State HIE Lab Summit and Pilot Program May 30, 2012

Team Pilot Overviews

3 Key Partners Scenario 2: Key Milestones Key Resources Open QuestionsUser Story Value Proposition Pilot Scenario Diagram – Partially Automated, Unstructured What will the CLIA requirements be to ensure Direct is compliant? What agreements are needed to ensure future participation in State HIE? What are the incremental steps needed to allow for participation in the State HIE. Participation in the State HIE can facilitate mandatory ELR reporting as well as providing a more complete patient record upon inquiry, thus adding value to patients care providers. How can EMR venders be convinced to participate? Orchard technical team, Grafton City Hospital Lab, REC technical support for Preston Taylor Community Health Center, Preston Taylor Operations Manager. Orchard generates first puff, creates a Direct message, attaches results and sends through WVDirect to Preston Taylor. 6/30/12. Preston Taylor receives message through WVDirect web portal and manually re-enters information in to EHR. 8/1/2012. WVDirect Subscription Agreement and BAA between WVHIN and Grafton City Hospital, and WVHIN and Preston Taylor Community Health Center. Scene 1: Patient visits Preston Taylor & lab tests are ordered from Grafton City Hospital using paper requisition form. Scene 2: Grafton receives paper order from the presenting patient, enters order into Orchard and includes WVDirect address as preferred result delivery method. Grafton completes tests and results are transmitted to Preston Taylor using WVDirect. Scene 3: Preston Taylor receives the results via WVDirect, manually enters info into EMR record and triggers a notification to treating physician. Our goal is to support unconnected rural hospital labs to deliver structured lab results to ambulatory providers in their community as part of their clinical workflow. If EMR vendor is not available, value will still be seen on the lab delivery side. Grantee team: Phil Weikle, Kathy Moore, WVHIN Lab representative: Nick Jachelski, Grafton City Hospital Lab LIMS vendor(s) Mark Jones, Ginger Wooster, Orchard Software Practice or hospital representative: Ann Rexroad, Grafton City Hospital. Preston Taylor Community Health Center (not attending) HISP vendor(s): Chris Lewis, Thomson Reuters Health Care. REC: Dwayne Edwards (not attending) West Virginia Grafton City Hospital Lab / Orchard WVDirect hosted by TRH Orchard programmatically generates pdf, creates Direct message, attaches message and sends to WVDirect.. Preston Taylor receives Direct message w/ attached ‘print image’ of results (e.g., PDF) in a webmail portal and manually re-enters results into EHR. Legal Agreements Preston Taylor Community Health Center Edge Protocol SMTP w/ S/MIME

4 Key Partners Key Milestones Key Resources Open Questions User Story Value Proposition Pilot Scenario Diagram Will NC HIE store results document? What is the format of the document? BG Jones, Orion Health John Lightfoot, Orion Health Patrick Blaylock NC HIE Keith Scott, NC HIE Rob Lindsey, Solstas Lab Partners Diane McAllister, Solstas Lab Partners Providers Identify providers and establish DIRECT capability Create human- readable lab results document Create Rhapsody route to send Direct message Educate providers on DIRECT use NC Direct Subscription Users Agreement. Scene 1: Provider orders a lab from Solstas using existing processes Scene 2: Solstas receives lab order, completes testing, and generates results. Results are rendered in a human- readable document. That document is transmitted to NC HIE using the established connection. Scene 3: NC HIE received the results document and forwards it to the Orion Health HISP for DIRECT delivery to the ordering provider. Scene 4: The ordering provider receives the DIRECT message and examines the lab results. The results can be added to the patient’s paper file or entered into a EMR. This pilot will give providers an interim solution to achieve a MU goal without the expense of an EMR. NC HIE Orion Health Solstas Lab Partners Providers to be identified from Solstas’ NC clients North Carolina Legal Agreements

