WHITE PAPER
VERIZON HEALTH
INFORMATION EXCHANGE
Transforming the way healthcare organizations share patient
information through HIE delivered as a service.
INTRODUCTION
In today’s healthcare industry, access to protected health information (PHI) at the point of care requires a new
level of interoperability among healthcare participants. Picture this: A patient visits his primary care physician
complaining of dizziness and shortness of breath. The physician reviews the patient’s virtual and longitudinal
electronic health record (EHR) on a health information exchange (HIE), using an intuitive interface that
encapsulates information from all caregivers on one screen. The patient is 54 years old and suffers from
hypertension, hyperlipidemia, diabetes and obesity. The screen reminds the physician that the patient recently
started exercising, eating better and losing weight. The physician checks a lengthy medication list, which the
system has already screened for contraindications and allergies.
While scanning the EHR, the physician receives an electronic transfer of the patient’s recent blood work from
the lab. The report shows no concerns. A lab report on the patient’s hemoglobin count is normal, too. The
physician checks the patient’s known allergies and notices shellfish. After a brief discussion, the patient realizes
the office potluck lunch might have contained shrimp. After checking the insurance formulary, the physician
prescribes an allergy medication and sends an electronic order to the pharmacist. With five minutes of
appointment time to spare, the physician answers questions on an exercise program that will lower the patient’s
insurance premium.
This scenario highlights what’s possible in a patient-centric health system where streamlined interoperability
supports a collaborative community of caregivers. With access to consolidated PHI at the point of care, health
providers can get back to the business of healing patients at the same time that they improve workflows and
speed claims resolution. Our current health system has yet to achieve this ideal level of connectivity. Instead,
critical patient data is locked in incompatible silos located within single organizations, across communities and
around the nation.
What healthcare needs is a nationwide, fully hosted HIE exchange that transforms and simplifies the way we
share health information. An ideal HIE will improve physician workflow and exchange information on a national
scale through standards set by the Office of National Coordinator (ONC), National Health Information Network
(NHIN) and other standards bodies. It will deliver the security, scalability and sustainability you need today and
for years to come.
INFORMATION EXCHANGE CHALLENGES IN THE ERA OF HEALTHCARE REFORM
The federal government has identified the exchange of healthcare information as integral to improving cost and
outcomes within the healthcare ecosystem. Even before the laws mandating electronic information exchange
solidify, healthcare providers must make technological buying decisions. Today, you might be in the throes of
deploying EHRs that will capture patient information. In the near future, you’ll need HIEs to share information
among each other as well as with patients, payers and government entities. Motivation has never been higher as
the American Recovery and Reinvestment Act of 2009 (ARRA) gears up to award $19 billion dollars to
healthcare providers that meet “meaningful use” requirements and penalize those that don’t.
Large organizations often face the multiple challenges of aligning the systems they already own as well as
connecting broadly with a larger pool of constituents. However, whether you are an integrated delivery network
(IDN) or a regional health network, you are going to need the guidance of a healthcare-savvy communications
expert to achieve nationwide exchange. Meaningful use alone cannot ensure that the HIE solution you select
will deliver the ongoing performance, around-the-clock reliability and security you will need to operate
effectively in the shifting landscape of healthcare reform. Below is a list of the challenges healthcare
organizations face in their quest to exchange information in ways that meet government mandates and
ultimately improve patient care.
Going Nationwide with Information Exchange
Stage 1 Meaningful Use in its final form focuses on electronic capture of information with certified EHRs. It
specifies only fundamental functionality and lenient metrics for communicating captured information to other
agencies or clinicians. Today’s HIEs must anticipate tomorrow’s more stringent regulations for information
exchange. Although not yet finalized, Stage 2 regulations will likely firm up the metrics surrounding exchange
among unaffiliated providers. Stage 3 will crank up information exchange another notch with a focus on patient
access to information. To deal with these challenges, you’ll need an HIE solution with a nationwide dial tone that
connects everyone, from a large medical complex to a remote doctor’s office. You’ll also need to solve the
problems of limited access created by specialized forms of connectivity.
