SWEA1 CSE 5810 HIE, Interoperability, and NHIN Prof. Steven A.
Demurjian, Sr. Computer Science & Engineering Department The
University of Connecticut 371 Fairfield Road, Box U-255 Storrs, CT
06269-2155 [email protected] http://www.engr.uconn.edu/~steve
(860) 486 - 4818 Copyright 2014 by S. Demurjian, Storrs, CT.
Slide 2
SWEA2 CSE 5810 Objective of Presentation Health Information
Change a Growing Concern Many Efforts are Ongoing/In Progress
Standards a Concern to Address Data Exchange Many Efforts in Play
NHIN
(www.nist.gov/healthcare/testing/nhin.cfm)www.nist.gov/healthcare/testing/nhin.cfm
Standards Efforts CONNECT www.connectopensource.org// DIRECT
(wiki.directproject.org) IHE http://www.ihe.net/ Well Review Many
Efforts by Leveraging Existing Materials and Progress
Slide 3
Towards a Nationwide Health Information Network (NHIN) Where
Should We Be in 2014 Building a NHIN NHIN-2004 NHIN-2005-2006
NHIN-2007
Slide 4
On July 21, 2004 the Department of Health and Human Services
(DHHS) announced the decade of health information technology for
delivering consumercentric and information-rich health care. The
vision is to build a National* Health Information Network (NHIN) of
regional health information exchanges formed by health care
providers who will utilize electronic health record systems.
Thompson TG and Brailer DJ. The Decade of Heath Information
Technology to Deliver Consumer-centric and Information-rich Health
Care. Framework for Strategic Action. US DHHS, July 21, 2004. US
National HIT Strategic Plan * Original term National has been
changed on Nationwide in January 2006
Slide 5
DHHS Framework for Health Information Technology: Building a
NHIN NHIN will be based on: Electronic Health Record Systems (EHRS)
that will enable Regional Health Information Exchanges (RHIEs)
organized via Regional Health Information Organizations (RHIOs)
Thompson TG and Brailer DJ. The Decade of Heath Information
Technology to Deliver Consumer-centric and Information-rich Health
Care. Framework for Strategic Action. US DHHS, July 21, 2004.
Slide 6
Presidents Strategic Framework for HIT
Slide 7
Provider Record Laboratory Results Specialist Record Records
Returned Index of where patients have records Temporary Aggregate
Patient History Authorized RHIO Inquiry Requests for Records
Another RHIO Patient data to other RHIO Source: Jennie Harvell. The
Decade of Health Information Technology Framework for Strategic
Actions. MMIS Conference, September 2004 US Nationwide Health
Information Network
Slide 8
US Health Information Network - 2014 Source: Dr. Peter Elkin,
Mayo Clinic, MN
Slide 9
RHIOs as NHIN Components Source: Dr. Peter Elkin, Mayo Clinic,
MN, 2006
Slide 10
Emerging data shows the value that standardized health
information exchange will provide to all stakeholders: Healthcare
purchasers and payers Hospitals and other healthcare providers
Laboratories Practicing clinicians Public health Source: John
Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D.C.
December 6-7, 2004 URL:
www.ehealthinitiative.comwww.ehealthinitiative.com Nationwide
Health Information Network (NHIN)
Slide 11
On November 15, 2004 Office of National Coordinator for Health
Information Technology (ONC), Department of Health and Human
Services (DHHS), released THE REQUEST FOR INFORMATION (RFI) on the
Development and Adoption of a National Health Information Network
Over 500 responses from various healthcare stakeholders has been
submitted. Building a NHIN URL: http://www.dhhs.gov
Slide 12
PHDSC Model: RHIO EHR-PH Info Exchange PHDSC Model for
Electronic Health Record-based Data Exchange
Slide 13
In October 2005 DHHS Office of National Coordinator (ONC)
awarded several NHIN contracts ($65M) as follows: Standards
Harmonization EHR Certification NHIN Architecture Prototypes Health
Information Security and Privacy NHIN Development Process URL:
http://www.hhs.gov/healthit/ahic.htmlhttp://www.hhs.gov/healthit/ahic.html
Slide 14
DHHS NHIN Contracts Standards Harmonization - Harmonize the
health care and technology standards used in health information
interchange to address gaps and conflicts in current standards EHR
Certification - Set forth certification criteria for the many
electronic health care record products and technologies currently
available on the market NHIN Prototypes - Develop and evaluate
prototypes for the network architecture to assess the feasibility
of developing a national health information network prototype
Privacy - Address privacy and security policy questions affecting
the exchange of health information. Work resulting from each of
these projects will be used by HHS to develop and refine the
business case for establishing the network.
Slide 15
Nationwide Health Information Network Presented by Lori
Blevins
Slide 16
Goals of NIHN: Develop capability for secure data exchange
Improve the coordination of care information among healthcare
facilities Ensure that appropriate information is available at the
time and place that care is provided Ensure that consumers
healthcare information is secure and confidential Reduce risks from
medical errors and support the delivery of appropriate care Provide
consumers with access to their health information Lower healthcare
costs by reducing inefficiencies, medical errors, and incomplete
patient information (Nationwide Health Information Network
2009)
Slide 17
Function of NIHN The NIHN will serve as a network of networks
to connect diverse entities that need to exchange health
information. The NIHN will provide for a more effective healthcare
marketplace and will promote greater competition, as consumers may
realize increased choice in selecting healthcare providers.
Accessibility of accurate healthcare information will enhance
delivery of care and improve outcomes.
Slide 18
Hardware The hardware utilized by the NIHN will consist of the
myriad operating systems that are part of the network. Therefore,
the hardware will consist of the hardware components of the
participating entities and will include: PCsHard disk
DesktopsRandom access memory LaptopsRead-only memory PDAsCache
memory CPUsCD-ROM Motherboard
Slide 19
LOOK HOW FAR WEVE COME SINCE 2009! Personal Digital Assistants
These small, hand held devices are becoming more commonplace among
healthcare workers PDAs will enable healthcare workers to enter
data in a more timely fashion, so that patient information is
updated in real time The premise of the NIHN is to make health
information readily available and accessible to all facets of
healthcare delivery. Therefore, PDAs are a logical choice in
implementation of the NIHN
Slide 20
Software Sun Microsystems Open Source software Sun GlassFish
Open Source Application Platform Java Composite Application
Platform Suite Sun Java Identity Management Suite (Sun Microsystems
2009)
Slide 21
Sun Open Source Technology Sun Microsystems open source
software is the backbone of the NIHN-CONNECT gateway This software
will connect the 26 NIHN member agencies hence the name
NIHN-CONNECT The CONNECT software will be available throughout the
health information exchange community (Sun Microsystems 2009)
Slide 22
Software Usability Usability refers to the ease with which an
interface can be used Sun Microsystems project teams employ a
Usability Lab to enhance user-centered design and evaluation
Evaluations include: Customer field studiesUsability focus groups
Competitive analysisParticipatory design Contextual
inquiryExploratory lab studies SurveysHeuristic evaluations (Sun
Usability Labs and Services 2009)
Slide 23
CONNECT Information System CONNECT has been developed by
federal agencies to link their existing systems CONNECT is an open
source gateway information system CONNECT allows existing systems
to speak to each other to facilitate the communication of
healthcare information (CONNECT Community Portal 2009)
Slide 24
CONNECT Gateway CONNECT is a special purpose open source
information system CONNECT will be used by physicians, nurses,
clinicians, and administrators anyone within the organization with
access to the EHR
Slide 25
CONNECT Gateway The primary function of CONNECT Gateway is to
inter-relate separate agencies so that their information systems
become connected If the NIHN is the information exchange, CONNECT
is the universal on-ramp for federal agencies (CONNECT Community
Portal 2009)
Slide 26
CONNECT Gateway CONNECT Gateway CONNECT will utilize ANSI and
Healthcare Informatics Standard Planning Panel SNOMED will be
employed as the disease/procedure classification CONNECT will
encompass many types of configurations
Slide 27
Advantages to NIHN Improve coordination of care Appropriate
information is available when and where it is needed Reduce risk of
medical errors Reduce inefficiencies and duplication of services
Lower health care costs
Slide 28
Disadvantages to NIHN May create a paternalistic environment in
healthcare May focus emphasis on the electronic health record and
not the patient Accuracy of information may be questionable
Possibility of security breach
Slide 29
References CONNECT Community Portal. Retrieved July 10, 2009.
