HIE Participant Onboarding Resources

Documents & Artifacts

• New World HIE On-Boarding Readiness Questionnaire
• New World HIE ADT Technical Design Document
• New World HIE Sample CCDA Use Case

Lessons Learned

Connectivity

Need a standardized, timely, and proven approach for testing and implementing VPNs and connectivity.

• What type of connection will the participant be using?
• VPNs should be completed prior to engaging participants for kick-off calls, so progress can be made without losing communication with participant
• How many VPNs can be completed concurrently?
• How many dedicated connectivity resources will the HIE have dedicated?
• Which participants are ready to engage at what time?
• Does HIE have a schedule in terms of building these VPN connections?
• VPN connectivity to all HIE environments: Test, Stage, Prod

Kick Off Meetings with Net New Participants

The following should be complete prior to kick off call if possible:

• Will participants be receiving information from HIE (outbound to participant)?
  • If so, what specs do they need to receive for each message type they plan to receive?
• What types of interfaces will the participant be connecting to HIE (inbound from participant)?
• System code for facility added to system and portal
• If participant is sending ORUs:
  • Are all results LOINC Coded?
  • Understanding how OBR-4/OBX-3 is sent
  • Ensure corrections, cancellations work as participant expects, etc…
  • Proper handling of sensitive lab information/do they send it?
  • If sending radiology, will they be participating in an Image Exchange?
• Interface Analyst Contact Information
  • Phone/email
• UAT Contacts (Validators)
  • Phone/email
• Test plan for UAT from participant?
  • If not, we need one
    • ADT – event type flow, testing all event types
    • ORU – testing cancellations, corrections (both OBR and OBX), testing microbiology results, testing pathology results
    • MDM – testing cancellations, corrections, etc…
• Established timeline for go-live
  • Testing
  • UAT
  • Activation
  • Go-live issue resolution

Preparedness

• Inbound Feeds
  • Version control – ensure interfaces are complete and thorough testing has occured prior to promoting them to production
  • Environment control – it’s important that all environments are the same, so any testing conducting in dev and test environments can be relied upon as sufficient
• Outbound Feeds
  • Understand how they function, where input facility specific logic needs to be input, etc…

Documentation of Standards

• Prefixes and Suffixes
• PV1 Providers and Copy To Providers in OBR NTE Segments
• OBX-3 is a copy of ‘OBR-4’ on RADs
• Naming Conventions

User Acceptance Testing

• Ensure that aesthetic formats and HL7 standards are met
  • OBR-4/OBX-3
  • PV1 Providers in NTE segments
  • Map OBR-4 to OBX-3 on RADs if OBX-3 is of no value
• Follow Test Plans through each message type
  • Event types and message order
  • Cancellations and corrections
  • Microbiology messages and pathology messages
  • Sensitive Lab testing
  • Look for invalid characters
• Create a schedule for validation in Stage, sign-off, validation in Prod, sign-off
  • Standardized process for HIE Validation
  • Standardized process for Participant UAT Validation
  • Standardized process for migration through environments

User Acceptance Criteria

The below identifies a sample user acceptance criteria to be used by the HIE during the User Acceptance Testing Process. These criteria are applicable based upon the HIE vendor in use and are predicated on the data provided by the HIE supporting the functionality. If data is lacking, functionality may not be possible.

Access Levels - Roles and Groups

The following roles and groups will be made available to manage privacy

• Front Desk 
• Care Support
• Support
• Provider 
• Facility Administrator
• Facility Privacy Administrator
• HIE Privacy Administrator
• HIE Administrator 
• EMPI Administrator

Administrator Homepage

Clinical Portal Users Search enables an administrator to find users registered in the Clinical Portal

Clinician Homepage

• Worklist - identifies the worklist that will appear on the user's Homepage 
• Recent Patients - a list of patient records that the user has recently accessed within the Portal
• Received Messages - a list of messages that the user has received from another user.

Documents

• Viewing Documents – Documents are stored in a hierarchy of folders in the document tree and can be filtered by the following metadata if available:
 o Category - document's type; e.g. X-ray or Chemistry 
 o Date - document was either created or received from an external system such as a laboratory. When viewed by date, the folder names change to reflect the age of the documents they contain; e.g. Today, Last Week, Last Month 
 o Service - lists the folders and documents by the service with which they are associated 
 o Author - lists the folders and documents in ascending alphabetical sort order of the name of the clinician responsible for ordering or creating the document
• Document Display Options - Folders and documents are listed in the document tree with the most recently created document appearing first. 
• Abnormal and Critical Abnormal Values - When a numerical result is returned from a laboratory that contains abnormal or critically abnormal values, that result's entry in the document tree is flagged.

