Gaps in Patient-Centric Healthcare Standards. IEEE Health IT Standards Study Group March 29, 2006
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1 Gaps in Patient-Centric Healthcare Standards IEEE Health IT Standards Study Group March 29, 2006
2 MedCommons Standards Participation HIMSS IHE ASTM-CCR Liberty Alliance Project ONC HITSP IEEE-SA 2
3 Consumer Orientation Banking Business Model Neither payor nor provider Voluntary participation Clear and practical Standardized and fungible Compete on privacy and service 3
4 Problem: Database Quality and Privacy Big Central Database Record Locator Service Application Specific Database Informed Consent Database (PHR Service) No Database (Paper) 4
5 The Consumer as a Bridge Public Interest Business Interest 5
6 Bridging NHIN Perspectives Public Interest Biosurveillance and Public Health Health Promotion (Pay-for-Performance) Volunteerism (Blood Banks, Transplants) Consumer Value Simplicity Portability Consumer-Friendly Standards and Informed Consent Business Branding Proprietary Advantage Profit 6
7 Interoperability Not Integration Cross-Enterprise Policy-Driven Choice of Long Distance Carrier, Telephone Hw., Phone Number Portability, Mac and PC Stupid Network Independent PHR Banking Innovation 7
8 Interoperability Drivers Objective Quality Metrics Pay for Performance Consistent Coding of Health Status Biosurveillance Decision Support Innovation Rules, alerts, pre-accreditation, co-pay Personalized Medicine Privacy 8
9 Privacy and Trust Protocols LAYER INTERFACE Top Federation. Corporations Single Sign-On.. People Linkage... Bottom Content... Accounts Private Information 9
10 Cross-Enterprise Standards Federation... SSO Consent... SSO... Preview PHR... Import PHR... Export PHR... Enterprise Accountability Identity Linkage Security Logs Role Sensitivity Relevance / Sections The PHR as Avatar 10
11 CXP is the Commons exchange Protocol Personal Health Records Government (My HealtheVet) Proprietary (Medem, WebMD) Hospital (Epic) Insurer Employer Quicken for Healthcare CCR Community Practices Hospitals Independent Practices RHIO Services Home Health CXP CCR 11
12 VistA My HealtheVet HOSPITAL RHIO PHARMACY HTTP Single Sign-On GATEWAY XML GATEWAY RECORDS LOCATOR PATIENT SAML HTTP COMMUNITY PRACTICE INSURANCE SECURITY NOTICES HTTP SAML CXP CXP CXP NATIONAL PHR SERVICE PROVIDER (MedCommons, others...) 12
13 CXP = PHRs on the Web Not tied to CCR ASTM CCR is the only XML patient summary available today. Supports all Patient ID schemes Both US and European privacy approaches Public Domain Not controlled by MedCommons Can remain in the public domain or be brought into any interested standards organization. 13
14 INFOCARD IDENTITY PROVIDER WS-* etc... INFOCARD RELYING PARTY LIBERTY IDENTITY PROVIDER SAML WSF etc... LIBERTY SERVICE PROVIDER Optional CXP CLIENT GET PUT DELETE CXP SERVER CXP Protocols WS-* PROTOCOLS SOAP / MTOM TCP / IP, etc... 14
15 Jane s PC HMO / RHIO Fictional_Home_Health_Hub.net CXP Client Perspective Federated IDP Perspective TRUST Federated SP Perspective CXP Server Perspective ACQUIRES IDENTITY GENERATES CERT / TRANS ID GENERATES X509 CERT ACQUIRES IDENTITY USES IDENTITY USES LIBERTY or INFOCARD USES IDENTITY CXP CLIENT INITIATOR CXP PAYLOAD WS-* CXP SERVER TARGET TRUSTS IDP CXP CLIENT INITIATOR CXP RESPONSE WS-* CXP SERVER TARGET15
16 Demo CXP in a PHR or EHR CXP Web Service Configuration Patient chooses registry Patient consents to account linkage Export Patient or clinician sends a medical summary Receives a confirmation code and privacy code (PIN) Import Preview on Web if desired Merge vs. Create New Notification Account Changes CXP Transfers 16
17 Consumer Centered 1. Unlike a typical RHIO, MedCommons indexes absolutely no private information and does not participate in master patient index arrangements that are presumed by typical RHIOs. 2. Support for two-factor authentication and SAML standard single sign-on provides a strong forensic audit trail for identity assertions across the Enterprise MedCommons boundary. 3. CXP Web service protocol is standards based and transparent to CCR and future XML-based PHR interoperability standards per market demand. 4. MedCommons sends simple, privacy-safe s notices to the patient each time their PHR account is accessed or updated by anyone. 5. The patient and community practitioners can access the patient s PHR using any modern web browser or via CXP-compatible PHR and EHR software. 6. MedCommons provides an informed consent mechanism for the patient to forward information to secondary registries such as a RHIO. 17
18 Additional Information CXP Protocol CXP 1.0 Protocol Specification CXP and Federated Identity White Paper CXP C# Sample Client Documentation CXP C# Sample Client Source Code HIMSS 2006 Interoperability Showcase Demo SAML Single Sign-On and Voluntary Account Linkage Presentation Liberty Alliance 18
19 Thank You! Contact: Adrian Gropper MD Chief Science Officer MedCommons (cell) 19
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