www.connectopensource.org. www.connectopensource.org McGonigle, D.,
Mastrian, K. and Terry, N. (2009). Nursing Informatics. Sudbury,
MA. Jones and Bartlett Publishers. Nationwide Health Information
Network (NHIN): Background & Scope. Retrieved 5/27/2009.
www.HealthIT.hhs.gov.www.HealthIT.hhs.gov Sun Microsystems Helps
U.S. Federal Government. Retrieved 06/10/2009. www.sun.com.
www.sun.com Sun Usability Labs and Services. Retrieved 06/10/2009.
www.sun.com/usability. www.sun.com/usability Terry, Nicholas P.
NCVHS Subcommittee on Privacy. Retrieved 07/28/2009.
www.ncvhs.hhs.gov.www.ncvhs.hhs.gov
Slide 30
TM Overview of National HIT Standards a presentation to the
Seminar Series on Integrated Surveillance Presented by Steven J
Steindel, Ph.D. National Center for Public Health Informatics
(NCPHI), CDC
Slide 31
TM Government Voluntary standards Consensus standards Industry
standards Consortia Standards Etc. Regulatory standards: Levels of
Protection Health, Safety Environment LAWS Non-Government MARKET
NEEDS When applicable and appropriate, voluntary standards may be
referenced in mandatory regulations.
Slide 32
TM Regulations Based on Health & Welfare (Legitimate
Objectives) Development Process (openness, public comment,
transparency, timely notification) Mandatory Voluntary Standards
Based on Market and Business Relevance (Demands or Needs)
Development Process (much the same as regulatory; regulators are
among the participants in standards development bodies)
Voluntary
Slide 33
TM Consideration for Standards Flow - where, when, and how data
move Format - mechanics of data transfer Content - which data
elements
Slide 34
TM Schematic Public Health Data Flow Example: Laboratory
Reporting Pathology Laboratory Text Report Encoding Systematic
Report Standards Standard Codes H7 Messages Architecture Reportable
Cases Public Health World Clinical Data Users Network Users Public
Health System NHIN/RHIO SNOMED, Numbers, Dates, Text 92 Disease
specific HL Messages Public Health Surveillance
Slide 35
TM Acronym Soup! AHIC American Health Information Community ONC
Office of the National Coordinator for Health Information
Technology (IT) HL7 Health Level 7 CCHIT Certification Commission
for Health IT HITSP Health IT Standards Panel NHIN Nationwide
Health Information Exchange Network
Slide 36
TM ONC Major Initiatives American Health Information Community
Standards Harmonization Process Certification of HIT Privacy and
Security Solutions Nationwide Health Information Systems Prototypes
Health Information Technology and Health-care Anti-fraud Health IT
Adoption Initiative Gulf Coast Task Force State RHIO Best Practices
In 2004, President Bush called for the widespread use of electronic
health records (EHRS) within 10 years. ONC has set the foundation
for interoperable EHRs though the following initiatives: For more
information: http://www.hhs.gov/healthit/
Slide 37
TM AHIC a Public and Private Sector Collaborative AHIC:
American Health Information Community HITSP: Health Information
Standards Panel CCHIT: Certification Commission for Health IT NHIN:
Nationwide Health Information Community HISPC: Health Information
Security and Privacy Collaboration State-Level HIE Initiatives:
State-level Health Information Exchange Initiatives AHIC is the
public-private collaborative that sets priorities and oversees
and/or endorses HIT Standards, certification, the NHIN, and polices
on a national level. For More information:
http://www.hhs.gov/healthit/community/background/
Slide 38
TM AHIC Workgroups (1/07) Population Health and Clinical Care
Subsumes work of the Biosurveillance WG Includes Data Content
Steering Group Consumer Empowerment Chronic Care Electronic Health
Records Laboratory Reporting Emergency Preparedness Privacy and
Security Quality Personalized Healthcare For more information:
http://www.hhs.gov/healthit/ahic/index.html
Slide 39
TM Health Information Technology Deployment Coordination
Slide 40
TM Standards Harmonization Process Health Information Standards
Panel (HITSP) Business driven standards harmonization process
Coordinated with AHIC Use Cases Funded for 3 years by ONC;
self-sustaining thereafter Published Implementation Guidance 10/06
Consumer Empowerment Biosurveillance EHR: Laboratory Reporting For
more information:
http://www.ansi.org/standards_activities/standards_boards_panels/hisb/hitsp.aspx?menuid=3
Slide 41
TM HITSP Technical Committees Cross-Technical Committee
Coordination Care Delivery Consumer Empowerment Population Health
Security and Privacy Emergency Responder-EHR
Slide 42
TM I Harmonization Request Harmonization Process Steps II
Requirements Analysis III Identification of Candidate Standards IV
Gaps, Duplications and Overlaps Resolution V Standards Selection VI
Construction of Interoperability Specification VII Inspection Test
VIII Interoperability Specification Release and Dissemination IX
Program Management Begin Support Receive Request HITSP
Harmonization Process
Slide 43
TM HITSP Framework
Slide 44
TM JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC HITSP 2007 Timeline
02/05/07 HITSP Board 04/23/07 HITSP Board 07/09/07 HITSP Board
10/09/07 HITSP Board 03/19/07 HITSP Panel 05/11/07 HITSP Panel
09/07/07 HITSP Panel 03/06 03/08 TC Face to Face Chicago IL 5/08
5/10 TC Face to Face Arlington VA 6/18 6/20 TC Face to Face San
Diego CA 09/04 09/06 TC Face to Face Arlington VA Public Comment
Inspect Test and Public Comment Implementation Support and Testing
(with annual updates as required) Comment Resolution and Panel
Approval 02/15 05/16 04/13 05/16 IS Construct Development 05/17
07/19 07/20 08/1608/17 10/15 Implementation Support and Testing
(includes minor document updates) EHR, CE and BIO v 2.0 Activity 1
Version 2.0 of Existing EHR, CE, BIO ISs Activity 2 Security and
Privacy for All Use Cases Activity 3 New Emergency Responder EHR
Use Case On-going Support 10/15/07 HITSP Panel 07/16/07 HITSP Panel
02/12/07 HITSP Panel Activity 4 New Use Cases from AHIC Detail
Schedule to be Established Upon Review of the Use Cases Work Plan
and Schedule Overview S&P and EHR-ER v 1.0 Requirements,
Design, Standards Selection Public Input on S&P 05/17
06/14
Slide 45
TM Coordinated Timeline Two Years We are here
Slide 46
TM Certification of EHRs Certification Commission for Health IT
(CCHIT) Privately founded and funded 11/04 ONC funding for three
years First certified Ambulatory EHRs 7/06 37 systems certified:
1/07 Inpatient EHR Certification 6/07 Network Certification 6/08
For more information: http://www.cchit.org/
