Recent Use Cases


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At MaxMD, we reach beyond the basics of the Direct Protocol to craft unique solutions for the data and interoperability challenges facing your organization. We view Direct as a sophisticated, payload agnostic, bi-directional channel; its foundation of trust-in-identity can be leveraged far beyondthe current Meaningful Use designated use cases. . Because the Direct protocol allows for sending and receiving both structured and unstructured data, it opens up an exciting number of use cases.
Using our data integration engine, MaxIntegration™, our dedicated team can help your organization solve those data and interoperability challenges, allowing you to optimize health information exchange – without the high costs or overhead of joining an HIE.

HL7 to PDF or C-CDA via Direct:

A hospital-based lab for a large regional hospital system wanted an easy way to share lab results with unaffiliated providers. They had been faxing results, a time-consuming task that was disruptive to the lab workflow. Other affiliated providers already received results through the hospital’s existing data hub. These one-to-one single use data interfaces were expensive, took time to implement and did not scale well. MaxIntegration™ was interfaced with the hospital’s lab information system, and results for non-affiliated providers were transformed through MaxIntegration™ into a format that could be exchanged via the Direct Protocol.. Because there were multiple destinations with differing technical capabilities , MaxIntegration™ treated lab results differently based on the fax number that they would have been sent to previously. Some non-affiliated practices received PDF versions of the lab results in their Hosted Direct mdEmail® Version 3.0 accounts. Other practices were able to receive the Lab Report in the form of a C-CDA for ingestion into the destination EHRs, while maintaining the Direct delivery method

Missing Metadata in CCD (SMTP+CCD Source to IHE XDM Destination):

There are two accepted formats for transporting a CCD using the Direct Protocol. The preferred method is between partners utilizing IHE-XDM as recommended in the Applicability Statement for Secure Health Transport. Another acceptable method involves attaching a CCD to an SMTP email; this is referred to as RFC 5322. Many non-hospital entities, such as ambulatory EHRs and some Inpatient EHRs, rely on the SMTP+CCD method. This method of exchange works well when an IHE XDM-hospital sends to a RFC 5322-physician, but does not work well in reverse. A client hospital was having problems ingesting CCDs from an Inpatient EHR using SMTP+ CCD, because the SMTP+CCD method does not include adequate metadata in the structure. In other words, although the data arrives, the complete information to tell the receiver what the data means does not. MaxIntegration™ was able to add the expected metadata through an inbound channel to reformat and deliver a structured data packet to the ambulatory EHR that could be seamlessly consumed.

Meaningful Use with Non-Meaningful Use Partners:

Meaningful Use is a great motivator for standards-based Health Information Technology, but it doesn’t apply to everyone. Long-term care facilities, nursing homes and home health, for instance, have to date been left out of MU incentive programs. These significant market segments account for over one-third of the hospital discharge dispositions in the United States. MaxIntegration™ is currently being used to provide reformatted Transition of Care data from hospitals to a major long-term care and rehab facility that does not utilize CEHRT. By utilizing Direct from end-to-end, the sending hospitals are able to count these transitions as part of their MU measures. When the message arrives to the Direct Address of the Long Term Care facility it is processed by request of the receiving party through the MaxIntegration™ product. MaxIntegration™ makes a copy of the CCD attachment, and reformats it as a customized PDF for facility personnel to view and delivers both versions to the non-CEHRT end point. This allows the recipient to view the information as a customized PDF formatted to their needs and also if necessary forward the original CCD on to another healthcare organization for consumption in a CEHRT,. In this use case, the patient, the hospital, and the recipient facility all benefit from better coordinated care.

Public Health

In states that offer a standard interface specification (or Direct address) to receive reportable clinical event notifications, MaxIntegration™ is able to add intelligent alerts to any outbound channel. These alerts interrogate the message for reportable information, and if any is present, forward a copy of the message in a format that is useful to the public health recipient. This ability ensures 100% of desired events are reported on, and takes the burden off the provider to keep track of what is and is not reportable. This can be used for registry population (immunizations, cancer, etc) or for communicable diseases. In addition, ad-hoc situational alerts can be configured to address timely and current public health concerns.

HIE Data Expansion

MaxIntegration™ fully supports all aspects of HIE technology, including query, master patient index, and record locator service functions. MaxIntegration™ can be configured to be the core technology for HIE; however, its footprint is light enough to enhance an existing HIE’s bandwidth. MaxIntegration™ has been designed to be a natural feeder to an existing HIE. For example, in cases where an HIE has been built on ADT encounter data, MaxIntegration™ can receive clinically-rich CCD messages from hospitals and deliver them to their destination for Meaningful Use, all while sending a copy of this advanced data to the local HIE. Not only does this give the HIE an opportunity for richer data from existing sources, it also offers them a potential ability to interface with the message recipient to increase their breadth of data capture among provider settings in the market.

Accountable Care Organizations

MaxIntegration™ is ideally designed to support use cases where multiple notifications need to occur based on a single clinical event. Usually, these instances occur within an Accountable Care Organization or a Patient-Centered Medical Home model. There are few limits to the rules engine embedded within MaxIntegration™, making it a unique solution for prioritized alerts and conditional copying of messages. Care providers or coordinators in these models can also take advantages of the HIPAA- compliant communication that is natively supported through Hosted Direct mdEmail® Version 3.0.

At its core, MaxIntegration™ is a powerful and versatile communication tool. With it, MaxMD’s team of engineers and solution architects work closely with you to overcome the technical obstacles your organization is facing. We tailor our solutions to your needs, with a forward-thinking approach that encompasses your overarching goals – instead of just solving today’s problem. Our expertise at distilling complex data and interoperability issues means the unique solutions we create are often far simpler and more elegant than you might expect.