AHCCCS - 2007 Medicaid Transformation Grant Final Report

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3.0 Phase 1: Health Information Exchange

3.1 Project Initiation

The HIE project had three major directives to govern how the HIE would be designed, built and deployed:

The project team was assembled using a mix of consultants from Computer Sciences Corporation (CSC), FOX Systems and Datalink Software Consultants. Requirement definition was largely completed by September of 2007, and in October of 2007, design and development began.

Through the guidance of Gartner Consulting, the roles and responsibilities of the team were defined and documented, development methodology, issue tracking, bug reporting, quality control and release management were all implemented.

With the aid of the AHCCCS Division of Business and Finance (DBF), expense tracking was implemented and the ability to manage detailed costs for the project was established.

3.2 Requirements Definition

To best understand the needs and requirements of the health care providers, 28 focus groups were conducted, and a survey was developed with Arizona State University that was delivered along with the annual medical license renewal process. The final report for the focus groups and the final report from the ASU Survey are attached in appendix..

The Arizona Health-e Connection, a workgroup formed by then Governor Janet Napolitano had developed a state-wide roadmap for health information exchange in 2006. The roadmap provided important information to help guide the strategy for the HIE we planned to implement.

We recognized very early in the process that the scope of the effort needed to be managed closely, and be defined as narrowly as possible to be achievable while still providing enough value in our initial implementation to inform decisions for growth. Based on the feedback from the provider community, three types of records were identified to be the starting point for the HIE:

The feedback also made it clear that if only Medicaid information is available, the value to the provider would be minimal, as the Medicaid members only represent a fraction of any provider&acutes patients. This led to the conclusion that all patient information would be available through the exchange.

3.3 Development

A significant amount of time and effort was spent on the development of contracts with our data partners and the providers/users of the exchange. Much of the formation of legal, privacy and security policies, leveraged work done by the Markel Foundation and the AHRQ funded, Health Information Security and Privacy Collaboration (HISPC) work done by the Government Information Technology Agency (GITA) of the State of Arizona.

There was a great deal of time spent with the participating hospital legal and compliance staff to educate them on health information exchange, the regulations that allow exchange of information in Arizona for treatment purposes, the security measures deployed by the project, and the policies that govern the Exchange.

The project team did a great deal of research into standards around messaging, clinical document exchange, lab data, consent directives among many other topics. The project decided upon a service oriented architecture (SOA), using web services, and the Clinical Document Architecture. The SOA proved itself through a demonstration project, where the in-house developed MPI was replaced with Initiate&acutes MPI product. Initiate participated in this project at their own expense. This resulted in a quick low effort project that demonstrated the ability for Initiate and the AMIE SOA to be integrated.

3.4 Implementation

After about one year of development and testing, the Arizona Medical Information Exchange (AMIE) Proof of Concept was launched on September 29, 2008. The Proof of Concept ended on December 29, 2008, but AMIE continued to operate through November 2009.

The AMIE Proof of Concept enabled 39 AMIE certified and credentialed AHCCCS registered clinicians to identify patients, locate their relevant medical information, and view individual patient records.

The &quotproof of concept" included:

These &quotstarter" record types were identified by clinicians as being of the highest value with respect to records that could be made available through the HIE. Although the sites and users were limited during the &quotproof of concept," AMIE was designed and built to support a state-wide expansion if called upon.

Starting February 1, 2009, the AMIE Behavioral Health Expansion began. AHCCCS, working with the Division of Behavioral Health Services (DBHS) from the Arizona Department of Health Services (ADHS), and the Regional Behavioral Health Authorities (RBHAs), added behavioral health medication information to the AMIE medication histories, and approximately 10 behavioral health care providers to access the information available through AMIE using the AMIE web-based Viewer.

While AMIE was in operation, we continued to add users, and accumulate data. Additional data types were made available by Banner Health System. The following tables show the types of records, sources, volumes and number and regional distribution of patients in the MPI.

AMIE statistics as of December 22, 2009

Over 3.1M patients are in the AMIE Master Patient Index.


There are over 7.6M records available through AMIE:

Organization
Total
Banner Baywood Medical Center 58,334
Banner Desert Medical Center 73,095
Banner Estrella Medical Center 34,014
Banner Gateway Medical Center 22,077
Banner Heart Hospital 16,135
Managed Care Pharmacy Consultants, Inc 1,031,172
MIHS 11,936
SJHMC 27,247
SonoraQuest 6,349,858
Grand Total 7,623,868


AMIE currently can provide access to 10 different types of records:

Record Type
Total
Cardiac Study/Report 6,875
Consultation 54,546
Discharge Summary 109,431
Emergency Report 2,782
History and Physical 38,124
Lab Report 6,349,858
Medication History 1,031,172
Operative Report 23725
Procedure Note 262
Study Report 7,093
Grand Total 7,623,868

AMIE Statewide Patient Distribution

AMIE Statewide Patient Distribution

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