Slide 47
TM CCHIT History and Status Sept 2004: AHIMA, HIMSS, and the
Alliance partner to launch CCHIT June 2005: Eight organizations add
$325k funding support Sept 2005: CCHIT awarded 3-year, $7.5M HHS
contract to develop compliance criteria and inspection process
Ambulatory EHRs (2006) Inpatient EHRs (2007) Infrastructure and
Networks through which EHRs interoperate (2008) July 18, 2006:
First batch of certified ambulatory EHRs announced Goals of Product
Certification Reduce the risks of investing in HIT Facilitate
interoperability of HIT products Enhance availability of adoption
incentives Ensure that the privacy of personal health information
is protected Goals of Product Certification Reduce the risks of
investing in HIT Facilitate interoperability of HIT products
Enhance availability of adoption incentives Ensure that the privacy
of personal health information is protected
Slide 48
TM Stakeholder priorities Availability in vendor marketplace
Practicality of certification Release for public comment CCHIT
Development Process Call for participants Random selection for each
market segment Conduct pilot Release for public comment Results
Final criteria Final test process and scripts Certification
handbook and agreement Criteria for next year Functionality
Security/ reliability Interoperability Roadmap for Next year + 1
Next year + 2 Release for public comment Methods Self-attestation
Juror observation Laboratory testing Test scenarios Step-by-step
test scripts Release for public comment Respond to comments Final
adjustments Commission review and approve Publish final materials
Gather Data Develop Criteria Develop Inspection Process Pilot Test
Finalize Launch Certification Program
Slide 49
TM CCHIT Myths and Realities MythReality CCHIT is a government
agency CCHIT is an independent, voluntary, private- sector
initiative organized as a limited liability corporation. CCHIT will
transition from HHS funding to a self-sustaining model. CCHIT is a
standards development organization CCHIT develops criteria based on
commonly available standards developed by SDOs. Certification could
stunt innovation and competition in the HIT marketplace basic
criteriaCertification is a pass/fail indication that the product
meets basic criteria in every area. It provides a baseline above
which HIT vendors may innovate and compete. CCHIT will only be
certifying EHRs for the physician practice Work groups are already
developing criteria for inpatient EHR certification. In 2007, the
effort will expand to the networks and technology components
through which EHRs interoperate.
Slide 50
TM HL7 Groups of Importance New Public Health and Emergency
Response Patient Safety Established Vocabulary Government Projects
Laboratory Attachments Structured Documents (CDA/Templates) For
more information: http://www.hl7.org/
Slide 51
TM Key Terminologies LOINC Lab Result Names SNOMED Clinical
Terminology Organisms Both distributed free for use
http://www.regenstrief.org/medinformatics/loinc/
http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html
Slide 52
TM Get Involved! No restrictions just join: HL7 HITSP Selected
Membership CCHIT NCVHS Open Meetings AHIC NCVHS CCHIT Town Halls
Registration LOINC SNOMED (IHTSDO)
Slide 53
TM Contact Information Steven J Steindel, Ph.D. Director, Data
Standards and Vocabulary Centers for Disease Control and Prevention
National Center for Public Health Informatics U.S. Department of
Health and Human Services 1600 Clifton Road, MS E-78 Atlanta, GA
30333 (tel) 404-498-2444 [email protected]
Slide 54
54 HIT STANDARDS COMMITTEE DRAFT: S&I Framework Principles
and Processes 54
Slide 55
55 S&I Mission Promote a sustainable ecosystem that drives
increasing interoperability and standards adoption Create a
collaborative, coordinated, incremental standards process that is
led by the industry in solving real world problems Leverage
government as a platform provide tools, coordination, and
harmonization that will support interested parties as they develop
solutions to interoperability and standards adoption.
Slide 56
56 ONC Standards and Interoperability Framework Tools and
Services (Use Case Development, Harmonization Tools, Vocabulary
Browser, Value Set Repository, Testing Scripts, etc) (Stanley)
Tools and Services (Use Case Development, Harmonization Tools,
Vocabulary Browser, Value Set Repository, Testing Scripts, etc)
(Stanley) Use Case Development and Functional Requirements
(Accenture) Use Case Development and Functional Requirements
(Accenture) Standards Development (TBD) Standards Development (TBD)
Certification and Testing (Stanley/Deloitte) Certification and
Testing (Stanley/Deloitte) Harmonization of Core Concepts
(Deloitte) Harmonization of Core Concepts (Deloitte) Implementation
Specifications (Deloitte) Implementation Specifications (Deloitte)
Pilot Demonstration Projects (Lockheed Martin) Pilot Demonstration
Projects (Lockheed Martin) Reference Implementation (Lockheed
Martin) Reference Implementation (Lockheed Martin)
Slide 57
57 Standards and Interoperability Organizational Structure
Standards and Interoperability Standards National Health
Information Network Certification and Testing FHA Standards Teams
NHIN Teams Certification Team FHA Teams Use Cases (Accenture) Use
Cases (Accenture) Standards Development (TBD) Standards Development
(TBD) Harmonization (Deloitte) Harmonization (Deloitte) Spec
Factory (Deloitte) Spec Factory (Deloitte) Architecture Reference
Implementations (Lockheed Martin) Reference Implementations
(Lockheed Martin) Emergent Pilots (Lockheed Martin) Emergent Pilots
(Lockheed Martin) Tools (Stanley) Tools (Stanley) Operations
(Stanley) Operations (Stanley) Certification (Stanley/Deloitte)
Certification (Stanley/Deloitte) Test Infrastructure
(Stanley/Deloitte) Test Infrastructure (Stanley/Deloitte) CONNECT
(TBD) CONNECT (TBD)
Slide 58
58 What is an IEPD? An Information Exchange Package
Documentation (IEPD) is a collection of artifacts that describe the
construction and content of an information exchange Developed to
provide the business, functional, and technical details of the
information exchange through predefined artifacts Created with a
core set of artifacts in a prescribed format and organizational
structure to allow for consistency Designed to be shared and reused
in the development of new information exchanges through publication
in IEPD repositories IEPDs contain design specifications for an
information exchange but may not include supplementary information
such as implementation decisions.
