum
Medical Center
No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs
b a sic a lly a se c ure e ma il syste m
he visio n o f a Dire c t-e na b le d he a lthc a re syste m is to pro vide a se c ure he a lthc a re ne two rk whe re a ll pa rtic ipa nts a re ve rifie d a nd c a n se c ure ly c o mmunic a te with a nyo ne e lse within this ne two rk. T his c o nne c tivity will e mpo we r c linic ia ns, a dministra to rs a nd syste ms to se c ure ly sha re info rma tio n.
(http:/ / h22168.www2.hp.c o m/ d o c s/ o rio n/ RS97 1_De mystifying _DSM_White Pa pe r.pd f )
No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs http:/ / www.njhite c .o rg / se rvic e s/ dire c t/
Direct email address from the NCHIE looks like: firstname.lastname@direct.yourdomain.nchie.net
No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs
– Re fe rra ls b e twe e n o rg a niza tio ns – Disc ha rg e summa rie s se nt to PCPs a nd
pa tie nts
– T
ra nsmit Ca re Summa rie s
– Se c ure pro vide r to pa tie nt c o mmunic a tio ns
No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs
a c h E HR is diffe re nt in the ste ps ne e de d to ma na g e Dire c t within the E HR a nd in pa c ka g ing info rma tio n fo r se nding via dire c t
SPS ta lk to e a c h o the r http:/ / www.dire c ttrust.o rg / me mb e r-list/
No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs No rth Ca ro lina Are a He a lth E duc a tio n Ce nte rs
Building a Community… 1. Impr
like ? Who a re o ur e xte rna l pa rtne rs?
2. Standar dize pr
like ? Wha t do e s the wo rkflo w lo o k like ? Ho w do we te st Dire c t Me ssa g ing c a pa b ilitie s?
3. E stablish ac c ountability- Wha t a re the ro le s invo lve d? Wha t
ta sks a re a ssig ne d to e a c h ro le ? Wha t do we do whe n we e nc o unte r a pro b le m?
4. Me asur e pe r for manc e - Ho w do we kno w we a re o n the rig ht
tra c k?
5. E nc our age str
e c oor dination- Wha t re so urc e
a llo c a tio ns o r po lic y a nd pro c e dure c ha ng e s a re ne c e ssa ry?
Direct Messaging in North Carolina
Dennis Andrison IS Project Lead II
NHRMC
North Carolina (Pender, New Hanover, Brunswick, Onslow, Duplin, Columbus, Bladen)
– Level II Trauma Center – Heart Center – Stroke Center – Women's & Children's Hospital – Orthopedic Hospital – Rehabilitation Hospital – Cancer Center – Neonatal, Pediatric and Adult Intensive Care – EMS
Memorial Hospital
Why Direct
Implementation
Lessons Learned
12
13
Success
Questions
14
Total Patients Since Inception: 4,051,703
diagnostic center
17
Solution Use Case COMMUNITY HEALTH RECORD Access to data outside your own network: Reduction in duplicate testing and more timely diagnosis and completion of care plan . Access to Acute Care Setting Documents – including ED: Community Practices have a full picture of acute setting care to provide appropriate follow up
Clinical Inbox – results delivery NOTIFY Alerting Unaffiliated Providers: Notifications are sent for emergency room and inpatient admissions and discharges for their patient population
during ED encounter Alerting Hospital Care Team Members (non-provider): ER and other Case Managers are receiving readmission alerts on top utilizers iNEXX Care Coordination Acute to Ambulatory: Electronic scheduling of ambulatory follow up appointment prior to discharge
Community Health Record Utilization
.
In September, transition of care was supported for 5,076 unique patients!
