Colorado

Project Overview

The goal of this initiative is to implement statewide information and communications technologies to enable clinicians to access patient information from other clinical data repositories at the point of care. The project is building a prototype data exchange among 4 providers. The prototype is serving as a learning laboratory for identifying the architecture and policy issues that need to be addressed by the community for establishing a sustainable model.

Partners

The health information exchange (HIE) project includes four University of Colorado Health Sciences Center-affiliated institutions -- Denver Health, Kaiser Permanente of Colorado, The Children's Hospital, and the University of Colorado Hospital. Through the Colorado Regional Health Information Organization (CORHIO), COHIE works with various institution- and county-based initiatives to create a cohesive HIE strategy for the State of Colorado.

Scope

Statewide

Stakeholders

Stakeholders include patients, providers, payers and the public health community.

Goal

The principal goal for the project is creating a model that is low-cost and self-sustaining, which accommodates diverse platforms, systems, needs, resources, and affiliations and synergizes with the Nationwide Health Information Network (NHIN).

State and Local Involvement

CORHIO is a convener of all HIE efforts in Colorado.

Funding

• Agency for Healthcare Research and Quality SRD Contract ($5 million)

Data and Functionality

CORHIO is piloting or is planning to exchange the following types of data:

• Demographic information
• Laboratory information
• Radiology reports
• ICD-9 coded visit diagnoses
• Electrocardiograms (EKGs)
• Medications and pharmacy history

CORHIO will provide the following functions and services:

• Point of care (for patient and/or provider)
  • Aggregation of clinical information from other hospital/ providers
  • Immunization history (Colorado Immunization Information System)
  • Individualized medication lists (Pharmacy Benefits Managers/Retailers)
  • Allergies, laboratory, radiology, procedures, electrocardiograms (EKG), etc.
  • Decision support for clinical guidelines
• Clinical messaging (from provider to provider)
  • Laboratory test orders/results exchange (to/from CDPHE, LabCorp, Quest)
  • Electronic prescribing
  • Case reporting, electronic laboratory reporting
  • Ancillary/referral service results (e.g., radiology, consultant reports)
• Administrative (for provider and payer)
  • Claims submission
  • Eligibility, credentialing
• Population/public health (for provider, payer and/or public health)
  • Analysis of quality, disparities, morbidity monitoring, pay for performance
  • Registry development
  • Registry support: immunization
  • Bio-surveillance
  • Community health assessments

Technical Design and Architecture

Colorado is using a federated point-of-care model. It is not a data repository. Data "lives" at its point of generation and is shared through CORHIO's hub (CORHIO Central) when it is needed via a secure and confidential process. Interfacing occurs via Web services.

Messages are in HL7 2.3.1 format. CORHIO can also accept XML formatted HL7 messages. The Technical Team has developed the nHAPI (NET HL7 Application Program Interface) conversion tool for HL7 and XML messages. Current work includes work with sub-contractor HEALTH Language to create a Common Vocabulary Engine (CVE) which maps information coming into the hub to common terms, normalizing the message. This phase is funded through additional grants, not AHRQ's SRD contract.

CORHIO Central's architecture includes:

• Hardware -- a hosted secure facility with technical support, redundant servers, server maintenance
• Telecommunications -- redundant internet access
• Software -- Master Patient Index, secure/audited messaging services, the Common Vocabulary Engine, a rules engine (for clinical decision support), functions to manage all services
• Staff -- 24/7 support resources for operations, inquiry management

The model allows for scalability both in volume (via added servers) and scope (via new software).

All transactions are conducted in a secure and encrypted manner. A "partner entity" -- a dues-paying regional node, provider coalitions, private network, etc. -- is authenticated and makes an initial request for information via an HL7 message through a Web services interface. The Master Patient Index (MPI) assists the partner entity in finding and confirming the right patient. A second query is then sent to CORHIO Central, for distribution to all known data sources with information relevant to the identified patient. Data are retrieved from each source and aggregated at CORHIO Central for presentation in a browser window.

Data Exchange Standards Used

• HL7
• LOINC
• SNOMED