Clinical Exchange Platform for procurement through the G-Cloud

Transcription

1 Clinical Exchange Platform for procurement through the G-Cloud Contents Cerner Clinical Exchange Platform Overview... 2 Open Source Components... 2 Information Assurance... 5 Backup/Restore and Disaster Recovery... 6 On Boarding... 6 Off Boarding... 7 Pricing... 7 Service Management Details... 7 Service Constraints... 8 Service Levels... 9 Training... 9 Ordering and Invoicing process Termination Terms Data Restoration / Service Migration Technical Requirements... 10

2 Introduction This document has been produced to form part of Cerner s response to the GPS invitation to Tender for G-Cloud and is designed to give you more information on the services we provide. Cerner Clinical Exchange Platform Overview Cerner s Clinical Exchange Platform (CEP) is a secure, standards-based Health Information Exchange (HIE). It provides a scalable, common platform to integrate clinical data from existing disparate systems across the healthcare economy and can manage the wide variety of clinical records and document types prevalent in today s healthcare system. CEP offers turnkey functionalities that reduce the complexities of HIE implementation while protecting the investments that have been made in the useful-life of legacy environments. By leveraging industry standards, CEP enables other vendor systems that also use those same standards to easily work together, avoiding much of the resource investment that is required to connect, upgrade and maintain non standards-based multi-vendor healthcare systems. CEP supports global industry and local national standards for the electronic exchange of healthcare information, including HITSP, HL7, EDI, ITK and IHE, providing a vendor-agnostic approach to connecting disparate systems. In the NHS we have connected or are in the process of connecting with prevalent suppliers. The data elements we will target for sharing include: conditions/problems, allergies, medications, immunisations, visits (encounters), results, and documents such as discharge letters, GP correspondence, reports, etc. CEP leverages Integrating the Healthcare Enterprise ( standards, a global initiative to create the framework for passing vital health information seamlessly, from application to application, system to system and setting to setting across multiple healthcare enterprises. Through IHE, healthcare information technology stakeholders implement standards to communicate patient information efficiently by developing a framework for interoperability. Because of its proven process of collaboration, demonstration and real-world implementation of interoperable solutions, IHE can accelerate the course to define, test and implement standards-based interoperability among electronic health record systems. Open Source Components The CEP leverages a suite of tools brought together by proprietary intellectual properties creating a low cost IHE standards based exchange (OpenHRE ). The CEP allows caregivers without an Electronic Patient Record (EPR), to gain access to a rich data set. The web portal includes a Web 2.0 interface allowing the user to customise

3 their experience. The web portal will bring to the clinician a HITSP Standard C32 driven Continuity of Care Document (CCD) of aggregated patient information. Caregivers with an EPR Solution can gain access to the HIE as part of their workflow. For Millennium users, this access is gained through the use of Millennium Pages (MPages). For those without Millennium, the EPR Solution will need the functionality to send Transport Layer Security (TLS) type of transaction to a Web Service; then present the CCD as an HTML. EPR Solutions that can access IHE Standards based HIEs can access the data directly using the IT Infrastructure IHE Profiles. Some of the main open source components include: IHE Profiles As the exchange hub for health records from multiple vendor systems, it is essential that an HIE solution support standard interfaces to exchange standardised documents. OpenHRE uses the IHE Web-Service-Based Profiles to achieve this. The IHE Profiles are the accepted standards for EPR interchange. Evolving protocols, including those from HITSP and ITK are based on IHE Profiles. An example is the document that allows for patient continuity of care. The IHE XDS.b profile is non-specific as to which document is to be used. HITSP recommends the C32 CCD document, based on the HL3 v3 CDA. The C32 is specific on matters of inter and intra system communication and semantic interoperability. Patient Locator Service (PLS) The OpenHRE Patient Locator Service maintains a registry of various demographics that patients have used to identify themselves to care providers, and a set of algorithms used to match these various demographics in order to locate all the care providers of a patient, regardless of variations in identifying demographics. The PLS is used to implement the IHE PIX and PDQ Profiles. Patient Identifier Cross-Referencing (PIX) PIX is the key profile that allows for patient matching across the HIE. The participating systems send their patient identifiers and key demographics to the HIE using the PIX Patient ID Feed. This allows OpenHRE to match patient identities between HIE participants. A PIX Query supplies patient demographics values to OpenHRE, which then returns identifiers for that patient across all of the participating systems within the HIE. Cross-Enterprise Document Sharing (XDS.b, XDR, XDS-SD, XD-Lab) Once the identities across the HIE have been established for a patient, XDS allows for the actual sharing of health information. Document sources can Provide and Register Documents in the XDS Registry and Repository. The Registries and/or Repositories can be Federated and/or Centralised. Document retrieval is usually accomplished in two phases. An XDS Registry Query supplies patient identifiers and

