• Today’s Objectives Arlo Jennings, Datalink• Review of HIT Collaborative Decision Points Vandana Shah, HWTF• Work Group Deliverables Arlo Jennings, Datalink• Deliverable Dependencies Melanie Allison, HWTF • NC HIE Challenges Melanie Allison, HWTF• NC HIE Strategy Submitted to ONC Arlo Jennings, Datalink &
Melanie Allison, HWTF• Role of Technical Infrastructure Work Group Arlo Jennings, Datalink &
Melanie Allison, HWTF
NC HIE StrategyTechnical Infrastructure Work Group
agenda
Thursday, December 03, 200910:00 am -12:00 PM1100 Navaho Drive
Raleigh1-866-427-0083
Room #: *8041709* (don’t forget the asterisks before and after the room #)
Today’s Objectives
• Discuss dependencies of Technical Workgroup Deliverables on Community HIE Deliverables
– Functional requirements
• Review architecture design proposed in Strategic Plan submitted to ONC on October 16th
– Shared Services Environment
– Service Oriented Architecture
• Discuss role of Technical Infrastructure Work Group– Working from the same “playbook”
– Service Design Process
StructureRole DefinitionProcess
Decision Point #1
Decision Point #4
Decision Point #3Decision Point #2
NEAR TERM DECISION POINTS
GovernanceCommunityDefinition
Functional Requirements
CHIE Geographic DefinitionDomain CHIEs Prioritization of MU Criteria by
statewide stakeholders
DeploymentRoadmap
“Where & When” Selection Criteria for Target Communities
Decision Point #5
Consent ModelDevelopment ProcessLeverage existing work?Time Constraints
Decision Point #6
Business Model
Core HIE ServicesStatewide Directories/RepositoriesOther Data or Functional Assets?
ROI ModelingRevenue Stream Projection
MUPrioritization
Community HIE Workgroup
Technical Infrastructure Workgroup
Business Model/Sustainability Workgroup
Legal/P & S Sub-workgroup
Goveranance Workgroup
Review: Technical Infrastructure Work Group Deliverables
Deliverable One:
– Define HIE Services & functional requirements• Core services
• Additional services
Deliverable Two:
– Deployment Roadmap• What is being developed for whom?
• How and when will it be deployed?
Deliverable Dependency on Community HIE Work Group Deliverables
Community HIE Work Group Status:2)Consensus on RHIO vs. CHIO3)Consensus on Defining a region based-HIE (RHIO) & Domain-based HIE4)Consensus on recognition of 3 RHIOs in NC & leveraging CCNC for organizing/convening other potential RHIO initiatives
Community HIE Work Group Status:2)In process of defining NC HIE services at high level of abstraction3)Exploring “tiered approach”: functional requirements of existing RHIO vs. new RHIO
NC HIE Challenges
• Limited Funding: $12.9M
• HIE Capacity Needs: CMS/Supporting MU Requirements & building capacity in other sectors
• Currently working in vacuum: MU final ruling due in December 2009 & could be delayed until Q1 2010
• Varying technical and resource capabilities across healthcare organizations
• Variability in HIE value propositions across stakeholders
• Privacy Issues: Delicate balance of protecting a patient’s privacy & allowing access to needed clinical information
• Non-defined consent management strategy
• Sustaining HIE over time post ONC funding
