Electronic Medical Record Integration

KRM has built and implemented extractors for OpenVistA™ and RPMS to participate in a Health Information Exchange (HIE). These adapters act as secure exchange points for the Electronic Medical Record (EMR) systems to transmit Continuity of Care (CCR) records to a Health Information Exchange.

Personal Health Record Integration

KRM has developed and demonstrated their Personal Health Record (PHR) solution not only interacting with EMR systems, but exchanging data through a functional HIE. A PHR interacting with an HIE is an innovative and unique approach, and enables a patient to most fully interact with their medical care in innovative ways.

HIE Exchange Model

KRM Associates Inc., working with Northrop Grumman™, demonstrated a nationally adoptable model for health information storage, exchange, and interaction using open-source technologies.

The Exchange

The challenge in developing an interoperable Health Information Exchange (HIE) lies within developing components which are adoptable and sustainable.  In West Virginia, the two most prevalant Electronic Medical Record (EMR) systems are OpenVistA™ and RPMS; both systems are based on Department of Veterans Affairs VistA software and represent affordable solutions for providers. Currently these are installed in 7 state hospitals and 40 rural clinics. These products were found to be some of the more robust and adoptable EMR solutions, especially when viewed relative to installation and support costs. West Virginia consists of a largely rural and low income population, which meshes well with these commercial alternatives.

Northrop Grumman's™ HIE solution is capable of exchanging health information in nearly any document format using NHIN CONNECT standards. In choosing the document format to exchange, KRM decided to use the non-proprietary Continuity of Care (CCR) standard, as it's robust architecture is not bound to any commercial vendor.

The demonstration showed in real time, KRM's Personal Health Record (PHR) requesting patient records from the HIE, the HIE communicating with Open-VistA™ and RPMS EMR systems, returning CCR records to the PHR through the HIE, and the PHR parsing and digesting this information into a readable data format.  KRM was responsible for developing the adapters for the RPMS and OpenVistA systems to interact with the HIE, as well as the PHR system.

The Benefits

The low-cost of open source technologies helps alleviate the cost of participation in HIE, which can contribute to establishing a sustainable model for this architecture once federal funding is no longer available.  Additionally, through operating with federal standards, the Health Information Exchange can potentially interact with state and federal provider systems.  Open-Source architecture means expandability as well.  These solutions can be adopted and transformed to meet many challenges of interactivity.

The CONNECT software is the outcome of a 2008 decision by federal agencies to begin work on connecting their health IT systems into the NHIN (National Health Information Network). ONC has been facilitating development of the NHIN which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payors and other stakeholders into a “network of networks.” Rather than individually building the software required to make this possible, the federal agencies collaborated through the FHA (Federal Health Architecture) program to create a single solution that can be reused by each agency within its own environment.

The solution now allows federal agencies to securely link their existing systems to the NHIN. More than 20 federal agencies collaborated to build CONNECT through the FHA, and as a result, agencies are heading towards interoperability.

CONNECT was built in open-source technology in order to keep costs low upon deployment at each organization. An additional benefit of this has been that CONNECT has now been made available to the healthcare industry at large. CONNECT will act as an accelerant to promote NHIN adoption and additional innovation in the industry.

The ability to share data electronically among organizations will have a vast number of benefits to citizens, among them:

• Having up-to-date records available at the point of care.
• Enhancing population health screening.
• Expediting the collection of case research to facilitate disability claims.

KRM has been operating within this framework as the backbone of its Health Information Exchange capabilities, and is capable of implementing this technology to meet any contractual requirements. Additionally, experiences gained within this technology act as a powerful baseline for any future HIE endeavors.