4 document filters to an XDS Registry, and identifiers are returned for documents that meet the criteria. Examples of document filters include document type identifiers and date ranges. The document identifiers can then be used by XDS Retrieve Document messages, which retrieve individual documents. This two-phase approach allows for a filtered list of documents to be displayed to the user, who may or may not request some or all of the listed documents. OpenHRE has the capability of returning individual documents in their original form, or aggregating and/or transforming them into a display format. Basic Patient Privacy Consents (BPPC) Patient consent must be either obtained or implied before their health information can be shared in an HIE. Some deployments require opt-in, whereas others allow for opt-out policies. In either case it is necessary to record the patients' consent choices and share that information throughout the HIE. Sharing Value Sets (SVS) SVS provides a means through which healthcare systems producing clinical or administrative data, can receive a common, uniform nomenclature managed centrally. Shared nomenclatures are essential to achieving semantic interoperability. SVS establishes a Shared Value Repository that can be accessed as needed across the HIE to provide shared nomenclature to encode and decode standardised health information. The C32 record, for example, includes many encoded standardised data items. Audit Trail and Node Authentication (ATNA) Automated controls to protect against any possible violations of policies is not possible in a healthcare environment without the potential for slowing down the delivery of health care, which can endanger patients. In addition, hospital systems are usually deployed and administered with an eye towards privacy and security. To this end logging and auditing is widely used by health information systems, under the presumption that providers who know that their actions are being recorded are likely to not violate policies without very good medical reasons. The "Node Authentication" portion of ATNA establishes the participating system nodes within the HIE that are trusted. Trust is certified between the ATNA Audit Record Repository and the audited nodes through Dual TLS, including the two-way exchange of certificates. The audit records themselves are recorded uniformly to conform to the RFC-3881 XML schema, which allows for standard auditing software to monitor and report on the records. Logging is an integral part of all the IHE Profiles, and a Profile will fail if it is not being processed by an ATNA Trusted Node.

5 Web Portal The desirable use of an HIE is as a back-end hub to allow data sharing between EPR systems. This allows providers to continue to use their familiar systems, without the need to learn and log on to yet another system. The IHE Profiles were created with this in mind, with the assumption that EPR vendors would implement the profiles to integrate HIE functions into the EPR systems themselves. There are some providers, however, that do not have access to an EPR system, but who could still benefit from the ability to access available HIE data for their patients. For this purpose OpenHRE provides a Web Portal and a user interface for querying and displaying HIE data, as well as an innovative system for gathering and storing patient consents using an electronic tablet. The OpenHRE user interface is browser-based, using the latest Web 2.0 techniques, including AJAX. Information Assurance Cerner has a comprehensive quality management framework and processes covering all aspects of operations from software development, testing and deployment to sales, implementation and support services. These quality controls are ISO certified under ISO 9001:2008 and ISO 13485:2003. Cerner s Quality System (CQS) along with its policies and procedures with respect to associate qualifications and training, vendor qualification and acceptance, and related good manufacturing processes are confidential and proprietary to Cerner. All quality system documentation required for compliance with applicable regulations and accrediting standards is maintained at Cerner s World Headquarters located in Kansas City, Missouri. Cerner s Quality System is a dynamic system and is intended to remain dynamic through continuous feedback, monitoring by system audits, management review, and corrective and preventive action. The UK Data Centre where CEP is hosted is ISO 9001, ISO 14001, OHSAS 18001, ISO and ISO certified. Internal quality audits are conducted to monitor Data Centre compliance with corporate policies and procedures.