Slide 59
59 The IEPD Artifacts IEPDs contain both required and
recommended artifacts Required : Bold Recommended : Italic Note:
Best practices for most organizations include many of the optional
artifacts listed here Business Process Use Cases Sequence Diagrams
Business Rules Business Requirements Exchange Content Model Mapping
Document Subset Schema Exchange Schema XML Wantlist Constraint
Schema Extension Schema Main Document IEPD Catalog IEPD Metadata
Sample XML Instances XML Stylesheets Scenario Planning Analyze
Requirements Map & Model Build & Validate Assemble &
Document Publish & Implement No required artifacts. Publish the
IEPD to a repository and implement the exchange
Slide 60
60 S&I NIEM Harmonization Strategy ONCs Office of
Interoperability and Standards is building a Health Information
Exchange Model (NIEM Health) that is harmonized with NIEM Health
and Human Services petal to serve as bridge between NIEM and NIEM
Health Human Services
Slide 61
61 Capability Elaboration Capability Formulation Construction
Release & Publication Use Case Development Spec Development
Harmonization Reference Impl Cert &Testing S&I Development
Phases S&I Governance Health Community Participants Scenario
Planning Analyze Requirements Map & Model Build & Validate
Assemble & Document Pub. & Impl. NIEM Lifecycle S&I
NIEM Process Harmonized
Slide 62
62 Addressing Challenges for the Health Information Exchange
Model ChallengeApproach Existence of disparate health information
exchange standards and specifications and implementation approaches
Map exchange requirements to existing standards &
specifications and address any gaps, duplications, or overlaps
Harmonization and management of several well-established, large
vocabularies for semantic interoperability Leverage existing
vocabulary repositories (e.g. PHIN VADS), coordinate with Unified
Medical Language System (UMLS), and collaborate with standards
development organizations Usability of existing HIT exchange
protocols and specifications Use NIEM processes and adapt
supporting tools to create computable, useable implementation
specifications NIEM only addresses data content, but transaction
behavior and security provisions are necessary for health
information exchange Adapt structure and content of S&I IEPD to
incorporate transport and security aspects of exchange
Compatibility of S&I IEPDs with existing NIEM infrastructure
and tools, as well as existing health information exchange
protocols Develop and adapt NIEM and health information technology
tools and framework to support NHIN goals
Slide 63
63 Requirements for a Model Centric Approach The modeling
approach used by the S&I Framework must Provide traceability
from Use Case and Requirements through to one or more
implementations Provide semantic and syntactic modeling constructs
to support defining the information and behavior that are part of
exchanges Support the need to harmonize with existing standards
defined at different levels of abstraction Be adoptable by
different organizations Be able to integrate into NIEM process
Slide 64
64 Model-Centric Solution - MDA Base S&I Framework modeling
on the 3 OMG/MDA model abstractions. Computational Independent
Model (CIM) Platform Independent Model (PIM) Platform Specific
Model (PSM) Define a mechanism to show traceability from Use Cases
and Functional Requirements through to technical bindings defined
in a PSM. Define a flexible modeling foundation by which different
types of specifications can be defined. Provides ability for
multiple technology bindings for the same set of logical
specifications (multiple PSMs)
Slide 65
65 Specification Models NIEM Processes and Artifacts S&I
Activities Harmonization of Core Concepts Implementation
Specifications Reference Implementation and Pilots Business
Processes, Use Cases Business Rules, Business Requirements Exchange
Content Model, Mapping Document Exchange Schema, Subset/Constraint
Schema, Main Document, IEPD Catalog, IEPD Metadata, Sample XML
Vision Document, Process Model Use Case Model, Interaction Model,
Domain Model Behavior Model Domain Model Web Services Schema and
WSDL Use Case Development and Functional Requirements Certification
and Testing CIM PIM PSM Scenario Planning Analyze Requirements Map
and Model Publish and Implement Build and Validate Assemble and
Document Model Centric Solution - NIEM
Slide 66
66 Prioritization and Backlog Lists Strategic Priorities
Strategic Priorities Operational Priorities Day to Day Priorities
within each functional team
Slide 67
67 Whats Next Create a NIEM Health standards harmonization
process and governance framework Establish roadmap for existing
NHIN standards, MU harmonization, and non-MU health information
exchange specifications Establishes a repeatable, iterative process
for developing widely reusable, computable implementation
specifications Establishing the tooling and repositories needed
Establishing the practices and guidelines for modeling Enables
semantic traceability so that useable code can be traced back to
original requirements and definitions Promotes transparency and
collaboration from broad range of health stakeholders Scenario
Planning Map & Model Analyze Requirements Build & Validate
Assemble & Document Publish & Implement Use Case
Development and Functional Requirements Standards Development
Certification and Testing Harmonization of Core Concepts (NIEM
framework) Implementation Specifications Pilot Demonstration
Projects Reference Implementation NIEM IEPD Lifecycle
Slide 68
68 ISSUES TO DISCUSS S&I Framework
Slide 69
69 Coordination Priority Setting Evaluating Artifacts S&I
Framework Issues and Challenges (1) Issues and Challenges How and
when do we get input from other stakeholders including those
outside of meaningful use? VLER Federal partners Other stakeholders
How do we foster multiple working groups and create a unified view
of priorities? HITSC HITPC Sustainable Operations Shared
Infrastructure
Slide 70
70 How do we create simple, easy to implement specifications
that will drive adoption? S&I Framework Challenges (2) How do
we facilitate access to SDO standards for providers and support
sustainable business models? Engaging the SDO community Developing
a one stop shop for implementation specifications How do we foster
community and industrial participation to support balanced
representation and diverse priorities? Identifying champions for
S&I lifecycle initiatives Engage communities throughout S&I
Framework Identifying demonstrable pilot programs Engaging and
incentivizing volunteers from existing community
Slide 71
71 S&I Framework Open Questions cont. What are the
appropriate interface points with HITSC through S&I Framework
lifecycle? Establish priorities, approve implementation
specifications, Identifying appropriate decision makers at S&I
control points Identifying appropriate roles and participants in
the governance of S&I Framework How do we identify and select
tools as shared resources that foster collaboration? Establishing
and adhering to agreed upon modeling conventions Tools to support
artifact lifecycle management and dissemination How do we extend
NIEM to accommodate needs of health care domain?
Slide 72
72 S&I Framework Priorities What should our priorities be
for the next six months, twelve months, twenty-four months? From
among Meaningful Use Stage 1 Meaningful Use Stage 2 & 3 NHIN
Exchange NHIN Direct Health Care Reform VLER New use cases (lab,
pharmacy, content specifications) Prioritization needs to
accommodate broad stakeholder needs, account for breadth and depth
of available expertise, and support a long term growth
strategy
Slide 73
FHA Presentation to HIMSS National Capital Area Chapter January
15, 2009 Vish Sankaran Program Director Federal Health
Architecture
Slide 74
Phase 1 2004 2008 Foundation for Health Information Exchange
Established In April, 2004 Executive Order 13335: Office of the
national coordinator created Executive Order 13410: Federal federal
agencies required to implement HHS Secretary recognized standards
and cost & quality transparency In the last four years, ONC
worked with Federal, States and private sector to: Harmonize
interoperable standards Create Health IT certification for
functionality, security, and interoperability Launch the Nationwide
Health Information Network Address Policy variations The Tipping
Point for Phase 2 is now at hand 74
Slide 75
President-elect Obamas Commitment to Electronic Health Systems
The goal is not to move from paper silos to electronic silos The
goal is an electronic health system that supports and requires the
movement of interoperable health information supporting: Continuity
of Care Population Needs (pandemics and other disasters) Bench to
Bedside Research Disability Determination 75 In a January 9, 2009
speech at George Mason University "To improve the quality of our
healthcare while lowering its cost, we will make the immediate
investments necessary to ensure that, within five years, all of
Americas medical records are computerized.
