PROJECT BRIEF: Arizona NW-HIN Pilot


Sponsor(s)/Contact(s):

Techsant Technologies LLC (Techsant): Sri Koka
Arizona Governor's Office of Health Information Exchange (GoHIE): Aaron Sandeen/Ryan Sommers
Maricopa Integrated Health Systems (MIHS): Dave Kempson
Microsoft HealthVault: Umesh Madan/Sean Nolan.

The Direct Pilot is a high-visibility, ONC-initiated national project providing both a path to provider Stage 1 Meaningful Use in 2011 and practical and achievable health information exchange. Direct Project will provide a secure, scalable, standards-based mechanism to send health information directly to known, trusted recipients over the internet. This pilot project will be a project with only test data and which will be an ideal vehicle to help the provide guidance and reference implementation for understanding the state healthcare landscape and it’s required data flow.The pilot will be implemented by a group of private vendors with volunteer efforts and under the governance of the state coordinator and the regional coordinator.

Objectives


1. Develop the prototype for the demonstration at national and local HIT conferences
2. Develop a system and exchange test data through the Direct protocol by mid of the second quarter 2011.

Description

This implementation in this pilot demonstrates the following four Direct Project deployment models.

Physician’s office using an internet browser
  • This demonstration uses Techsant HISP Gateway to provide all of the requirements of the Direct Project. In this model the user interacts using only their Internet.. The Techsant HISP Gateway is fully trusted and responsible for content packaging, addressing, security, and delivery. The prime advantage of this deployment model is that the end-user needs only a browser.

Physician’s office using an E-mail client that does not use S/MIME
  • This demonstration uses a common e-mail functionality with Techsant Gateway that intercepts all outbound/inbound e-mail messages. This Gatweay is fully trusted and will apply the security functionality to encrypt and sign outbound e-mail; and decrypt and validate signatures on inbound e-mail. The prime advantage of this deployment model is to move the complexity of security to an external device.

Specialist E-mail client using native S/MIME
  • This demonstration requires an e-mail system that supports the Security requirements. This e-mail system could be a fully functional e-mail client, or a common enterprise class e-mail system. The prime advantage of this demonstration is that the security is truly end-to-end which means that there is no third-party that has access to the PHI. Pleae note that there is no gateway requirement and all the secured transaction occurs at the centralized HISP service which is provided by Axway’s proprietary secure exchange which meets the Direct Project Specification.

Physician’s office using EHR or PHR to send the summary care record to the specialist.
  • This demonstration integrates all of the requirements into the EHR or PHR application. In this model the user is likely to be given a very simplified interface simply to select the documents to send and the destination address. The user interface is not defined by the Direct Project and would be dependent on the EHR or PHR supplier. The prime advantage of this is transparency to the user. The EHR that is using XDR for push workflows. The EHR applications would like to send to and receive from participants the information through the XDR protocol to the Techsant Gateway which sits at the statewide HISP which takes in the XDM package and turns around and hand it over to the Direct module at the AZ HISP. Direct module takes the package and ships to the destination address using SMTP/SMIME and the Direct Project Specification.

Market Forces

  • Improved Patient Care
  • Shift in reimbursement models
    • Accountable Care Organizations.
  • Federal Incentives & Disincentives
  • Demands for Interoperability
  • Customer Expectations
  • Privacy and Security

Document Sets and Data Elements

  • HL7 Continuity of Care Documents (CCD)
  • HITSP C32 Standard Documents.

Discrete Data Elements

  • Allergies

  • Current Medications
  • Immunizations
  • Insurance Information
  • Last Filed Vitals
  • A list of encounters in the last three months
  • Discharge Notes
  • Problem List
  • Recent Procedures
  • Recent Lab Results.

Participants

  • HISP(s): AzHISP is developed by Techsant and hosted at Maricopa Integrated Health System's Data Center.
  • Techsant Technologies: Techsant provides all the technical resources for the project in the pilot phase.
  • GoHIE and Az GITA: Provides the Business System Analysis resources and the governing of the project. GoHIE works with MIHS and other state entities to identify and on-board the state providers for the pilot.
  • MIHS provides all the EHR related resources required for the project.
  • Microsoft provides the PHR interface releated resources for the project.

Success Metrics

  • Ability to exchange patient information between providers usning NW-HIN Direct compliant secure transaction
  • Demonstrate both web-based and Outlook based transactions
  • Gain an understanding of the requirements and barriers to scaling to a statewide solution
  • Test and evaluate capability of integrating exchange workflows and data flows into the products from major EHR vendors in the state.

Assumptions for the Pilot Initial Phase:

  • Test only pilot, not intended for production in the intial phase
    • Test is used for the project
    • No BAAs are required for and during this initial pilot phase
  • All the required resources are through the volunteer efforts by the local public and private organizations
  • Chosing policies and practices is outside the scope of the pilot project because this project is for the proof of concept and fore runner and foundation project for the future major statelevel initiatives.

Other Notes

  • Other Note #1
  • Other Note #2