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by Michael Carbery, CIO for Population Health
Maimonides has long recognized the importance of having current and comprehensive community wide clinical information available to users and analysts working in the care coordination system and data warehouse adopted by Maimonides for population health programs. Optimal use of this information, whether in care management or clinical workflow, background supporting processes, and advanced analytics, requires that the information be updated automatically, in near real time, without the requirement for a user to initiate a query for an update. This requires a “Push” model whereby the QE/RHIO pushes new and updated clinical information to the care coordination system via automated background processes without the need for human intervention.
Starting in 2012, Maimonides and the Brooklyn Health Information Exchange (BHIX) implemented a “Push” model for CCDs (C-32 format) via electronic interface from BHIX/Healthix to GSIHealthCoordinator (GSIHC), the care coordination system adopted by Maimonides for population health programs. This model was based on “Enrollment” and affirmative patient Consent. This original “Push” model used a combination of triggers (e.g., ADT messages) and periodic sweeps to generate and “Push” full longitudinal CCDs from BHIX/Healthix to Maimonides. While valuable to Maimonides programs, the technical solution was sub-optimal, as the original triggering and sweeping mechanisms led to both to gaps and overlaps in information, as well as the redundant generation of full CCDs wasting system resources. Also, as a custom interface based on earlier semi-standard technology, the process proved difficult to maintain as Healthix migrated to new and enhanced technology.
Recognizing both the value of the “Push” model and the limitations of the original technical implementation, Healthix has collaborated with Maimonides to create the new “Clinical Information Update” (CIU) process as a unique Healthix service offering. Based a patient’s inclusion in a “Subscription file”, along with affirmative patient Consent or other enabling mechanism (e.g., 1:1 Exchange), the new CIU process will deliver an incremental CCD (C-CDA format) in near real time to the requesting organization containing only that information that is new or updated since the last CCD was sent.
This mechanism both enhances the value and alleviates the technical shortcomings of the previous approach, and will be fully supported as a Healthix standard service as Healthix continues to maintain and enhance its technical environment.