Slide 76
FHA Mission Effective Government Secure Exchange of
Interoperable Health Information Working together to provide the
tools and solutions to support the development and exchange of
interoperable health information within the federal government and
with the tribal, state, local and private sector, thereby, enabling
better care, increased efficiency, and improved access to care for
American citizens. 76
Slide 77
77 Agency Concept of Operations 77 4 Implement Solutions 3 Plan
Investments 1 Business Priorities 2 Architect Solutions 5 Measure
Progress FHA can provide guidance / support in any phase of your
operations. 77
Slide 78
78 2009 Vision Agencies Collaborate to Reform Healthcare
through IT VISION Reform HealthCare RESULT Improved Performance
GOALS Reduce Costs Improve Quality Increase Access POPULATIONS
ElderlyVeteransMilitaryNative AmericansDisabledChildrenUnderserved
PROCESS Solutions STAKEHOLDERS State, Local, Private State
AgenciesLocal AgenciesProvidersHealth IT VendorsPayers
COLLABORATION Federal Programs Others.. ImplementInvestment
Business Needs Architect 7878
Slide 79
The Nationwide Health Information Network Health Bank or PHR
Support Organization Community #1 Integrated Delivery System
Community Health Centers Community #2 State and Local Gov Labs
Pharmacies CDC VA FDA DoD SSA The Internet Standards,
Specifications and Agreements for Secure Connections Common Dial
Tone & Chain of trust 7979
Slide 80
80 CONNECT: Tools for Information Exchange FHAs CONNECT
Initiative provides three related tools to enable organizations to
connect to the NHIN: The Gateway, which implements the core
services defined by the NHIN Enterprise Service Components, which
provide robust tools for indexing patient identities, maintaining
patient health documents, implementing business rules for
authorizing the release of medical information and more The
Software Development Kit (SDK), which enables developers to
customize the Gateway and add or replace enterprise service
components 80
Slide 81
CONNECT 2008 Progress Collaboration you can be proud of! 81
20082009 March 2008 CONNECT development started Sep 2008 3 agencies
demonstrated HIE with private sector Dec 2008 6 agencies
demonstrated HIE with private sector 2009 Plan to include all
health agencies by end of year 81
Slide 82
CONNECT Roadmap: 2008-2011 Participate in NHIN Trial
Implementations Develop first release of the Federal NHIN Gateway
Demonstrate value of connecting to the NHIN for agencies Move
selected agencies into production using NHIN Use of NHIN to solve
agency needs and improve performance Distribute Gateway software to
facilitate NHIN solution development by marketplace Expand the set
of agency programs using the NHIN Begin the process of
transitioning to gateway software provided by the marketplace
Complete process of transitioning to gateway software provided by
the marketplace Support every agency that performs health-related
information exchanges using the NHIN 82 2008 2009 2010 2011
Slide 83
83 Private sector and Government Must Care Data flow in our
health care systems is a must for the coming years Government
Ensure interoperability is in agency business and strategic plans.
Systems integrators: Support the federal, state, private providers
and public health agencies transformation towards interoperability.
Leverage the CONNECT tools as a means to integrate existing health
information systems. Product vendors: Create unique HIE solutions
for the health marketplace by adding value on the CONNECT solution,
or create your own products that provide NHIN services. For this
transformation to succeed, all of us must participate
Slide 84
SWEA84 CSE 5810 What is Direct? Allow individuals, providers
and organizations to share information with best practices that
have trust and privacy considerations Health Information Service
Provider (HISP) Manage security/transport for directed exchange
Organizational model that performs HISP functions Works to
send/receive to organization or individual Legal Business Associate
Agreements with HIPAA Includes all data collection, use, retention,
and disclosure policies 84
Slide 85
SWEA85 CSE 5810 One Possible Architecture
Slide 86
Other Direct Deployment Models A.e-Mail client (no S/MIME)
NHIN-Direct developed security agent off-the-shelf S/MIME proxy
B.e-Mail client using Native S/MIME Internet e-Mail Service
Provider Healthcare specific e-Mail Service Provider C.Web Portal
to common Internet e-Mail service with S/MIME support to Healthcare
specific messaging service with S/MIME support D.EHR/PHR with
integrated S/MIME functionality deployed inside the Provider
deployed as SaaS E.NHIN Direct to/from NHIN Exchange Trusted NHIN
Gateway End to End secure
Slide 87
Source Client Destination Client Source Full Service HISP
Source Full Service HISP Destination Full Service HISP Destination
Full Service HISP Send Locate Destination Certificate POP/IMAP +
TLS Receive S/MIME Encrypt w/ Destination Cert S/MIME Encrypt w/
Destination Cert S/MIME Verify w/ Source Cert S/MIME Verify w/
Source Cert S/MIME Decrypt w/ Private Key S/MIME Decrypt w/ Private
Key A) e-Mail client with Full Service HISP XDM Xpath Data Model
SMTP + S/MIME Locate Destination Address Locate Destination Address
SMTP + MIME+ TLS SMTP + MIME+ TLS Document Or XDM Document Or XDM
S/MIME Sign w/ Private Key S/MIME Sign w/ Private Key Encrypted
Content A.1 A.2 A.3 A.4 A.5 A.6 A.7 A.8 A.9 A.10 A.11 Private Key
Store
Gateway: Direct Project to XDR (Destination HISP) Gateway:
Direct Project to XDR (Destination HISP) Receive S/MIME Verify w/
Source Cert S/MIME Verify w/ Source Cert S/MIME Decrypt w/ Private
Key S/MIME Decrypt w/ Private Key E) Direct Project sending to XDR
with Trusted Service Provider (e.g. NHIN Exchange) Convert XDM
metadata and content to XDR format SMTP + S/MIME Direct Project
Sender XDR + TLS XDR + TLS Destination Certificate is shared with
all XDR destinations in XDR Exchange Endpoint in XDR Exchange E.1.1
E.1.2 E.1.4 E.1.6 E.1.7 Private Key Store Address Book w/ Certs
E.1.3 E.1.5
Slide 92
Gateway: Direct Project from XDR (Source HISP) Gateway: Direct
Project from XDR (Source HISP) Send S/MIME Encrypt w/ Destination
Cert S/MIME Encrypt w/ Destination Cert E) Direct Project receiving
from XDR with Trusted Service Provider (e.g. NHIN Exchange) XDR +
TLS XDR + TLS S/MIME Sign w/ Private Key S/MIME Sign w/ Private Key
Extract Destination Address from XDR metadata Extract Destination
Address from XDR metadata Convert XDR Metadata and Documents to XDM
Zip file Direct Project Recipient Endpoint in XDR Exchange Locate
Destination Certificate SMTP + S/MIME Private Key Store Address
Book w/ Certs E.2.6 E.2.4 E.2.1 E.2.2 E.2.3 E.2.5 E.2.7 E.2.9