5 Open Questions 1.What validation requirements exist for the lab? 2.Will HIE need to provide HL7 translation services? 3.Will HIE provide LOINC standardization services? 4.Will HIE store lab results? 5.Do any of the participating LIMS or EMRs have Direct messaging built in or will we need a second HISP? 6.Should the lab generate a PDF or the HIE? 7.What output format does Providence and State LIMS support? 8.How will delivery and read notice be accomplished? 9.Do participants need to have an interface to the HIE in order to participate? 10.What documentation is necessary for HIPAA/CLIA to prove system is compliant? 11.If lab results are to be stored in the repository as well as sent to the ordering provider how will the HISP know which message to store or which PCP should receive them via Direct? 12.Can the human readable form be included in the HL7 attachment? 13.How will destination of lab results be identified in the message? Key Resources Providence: To be determined State: Money Key Milestones Providence: Finalize user stories Determine which lab results will be included Develop LIMS functionality to send results Develop EHR/LIMS functionality to receive results Send test results Validate receipt of test results Send live results Validate against paper results Capture lessons learned State: Determine which lab results will be included Develop LIMS functionality to send results Send test results Validate receipt of test results Send live results Validated against paper results Capture lessons learned Legal Agreements Alaska eHealth Network Data Use Agreement MOU between ANHC and State Lab Additional to be defined User Story Providence: LaTouche Pediatrics PCP orders a lab test from the Providence lab using a paper requisition form. LaTouche’s EHR creates and prints the paper order which is sent via fax or with specimen. Providence lab receives the paper order and enters the order into the LIMS including Direct as preferred result delivery method. Lab completes test. Providence LIMS transmits to LaTouche PCP using Direct via AeHN HISP. LaTouche receives results via Direct. LaTouche staff attaches lab results to patient record. State: Anchorage Neighborhood Health Clinic (ANHC) PCP orders lab from State lab using paper requisition form. State lab receives the paper order and enters the order into the LIMS including Direct as preferred result deliver method. Lab completes test. State lab Chemware LIMS transmits results to HIE via HL6 interface. HIE stores results and transmits results to PCP using Direct via AeHN HISP. ANHC staff attaches lab results to patient record. Value Proposition Since national labs are offering electronic delivery to EHR’s, Providence needs to offer similar service in order to maintain market share. Additionally there should be improved patient outcomes by more timely access to results.. Key Resources State HIT Office AeHN – State HIE Orion Health – HISP Providence Providence Hospital Epic LaTouche Pediatrics Allscripts State State Lab Chemware Anchorage Neighborhood Clinic Orchard LIMS Vitera Intergy Alaska

Key Partners 1.Guam HIE 2.Hawaii HIE 3.Guam providers 4.Hawaii providers 5.Medicity (The Hawaii HIE/HISP technical vendor) 6.ApeniMED (The Guam HIE/HISP technical vendor) Key Milestones xx/xx/2012 – Plan and timeline finalized for HISP to HISP connectivity. xx/xx/2012 – Completion of legal agreements. xx/xx/2012 – Testing for HISP to HISP connectivity. xx/xx/2012 – HISP to HISP connectivity go-live. Key Resources 1.ApeniMED HISP interface 2.Medicity HISP interface Open Questions 1.Provider discovery 2.EHR integration User Story 1.Guam PCP receives lab reports as attachments via the Guam HIE Direct Portal. 2.The lab reports indicate a condition that leads to a referral to a Hawaii provider. 3.The referral and lab reports are sent to Hawaii using Direct and the HISP to HISP connection. 4.The Hawaii provider treats the patient. 5.The patient discharge report and related documents are sent to the Guam PCP Direct. Value Proposition 1.HISP to HISP connectivity facilitates fast, secure coordination of care through transmission of referrals, lab results and related documentation throughout the Pacific. Pilot Scenario Diagram Guam and Hawai’i Legal Agreements 1.Business Associate Agreements between providers and their respective HIEs 2.Data sharing agreement between the Guam and Hawaii HIEs Local and Regional Labs Hawaii Provider HISP to HISP connection facilitates transmission of referrals and relevant lab reports and related documentation. HISP to HISP connection Hawaii HIE /HISP Guam HIE /HISP Lab results as Direct Message attachments Guam Provider Guam PCP receives lab reports that lead to a referral to a Hawaii provider. The referral and lab reports are transmitted to Hawaii using Direct messaging. Hawaii Provider accepts the referral using Direct Messaging. Later, she returns discharge information to the Guam PCP using Direct Messaging. Direct Messages