NC HIE Strategy Submitted to ONC
North Carolina Harmonization:Shared HIE Services
NC
HIE
TE
CH
NIC
AL
INFR
AS
TR
UC
TU
RE
PHIN
Commercial Labs
RXHubGateway Service
CHIO
Hospital EHR Primary Care
Providers:EHRDiagnostic Imaging
Service Providers ConsultingClinicians
COMMUNITY DATA PROVIDERS& USERS (Consumer)
CommonServices
NC SHARED HIESERVICES
NHIN
MPI,Data &Query Services
Hospital HISSource System
Hospital RXSource System
Hospital LisSource System
HO
SP
ITAL D
ATA
PR
OV
IDE
RS
& C
ON
SU
ME
RS
MPI,Data &Query Services
LIS Source System
MPI,Data &Query Services
CHIO
MMIS
COMMUNITY HOSPITALS
MPI,Data &Query Services
Co
mm
erc
ial L
abs
IDN
sH
ealth
Pla
ns
IMMUNIZATIONREGISTRY
DISEASERGISTRY
PROVIDERDIRECTORIES
DHIO( Domain Community)
MPI,Data &Query Services
CLINICS
Table 3: Service Implementation Estimate
2010
2011
2012
2013
RHIO 1
CHIO 2
UTILITY SERVICES
Patient Id Resolution Svc: MPI & RLS 2010Access Conrol/Security ServicesIntegration ServicesEMR Data Service 2011Healthcare Vocabulary Service 2011Provider Registry 2013 2013Immunization Registry 2013 2013NHIN Gateway 2013 2013
TASK SERVICESElectronic Eligibility and Claims 2013 2013Electronic Prescribing and Refills 2011Electronic Clinical Lab ordering and Results 2012Electronic Public Health Reporting 2013 2013Quality Reporting 2013 2013RX Fill Status and/Med Fill History 2011Clinical Summary Exchange (CCD) 2013 2013
GOVERNANCEMaster Consent/Participation Agreement 2010Master Data Sharing Agreement (DURSA) 2010
Co
re S
erv
ice
s
BUILDING HIE SERVICE AND E.H.R. CAPABILITIES SIMULTANEOUSLY TO RAPIDLY EXPAND CAPACITY
COMMUNITY HIE ONE
HIE SERVICE BUILD-OUT
CORE HIE SERVICES & ACCESS TO CLINICAL DATA VIA WEB APPLICATION
ADDITIONAL CLINICAL DATA SOURCES
REAL TIME CLINICAL ORDERS/ RESULTS
EXCHANGE OF PATIENT DATA ACROSS PROVIDERS
E.H.R. CAPABILITY DEVELOPMENT LIFECYCLE
E.H.R.IMPLEMENTATION
CAPABILITIES EXPAND:E.H.R CAN GENERATE CLINICAL ORDER & RECEIVE RESULT
CAPABILITIES EXPAND: HISTORICAL LAB RESULTS & MEDICATION HISTORY POPULATE E.H.R
CAPABILITIES EXPAND: E.H.RCAN GENERATE A CCD/PATIENTSUMMARY
CAPABILITIES EXPAND: E.H.REXCHANGING PATIENT DATAACROSS PROVIDERS
NHIN-COMPLIANT HIE SERVICE
E.H.R.IMPLEMENTATION
CAPABILITIES EXPAND: HISTORICAL LAB RESULTS & MEDICATION HISTORY POPULATE E.H.R
CAPABILITIES EXPAND:E.H.R CAN GENERATE CLINICAL ORDER & RECEIVE RESULT
CAPABILITIES EXPAND: E.H.RCAN GENERATE A CCD/PATIENTSUMMARY
COMMUNITY HIE TWOITERATIVE IMPLEMENTATIONPROCESS
NCSHS
E.H.R.
NC SHARED HIE SERVICES CAPABILITY DEVELOPMENT LIFECYCLE
Role of Technical Infrastructure Workgroup• Tight alignment with Community HIE Work
• NC HIE adoption of HIE terms/concepts
• Working from the same “playbook”– Fundamentals of SOA
• Basic Terms & Concepts/Architecture Fundamentals
• Architecture of Service-Orientation
• SOA Design Pattern– Fundamentals
– Pattern Notation & Profiles
• Service Inventory Design Patterns
• Service Design Patterns
• Service Implementation Patterns
• Service Composition Design Patterns
– Service Design Process
• Creation of Service Design Team: Developing service inventory functional requirements