E.2.8
Slide 93
NHIN Direct to NHIN Exchange (Destination HISP) NHIN Direct to
NHIN Exchange (Destination HISP) Receive E) NHIN Direct sending to
non-trusted NHIN Exchange (End-to-End Secure) SMTP + S/MIME NHIN
Direct Place S/MIME message as XDR content XDR + TLS XDR + TLS
Destination Certificate is Individual or Organization NHIN Exchang
e
Slide 94
NHIN Direct to NHIN Exchange (Destination HISP) NHIN Direct to
NHIN Exchange (Destination HISP) Receive S/MIME Verify w/ Source
Cert S/MIME Verify w/ Source Cert S/MIME Decrypt w/ Private Key
S/MIME Decrypt w/ Private Key E) NHIN Direct sending to NHIN
Exchange Convert XDM metadata and content to XDR format SMTP +
S/MIME NHIN Direct Place S/MIME message as XDR content XDR + TLS
XDR + TLS Destination Certificate is Group NHIN Exchange
Destination Certificate is Individual or Organization NHIN Exchang
e
Slide 95
Non Trusted NHIN Exchange Gateway E) NHIN-Direct receiving from
non-Trusted NHIN Exchange (End-to-End Secure) NHIN Direct NHIN
Exchang e Source Certificate is individual or organizational Source
Client S/MIME Encrypt w/ Destination Cert S/MIME Encrypt w/
Destination Cert XDM Zip file S/MIME Sign w/ Private Key S/MIME
Sign w/ Private Key Locate Destination Address + Certificate Locate
Destination Address + Certificate XDR + TLS XDR + TLS Extract from
XDM metadata the To and From addresses Extract S/MIME message from
XDR content SMTP + S/MIME
Slide 96
Trusted NHIN Exchange Gateway Non Trusted NHIN Exchange Gateway
Send S/MIME Encrypt w/ Destination Cert S/MIME Encrypt w/
Destination Cert E) NHIN-Direct receiving from NHIN Exchange XDR +
TLS XDR + TLS S/MIME Sign w/ Private Key S/MIME Sign w/ Private Key
Extract Destination Address from XDR metadata Extract Destination
Address from XDR metadata Convert XDR Metadata and Documents to XDM
Zip file NHIN Direct NHIN Exchang e Locate Destination Certificate
Source Certificate is NHIN Exchange Group Certificate Source
Certificate is individual or organizational Source Client S/MIME
Encrypt w/ Destination Cert S/MIME Encrypt w/ Destination Cert XDM
Zip file S/MIME Sign w/ Private Key S/MIME Sign w/ Private Key
Locate Destination Address + Certificate Locate Destination Address
+ Certificate XDR + TLS XDR + TLS Extract from XDM metadata the To
and From addresses Extract S/MIME message from XDR content SMTP +
S/MIME
Slide 97
June 28-29, 2005 Interoperability Strategy Workshop 97 W W W. I
H E. N E T Providers and Vendors Working Together to Deliver
Interoperable Health Information Systems in the Enterprise and
Across Care Settings
Slide 98
June 28-29, 2005 Interoperability Strategy Workshop 98 Lab
Results Document Content Format of the Document Content and
associated coded vocabulary For Display Document Format of the
Document Content Selected IHE Integration Profiles for RHIOs What
is available and is added in 2005 Consistent Time Coordinate time
across networked systems Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to
create a secured domain. Patient Demographics Query
Cross-Enterprise Document Sharing Registration, distribution and
access across health enterprises of clinical documents forming a
patient electronic health record Notification of Document
Availability Notification of a remote provider/ health enterprise
Imaging Information Sharing Format of the Document Content and
associated coded vocabulary Medical Summary Document Content Format
of the Document Content and associated coded vocabulary
Cross-enterprise User Authentication Authentication & Auditing:
Basis for Access Control Document Digital Signature Attesting
true-copy and origin Patient Identifier Cross-referencing Map
patient identifiers across independent identification domains
Slide 99
June 28-29, 2005 Interoperability Strategy Workshop 99 HIMSS
2005 Interoperability Show Case Vendors Leadership Level
CapMed/SanDiskEclipsys GE Healthcare
IDXInterSystemsKryptiqQuovadx/CareScienceSiemensWebMD Participant
Level AllscriptsCedaraCernerDictaphone Eastman Kodak
EclipsysEmageonEpicETIAM INFINITT Tech.
MedcomSoftMediNotesMedCommonsMidMark Mortara Instrument, Inc
National Institute of Standards & Technology Standards &
TechnologyNextGenNovell Open Text Sentillion Supporter Level
AccessPtAGFAdbMotionDinmar Oacis EMCHealthvisionHealthrampMcKesson
Valco Data Systems
Slide 100
June 28-29, 2005 Interoperability Strategy Workshop 100 IHE
North America Vendors (2004-2005) Agfa HealthCare Allscripts
Camtronics Medical Systems Cedara Software Corp. Cerner Corporation
Dictaphone Corporation Dynamic Imaging, LLC Eastman Kodak Company
Eclipsys Emageon Epic Systems Corporation ETIAM FujiFilm Medical
Systems, USA, Inc. GE Healthcare Heartlab, Inc Hitachi Medical
Corporation Hologic IDX Systems Corp. INFINITT Technology InSite
One, Inc. Intelerad Medical Systems InterSystems Corporation
Konica-Minolta Medical Imaging, USA, Inc. Kryptiq Marotech McKesson
Information Solutions MedCommons Inc. MedCon, Inc. Merge eFilm
Mortara Instrument, Inc. Novell, Inc. Philips Medical Systems QRS
Diagnostic Quovadx St. Jude Medical A.B. Sectra Imtec A.B. St. Jude
Medical A.B. Sectra Imtec A.B. Sentillion Siemens Medical Solutions
Stentor Swissray International, Inc. Tiani Medgraph A.G. Tiani
Spirit Gmbh Toshiba Medical Systems Company Vital Images WebMD
Practice Services
Slide 101
June 28-29, 2005 Interoperability Strategy Workshop 101
community Clinical Encounter Clinical IT System Index of patients
records (Document-level) Temporary Aggregate Patient History
4-Patient data presented to Physician Sharing System
3-RecordsReturned Reference to records Clinic Record Specialist
Record Hospital Record 2-Reference to Records for Inquiry At HIMSS
in 2005 : IHE-XDS
Slide 102
June 28-29, 2005 Interoperability Strategy Workshop 102
community Clinical Encounter Clinical IT System Index of patients
records (Document-level) Temporary Aggregate Patient History
3-RecordsReturned Reference to records Laboratory Results
Specialist Record Hospital Record 2-Reference to Records for
Inquiry At HIMSS in 2005 : IHE-XDS Sharing System Shared prototype
cross domain content: Medical Summaries (Pre-CCR) Discharge
Summaries (CDA-R1) Lab Results (HL7) Other (PDF)
Slide 103
June 28-29, 2005 Interoperability Strategy Workshop 103
community Clinical Encounter Clinical IT System Index of patients
records (Document-level) 1-Patient Authorized Inquiry Temporary
Aggregate Patient History 3-RecordsReturned Reference to records
Laboratory Results Specialist Record Hospital Record 2-Reference to
Records for Inquiry Demo a RHIO with IHE at HIMSS 2006 ? Sharing
System Secured Sharing of: Medical Summaries Images & reports
ECG Reports PDFs Lab Results ? + Notif of Doc Avail.
