Manifest MedEx

Manifest MedEx (MX) is California’s nonprofit health data network—delivering real-time information across over 200 healthcare organizations including almost 60 hospitals. Among the larger participants are:

• • Stanford Health Care
  • Heritage California
  • Hill Physicians
  • Scripps Health
  • Health Net
  • Loma Linda University Hospital
  • Arrowhead Regional Medical Center
  • Blue Shield of California
  • Anthem Blue Cross of California
  • Inland Empire Health Plan

Manifest MedEx is helping healthcare providers care for patients across the State of California every day. Together, their goal is to transform the healthcare landscape across the state, supporting California as a leader in affordable, proactive, and compassionate medical care. This is a challenging goal by any measure, and to tackle this task, a more flexible, modern technology platform was required to get the job done.

Manifest MedEx’s Interoperability Platform

Manifest MedEx selected HealthShare from InterSystems as the central platform that would enable them to make their vision a reality. Along with HealthShare, Manifest MedEx also needed expertise and experience to implement their new platform. J2 was chosen to serve as MX’s implementation partner, and engaged with MX in November, 2017.

Over the next ten months, an initiative between both organizations and several other partners for components such as EMPI, notification services, and architecture was undertaken.  Adding to the complexity and challenge of this project, clinical data migrations were added to the mix. According to J2’s Principal Consultant Jim Powers, “We wanted to provide a seamless experience for providers with transaction data in HealthShare from before and after the migration.”

Legacy Data Migration Into HealthShare

To rise to this challenge, J2 created a sub-team within the MX team with the task of reverse-engineering the legacy data model via scripted SQL, transforming it into SDA, (HealthShare’s proprietary data model), and loading it safely and reliably into HealthShare. Additionally, a separate initiative focused on recreating transactional messaging from archived message stores in order to properly layer data presented by participant organizations without requiring participant resources and cost to prepare the new platform.

Beyond the challenge of consuming historical clinical data, MX also had the challenge of integrating claims data from payer sources (this combination of clinical + claims data is a major innovation that MX leads for California) and not only consuming it into the exchange, but also correlating it to clinical data to provide a unified view of diagnoses, medications, encounters, and procedures containing data from both disparate sources. For this task, J2 extended the HealthShare SDA data model.

Manifest MedEx’s Choice of Hosting Provider

In order to deliver maximum performance and value with a limited resource pool, MX made the architectural choice to stand up their environments in the Amazon Web Services (AWS) Cloud Platform. This approach brought with it several challenges. J2 was engaged from the very first conversations with MX’s hosting partner through delivery to the final product and beyond into day to day support and performance improvements. 

A wide variety of cloud-hosted tools were added to the mix, including Elastic Load Balancing to support high availability infrastructure, a high frequency backup solution to ensure regular and comprehensive backups in case of a disaster, and monitoring both through AWS tools and J2’s own OpsMonitor utilities.

In order to make their platform easy to access and easy to manage, MX tasked J2 with creating a single sign-on and identity management platform that would also serve as a front page and navigator for MX’s various solutions. After defining requirements, J2 recommended a Cognito-based solution for identity management, and designed and developed a fully custom Angular app to handle the initial user experience. 

This was later extended to include the ability to delegate administrative permissions to end users. Both applications, called “UUX” and “UUA” by MX internally were delivered in time for initial go-live. A separate Angular app was created to handle the need for patients to opt in or out from participation within the exchange, and J2 also developed and delivered this application. In both cases, the applications are tightly integrated with HealthShare’s backend and coexist with HealthShare, efficiently extending MX’s platform without the need for additional EC2 instances or hosting costs.

Managed Terminology Services

When MX needed advanced terminology management for data normalization, mapping, and sensitive data handling, they selected HealthTerm.

HealthTerm increases patient safety and security by delivering a defined, consistent, and precise terminology base for MX users.

The standardized and normalized data ensures semantic coherence and consistency in diagnosis, treatment, quality assurance, and reporting across over participant organizations.

Today, Manifest MedEx has a robust, scalable cloud infrastructure in place to support their mission. Their platforms are working to achieve the ultimate goal all organizations strive for: to improve patient outcomes through access to clinical data wherever and whenever it’s needed.