Stepping into the Age of Pay-for-Performance
The Centers for Medicare & Medicaid Services (CMS) presently offers a 2% bonus reimbursement on
electronically submitted Medicare claims that report quality measures. As of 2010, CMS has vetted and
adopted 179 quality measures and proposes to levy financial penalties for future noncompliance. Your
organization can expect a growing number of pay-for-performance measures in the future. You’ll need the
flexibility to respond to these measures without increasing the time and personnel required to administer care.
Winning the Security Battle
Widespread Web access to electronic medical records creates a new breed of security vulnerabilities that can
jeopardize the security of protected health information. You’ll want to consider constant monitoring of systems
storing PHI to safeguard against the latest threats. To maintain continuous access to health information in the
event of a disaster, you need to include failover sites located in different geographical regions. Encryption of
data at rest and in transport is a necessity for complying with complex rulings in the Health Insurance
Portability and Accountability Act (HIPAA) that is designed to protect patient privacy.
Managing Consent and Data Acquisition
Still another aspect of HIPAA compliance involves your ability to fine-tune consent management in ways that
both honor a patient’s wishes and verify the identity of healthcare providers requesting access to patient
information. You’ll need consent capabilities that are highly configurable, secure and in keeping with your
organization’s governance policies.
Handling Growing Data Volumes
One of the challenges of a connected health system is the sheer volume of data that needs to be accessed,
transferred, secured and stored. You’ll need to scale to support growing data volumes. And that means adding
capacity on demand and meeting ever-increasing bandwidth requirements for the real-time exchange of records
and radiological reports. It also means using fast, reliable ways of maintaining data integrity during the
exchange process.
Building Your Own HIE—A Matter of Time, Budget and Expertise
Building an HIE requires an extensive and costly infrastructure. You’ll have to purchase the hardware necessary
to deliver your applications to providers, including the equipment at your backup location.
In addition, you will need numerous software licenses, such as an Enterprise Master Patient Index (EMPI),
Record Locator Service (RLS) and robust database solution. Beyond initial software purchases, you can expect
to pay approximately 20% of the original software purchase cost in yearly maintenance agreements. You’ll need
to manage the service-level agreements (SLAs) of multiple vendors and enable your help desk to interface with
those vendors. Building your own HIE will require a continual investment in the platform to meet evolving
federal regulations. How you handle your failover implementation could put you at risk of losing data as
happened to the Rhode Island HIE during a March 2010 flood. Finally, unless you are working with government
entities to solve the challenges of nationwide interoperability, you’ll need the counsel of an IT expert who is
doing just that.
According to IDC,
“Cloud-based
platforms will appeal
to small and midsized
organizations looking
to shift technology
investment from
CAPEX to OPEX and
to large regional or
statewide initiatives
that need to establish
connectivity with
myriad stakeholders.”
Creating a Patient-Centric, Evidence-Based System of Care
Everyone in the healthcare arena, whether they agree or disagree with healthcare reform,
has something to gain from modernizing an inefficient healthcare system that’s lost track
of the patient in the process of providing care. Information exchange has the potential to
revitalize the U.S. healthcare system. However, if it’s going to live up to its promise, it has
to be designed for intuitive use and easy access from virtually anywhere at any time of
day. A Web portal is an ideal interface, especially one that honors a physician’s workflow
by keeping clicks to a bare minimum.
Addressing the above challenges will help you make the right technology decision for your
organization. Furthermore, it will ensure that you choose an HIE partner with the capability
to help you succeed.
MEETING THE NEEDS OF THE ENTIRE HEALTHCARE ECOSYSTEM
Verizon HIE meets the needs of every stakeholder in healthcare by providing the
underlying infrastructure that allows governments, payers and health providers to
collaborate on care while providing patients access to their virtual records. With HIE
delivered as a service, you forego software and hardware licenses, reduce the need for
large capital expenditures and save resources through the use of a flexible, integrated
platform that resides on the Verizon global network.
