EHR Integration Strategy Kit

An Overview of the Ongoing Efforts from Carevive Systems and Redox Engine

The US market for Electronic Health Record (EHR) systems has witnessed significant growth after the Health Information Technology for Economic and Clinical Health Act (HITECH Act, the Meaningful Use Incentive program, in particular) and is now the largest marketplace for EHRs globally. And with that comes an influx of new technologies and new expectations. Carevive Systems and Redox Engine have worked together to create an integration strategy to facilitate this process.

Many hospitals want to meet certain accreditation standards, Meaningful Use deadlines, and adopt new technologies to better service patients and streamline workflows within their service lines. However, many companies are encountering hurdles when it comes to integrating their software with hospital EHR systems. Carolyn Bradner Jasik, MD, VP of Medical Outcomes at Mango Health expresses the common scenario for many: “For every digital health company that produces clinically relevant data, the inevitable question at meetings is: “Can you integrate with our EHR system?”

A 2013 Patient-Centered Outcomes Research Institute (PCORI) workshop identified two types of EHR integration: 1) full collection or discrete data integration or 2) systems collect, store, and report data independently, with summary information integrated into the EHR. The industry is now seeing more movement into option 2 with “wraparound” solutions that embed data visualization from the digital health platform that clinicians can then review. (Aaron Neinstein summarizes this well here.)

In February, we announced to the healthcare industry our partnership with Redox engine with the goal to integrate our care planning software with existing EHR platforms. Many advances have been made these past couple of months specifically with regards to Epic Systems and Cerner. Now both the Carevive Systems and Redox development teams have created a EHR Integration Strategy Kit that describes the processes, workflows, and timelines involved to implement our care planning system in various scenarios.

I believe it’s just a matter of time before the inevitable question shifts from “can you integrate with our EHR/EMR system?” to “what services do you need from our EHR/EMR system?” to optimize the value you can deliver to our clinicians and patients?”

“The industry movement towards ‘wraparound’ solutions is a reflection of where value is being realized from the use of healthcare IT,” stated Bob Bausmith, Carevive Systems’ Chief Technology Officer. “What we’ve learned from other industries is that wraparound solutions is where user experience and workflow innovation occurs. I believe it’s just a matter of time before the inevitable question shifts from “can you integrate with our EHR/EMR system?” to “what services do you need from our EHR/EMR system?” to optimize the value you can deliver to our clinicians and patients?”

The Carevive integration strategy is focused on identifying an initial group of health systems interested in partnering both with Carevive and Epic Systems as part of a program to provide more comprehensive survivorship tools to cancer patients. Integration is broken into an initial phase, utilizing currently available Epic functionality, and a secondary phase that takes advantage of currently planned Epic development. The outlined approach ensures each participating health system can take full advantage of both Carevive and Epic functionality with minimized effort from their IT and integration teams.

Redox Engine co-founder, Niko Skievaski, believes it is important to have an integration strategy that customers can approve. “Often times you’ll need to start with a smaller integration project to get it through the approval process. Then, as your product proves valuable, it’ll make more sense to do a full in-line integration. The integration kit helps you scope a project and phased integration approach that will help you move quickly with your customers.”

The Redox team is composed of former Epic employees with over 35 years of combined experience in EHR implementation, development, integration, and support. Redox was founded to help healthcare technologies easily access data available in the EHR through standardized web services. Beyond their integration engine, Redox provides professional services to lead health systems through each integration project.

Under the HITECH Act, the United States Department of Health and Human Services has $25.9 billion to spend to promote and expand the adoption of health information technology. The EHR market is estimated to grow at a rapid pace and reach a staggering $9.3 billion by end of 2015.

Initial Phase

Carevive streamlines the clinician and patient workflow via three key integrations.

1. Scheduling: The first integration streamlines the patient onboarding and check-in process. This integration uses Redox’s Scheduling data model to ensure patients scheduled to be seen are communicated to the Carevive Health platform along with key demographic information used to register the patient in Carevive. This creates a link, based on Facility ID and MRN, between the patient in Carevive Health and the facility’s EHR that facilitates single sign on and the ability to add care plans to the patient’s chart.

2. Clinical Summary: The second moment of integration uses the Redox Clinical Summary data model. The Clinical Summary query pulls key clinical information from the EHR into Carevive to help personalize the patient’s survivorship care plan.

3. Media Messages (MDM): Media messages are used to add documents to a patient’s chart. In particular, PDF reports can be added to a patient’s chart using the Media messages. The third and final piece of integration uses Redox’s Media data model to store the finalized survivorship care plan back into the EHR. Once completed, a PDF of the plan is stored in the chart for easy review and incorporation into notes to support billing workflows.

Secondary Phase

The second phase of integration looks to augment information available in the Clinical Summary data model, this further streamlines the clinician and patient workflow (Table 1). Epic enhancements planned for their next release will include cancer treatment plan and staging information as part of the C-CDA framework. Once released, this information will be directly integrated into Carevive’s platform to ensure further personalization of the survivorship care plan.