1000 2000 3000 4000 5000 6000
Logins Unique Patients Accessed
From Sept 15 to Oct 15 – CCHIE
Direct Secure 80 practices/ 6444 transition of care or referral documents Direct Trust 34 providers/ 780 messages As practices get their Direct Trust set up – CCHIE numbers will decline
Batish Family Medicine, Leland, NC sanjay-batish@batishfamily.e-mdsdirect.com
weckelmd@drweckel.amazing-direct.com Wilmington Access for Teens, (WHAT), Wilmington, NC whatswhat@direct.myezyaccess.com Coastal Internal Medicine, Wilmington, NC Coastal.internal.medicine@direct.coastalinternal.nextgenshare.com ayman.gebrail@direct.coastalinternal.nextgenshare.com feras.tanta@direct.coastalinternal.nextgenshare.com Orthowilmington, Wilmington, Leland, Jacksonville, Supply, Southport, Sunset Beach, NC referral.coordinator@orthowilmington.coastalconnectdirect.org
Patient MCOne-One Zzzztest Date of birth January 1, 1901 Sex Female Race Ethnicity Contact info Primary Home: UNK WILMINGTON, NC 28401, USA Tel: +1-000-000-0000 Patient IDs 12294425 1.2.840.114350.1.13.298.2.7.5.737384.775029 Document Id 1.2.840.114350.1.13.298.2.7.8.688883.255988 Document Created: October 28, 2014, 13:43:14 -0400 Performer (primary care provider) Author Epic - Version 7.9 Contact info Encounter Id 207939056 1.2.840.114350.1.13.298.2.7.3.698084.8 Encounter Date at October 28, 2014 Encounter Location id: 14800 1.2.840.114350.1.13.298.2.7.2.688879 Document maintained by New Hanover Regional Medical Center Contact info 2131 S. 17th. St. Wilmington, NC 28401 Tel: +1-910-343-2498 Continuity of Care Docum ent
Table of Contents
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
President and CEO, DirectTrust Senior Advisor, AAFP
November 4, 2015
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
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DirectTrust.org, Inc. (DirectTrust) is a voluntary, self-governing, non- profit trade alliance of 150
growth of Direct exchange at national scale, through the establishment of policies, interoperability requirements, and business practice requirements. DirectTrust operated under a two- year Cooperative Agreement with ONC, 2013-15, to support its work
interoperable Direct exchange services providers.
Security & Trust Framework EHNAC- DirectTrust Accreditation Programs Trust Anchor Bundle And Network Services
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
actively supporting Direct exchange through policy setting, accreditation, trust anchor distribution, and outreach activities. DirectTrust is an outgrowth of the Direct Project and supports the “triple aim” set by ONC and HHS: improvement of the health care experience; improvement in the care of populations; and reduction in the cost of care.
Cooperative Agreement with DirectTrust.
exchange via standards, used in a manner consistent with these governance mechanisms, including the use of certified EHR technology capable of sending and receiving Direct messages and attachments.
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See: http://www.healthit.gov/buzz-blog/health-information-exchange-2/onc-partners-health-information-exchange-governance-entities and also http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/directtrust-builds-transparency-confidence-direct-exchange).
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 32
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DirectTrust’s membership has doubled in the last year and a half.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DirectTrust’s membership has doubled in less than a year.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
April 2010
launched
secure, scalable, standards-based way to send health data
Internet
April 2011
Statement published
Road” Workgroup started
w/ Direct
Feb 2013
accreditation program starts
program to require Direct in all EHRs by 2014
Sept 2015
provide service to >48,000 HCOs and provision
addresses
Direct = secure, identity validated, vendor/app neutral messaging + content May 2012
incorporated as non-profit trade alliance, 501(6)(c)
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 36 36
Health Information Service Provider (HISP) Healthcare Organization (HCO)
Identity vetting at a specific level of Assurance, LoA.
Certificate Authority (CA)
Certificate Validation Service X.509 Certificate Issuance Service Revocation Services Certificate Signing Services
Registration Authority (RA)
Compile/Validate Identity and Trust Documentation
The CA and RA enforce the policies specified in the DirectTrust and FBCA Certificate Policy (CP).
Credential issued
Identity vetting at specific LoA.. HCO Direct Addressees
Basic services for user: DNS discovery; encryption; certificate signing and validation; send/receive MDNs; provide HISP-side of edge protocol connection compliance with Direct standard,
The HISP enforces the policies specified in the DirectTrust HISP Policy (HP), and MUST use accredited RA and CA. The HCO relies on HISP, CA, and RA as accredited trusted agents, and bears ultimate responsibility for HIPAA privacy and security.
NOTE: Three separate roles and responsibilities from “trusted agents” combine to enable Direct exchange
1. 2. 3.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
DrBob@direct.familypractice.com (has been identity vetted, has X.509 Digital certificate bound to address.) DrSusan@direct.cardiology.com (has been identity vetted, has X.509 Digital certificate bound to address.)