Key benefits of cloud-based platforms are the ability to dynamically scale technical resources and pay only for
the resources you use, according to IDC. “Cloud-based platforms will appeal to small and midsized organizations
looking to shift technology investment from CAPEX to OPEX and to large regional or statewide initiatives that
need to establish connectivity with myriad stakeholders.”1
Verizon delivers its HIE service through a choice of centralized, federated or hybrid implementations. The
centralized offering enables consolidated storage of clinical data within Verizon Smart Centers to provide
around-the-clock availability. The federated offering gives large organizations that want to keep data at its
original source the greatest control over their environment, with the deployment of an edge server and a secure
virtual private network (VPN) connection to the HIE. Users access both HIE offerings over the Internet through
a Web-based portal.
Verizon builds its HIE service to client specifications and provides dedicated staff to handle all aspects of
bringing a customer onto the Verizon system. This includes configuring an identity management system that
authenticates clinicians and authorizes PHI access. We also take care of defining the clinical workflow
processes for interface customization, configuring the Oracle® Healthcare Master Person Index (OHMPI) to
provide a high level of patient and provider matching, and adding terminology services that meet individual
customer requirements.
Verizon HIE speeds deployment, so you can comply with federal mandates and qualify for incentives. It enables
regional, state and independent networks to exchange information on a national scale through the NHIN. As a
world leader in identity management that connects daily with millions of customers, Verizon locks down your
security needs for the safe interchange of patient information.
With robust features such as a user-friendly patient portal, record locator services that pinpoint patient
records and consent management criteria that put privacy stipulations in the hands of the clinician, Verizon HIE
is truly in a league of its own. It uses an EMPI to cross-reference patient and provider identifiers across
information systems and a clinical messaging service to move lab and radiology reports to the right clinician at
the right time.
BRINGING TOGETHER ADVANCED TECHNOLOGY
While a traditional on-premises HIE solution may allow an organization to extend its existing technology
investments, deploying HIE as a service from the Verizon cloud provides significant benefits, including fast and
cost-effective access to leading-edge healthcare IT. Verizon HIE offered as a service meets the challenges of
user functionality, interoperability, data security and integrity. It complies with meaningful use, and it
eliminates expensive capital expenditures with advanced technology that delivers immense value for all
healthcare participants.
Unbeatable Ease of Use
Some analysts judge the success of an HIE user interface by the number of clicks it takes to view necessary
information. Verizon HIE delivers clinician access through an innovative and pioneering portal application
interface—MEDfx’s Lifescape—which lays out a patient’s entire health record on a single screen for quick
assessment. A physician can decide whether to display information by the problem or the disease. A Googlestyle search window operates systemwide.
The Lifescape presentation layer leverages the Oracle Healthcare Transaction Base (HTB) to capture and store
health records. It writes to APIs and Web services within HTB to display that information. Oracle HTB stores the
medical records in a “harmonized manner” by normalizing terminology between health organizations. This
ensures that everyone using the HIE understands the information. Verizon uses a powerful record locator
service to enable the quick and accurate pinpointing of records no matter where they are located on the HIE.
With our role-based security, only users with specific permissions can use Lifescape to view patient records, yet
it also provides the flexibility to override access control rules in unanticipated situations where a patient’s
health is at stake.
Built on the global Verizon network, the HIE gives users access via the Internet or private connection over
Verizon’s Private Internet Protocol (PIP) network. Verizon doesn’t require any specific network connectivity to
access the HIE. Its ability to rapidly deliver health information is limited only by the speed of the connecting site.
Incomparable Scale
Exchanging information with an ever-increasing number of patient records can cause systems to experience
slowdowns. Performance remains stable for Verizon customers, because our HIE service is built on the Verizon
Network Computing Platform, which is capable of adding capacity on demand. By establishing virtual machines
on servers to support multiple clients, Verizon can employ an unlimited number of servers to support such
functions as Web portals and Oracle HTB components. With this level of scalability, Verizon can provide HIE
service to the entire nation.