Slide 104
June 28-29, 2005 Interoperability Strategy Workshop 104
Document Life Cycle Management A two-way relationship between
Original and Addendum Document Addendum Document 1 (Approved)
Addendum Replacement Document Replacement Document 1 (Deprecated)
Document 2 (transform) Transform Document 1 (Approved) A two-way
relationship between Original and Replacement Document. A two-way
relationship between Original and Transform (alternative format
with same scope or DSG). Time Addendum to a registered document
Replacing a registered document by a new document Registering an
alternate form or a signature for a registered document Time
Slide 105
June 28-29, 2005 Interoperability Strategy Workshop 105 Local
& Regional RHIOs Infrastructure and Interoperability
Cross-Enterprise Document Sharing (XDS) minimizes clinical data
management by the infrastructure. Transparency = Ease of Evolution
XDS works with other IHE Integration Profiles: patient Id mgt,
security, etc. Flexibility of RHIO configuration With introduction
of new Integration Profiles, IHE ready to build regional health
networks linking interoperable EHRs. Major milestone for 2006 RHIO
projects Goal is to offer a consistent, standards-based and
functional for EHRs and other ancillary systems.
Slide 106
June 28-29, 2005 Interoperability Strategy Workshop 106
Creating a Health Information Network with IHE Care Delivery IT
system Care Delivery IT system Care Delivery IT system Tier 1 EHRs
and Ancillaries
Slide 107
June 28-29, 2005 Interoperability Strategy Workshop 107
Creating a Health Information Network with IHE Care Delivery IT
system Care Delivery IT system XDS Document Registry Document
Entries Care Delivery IT system Tier 2 Community HIN What and Where
? XDS Document Repository XDS Document Repository XDS Document
Repository
Slide 108
June 28-29, 2005 Interoperability Strategy Workshop 108
Creating a Health Information Network with IHE Care Delivery IT
system Care Delivery IT system XDS Document Registry C-HIN Patient
Identity Source Document Entries PDQ Consumer Care Delivery IT
system Tier 2 Community HIN Patient Demo Supplier Patient Id X-Ref
Mgr XDS Document Repository XDS Document Repository XDS Document
Repository Patient Id X-Ref Mgr Who, What and Where ?
Slide 109
June 28-29, 2005 Interoperability Strategy Workshop 109
Creating a Health Information Network with IHE Care Delivery IT
system Care Delivery IT system XDS Document Registry C-HIN Patient
Identity Source Document Entries PDQ Consumer Care Delivery IT
system Tier 2 Community HIN Patient Demo Supplier Patient Id X-Ref
Mgr XDS Document Repository XDS Document Repository XDS Document
Repository Patient Id X-Ref Mgr Time Server Who, What When and
Where ?
Slide 110
June 28-29, 2005 Interoperability Strategy Workshop 110
Creating a Health Information Network with IHE Care Delivery IT
system Care Deliver y IT system XDS Document Registry C-HIN Patient
Identity Source Document Entries PDQ Consumer Care Delivery IT
system Tier 2 Community HIN Patient Demo Supplier Patient Id X-Ref
Mgr XDS Document Repository XDS Document Repository XDS Document
Repository Patient Id X-Ref Mgr Time Server Who, What When and
Where ? Trusted !
Slide 111
June 28-29, 2005 Interoperability Strategy Workshop 111 Secured
Node Document Consumer Retrieve Document Query Documents Patient
Identity Source Patient Identity Feed Document Source Document
Registry Document Repository Provide&Register Document Se t
Register Document Set Secured Node ATNA creates a secured domain:
User Accountability (Audit trail) Node-to-Node Access Control
Node-level user authentication User access control provided by node
BUT Registry/repository based User-Level Access Control and policy
agreements is beyond XDS. User-level Access Control is provided by
XUA Security for XDS Security for XDS Leverages IHE Audit Trail
& Node Authentication A formal Security and Privacy profile is
provided for XDS
Slide 112
June 28-29, 2005 Interoperability Strategy Workshop 112
Cross-Enterprise User Authentication Transaction Diagram Identity
Provider 2 Request Assertion (of who this user is) 1 XDS Retrieve 3
Request User ID 4 User Identity 5 Authentication Assertion Record
Auditable Event ATNA Audit Repository XDS Repository
Slide 113
June 28-29, 2005 Interoperability Strategy Workshop 113 Is it
possible to federate multiple XDS-based HIN ? Care Delivery IT
system Care Delivery IT system XDS Document Registry C-HIN Patient
Identity Source Document Entries PDQ Consum er Care Delivery IT
system Tier 2 Community HIN Patient Demo Supplier Patient Id X-Ref
Mgr XDS Document Repository XDS Document Repository XDS Document
Repository Patient Id X-Ref Mgr Time Server Who, What When and
Where ? Trusted ! Care Delivery IT system Care Delivery IT system
XDS Document Registry C-HIN Patient Identity Source Document
Entries PDQ Consum er Care Delivery IT system Tier 2 Community HIN
Patient Demo Supplier Patient Id X-Ref Mgr XDS Document Repository
XDS Document Repository XDS Document Repository Patient Id X-Ref
Mgr Time Server Who, What When and Where ? Trusted ! Care Delivery
IT system Care Delivery IT system XDS Document Registry C-HIN
Patient Identity Source Document Entries PDQ Consum er Care
Delivery IT system Tier 2 Community HIN Patient Demo Supplier
Patient Id X-Ref Mgr XDS Document Repository XDS Document
Repository XDS Document Repository Patient Id X-Ref Mgr Time Server
Who, What When and Where ? Trusted ! Care Delivery IT system Care
Delivery IT system XDS Document Registry C-HIN Patient Identity
Source Document Entries PDQ Consum er Care Delivery IT system Tier
2 Community HIN Patient Demo Supplier Patient Id X-Ref Mgr XDS
Document Repository XDS Document Repository XDS Document Repository
Patient Id X-Ref Mgr Time Server Who, What When and Where ? Trusted
! Care Delivery IT system Care Delivery IT system XDS Document
Registry C-HIN Patient Identity Source Document Entries PDQ Consum
er Care Delivery IT system Tier 2 Community HIN Patient Demo
Supplier Patient Id X-Ref Mgr XDS Document Repository XDS Document
Repository XDS Document Repository Patient Id X-Ref Mgr Time Server
Who, What When and Where ? Trusted ! Tier2 Community-HINs e.g. XDS
Affinity Domain
Slide 114
June 28-29, 2005 Interoperability Strategy Workshop 114
Federating Tier 2 Health Information Networks On IHE Roadmap for
2006-2007: X-Registry Federation (Addressed by ebXML Registry 3.0)
Patient / Registry Locator Service Managed Identification Federated
Identification T2 C-HIN B e.g. XDS Affinity Domain T2 C-HIN D e.g.
