Integrating All Those Islands of Information

 

New Mexico’s Department of Health (DOH) manages one of the nation’s few centralized public health systems, with county offices reporting to state officials in Santa Fe.  How does DOH manage communications with 54 remote facilities and public health programs, comply with Health Insurance Portability and Accountability Act (HIPAA) rules, and preserve various database investments?  With the innovative application of enterprise integration and business process management technologies in New Mexico’s Integrated Client Data System (ICDS), DOH is positioned for success.

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HIPAA is the overriding paradigm for data sharing related to healthcare and, as such, poses significant challenges for existing Medicare and Medicaid systems.  In a geographically large state with a relatively high percentage of pubic health patients who are widely dispersed, New Mexico had its work cut out for it.

 

So much data, so little time

In the late 1990s, POD, Inc. created DOH’s Integrated Network for Public Health Official Records Management (INPHORM) system so that Public Health Division offices throughout the state could store patient records.  Over 80 separate database systems were integrated functionally, with all the data converted into a single centralized SQL Server database.  First implemented as Visual Basic client/server applications, the General INPHORM Interface went into production in 1999.  Later, it and all its components were ported to browser-based applications.  POD has gone on to develop reporting and data cube analysis interfaces for INPHORM, as well as interfaces to support all aspects of public health programs (e.g., Newborn Hearing Screening, Immunizations, Sexually Transmitted Disease Surveillance and Reporting, Family Planning, Billing, Provider Payments, Breast and Cervical Cancer Surveillance and Reporting, Pharmacy, etc.).  The Cube Reporting Engine is an ASP.NET implementation of the data analysis component for SQL Server 2000's OLAP analysis.  The Reports Engine is built on ASP.NET interfaces for Crystal Reports.  All system integration with the DOH client systems—and there are over 100 in the Scientific Labs Division alone—is performed via BizTalk. 

 

POD also has developed and implemented HL7 import and export interfaces for INPHORM, to allow the electronic interchange of health data with the Centers for Disease Control, other organizations, and the Statewide Immunization Information System (SIIS). 

 

Currently, INPHORM is over 8GB of data and covers over a decade of health information for the citizens of New Mexico (including all vaccines administered under the Vaccines for Children program and in the Public Health Division public health offices).  And, INPHORM continues to grow as additional public health programs such as Tuberculosis, Dental Screening, HIV/AIDS, and School Health are integrated.

 

As the central repository for public health patient information, INPHORM obviously had to be tied to Medicaid.  So, POD developed and implemented a Medicaid Billing Interface (MBI). The MBI is a Visual Basic client/server application that runs in Windows 95, 98, NT 4 or 2000. The MBI allows users to specify:

 

·         whom to bill (i.e., Medicaid fiscal agent for fee-for-service claims or New Mexico’s three Medicaid managed cared organizations);

·         the type of billing to be performed (e.g., Family Planning, Immunizations, Prenatal, All, etc.);

·         the billing date; and,

·         the type of output (i.e., HCFA-1500 or electronic batch file).

 

The MBI then queries the INPHORM data sources, collects all unbilled procedures as of the billing date, and generates the appropriate files or prints out the appropriate HCFA-1500s. The MBI correctly counts procedures and diagnoses to ensure that the maximum numbers are not exceeded on the HCFA-1500s, and calculates procedure and HCFA-1500 totals.

 

POD also ported a Microsoft Access-based AIMS Medicare Billing Interface into a browser-based Medicare Billing module in the General INPHORM Interface. Functioning similar to the MBI, this Medicare Billing module collects all INPHORM immunizations billable to Medicare (e.g., pneumococcal vaccines for clients age 65 or over) and generates an electronic batch file in the AIMS-readable format.

 

Making compliance part of the overall architecture

As the new century got under way, the State of New Mexico began examining HIPAA requirements and looming deadlines for compliance.  DOH decided to take a systematic approach and begin at the beginning, with gap analyses.  POD worked with New Mexico’s Medicaid fiscal agent to perform transaction and code set gap analyses, mappings, and remediation recommendations for all HIPAA transactions for the INPHORM system.  And, the state engaged a prominent HIPAA consulting firm to complete privacy gap analyses and make remediation recommendations.  Then, working with the various recommendations, POD generated a conceptual model and architecture within DOH called the Integrated Client Data System (ICDS)—to integrate privacy-related data (i.e., consents, notices, authorizations, disclosures, and amendments) and provide secure access control to all systems and data.   

 

In its ICDS prototype, POD has integrated data from dozens of systems for reporting purposes and to generate a DOH-wide patient registry.  This system correlates patients from all DOH systems and programs, including Public Health, Scientific Labs, Behavioral Health, Long-Term Care, and the six residential treatment facilities operated by the state.  The architecture allows direct secure electronic communications and data upload from DOH partners such as external labs and hospitals, and supports communications in HL7 and other protocols.  The Patient Correlation Engine is unique in that it utilizes the SQL Server 2000 decision tree OLAP analysis capabilities to perform correlations of patients from all of the DOH client systems.  It is implemented as a web service and makes the correlation capability available as a .NET web service—SQL Server 2000 back end and ASP.NET front end.  The associated Privacy Tracking System has been designed with a SQL Server 2000 back end and ASP.NET front end on DOH's intranet.  An INPHORM News System is an ASP.NET interface for ICDS and client system newsletters, etc.  And, an INPHORM Training System combines ASP.NET and web service interfaces with SQL Server 2000 for browser-based training on ICDS, client systems, and for all HIPAA privacy training for DOH.