End-to-End Security
Regardless of the depth of your IT resources, security issues in the world of connected healthcare require
investment on a national scale. Verizon provides comprehensive, end-to-end security. Verizon Smart Centers
provide 24-hour monitoring, management and technical support. We assess our systems and critical data
against configuration standards, hardening guidelines and security best practices.
Verizon monitors in real time any change to the infrastructure that might impact the security of our systems.
Strong encryption and real-time authorization checks protect information from being passed to people for
whom it was not intended.
Verizon HIE uses two-factor authentication. It provides an identity proofing solution that uses claims history
data, motor vehicle records, police records, credit information and modeling services. In addition, it can support
tokens, phone, email and other proofs of identity. In fact, its two-factor authentication integrates with hospital
ID systems to leverage the security already in place and maintain a single sign-on.
Verizon provides a layered defense that includes encryption, sophisticated database access management and
secured backup to protect ‘”data at rest” within the confines of the database. Fine-grained auditing and an audit
log maintain a record of who accesses personal health information.
Unparalleled Data Integrity
To reduce redundant data entry and enable consistent, high-integrity information across the healthcare system,
Verizon HIE utilizes Oracle HTB’s powerful translation and semantics engine for an unsurpassed level of data
interoperability and integrity. By exposing a clinical infrastructure based on industry information standards
(HL7 version 3.0), clinical, administrative and financial objects common to multiple systems are defined once
and shared across different applications.
In addition to traditional integration issues, HIEs must ensure semantic interoperability of information coming
from many different data sources. HL7 version 3.0 messaging standards define consistent semantics for
clinical messages. The HTB translation engine includes mechanisms to achieve semantic interoperability of
clinical information, providing a healthcare-specific services model above a normalized clinical repository.
The Oracle HTB includes a terminology equivalence service, which equates corresponding codes in different
versions of the same terminology or equivalent codes across different terminologies. By using clinical
information encoded at different care sites, the terminology equivalence service enables the semantic
interoperability of this information across various healthcare organizations. Oracle HTB provides built-in data
validation for consistency and semantic accuracy for API as well as message-based data persistence. The
terminology mediation service ensures data aligns correctly with codes. The terminology equivalence service
enables this alignment to be protected for future processing.
High Availability
Healthcare is an around-the-clock business, where real-time access to patient data could mean the difference
between life and death. With bicoastal Smart Centers performing redundant, virtualized instances with
real-time, replicated failover, Verizon HIE provides high availability, even if disaster strikes. Every change that
occurs in the Beltsville, MD, Smart Center database is automatically transferred to a data log file in the San
Jose, CA, Smart Center via an encrypted connection, which reduces bandwidth requirements and maintains data
synchronization between the two locations. This bicoastal recovery plan allows Verizon to switch from one
Smart Center to another with minimal interruption.
As the operator of one of the largest IP networks in the world, Verizon has immense experience at providing
high levels of availability. The Verizon HIE is deployed as a fully managed service that leverages the breadth of
services that Verizon has to offer. In fact, these areas of service expertise—Managed Security Services (MSS),
Managed Network Services (MNS), IP Application Hosting Services (IPAH) and Remote IP Application
Management/Remote Operations Center (RAM/ROC)—were leveraged to build the Verizon HIE infrastructure.
Verizon IPAH offers HIE customers a low total cost of ownership, service-level objectives (SLOs) and enhanced
levels of security, scalability and performance. Remote IP Application Management/Remote Operations Center
supports the day-to-day life cycle of your HIE to maintain functional, responsive and secure systems. In
addition, proprietary processes, tools and systems enable management of your HIE from a Remote Operations
Center. With a highly experienced staff, Verizon can effectively manage and monitor your operations to help
you meet your healthcare information goals.
DELIVERING UNMATCHED BENEFITS NOW AND IN THE FUTURE
Verizon HIE does more than meet meaningful use requirements for the electronic mobilization of data. It
creates the patient-centric model of healthcare that to date has been unimaginable. Clinicians get a concise,
customizable view of patient health that helps accelerate care, eliminate redundant tests, streamline the
referral process and stop time-consuming, error-prone procedures, such as faxing, phone calls, paper
prescriptions and inadequate medication reconciliation.