Exposing participating HISP provider or participant directories for use by each connected HISP Proposed read receipt or other network to network delivery notifications meeting legal and regulatory requirements such as CLIA? Implementation of XD* within the proposed timeline Alignment of marketing and outreach communications to drive mutual adoption among participating organizations Impact of other unknowns TBD Finalize lab summit preplan with team by May 23, 2012 Finalize post-summit plan by June 13, 2012 Quest HISP in Test by July 1, 2012 IOS HISP in Test by August 1, 2012 Production Implementation by September 1, 2012 Florida HIE DSM Direct Reciprocal Support Agreement (DRESA) for HISP to HISP connections Florida HIE DSM Terms of Use and Subscription Agreement for DSM Users Quest Diagnostics Terms of Use Agreements for Care360 Users IOS Health Systems Terms of Use and Agreements for IOS Users HMA State Labs Health Systems Terms of Use Agreements for HMA Users Scene 1: HMA Labs receives a paper order from Dr. A for a CBC with request for copy to Dr. B and Dr. C. All three physicians’ Direct addresses are in the order. HMA labs logs onto DSM, creates new and attaches the report and addresses it to the three physicians. Dr. A logs onto DSM and views the new directly. Dr. B using Care 360 mailbox views the result and saves in the patients record. Dr. C using iOS Inbox views the results and saves to chart Scene 2: Quest Diagnostics Labs receives an order from Dr. A for a CBC with request for copy to Dr. B. The physicians’ delivery mode was previously defined as Direct. Both PDF &HL7 results created. Quest Diagnostics labs automatically sends the reports via their HISP to the two physicians. Dr. A logs onto DSM and views the new directly. Dr. B using iOS Inbox views the results and saves to chart Scene 3: Quest Diagnostics Labs receives an order from Dr. A for a CBC with request for copy to Dr. B. The physicians’ delivery mode was previously defined as Direct. Both PDF &HL7 results created. Quest Diagnostics labs automatically sends the reports via their HISP to the two physicians. Dr. A logs onto DSM and views the new directly. Dr. B using iOS EHR views the results that have already been saved to chart Standard interface – labs and EMRS can interface via Direct and those providers on the Florida HIE DSM Portal Enable exchange of information between ancillary service providers like labs, EMRs and providers Automated feeds to remove human in the loop Provide an audit trail for both manual and automated lab results & other messages Decrease costs and reduced errors in providing copies of lab results in either a structured or unstructured format Grantee team (Florida Agency for Healthcare Administration) Florida HIE - Harris Corporation Quest Diagnostics Lab & EMR HMA State Lab iOS Health Systems Florida Legal Agreements Value PropositionOpen QuestionsKey Milestones Key Resources Key Partners User Story Florida HIE - Direct Secure Messaging HISP - Web Services to receive XD message - Integration Support staff Quest Diagnostics Lab & EMR - Quest Diagnostics HISP - Automated lab feed for copy of HL7 & pdf of lab report - Automated interface between Quest HISP & Care360 EMR - Integration support staff HMA State Lab - LIS - CONNECT GW provided by Florida HIE - Automated lab feed for copy of HL7 & pdf of lab report - XDR from CONNECT GW to other HISPs - Integration support staff iOS Health Systems (EMR) - iOS HISP - Automated interface to EMR - Integration support staff

Florida Implementation Scenario Diagram: Manual to Manual HMA Lab Florida HIE DSM HISP Quest Diagnostics HISP IOS Health Systems HISP HMA labs logs onto DSM, creates new and attaches the report created from their LIS and addresses it to the three physicians. Dr. A logs onto DSM and views the new directly. Dr. B using Care 360 mailbox views the result and saves in the patients record. Dr. C using iOS Inbox views the results and saves to chart Ambulatory Provider(s) Direct Backbone SMTP w/ S/MIME Edge Protocols Florida Implementation Scenario Diagram: Automated to Manual Quest Diagnostics Lab Quest Diagnostics HISP Florida HIE DSM HISP IOS Health Systems HISP Quest Diagnostics Labs receives an order from Dr. A for a CBC with request for copy to Dr. B. The physicians’ delivery mode was previously defined as Direct. Both PDF &HL7 results created.. Dr. A logs onto DSM and views the new directly. Dr. B using iOS Inbox views the results and saves to chart Ambulatory Provider(s) Direct Backbone SMTP w/ S/MIME Florida Implementation Scenario Diagram: Automated to Automated/Manual Quest Diagnostics HISP Florida HIE DSM HISP IOS Health Systems HISP Quest Diagnostics Labs receives an order from Dr. A for a CBC with request for copy to Dr. B. The physicians’ delivery mode was previously defined as Direct. Both PDF &HL7 results created.. Dr. A logs onto DSM and views the new directly. Dr. B using iOS EHR views the results that have already been saved to chart Ambulatory Provider(s) Direct Backbone SMTP w/ S/MIME Edge Protocols Quest Diagnostics Lab