HIN allows providers to identify with or link to a patient. Once they are linked HIN is able to push event and documentation notifications to the provider. There are currently six "notifiable" events and this list is expected to grow. There is a near real-time monitoring that can occur which has the potential to improve communication, efficiency and effectiveness particularly for care management.
HIN is also emerging as middleware allowing a provider or a user to specify information they would like to receive on a patient. HIN routes (or pushes) the information to a reconciliation cue at which point the receiver reviews and decides whether to incorporate the data/document into their EHR. Issues are emerging with this practice including the potential to overwhelm the user with too much information to review and reconcile.
Figure J-4 provides an illustration of HIN's technical architecture. Information is exchanged using a variety of standards including Health Level 7 (HL7) version 2.x for messaging and clinical document architecture (CDA) and continuity of care document (CCD) for document exchange. Table J-4 summarizes the information exchanged and HIT standard used by HIN and EMHS's ability to support the standards.
FIGURE J-4. HealthInfoNet HIE Technical Architecture
TABLE J-4. HIT Standards Used by HIN and EMHS Capabilites
|Information Type||HIT Standard and HIN Use/Findings||EMHS Standards-Based Exchange Capability|
|Messaging||HL7 Version 2.x.||Supporting ADT messages.|
|Labs||HL7 Version 2.7 (may receive in other HL7 versions, but converts to 2.7).||Supporting lab standards.|
|Documents||HL7 2.3x to 2.5x--HIN may receive document data.
HL7 CDA--The content sent in the wrapper is good, but data in the document requires clean up because it is not standardized.
HL7 CCD--HIN is experiencing problems with this standard. Every vendor has implemented it differently. HIN will take the CCD if they can parse out the data.
|The home care POC & other documents are sent using HL7 a results message. The content of sent as a text blob. Application versions used by EMHS currently do not have the capability to support a CDA.
Next version of EMHC EHR may include CCD, but it has not been installed at this time.
|Medications||RxNorm or NDC codes.
NCPDP used for communication standard.
|Not applicable. As a user requests a look up of the medication history, HIN queries the medication database from SureScripts & the Maine Medicaid database for the latest information.|
"HIEengage.pdf" (pdf, 976.86Kb)
"HIEengageA.pdf" (pdf, 122.65Kb)
"HIEengageB.pdf" (pdf, 132.47Kb)
"HIEengageC.pdf" (pdf, 62.72Kb)
"HIEengageD.pdf" (pdf, 64.52Kb)
"HIEengageE.pdf" (pdf, 71.74Kb)
"HIEengageF.pdf" (pdf, 67.17Kb)
"HIEengageG.pdf" (pdf, 128.62Kb)
"HIEengageH.pdf" (pdf, 1.02Mb)
"HIEengageI.pdf" (pdf, 264.75Kb)
"HIEengageJ.pdf" (pdf, 663.47Kb)
"HIEengageK.pdf" (pdf, 126.77Kb)
"HIEengageL.pdf" (pdf, 141.17Kb)