In this Interoperability refers to the ability of two or more systems or components to exchange information and to use the information that has been exchanged. Success story featuring Anne Arundel Medical Center (AAMC), we’ll highlight how the organization successfully connected the hospital’s main Epic system to the athenahealth system shared by their 49 separate, affiliated ambulatory physician offices.
Creating a connected health system directly supports AAMC’s strategic plan, titled AAMC’s Vision 2020 , which includes building a “System of Care” where the local physician offices, ambulatory healthcare providers, and the community are closely aligned to provide a coordinated and cost-effective approach to improving patient care.
The AAMC Interface Team had to overcome many challenges to build a modern, connected health system, including patient and provider identification and filtering out specific HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... message types from connected, yet unaffiliated physician groups. We spoke with Jay Marquez, an Integration Analyst at AAMC.
Some key AAMC facts about this project:
- AAMC-affiliated ambulatory physician offices use athenahealth’s practice management system for scheduling, registration, and billing. They use the hospital’s Epic Electronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that can be... for clinical documentation and orders.
- The athenahealth system uses a single, networked server to interface with the hospital’s Epic system.
- There are 49 different ambulatory physician office locations organized within 33 provider groups. These offices are connected to the main hospital via a single ADT  interface and a single scheduling interface from athenahealth to Epic, and also a single ADT interface and a single billing interface back to athenahealth from Epic.
- HL7 data transmitted from athenahealth to Epic: patient registration, patient demographic updates, and appointment scheduling.
- HL7 data transmitted from Epic to athenahealth: patient registration, patient demographic updates, and professional charges.
- Patient identification. In the athenahealth system, each patient is assigned a new identifier for each provider group they visit. Because the athenahealth patient ID is a coded value data type. The value of such a field follows the formatting rules for a ST field except that it is drawn from a table of legal values. Examples of ID fields include religion and sex. is different depending on where the patient is seen, AAMC needed to provide context to the patient IDs to positively match them to the single patient record in the hospital’s Epic system.
Jay: “In athenahealth messaging to Epic, Corepoint Integration Engine  allows us to build a Patient ID Type on the fly by populating the PID-3.5 (Patient ID Type) HL7 field with a concatenated string of ‘ATH_’ + [value in MSH-4.3 (Sending Facility ID Type)]. These ID types are created in Epic so that the specific athenahealth Provider Group patient ID can be added to the Epic Master Patient Index (MPI) when either an ADT or scheduling message files.”
- Provider identification. In the athenahealth system, each provider has a unique provider record and an athenahealth provider ID for each “Provider Group” of physician offices. In AAMC’s Epic system there is only one provider record for each provider. A major challenge arose when a provider needed to see patients in more than one Provider Group, creating the need to map from one provider record in Epic to many provider records in athenahealth.
Jay: “This was resolved in Corepoint Integration Engine by linking Epic provider IDs with athenahealth provider group IDs to create unique provider group-specific provider IDs on messaging from Epic to athenahealth.”
- AAMC worked with the ambulatory physician offices to include National Provider Index (NPI) provider IDs within the athenahealth and Epic records for credentialed providers. However not all caregivers have an NPI ID.
Jay: “Corepoint  Integration Engine  provides group ID for context in the HL7 messages to athenahealth so the messages map to the appropriate provider records in the athenahealth system for the individual. For the caregivers without an NPI ID, Corepoint allows us to evaluate the provider ID type sent by athenahealth to appropriately handle references to non-credentialed caregivers in messaging to both athenahealth and Epic.”
- The athenahealth system includes many local physician offices that are not affiliated with AAMC. Anne Arundel wanted to accept demographic-level messages from these unaffiliated practices for patient awareness and demographic updates. However, AAMC did not want to receive encounter-level messages for registration or scheduling until the physician office became integrated with the AAMC EMR.
Jay: “Corepoint Integration Engine allows us to evaluate HL7 field MSH-4.3 (Sending Facility ID Type) and filter out/suppress all unwanted encounter-level HL7 messages such as A04 (Arrival), A08 (Encounter Update), S12 (New Appointment), S14 (Update Appointment), and S15 (Cancel Appointment) for those athenahealth groups that are not live on our hospital’s Epic EMR.”
Additional Reading: Anne Arundel Medical Center Case Study