XDS Affinity Domain RG What are the document registries where a
patient has information ? Tier 3 HIN e.g. State Level
Slide 115
June 28-29, 2005 Interoperability Strategy Workshop 115
Federating Tier 2 Health Information Networks On IHE Roadmap for
2006-2007: X-Registry Federation Patient / Registry Locator Service
T2 C-HIN A e.g. IDN Tier 3 HIN e.g. State Level Managed
Identification Federated Identification T2 C-HIN B e.g. XDS
Affinity Domain T2 C-HIN C e.g. IDN T2 C-HIN D e.g. XDS Affinity
Domain RG +Adapt RG Integrating existing IDNs: Adaptor +
Registry
Slide 116
June 28-29, 2005 Interoperability Strategy Workshop 116
Federating Tier 3 Health Information Networks On IHE Roadmap for
2006-2007: X-Registry Communication Patient / Registry Locator
Service T1-RHIO A e.g. IDN e.g. State HIN T1-RHIO B e.g. XDS
Affinity Domain T1-RHIO C e.g. IDN T1-RHIO D e.g. XDS Affinity
Domain RG Patient / Registry Locator Service T1-RHIO A e.g. IDN
e.g. State HIN T1-RHIO B e.g. XDS Affinity Domain T1-RHIO C e.g.
IDN T1-RHIO D e.g. XDS Affinity Domain RG Patient / Registry
Locator Service T1-RHIO A e.g. IDN e.g. State HIN T1-RHIO B e.g.
XDS Affinity Domain T1-RHIO C e.g. IDN T1-RHIO D e.g. XDS Affinity
Domain RG Patient / Registr y Locato r Servic e T1-RHIO A e.g. IDN
e.g. State HIN T1-RHIO B e.g. XDS Affinity Domain T1-RHIO C e.g.
IDN T1-RHIO D e.g. XDS Affinity Domain RG Patient / Registr y
Locato r Servic e T1-RHIO A e.g. IDN e.g. State HIN T1-RHIO B e.g.
XDS Affinity Domain T1-RHIO C e.g. IDN T1-RHIO D e.g. XDS Affinity
Domain RG Nation-Wide Health Info network (Tier 4)
Slide 117
June 28-29, 2005 Interoperability Strategy Workshop 117 IHE:
RHIOs Interoperability Partner IHE offers a solid technical
foundation to establish interoperability for RHIOs.
Standards-based, open, multi-vendor, provider-led. Yearly progress,
validation testing built in, backed by a proven process.
Implementation by many vendors. IHE welcomes RHIOs technical
architects active involvement. The IHE Technical Framework
accelerates RHIOs pilot development ( e.g. XDS Affinity Domain ).
This is being applied: Norway, Italy, then Canada, soon USA,
France, ?
Slide 118
June 28-29, 2005 Interoperability Strategy Workshop 118
Clinical Encounter Clinical IT System 1-Expression of a need for
additional information Index of patients records (Document-level)
Temporary Aggregate Patient History 3-DocumentsReturned Document
Repositories 4-Patient data presented to Physician 3-Reference to
Docs from Inquiry 2- Inquiry for Docs Clinicians access XDS
Services through their clinical IT system (EHRs)
Slide 119
June 28-29, 2005 Interoperability Strategy Workshop 119 Sharing
Radiology Reports and Images with XDS in a Regional Health
Information Network Radiology Enterprise A Radiology Enterprise B
Physician Office Regional Health Information Network PACS B PACS A
Radiology-to-radiology Radiology-to- Physicians
Slide 120
June 28-29, 2005 Interoperability Strategy Workshop 120 Sharing
Radiology Reports and Images in a Regional Health Information
Network Radiology Enterprise A Radiology Enterprise B Physician
Office Regional Health Information Network Cross- Enterprise
Registry Patient Id= 3547F45 Report 5/21/1998 : CT Head B Study
5/21/1998 : CT Head B Report 2/18/2005 : Chest Xray A Study
2/18/2005 : Chest Xray A PACS B PACS A
Slide 121
June 28-29, 2005 Interoperability Strategy Workshop 121
Physicians and Systems within a Regional Health Network - Routine
Imaging Referral Radiology Enterprise A Radiology Enterprise B
Physician Office Regional Health Information Network Query for
Documents Register Imaging Information for sharing Prior imaging
Reports & Studies Cross- Enterprise Registry Register Imaging
Information for sharing Patient Id= 3547F45 Report 5/21/1998 : CT
Head B Study 5/21/1998 : CT Head B
Slide 122
June 28-29, 2005 Interoperability Strategy Workshop 122
Physicians and Systems within a Regional Health Network - Routine
Imaging Referral Radiology Enterprise A Radiology Enterprise B
Physician Office Regional Health Information Network Register
Imaging Information for sharing Cross- Enterprise Registry
Notification of Doc Availability Register Imaging Information for
sharing
Slide 123
June 28-29, 2005 Interoperability Strategy Workshop 123
Physicians and Systems within a Regional Health Network for a
Routine Imaging Referral Radiology Enterprise A Radiology
Enterprise B Physician Office Prior Imaging Report & Study
Regional Health Information Network Query for documents Imaging
Report & Study Cross- Enterprise Registry Patient Id= 3547F45
Report 5/21/1998 : CT Head B Study 5/21/1998 : CT Head B Report
2/18/2005 : Chest Xray A Study 2/18/2005 : Chest Xray A
Notification of Doc Availability
Slide 124
June 28-29, 2005 Interoperability Strategy Workshop 124
Regional Health Information Network Images and reports part of a
shared health record Enterprise A Enterprise B Physician Office
Retrieve Prior Documents Query for Documents Regional Health
Information Network Query for documents Retrieve Documents Register
Documents for sharing Retrieve Prior Documents Cross- Enterprise
Registry Register Documents for sharing Notification of Doc
Availability
Slide 125
June 28-29, 2005 Interoperability Strategy Workshop 125 or Lab
Results Document Content Format of the Document Content and
associated coded vocabulary For Display Document Content Format of
the Document Content Requirements for care delivery IT system in a
RHIO (e.g. EHR, Lab, Imaging, etc.) Consistent Time Coordinate time
across networked systems Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to
create a secured domain. Patient Demographics Query
Cross-Enterprise Document Sharing Registration, distribution and
access across health enterprises of clinical documents forming a
patient electronic health record Notification of Document
Availability Notification of a remote provider/ health enterprise
Imaging Information Sharing Format of the Document Content and
associated coded vocabulary Medical Summary Document Content Format
of the Document Content and associated coded vocabulary Document
Digital Signature Attesting true-copy and origin Patient Identifier
Cross-referencing Map patient identifiers across independent
identification domains Cross-enterprise User Authentication
Authentication & Auditing: Basis for Access Control
Slide 126
June 28-29, 2005 Interoperability Strategy Workshop 126 IHE:
Interoperability for RHIOs By starting with a secured document
sharing infrastructure, RHIOs have a a platform on which to build
clinical content (more structure & coded terminology,
specialized content). Solid SAML 2.0 authentication and document
digital signature (need a PKI). Practical HL7 V3 approach with
CDA-R2 and other content (e.g. imaging, CCR, legacy, PDF, etc.).
Establishing a critical mass of products implementations, both in
clinical applications and infrastructure for deployment in 2006. An
architecture that caters to various RHIOs architectures:
centralized, decentralized and mixed (operational decision).