Frontdesk

Patient Search enables a clinician to find a patient or patients by searching on their personal details. A Patient search will return all patients that have been registered with the hospital or one of its facilities or clinics

Notifications

• Inpatient Admission
• Inpatient Discharge
• New Laboratory Result (Final) is available
• New Radiology Result (Final) is available
• Interim Microbiology Result available
• Patient is admitted to the ER

Delivery Options for notifications are: Email – this will send a notification to the user via email that new information is available:

• Individual Email: Sends the summary notification (without patient information) to the email address identified above. 
• Daily Summary Email: Sends a daily summary email (without patient information) of the notifications as opposed to individual notifications 

HIE Portal User Messaging (Individual): Sends the detailed notification containing patient information and selected document or result from the document tree securely to ‘Received Messages’ in HIE Portal. Note the user receiving the message needs to be an existing HIE Portal user Daily Summary HIE Portal User Messaging: Sends a daily summary of the notifications containing patient information and selected document or result securely to ‘Received Messages’ in HIE Portal as opposed to individual notification. Note the user receiving the message needs to be an existing HIE Portal user

Patient Lists

• Favorite Search is a saved set of criteria that can be recalled for later re-use by the logged in user. A favorite search is created by performing a search then entering a name for the criteria set into the Enter a new favorite search field
• Search Results in Context the names returned by a search are held in memory when an individual is selected. This allows an alternative patient to be selected without having to repeat the search
• Recent Patients list is automatically populated with the names of the 40 most recent patients as they are seen by the user. It is subdivided by how long ago the record was viewed; e.g. Today, Last 7 Days, Last 4 Weeks or Last 12 Months

Patient Search

• Patient Search enables a clinician to find a patient or patients by searching on their personal details. A Patient search will return all patients that that match the criteria within the HIE EMPI 
• Patient Demographic search results will display the EMPI identifier, EMR (Local) IDs, Name, Date of Birth (Age), Sex, Consent and Zip Code. A tooltip will display the address and phone number.

Patient Summary

• Patient Context Bar: Once a patient has been placed in context, their identification details are displayed in the Patient Context Bar. These include the patient's EMPI Identifier, Local MRNs, the patient's family name in 
capitals, followed by their first and other names, the patient's gender and date of birth, displayed in smaller text, and an indicator that  the patient is deceased
• Demographics: displays key demographic information for the patient including next of kin
• Encounter History: displays a list of all inpatient and ED visits for the patient including Ambulatory
• Medication History: displays a list of current and historic medications for the patient
• Allergies: displays a list of current and historic allergies for the patient
• Procedures: displays a list of procedures performed for the patient
• Problems: displays a list of current and historic problems for the patient
• Insurance: displays a list of latest insurance information from each contributing source.

Results Viewer

Textual Results The Results panel displays the text of the report and includes report's Status: Interim, Final or Updated Each result contains the following data in the header:

• Time Collected – date/time the investigation was requested 
• Time Received – date/time the request was received  
• Time Reported – date/time the report was returned to the hospital 
• Order Number - the unique order number associated with the report 
• Ordering Provider -name of clinician who requested the investigation 
• Placer Notes - identifier associated with request when it was received 
• Filler Notes -identifier associated with the request when it was filled 

Numerical Results Each result contains the following data in the header:

• Latest Version 
• Source System - (or other text) identifies the name of the source system 
• Time Collected – date/time the test specimen was collected 
• Time Received - date/time the test specimen was received by the laboratory 
• Time Reported - date/time the results were returned to the hospital  
• Order Number - the unique order number associated with the test 
• Status - the status of the results (Updated, Final, Interim) 
• Location - (optional) the location where the test was performed 

Charting - A Chart can be generated to reveal any trends or patterns that may be present in the results. Individual values are selected for inclusion in the chart by clicking their corresponding checkboxes.

Microbiology Results The main report message contains the header information and usually provides an update with the micro-organisms found in the specimen. Each of the child report messages contains the full information for a particular organism. The main report message and children report messages are linked together to provide the complete micro-biology report. Abnormality flag identifies test values outside the reference range. An associated description will be displayed in red: for example Above upper panic limits. The HIE Clinical Portal does not determine whether or not this flag is displayed; this is determined from the contents of the message returned by the laboratory Data normalization is achieved using Health Language’s Language Engine (LE). Lab results presented in the results viewer will be normalized using the LOINC content set, allowing a cumulative view and charting across multiple source systems.

User Messaging

Portal users will be able to send messages to and receive messages from other Portal users via the Portal’s User Messaging. Notifications will also arrive as a user message within the Portal.

• Filtering Received Messages by selecting one or more of the options from the navigation bar:
• Urgent Messages: Allows a user to view all urgent messages
• Unread Messages: Allows a user to view all messages that have not been read
• User Messages: Allows a user to view all messages sent by other Clinical Portal users
• System Messages: Allows a user to view all messages sent by the Administrator
• Reset: Allows the user to reset the filter criteria

Users may also perform a text search to identify text in the message’s subject line. Users may enter the text and select the Search button. The following six columns appear on the Received Messages screen: Icons: The icon indicates an unread message. The icon indicates a read message. The icon indicates an attachment is included in the message.

• From: Provides the name of the Clinical Portal user who sent the message. Note: Users may sort this column by clicking the From link.
• Subject: Displays the subject line of the message. Note: Users may sort this column by clicking the Subject link.
• ID: Shows the identification of the patient e.g. name or MRN. Note: Users may sort this column by clicking the ID link.
• Event: Indicates the type of event e.g. blood test, scan etc. Note: Users may sort this column by clicking the Event link.
• Received: Displays the date the email was received. Note: Users may sort this column by clicking the Received link.

New Messages - Users may send new messages to other Clinical Portal users. The recipient's User ID can be typed directly into the To: field or, by clicking the To: button.
Sent Messages - Users may view messages they have sent to other Clinical Portal users.
Deleting a Message - A message can be deleted by selecting its associated checkbox and clicking the Delete button.

Worklists

• Personal to the clinician who created the worklist
• Patient names can be added to a worklist either from the results of a search, or from the Patient context bar