Www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Christopher Ross, CIO 1 The Present and Future of Interoperable Health IT at Mayo Clinic

www.DirectTrust.org1101 Connecticut Ave NW, Washington, DC 20036 1

Christopher Ross, CIO

The Present and Future of Interoperable Health IT at Mayo Clinic

http://www.directtrust.org/


Mayo Clinic at a glance

• Rochester and Midwest, Phoenix, Jacksonville• 4000 physicians• 66,000 employees• Rochester - HIMSS Level 7 and Most Wired• Phoenix, Jacksonville, Midwest hospitals – Level 6• MU 2 Certified• 1.5M patients/year, 50 states, 150 countries• Member, DirectTrust.org



Strategy

We have come to realize that Mayo’s most scalable product is our knowledge

We are pursuing a business model based on knowledge management and diffusion of knowledge as our integration tool rather than consolidation, mergers, and acquisitions of assets

The important next step is sharing that knowledge more broadly through accessible tools



Mayo Clinic Care Network



Digital strategy evolution

Plummer record

Pioneering electronic tools

Campus EMRs

Converged EMRRefined tools: YES, Aware, others

Knowledge to Delivery

Connected CareEase, Watson

Unified data platform

Digital care

Digital health system integration

Health Care Automation

Health Care Digitization

• Inside• Physical• Scale

• Standardization• Quality• Effectiveness Automation

• Outside• Reach• Scope

• Diversification• Flexibility• Adaptability Digitization

Unified platforms – knowledge, process

Central lab

Mayo Scheduling System

Destination 2.0: Mayo Clinic is the digital destination where

clinicians, patients, and consumers find answers, hope

and healing.

Knowledge Content Management System



Goals for Interoperability

• Enable patient care for a premier destination medical center

• Enable strategic vision “knowledge to delivery” and “meaningful relationship with 200 million people” – health care, guidance, information

• Create “bridges to somewhere” – forward/backward compatibility



Building Blocks

• Proprietary and pre-HIE examples– Online Services for Referring Physicians (OSRP)

• Application to request and access Mayo records, knowledge, and specialty care from a distance. Submit requests for eConsults, referrals, and medical records.

• >27,000 accounts– Connected Care examples

• eConsult• Telestroke• eICU• Image exchange (Dicom Grid)



HIE pioneering

• Care Connectivity Consortium– Geisinger, Group Health Cooperative/OCHIN,

InterMountain Health, Kaiser Permanente, Mayo– 2011 – bridge amongst and between geographic HIEs,

NwHIN, Connect

• Beacon– ONC-funded pilot for regional exchange– Asthma trials

• Geographic HIE – AZ, FL, MN, WI



Digital adjacency to HIE

MayoClinic.org 344 million unique visitors 2013Ask Mayo Clinic Online Best-selling Mayo Clinic Diet Program onlineHealthy Living OnlineBetterE-consultsAsk Mayo ExpertKnowledge Content Management SystemMayo Clinic Patient App



Mayo Clinic App



Core HIE - Connect

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PH-DOCSystems

Public HealthCase Management

Mayo’s HIE Document Exchange

Network

Documentexchange via

NwHIN standardsbased software

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Core HIE - Direct



Assembling and integrating

• We need national (international) class HIE– Attributes

• Trusted, secure and private• Ubiquitous• Economical• Effective clinical content• Effective transaction methods and rules

– Reach beyond inter and intra-EHR connectivity– Ladder of adoption and backwards compatibility

• Congruent with our other digital strategies



What can we use today?

• Transaction types– Results (HL7 V2 ORU)– ADT (HL7)– Transcriptions (HL7 V2 MDM)– Financial transactions – Financial (X12 837), Pharmacy

(NCPDP B1)– ePrescribing (NCPDP)– Direct (SMTP + S/MIME) (MU2 and DirectTrust drive scale)– Patient Portal + C-CDA Download (HTTPS + C-CDA)



Gaps?

• Ubiquity of Direct and new transport technologies– REST/FHIR/OAuth inevitable– Bridges from Direct SMTP to FHIR content and services

• Usability of clinical content – CCDA• Query• Patient identification• Record locator• Physician directories and trust• Security – evolved and evolving effectiveness



Where is the puck going?

• More granular, bidirectional interoperability• FHIR-based content and services

• Scalable identity • OpenID Connect / OAuth2• DirectTrust as identity provider/broker (beyond Directed

Exchange)• NSTIC

• App frameworks• SMART on FHIR• Consumer apps - Apple HealthKit



Remaining frontiers

• Knowledge interoperability– Clinical decision support– Contextual knowledge tools and services for clinicians– Effective guidance and information tools for health-seekers– Semantic interoperability / cognitive computing– Fully secured with inter-organizational identity

management

• Business models for interoperability– Regulatory, financial and ethical frameworks– Emerging dominant utility players



Thank you

Comments, challenges, disagreements, questions?


Documents

Www.DirectTrust.org 1101 Connecticut Ave NW, Washington, DC 20036 Christopher Ross, CIO 1 The Present and Future of Interoperable Health IT at Mayo Clinic