Exchange between HISPs requires active use of the Direct protocols for secure Internet email exchange
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EHR EHR
encryption
identity validation
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
667 1,460 3,336 5,627 28,148 35,657 39,751 46,797
10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Health care organizations served by DirectTrust HISPs
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www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
8724 45,300 73,922 182,279 428,105 663,321 752,496 998,313 200000 400000 600000 800000 1000000 1200000 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Number of Trusted Direct Addresses
39
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
122,842 2,195,433 2,567,110 3,938,346 7,746,375 22,959,139 27,316,438 57,247,435 10,000,000 20,000,000 30,000,000 40,000,000 50,000,000 60,000,000 70,000,000 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q3 2014 Q4 2014 Q1 2015 Q3 2015
Number of Send and Receive Direct Transactions to/from Trusted Endpoints
40
Increase of 30 million transactions from Q1-Q3 2015
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
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DirectTrust Accredited Bundle Interoperability Benchmarking Results as of 10/2/2015
Health Companion iShare Medical MedAllie s Cerner Data Motion EMR Direct ICA Max MD McKesso n/Relay MRO Sure- scripts Updox NY eHlth Collab Cozeva MHIN Axesson Inpriva Nitor Glenwoo d Systems SES Medicity Athena- health CareAcco rd CernerMHealth Companion
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Jul Sept Jul Sept Jul Jul Jul Jul Jul Sept Jul Jul Jul Jul Aug Sept Aug Jul, 633 97% iShare Medical
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Sept Sept Jul Sept Jul Jul Jul Jul Sept Jul Jul Jul Jul Sept Jul Sept Jul Sept33 97%
SeptMedAllies
Jun Jul Jul Jun Jul Jun Jul Jul Jun Jul Jun Jul Jun Jun Jun Jun Jul Jul Jul Jul Jul Jun Jun Jul Jul Jun Jul Jul Jul Jul Aug Sept Jun Jul, 933 97% Cerner
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Aug Jul Jun Jun Jun Jun Jul Jul Jun Jun Sept32 94%
AugData Motion
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Apr Jun Jun Jul Jun Aug Jul Jun Jun Jun Jun Aug Apr Jul Jun Sept, 16,1732 94% EMR Direct
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jun Jun Jun Aug Jun Jun Jun Jun Jun Jul Jun Jun Jun Sept32 94%
Aug AugICA
Jun Jun Jul Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jul Jun Jul Jun Jun Jul Jul Jul Jul,19 Aug Sept32 94% Max MD
Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Sept Jul Sept Jul Aug Jul Apr Aug Jul Jun Jul Sept Sept Jul Jul Jul Jul Jul Jul Apr Sept Sept32 94%
Aug SeptMcKesson/Relay
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Jul Jul Aug Jul Aug,9,17,22,20 3294% MRO
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Aug Jul Jul Jul Jul Jul Jul Jul Jul Sept32 94% Sure- scripts
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Jun Jul Sept Jun Aug Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Sept Aug Sept32 94% Updox
Jun Jun Jun Jun Jun Jun Jun Jun Aug Jun Jun Jun Jun Jun Jun Aug Jun Aug Aug Jun Jun Jun Aug Aug Jun Jun Jun Jun Aug Aug Jun Sept,13 Aug Sept32 94%
NY eHlth Collab
Jun Jul Jul Aug Jul Jul Jul Jul Jul Jul Aug Jun Aug Aug Aug Jul Jul Jun Aug Jun Jun Aug Jul Jul Sept Jul Aug Aug Sept Aug Aug Sept,12,931 91% Cozeva
Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Sept,13 Jul Jun Jun Jun Jun Sept,13 Jul Jun Jun Jun Jun Jul Jul Jun Sept Oct,13 Aug30 88% MHIN
Aug Aug Aug Aug Sept Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Sept Aug Aug Sept Aug Aug Sept, 2 Aug Aug Sept, 930 88% Axesson
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Jul Jul Jul Jul Jul Jul Jul Aug28 82% Inpriva
Jul Jun Jun Jun Jun Jul Jun Jun Jun Jul Jun Jun Jun Jun Jun Jul Jun Jul Jun Jul Jun Jun Jun Jun Jun Jun Jun Jun Sept,9,12,23,24 2882% Nitor
Jul Sept Jul Jun Jun Jun Jun Jul Jul Jul Jun Jun Jul Jun Jul Jul Jun Sept, 2 Jun Aug Jul Jun Aug Jul Jul Jul Jul Aug Sept, 2 Jul Sept, 1428 82% Glenwood Systems
Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Oct Sept Sept Sept Sept Sept Aug Sept 9,2227 79% SES
Jun Jul Jun Jun Aug,13 Jun Jun Sept Jun Jun Jul Jun Jun Jun Sept Jul Jun Jun Sept Jun Jun Sept Aug 2,13 Jun Jul Sept Sept Sept Jul,13 Aug,13 Sept,13 Sept,13 Aug Sept,16,17,22 2779% Medicity
Oct, 2 Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct Oct, 2 Oct Oct Oct Oct, 2 Oct, 2 Oct Oct Oct Oct Sept Oct,1,2 Sept Aug, 1626 76% Athena- health
Jul Jul Jul Jul Aug Jul Jul Aug Jul Jul Jul Jul Jul Sept Jul Jul Jul Jun Jul Sept Jul Jul Aug Jul Jul,6,924 71% CareAccord