POD extended the conceptual model and architecture of ICDS for programs where DOH is a HIPAA covered entity both as provider and as payer.  The ICDS Transaction and Payment Engines provide DOH with a single, department-wide system: 1) for integrating billing data from any of the dozen plus DOH client-healthcare billing systems into all of the HIPAA-compliant transactions; and, 2) for integrating claims payment data from any of the DOH client-healthcare billing systems, including acceptance of all of the HIPAA-compliant transactions, and allowing direct entry of claims by providers via a secure Internet web interface.  Specifically, the ICDS Transaction Engine expansion involves allowing direct electronic billing, either batch or real-time, to Medicaid, Medicare and other third party payers.  It has been built in BizTalk with the HIPAA Accelerator.  And, the ICDS Payment Engine expansion involves allowing direct electronic file transactions (e.g., eligibility, provider agreements, claims, etc.) to the NM Medicaid.  It has been built with a SQL Server 2000 back end and ASP.NET front end on DOH’s intranet.  POD is now developing the ICDS Transaction and Payment Engines expansion projects for all of DOH (consents, authorizations, disclosures, amendments, access logging, and security).  

 

Deployment of ICDS is planned as a phased process between December 2002 and August 2003.  In fact, the success with the project thus far has prompted the New Mexico Retirees Health Care Authority (NMRHCA), the NM Children Youth and Families (CYFD) and the Human Services Department (HSD – the State’s Medicaid agency) to decide to hitch their HIPAA solutions onto the ICDS wagon.

 

 

Client Profile: New Mexico’s Department of Health has 54 Public Health Division offices and 2,700 PCs spread across the state’s 121,666 square miles (it’s the fifth largest state in size).  Headquartered in the state capitol of Santa Fe, DOH is the central public health authority for New Mexico’s 33 counties and 1.8 million residents (2000 census estimate).  DOH has its work cut out for it.  According to the New Mexico Health Policy Commission’s County Funded Health Care Report for State Fiscal Year 2001 (published January 2002), the state has about 450,000 residents without health insurance coverage.  So, communicating with Medicare and Medicaid is critical for DOH, as is complying with HIPAA rules.

 

Business Situation: The New Mexico Department of Health (DOH) wanted to build interfaces with Medicaid and with its many client systems (there are over 100 DOH clients in the Scientific Labs Division alone).  But, for such interfaces to be useful, the more than 80 separate database systems that stored the state’s public health records needed to be integrated, made easily accessible, and perfectly maintained.  The resultant Integrated Network for Public Health Official Records Management (INPHORM) system—more than 8GB of data covering over a decade of information—then had to be made HIPAA compliant.

 

Solution: With SQL Server as the foundation, POD, Inc. built the browser-based Integrated Network for Public Health Official Records Management (INPHORM) system.  All system integration with the Department of Health (DOH) client systems is performed via BizTalk.  ASP.NET, data cube technology, and Crystal Reports provide robust reporting capabilities.  To integrate privacy-related data and provide secure access control to all systems and data, POD generated a conceptual model and architecture called the Integrated Client Data System (ICDS).  The ICDS Patient Correlation Engine utilizes the SQL Server 2000 decision tree OLAP analysis capabilities to perform correlations of patients from all of the DOH client systems.  It is implemented as a web service and makes the correlation capability available as a .NET web service—SQL Server 2000 back end and ASP.NET front end.  The associated Privacy Tracking System has a SQL Server 2000 back end and ASP.NET front end on DOH's intranet.  An INPHORM News System is an ASP.NET interface for ICDS and client system newsletters, etc.  An INPHORM Training System combines ASP.NET and web service interfaces with SQL Server 2000 for browser-based training on ICDS, client systems, and for all HIPAA privacy training for DOH.  The ICDS Transaction Engine expansion involves allowing direct electronic billing, either batch or real-time, to Medicaid, Medicare and other third-party payers.  It has been built in BizTalk with the HIPAA Accelerator.  And, the ICDS Payment Engine expansion involves allowing direct electronic file transactions to NM Medicaid.  It has been built with a SQL Server 2000 back end and ASP.NET front end on DOH’s intranet. 

 

Benefits: BizTalk allowed POD to quickly and effectively integrate various databases without compromising existing or future functionality of those databases and preserving the State of New Mexico’s database investments.  The .Net products supported web-based interfaces from various clients and resulted in a solution that is positioned for the e-future. 

 

Products Used:

Building in

·        MS BizTalk,

·        MS BizTalk HIPAA Accelerator

·        MS SQL Server (6.5.7, and 2000)

·        MS Access (97 and 2000)

Integrating with

·        MS Exchange (5.5 and 2000)

·        Lotus Notes R5

 

Other Products Used:

·         VS6 (VB, ASP, VC++, VFP, etc.)

·         VS.NET (VB.NET, ASP.NET, etc.)

·         Crystal Reports

 

For More Information:

About POD, Inc.

www.PODassoc.com

POD, Inc. is a woman-owned, 14 year old solutions provider and systems integrator headquartered in Albuquerque, New Mexico, and with staff in Santa Fe, New Mexico, and Phoenix, Arizona.  POD applies an unrelenting focus on serving clients through consistency, communication, and competence to deliver projects on time and within budget.  With 35 full-time developers on staff, POD leverages its extensive experience in health systems, HIPAA, bio-terrorism (including Health Alert Network (HAN) and Nationwide Electronic Disease Surveillance System (NEDSS)), healthcare professional criminal background screening, and education support systems to meet the needs of commercial and government clients alike.  Write Katherine@PODassoc.com.