Inter-institutional Data Sharing, Standards and Legal Arthur Davidson, MD, MSPH Agency for Healthcare Research and Quality, Washington, DC June 9, 2005 Funded in part through a contract with Agency for Health Care Research and Quality (AHRQ), and the Foundation for eHealth Initiative (FeHI) and their cooperative agreement with HRSA, Office for the Advancement for Telehealth (OAT). The contents of this presentation are solely the responsibility of the author and do not necessarily represent the official view of AHRQ, HRSA/OAT or FeHI. Colorado Health Information Exchange

Goal: Create a local health information infrastructure for clinicians to access patient information across individual health care institutions Colorado Health Information Exchange 2 Complementary Initiatives Build upon what exists Denver Health (DH) 150,000 residents (25% of population) Kaiser Permanente of Colorado (KPC) 3 rd largest CO HMO (350,000 members) The Children’s Hospital (TCH) Largest pediatric specialty care provider University of Colorado Hospital (UCH) Largest Metro area teaching hospital

COHIE to CORHIO COHIE Learning Laboratory Steering Committee Working groups: Technical Clinical Evaluation Legal Organizational Community Advisory Council Colorado Regional Health Information Organization A sharing, self-sustaining non-profit structure that: Promotes legal agreements for participation and access Maintains a robust technical environment Defines clinical value through policy and procedures Manages the budget and sustainable business model Supports national standards and public health interfaces PROJECT (10/2004) VISION (10/2009)

COHIE: 2005 plan

RHIO: 2005 vision Organizational / Governance Layer Inter- Enterprise Utility Services Network Transport Inter- Enterprise Business Services Internal Operations Layer Operating Entity Organizing / Convening Entity Participating Entity Operational / Project Sub-committee Financing Entity Operational / Project Sub-committee Message Standards Validation Internet Leased Private Network Message or Other Storage Privacy / Security Authorization Record Locator (MPI) Hosted Routing Services Customer / User Portal Call Center Message Translation Message Handling Process- / Data Content-Specific Applications Standard Software Applications / Services / Tools Adapter Hospital Information System Electronic Medical Record (EMR) System Physician Office Practice Management System Lab,/ Diagnostic Imaging / Ancillary System Adapter Payer Claims System Adapter Pharmacy / PBM System Adapter Public Health / Disease Surveillance System Adapter

The “Primary” Scenario Clarifies the scope (common understanding) Provides a structure to focus meetings and discussion Creates a mechanism for logging issues and decisions

COHIE Working Groups Iterative reviews COMPONENTS Legal Clinical Technical Research/Evaluation

Timeline – October 2005 MPI prototype, record locater service (RLS) Data sharing agreement: based on IN avoids multiple BAA no research references Incidental disclosures: CFH Policy Group Design modification: ? near 100% match for disclosure (high threshold to start), role-based threshold (ED vs. referral MD), challenge to business case Minimum certainty before RLS returns demographic information to the requester Minimum number of required demographic fields supplied by the requester before the RLS returns demographic information.

Timeline – October 2006 Proxy servers with standardized data Laboratory (LOINC, SNOMED encoded) ICD-9 billing diagnoses HL7 messaging V2.x for MPI queries to/from institutional MPI V3.0 for clinical data Future: (after 10/06) Arden syntax/GLIF for guideline implementation on aggregated data

CORHIO Process Colorado Health Institute (neutral convener) Legal support Explore/define relationship COHIE ⇔ CORHIO Working Group Business plan Articles of incorporation (501c3) Defining the board Education/public relations Community Advisory Council (greater than 40 members, most HIT projects going on in Colorado

CORHIO Candidate Partners