Jul Jul Jul,13 Jul Jul Jul Jul Jul Aug,13 Jul Jul Jul Jul Jul Jul Jul Jul Jul Sept Sept Jul Jul,2 Aug,13 Jul, 13 Jul Jul Jul Jul Jul Jul,1,13 Aug2,13, Jul,13 Sept24 71% CernerMobileMD
Aug Aug Aug Aug Aug Aug Aug Sept Aug Aug Aug Aug Aug Sept Sept Sept,13 Aug Sept Aug Aug Aug Aug Sept Aug Aug Sept, 16,17,24 2471%
SepteClinical Direct
Jun Jul Jul Jul Jul Jul, 18 Jul Aug Jul Aug Jun Jul, 2 Jun Jul Jul Jun Aug Jun Jul Jun Jul Jul Jul Jul Jul Sept 17, 20,9,23 2471% IOD
Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul Jul, 924 71% Rochester RHIO
Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Jan Sept,13 Sept Sept,13 Jan Sept Sept Sept Sept,13 Sept Sept Sept Jan Sept Sept,13 Jul, 1523 68% Orion Health
Aug Sept Aug Aug Sept,13 Aug Aug Aug Sept,13 Aug Aug Aug Aug Aug Aug Aug Sept Aug Sept,13 Aug Aug Sept,13 Sept,13 Aug Aug Aug Sept,13 Sept,13 Sept21 62% NextGen (Mirth)
Aug,2 Aug,2 Aug Aug Aug Aug Aug Aug Aug,13 Aug Aug Aug Aug Aug Jan Aug Aug Aug Sept Aug,13 Aug Aug Aug Aug Aug,2 Sept Aug,2 Aug,13 Jan Aug,13 Sept20 59% Truven Health Anltcs
Aug Aug Aug Aug Aug Aug Aug Aug Aug Aug Sept 22,1710 29% Covisint
Sept Sept Sept Sept Sept Sept Sept Sept Sept Sept Aug, 12,169 26% Optum
Aug Aug,9,201 3% HealthUnity
Sept, 16,12,250% HIXNY
Sept 17,16,22,230% Shifox
Sept, 140%
Interop Testing Bundle (Test PKI) Accredited Bundle Results SummaryS e n d e r
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Current market view of the usage, value and future of Direct Messaging
Themes from the survey results:
access,
community, and
exchanging data.
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www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Health Information Service Provider, HISP An entity or service providing its subscribers Direct accounts, addresses and secure, encrypted exchange of messages between users within the same domain, and also with users in different domains, that is, who are subscribers of different
subscribers’ identity proofing and verification (the Registration Authority function) and for its subscribers’ digital certificate issuance and management (the Certificate Authority function). HISPs may be organized along several different business models. For example, an EHR technology vendor may operate a HISP internally for its customers. A so-called “full service” HISP may operate a stand alone business, and partner with several EHRs as well as offer its Direct services through a web portal or other set of tools and devices.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Direct Project A public-private sector initiative sponsored and run by ONC whose aim was to create a simple, secure, and open standard for transport of messages and attachments between health care participants over the Internet, regardless of end-user technology. Direct Standard The outcome of the Direct Project. A set of protocols and specifications, along with a security and trust architecture, for simple, secure, inter-vendor communications over the Internet for use by health care professionals and patients. Direct Message Exchange Use or deployment by individuals or entities of health information exchange utilizing the Direct standard. Also sometimes referred to as Directed “push” exchange, Direct exchange. Direct User or Subscriber An organization or an individual that participates in sending and receiving messages and attachments using technology equipped to do so, e.g. an EHR or a web portal, via the Direct standard, and who has the authority to do so.
www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036
Direct Project A public-private sector initiative sponsored and run by ONC whose aim was to create a simple, secure, and open standard for transport of messages and attachments between health care participants over the Internet, regardless of end-user technology. Direct Standard The outcome of the Direct Project. A set of protocols and specifications, along with a security and trust architecture, for simple, secure, inter-vendor communications over the Internet for use by health care professionals and patients. Direct Message Exchange Use or deployment by individuals or entities of health information exchange utilizing the Direct standard. Also sometimes referred to as Directed “push” exchange, Direct exchange. Direct User or Subscriber An organization or an individual that participates in sending and receiving messages and attachments using technology equipped to do so, e.g. an EHR or a web portal, via the Direct standard, and who has the authority to do so.