1. Statewide Collaboration Process Protocol and Services Work Group HEAL 5 Kick Off Mtg May 12, 2008 DRAFT

2. Vision to Implementation: NYHII and SHIN-NY Today RHIOs in early stages CHITAs nascent; NYC roll out Statewide infrastructure efforts in planning (common policies approaches) – bottom up and state-level approach The Road SCP coordinates planning process Decisions and schedules created ASAP SCP manages integration of policy, technical, operational plans and implementation Vision Robust efforts operational at local, regional, state levels Statewide infrastructure ubiquitous to achieve critical quality/pubh goals and drive regs. CHIxP Protocols used at all levels

3. Today’s Discussion Scope of Interoperable EHRs for Medicaid/Medication Management Use Case Straw dog proposal and objectives Key work streams/next steps

4. Scope of Medication Management Medication Management is: –Across the continuum of care, complete access to medication history and other clinical information for clinicians and consumers to have the right information at right time to improve care –Electronic prescribing, including: formulary, eligibility, administrative authorization and clinical decision support functions to improve quality and safety and reduce costs Medication Management requires the following system components: –Data Sources Medicaid data is leading the way Surescripts for eRX network and medication history RxHub for formulary, medication history Other hospital, mom n’ pop retail pharmacies, long term care pharmacies Laboratory information to support clinical decision support –HIE Services Patient uniform id and identity reconciliation 4As Secure physical connection

5. Medication Management Straw dog and Objectives State level Medicaid service –Most projects are participating (ubiquity) –Strategic integration vs. point-to-point; consistent with MITA principles and ability to leverage other services –Clinically effective and cost effective Additional state level data services to achieve medication management goals –Good potential for horizontal integration and standardization with other medication information services (e.g. – RxHUB, SureScripts) –Economies of scope are realized if the aforementioned integrations occur, as one interface will now yield multiple feeds –Ability to drive key services for data quality and utility Prerequisite HIE services

6. Medication Management A View From the Top EMR1 getRx (PUID*) Rx Object Medicaid, SureScripts, RxHub, … *PUID - Positive, Uniform ID EMR1 Medicaid EMR1 Local EMR1 SHIN-NY Medicaid LogicalPhysical? 1 EMR1 Medicaid TODAY - Point-point proprietary VISION – Many Physical Architectures, Uniform CHIxP CHIxP Medicaid

7. Breaking it Down EMR1 getPUID (identifying attributes*) PUID Object PUID System 2 *identifying attributes can be demographics, biometrics, etc. 3 EMR1 secureConnect (credentials) 4A’s System Security Object Before we can request the history we need a PUID… Before we can get a PUID we need to connect and login…

8. Diving down EMR1 Authenticate (PUID, telephone #) Security Object 3.1 3.1.1 Audit (transaction) Audit System Audit Object 4a’s System PUID System Authentifying System Verify(PUID, telephone #) PUID Object - verified Authenticate (PUID, telephone #) Security Object 4A’s System Requester PUID (provider) Before we can login we need to authenticate… Before we finish authenticating we need to record an audit log…

9. Infrastructure Secure connection – Transport: HTTPS, TLS – Discovery: SHIN-NY DNS – Encryption: digital certificates, certificate authority PUID System – Enrollment: IDs (self selected?), phone numbers?, pictures? – Management: Additions, Verification, Removal ( death) – Implementation: high availability system Before we can invoke many of the services described we need underlying infrastructure support…

10. Protocols from the Pictures High Level – Services getRX getPUID secureConnect Authenticate Audit … – Structures RxObject PUID Object Security Object Audit Object … Further refinement (lots) will get us to UML diagrams or whatever final form we prefer Issues begin to surface – PUID? Do we want this? Can we do it? – Do the protocols go all the way to the EMR? – Do we create protocols for infrastructure? – Do we provide implementations for statewide services or just protocol definitions? The needed protocols fall out from the diagrams

11. Work Stream Process Create P&S subgroup on Medication Management if needed Assess NY, National efforts for leverage, compatibility considerations Choose Exchange Architecture –Geographic with technologic exceptions (local EHR integration strategy) Choose Extent –Base Standards (NCPDP, …) –Constrained Standards? –Common Instantiations? Develop proposed CHIxP –Draft and review –Plan for testing (instantiation or higher level extents if needed) Coordinate with other groups –Plans for policy, adoption, evaluation

12. Straw Dog Work Streams Identity Management –PUID System? Identity Reconciliation –‘MPI’ services: subject matching, … 4A’s –Authentication, Authorization, Access, Audit Connection –Physical transport –Dynamic discovery Medication Management –Medication history protocol: Medicaid exemplar –eRx –Clinical information protocols related to medication management –Clinical services: de-duping, interactions, …