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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Linh H. Le, MD, MPH; Ivan J. Gotham, PhD; Lori Evans, MPH, MPP; Dale Morse, MD, MS; John Fuhrman; John Brady (New York State Department of Health); Farzad Mostashari, MD, MPH; Nicholas Soulakis, MS (NYC Department of Health and Mental Hygiene); LeRoy Jones (GSI Health); Mark Ciampa, MS, PMP (Booz Allen Hamilton)
Universal Public Health Node (UPHN):An Evolution of Health Information Exchange in New York
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Why a new architecture for Health Information Exchange (HIE) for Public Health in New York
Unprecedented investment in HIE from New York State with HIE for Public Health as one of clinical investment priorities
Support from CDC new initiative for Enhancing Public Health Capabilities Through Health Information Exchanges
Need to move from uncoordinated, point to point communications to a common, bi-directional health information exchange for public health
Need to take advantage of and comply with the Statewide Health Information Network - New York (SHIN-NY) architecture and national standards for healthcare interoperability
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Evolution of Health Information Exchange (HIE) for Public Health In New York
Hospitals
Pharmacies
Physicians
Clinics
Labs
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Payers
Patients
Public Health
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HL 7 2.4
HL 7 2.3
HL 7 2.5
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cvs
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UPHN
HospitalsPharmacies
Physicians
ClinicsLabs
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Payers
Patients
RHIOs
Public Health
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Critical Challenges
How can information from different HIEs be integrated?
How can we move from a one-way to bilateral exchange of information from clinical systems to public health?
How can we exchange data in a timely, secure and standardized manner?
How can we achieve our above goals while protecting patient privacy to the greatest extent possible?
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
What is the Universal Public Health Node
A collection of services and operational policies designed to fulfill designated biosurveillance and public health reporting objectives by exchange of data, bi-directionally between RHIOs and public health agencies
A subset of the architecture for the Statewide Health Information Network of New York (SHIN-NY), and complies with its architectural parameters for full compatibility with other SHIN-NY domains beyond public health
Based on a service-oriented architectural paradigm (SOA), implemented through web services operating through an enterprise service bus (ESB)
Developed as part of a statewide collaboration process with active participation across public and private sectors under leadership from NYSDOH
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Overarching Architecture Principles
Integration of Public Health Reporting Across Multiple HIEs– Exchange of data for public health in a standard manner– Collaborative Development of Consensus Implementation Guide
Enabling Bidirectional Flow of Information and Intelligence– Public Health Participation in RHIO data exchange as equal partners, providing
and receiving information as needed– Dynamic Querying Capabilities
Ensuring Patient Privacy– Implement and Enforce of Privacy & Security Standards– Minimum Data Necessary - Filtering, Anonymizing, Aggregating
Compliant with not only the SHIN-NY architecture, but also the national standards for healthcare interoperability– UPHN is a HITSP-compliant and HITSP-consistent architecture – UPHN also leverages the work of the NHIN effort in its architectural framework
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
UPHN Primary Functionalities
Patient Query: allow public health to query and receive responses for data about and individual patient based on query parameters
Line List Query: enable public health to request and receive patient-level data for specific disease conditions
Anonymize/Re-identify Query: enable the linkable de-identification and re-identification back to identified data as needed for public health investigation
Analytic Query: enable public health to receive data based on predefined queries for counts of specific disease conditions
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Public Health Scenarios
Public Health Investigation
311 Patient Locator
Tuberculosis (TB) All Points Bulletin (APB)
Influenza Surveillance
Syndromic Surveillance
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Public Health Investigation
In response to a suspect or confirmed case report of public health significance, public health authorities can query multiple RHIOs using a standard interface and receive additional clinical information regarding past medical history, treatment, etc
Data SourcesPublic Health
RHIOs
Send request for data about certain patientsGet available data for requested patients
Return data for requested patients
Patient Query
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
311 Patient Locator
In case of emergency, public authorities can query multiple RHIOs using a standard interface and receive information regarding recent encounters/ admissions, which could help in locating and tracking missing persons.
Data SourcesPublic Health
RHIOs
Send request for data about certain patientsGet available data for requested patients
Return data for requested patients
Patient Query
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Tuberculosis (TB) All Points Bulletin (APB
In case of an imminent public health threat posed by an individual with contagious condition who has been lost to public health follow-up (e.g., XDR TB, SARS case)
Data SourcesPublic Health
RHIOs
Send request for data about certain patientsGet available data for requested patients
Return data for requested patients
Patient Query
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Influenza Surveillance
For regular surveillance and in response to an influenza outbreak, RHIOs would send patient care and hospital resource data to the public health authority.
Get available data for requested case definition
Data SourcesPublic Health
RHIOs
Return data for requested case definition
Line List Query
Data Sources
Public Health
RHIOs
Anonymize/Re-identify Query
Send request for data with certain case defintion
Send request for identified data with pseudomized linker
Return identified data
Send anonimized data with pseudomized linkerRe-identify record using pseudomized linker
Get identified record
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Syndromic Surveillance
To monitor the rate of outpatient, ED and inpatient encounters for respiratory and gastrointestinal illnesses. As more specific information regarding the illness is obtained, public health can distribute an updated query to partner RHIOs specifying case definition and other parameters relevant to this outbreak. The RHIOs modify their aggregation and reporting system to incorporate this new query.
Get data based on pre-defined query definition
Data Sources
Public Health
RHIOs
Analytic Query
Send aggregated data based on pre-defined criteria
Send updated query definitionGet data with updated query definition
Return aggregated data with updated criteria
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Key System Components
Enterprise Service Bus (ESB)
Service Registry and Discovery
Common communication and transport protocols
Standardized messaging format and vocabulary
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Enterprise Service Bus (ESB)
The SHIN-NY ESB is a federated (or “distributed”) ESB, allowing multiple physical ESB instantiations to be exposed as one logical instantiation
An integrated physical instantiation of the SHIN-NY ESB is referred to as a SHIN-NY ESB node
UPHN ESB is a domain-specific ESB node, exclusively handling public health services and transactions
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Service Registry and Discovery
UPHN ESB will maintain a restricted service registry using UDDI v2.0.4 as documented in the NHIN Messaging Platform Specification
The service registry will keep both endpoint servers addresses and Web Services Description Language (WSDL) service definitions
Copies of the registry that are kept in synch via replication or another appropriate means with other ESBs within the SHIN-NY
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Common communication and transport protocols
UPHN supports the communication and transport protocols specified in the NHIN Interface Specification – Messaging Platform v1.9– Common transport layer for all messages using SOAP 1.2 over HTTP
– Messages between UPHNs will be secure from end to end by the use of encryption as well as addressing within messages
– Message envelope will support assertions about security and trust between UPHNs
– Authentication will use X.509 certificates issued by a common trusted certificate authority
– All messages will be digitally signed for purposes of authentication and non-repudiation
– Use WS-ReliableMessaging as a baseline message exchange pattern to ensure acknowledgement of all communications (uni- or bi- directional)
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Standardized messaging format and vocabulary
Fully comply with HITSP Interoperability Specification for Biosurveillance
HL7 2.5 is implemented initially
HL7 3.0 will be used when become more broadly used
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Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange
Contact Information
Linh Le, M.D., MPHResearch ScientistNew York State Department of HealthBureau of Healthcom Network Systems Management800 North Pearl, Albany, NY 12204Phone: 518-473-1809Email: [email protected]