Table 1. Redox Data Model (and corresponding HL7 interfaces) 

R^ Data Model	Description	Trigger	HL7
Scheduling (SIU)	Scheduling messages are generated by a scheduling user in the EHR. They are used to notify external systems of new appointments and changes to existing appointments. Every appointment gets assigned a Visit Number to track changes to the unique visit.	New VisitScheduledVisit RescheduledVisit ModifiedVisit CancelledPatient No Show	SIU
Clinical Summary (C-CDA)	A clinical summary represents a snapshot of the patient’s chart at a moment in time. It contains numerous different “sections” each of which holds information like Allergies, Immunizations, and Medications.	Clinical Summaries are obtained via query.	C-CDA
Media (MDM)	Epic Only. Media messages are used to add documents to a patient’s chart. In particular, PDF reports can be added to a patient’s chart using the Media messages.	Media messages are currently only available with the POST DataAction.	MDM – Transcription

Implementation

Redox leads the integration project and partners with the client throughout each phase (Table 2). Beginning with connectivity and application integration readiness, they guide the client through the EHR-specific nuances of connecting to a health system and assist our technology team to receive/send transactions. During workflow validation and testing, Redox publishes documentation, presentation, and education material for to share with health system counterparts. As we approach go-live, Redox works with the health system technology team to coordinate cutover and conversions (as needed). They actively manage the message queue at go-live, escalating/resolving any errors, until all parties are confident that the connections are stable.

Table 2. Work Effort

Task	Carevive Participants	Health System Participants
Phase 1 – Connectivity
1. Get sample messages from health system	Customer Engagement Lead	Interface Analyst
2. Set up secure VPN connection to Redox	Customer Engagement Lead	Network/Security Analyst
Phase 2 – Testing
1. Connectivity testing		Interface Analyst
2. Functional testing		Interface Analyst
3. Integrated testing between Redox and the application	Technology Lead
4. Integrated testing between the health system, Redox and the application	Technology Lead	Interface Analyst
Phase 3 – Go-Live
1. Move interface engine configuration to production		Interface Analyst
2. Soft go-live	Technology Lead	Interface Analyst
3. Migrate application build to production application	Technology Lead
4. Go-live support	Customer Engagement Lead, Technology Lead	Interface Analyst
Phase 4 – Optimization
1. Optimization	Customer Engagement Lead, Technology Lead
TOTAL: 35 DAYS

Phase 0 – Launch

Phase 0 is typically done in parallel or as part of the sales process. The items outlined as part of this phase ensure the project gets kicked off quickly and is set up for success. The Redox team is available to support any and all tasks outlined.

1. Your integration story: Why does integration make sense for your product? What additional value does it bring? Make sure your story is awe-inspiring to ensure everyone wants to champion your integration project
2. Connect Carevive application to the Redox API: The Redox team works directly with Carevive to establish connectivity and run through initial testing.
3. Find best friends: If you do not have them already, go and find thepeople that will pave the way for a smooth integration project.
   • Executive Champion: Acts as your main liaison, has the political power to get things done.
   • Integration Lead: Responsible for interface setup and testing.
   • Network/Security Lead: Responsible for VPN setup and testing.
4. Finalize project scope: This includes a finalized integrated workflow, integration requirements, locations and users involved in the project.
5. Technical and security review: Each health system will review the overall architecture of your product. Work with us to appropriately represent Redox Integration in technical diagrams.
6. Legal documentation: Each health system has different requirements. We typically expect a background check, an IT access form and a confidentiality form.

Project Kickoff

This marks the beginning of your integration project. Tasks at this point should be actively tracked by your project lead in conjunction with the Redox team.

Connectivity:  Weeks 1-2

 

Testing: Weeks 3-5

 

Go Live: Weeks 6-7

 

Optimization: Week 8

 

Phase 1 – Connectivity

1. Get sample messages from health system: The Redox team works directly with the interface analyst from the health system to pull out required messages from their test system. The Redox team will review these messages to ensure they contain needed data fields and incorporate any message configuration into Redox as needed.

2. Set up secure VPN connection to Redox: The Redox team works directly with the health system’s network analyst to set up and connect a VPN. The Redox team provides all needed information to the health system network analyst to ensure set-up is done efficiently.

Phase 2 – Testing

1. Connectivity testing: The first step for connectivity testing is for the health system interface analyst to configure appropriate message types to be sent over the specified VPN tunnel. Once this is completed the Redox team works directly with the interface analyst to trigger and review messages. This review typically happens over the phone and includes real-time review and troubleshooting from the Redox team.

2. Functional testing: Functional testing allows the Redox team to review each message type in detail. The goal of functional testing is to ensure complete mapping between the health system’s interface messages and the Redox data models. The Redox team works with the health system’s interface analyst to review additional sample messages that are mapped to the Redox data model.

3. Integrated testing between Redox and the application: The Redox team works directly with the application team to do initial integrated testing between Redox and the application to identify and fix issues before engaging with the health system team.

4. Integrated testing between the health system, Redox and the application: Full integrated testing includes testing scenarios initiated in both the EHR and the application to ensure all messages are triggered.

Phase 3 – Go-Live

1. Move interface engine configuration to production: The health system’s interfaces should be moved into the production environment once integrated testing is completed and workflows are fully functional in the test environment. This requires the health system’s interface analyst to make updates to the interface engine in the production environment.

2. Soft go-live: Once interfaces are live in production, the Redox team reviews real messages as they pass into Redox. In that review, the Redox team identifies any additional configuration in Redox to ensure complete data matching. Once all items are completed by the Redox team messages are passed through to the application for additional testing based on live production data. The application team should finalize a plan to wipe all patient data from the test application before receiving any production data.

3. Migrate application build to production application: The final step before go-live is moving the build from the test application to the production application.

4. Go-live support: Once updates to the production application are complete all key workflows should be reviewed to ensure migration was successful. The application team, Redox and an integration analyst from the health system should be available for real-time support for the first day.

Phase 4 – Optimization

1. Optimization: It is essential to track user satisfaction by asking users for their feedback and actively incorporating it into your product. The Redox team can help incorporate feedback into deeper integrations.

So there you have it! The detailed and phased approach steps can help to strategize smaller projects and to scope out larger implementations.   Naturally, there are more specifics we could drill down on and more details to cover.  If you have any questions we would love to hear from you.  Leave us a comment below.