A pioneering Web portal and role-based security allow physicians to efficiently orchestrate patient care and
payers to answer claims questions quickly and efficiently. The result is a system with the potential to cut the
cost of healthcare and improve outcomes. By offering HIE as a service, Verizon presents an attractive pricing
model that allows organizations of all sizes to reap the benefits of healthcare in the cloud.
Verizon doesn’t stop there. Our Health Information Management (HIM) platform has the breadth and depth to
evolve along with government regulations and health industry needs. It also powers our vast array of unified
communications and collaboration (UC&C) and mobility solutions, such as Telehealth Collaborations Services
and Home Health Monitoring. Our commitment to healthcare means you can count on us to continually enhance
our services with technology investments.
Armed with an evolutionary and revolutionary roadmap, we’ve deployed a nationwide HIE service onto our
platform and stand ready to enable many advanced HIM capabilities. We can enable Accountable Care
Organizations (ACOs) and Patient Centered Medical Home (PCMH) initiatives via the Medical Home Information
System (MHIS). Our fully normalized clinical data repository (CDR) offers opportunities for holistic analytics
and real-time health alerts via the translation and collection of patient health records from intelligent clinical
care management applications. Still other innovations supported by our platform include e-prescribing and
computerized physician order entry (CPOE).
CONCLUSION: BUILDING AN HIE/HIM PLATFORM FOR TOMORROW, TODAY
Choosing the right HIE solution for your health organization is a major decision. You’ll need an HIE/HIM solution
that connects siloed data sources inside and outside of your health infrastructure. It must be capable of scaling
to meet future data volumes while maintaining data security and availability. A user-friendly interface and the
ability to electronically transfer quality measures to CMS will help you streamline your workflow. The right
cloud-based service can reduce the need for large capital expenditures, enable rapid deployment and accelerate
return on investment.
Verizon HIE delivers an efficient and manageable interchange of medical information to link payers, clinicians
and government agencies. It facilitates access to and retrieval of clinical data with a pioneering Web portal and
uses state-of-the-art communications technology to share information in a safe, timely and equitable manner.
Most importantly, it takes the complexities of managing a sophisticated platform out of the hands of healthcare
providers, so they can get back to the business of caring for patients. As the company that provides
communication, security, and IT services to 90% of the Fortune Healthcare 1000 companies, Verizon is
transforming the way healthcare organizations share patient information by delivering HIE as a service from the
Verizon cloud.
ABOUT VERIZON BUSINESS
Verizon Business is evolving to an everything-as-a-service (EaaS) model in which cloud-based, converged
solutions are delivered with built-in security via managed and professional services over the company’s global
IP network. Verizon is assembling the key components of that unique and powerful approach to serving
enterprises, and this latest expansion and enhancement of the company’s data and cloud centers is another step
in that evolution. The EaaS platform—with Verizon’s global IP network and data centers as its foundation—is at
the heart of the company’s strategy.
ABOUT VERIZON BUSINESS
Verizon Business, a unit of Verizon Communications (NYSE: VZ), is a global leader in communications and
IT solutions. We combine professional expertise with one of the world’s most connected IP networks to
deliver award-winning communications, IT, information security and network solutions. We securely
connect today’s extended enterprises of widespread and mobile customers, partners, suppliers and
employees—enabling them to increase productivity and efficiency and help preserve the environment.
Many of the world’s largest businesses and governments—including 96% of the Fortune 1000 and
thousands of government agencies and educational institutions—rely on our professional and managed
services and network technologies to accelerate their business. Find out more at verizonbusiness.com.
1 International Data Corporation (IDC) IDC Health Insights, DunBrack, Lynne A., Program Director, “Verizon Unveils ‘Cloud’
Solution to Facilitate Sharing of Patient Information Among Health Care Providers.” Verizon Business News, July 14,
2010. http://newscenter.verizon.com/press-releases/verizon/2010/verizon-unveils-cloud.html
© 2012 Verizon. All rights reserved.h