6 Backup/Restore and Disaster Recovery The CEP solution hosting platform is located in Cerner s Slough, UK based data centre by its own professional hosting team known collectively as CernerWorks. CernerWorks is an ISO 9001:2000 certified organisation, whose primary function is to host, manage and monitor client systems. Over 100,000 users are actively using CernerWorks. CernerWorks Production Data Centres are designed to provide a fully redundant, N+1 Power and Air Conditioning environment. A redundant UPS system is utilised to provide temporary power in case of loss of the primary power source. Backup generators provide power for extended interruptions of the primary power source. CernerWorks provides support staff 24x7x365 to ensure alert, prepared, and knowledgeable resources are immediately available for daily operations and during a disaster. Knowledgeable personnel are staffed at multiple facilities to ensure coverage in the case of a facility-specific event. CEP Support Services include the following: Secure hosting in Cerner s N+1 Technology Centre Hardware and Maintenance Data Centre Operations (24 x 7 x 365) Technical (IT) Support Network Connectivity to Client Site Offsite Tape Backup Project implementation services CernerWorks Enterprise Back Up Policy defines the minimum requirements for backing up system and electronic information/data for the purpose of recovering critical systems and services in case of data loss or failure. The UK Data Centre has a documented Disaster Recovery Plan, the document was last reviewed December 15 th 2011 (ISO ISF meeting). Monthly, the Data Centre carries out Generator Full Load Tests. On Boarding The on-boarding process takes into account the addition of consumers to the service that access the patients longitudinal record at the point of care. Also as contributors to the service who will augment the patients longitudinal record. Once Client and Cerner have signed the Call-Off Agreement and the Cerner Heathe Intent Services and Clinical Exchange Platform Agreement (including the Sales Order for CEP ) the following will be carried out: 1. Design decisions on how data will be supplied and accessed, including security and consent. 2. Review requirements and extend infrastructure as required.

7 3. Analyse new contributors of data and test in non-production. 4. Test as consumers of data ideally within existing clinical workflow in non-production. 5. Analyse live feeds from contributors and ability of consumers in non-production 6. Training on solution and tools. 7. Load historical data into production. 8. Live with new contributors and consumers. Off Boarding The off-boarding process takes into account the Client as consumer and third parties as data contributors. If Client requests termination of a contributor source: -Contributor source will be disconnected within ten (10) working days of the request. -Data previously contributed by the source will remain in the system, but no more data will be contributed. If Client requests full termination of the CEP the website will be disconnected for access within ten (10) working days. The database will be deleted within a period of forty five (45) days from the request. Pricing The pricing below is as of March 6 th, 2013 CEP Set-Up Fee 200,000 CEP Set-Up Fee for each additional data source 20,000 Annual Support Fees for CEP 120,000 Annual Support Fees for each additional data source 4,000 The above price is subject to indexation as follows: The first indexation date will be one year after the signature of the Framework Agreement between the Government Procurement Service and Cerner and annually on each anniversary date thereafter.

8 Cerner s prices will be adjusted to reflect the effects of inflation after that date. The adjustment shall be measured by changes in the relevant index published for that twelvemonth period as calculated in accordance with the following formula: Amount or sum x RPId RPIo Where RPId is the value of the Retail Prices Index published or determined with respect to the month most recently preceding the date when the provision in question is to be given effect and RPIo is the value of the Retail Prices Index on the signature of the Framework Agreement between the Government Procurement Service and Cerner. Service Management Details Cerner will provide for the management, security and performance of the computing systems required to operate Cerner s CEP. The computing system includes host nodes running the CEP database, communication clients, and interface engine. This aspect of the computing system is commonly referred to as the back-end systems, and also includes the storage technology and media. The back-end systems also include the required operating systems (OS) and layered-products necessary for the environment to operate. The computing system also includes the Microsoft-based web server resources necessary to provide access to the CEP environment and execute application and server requirements to facilitate printing (excluding client print servers required for and on the User PC). In the context of Cerner s CEP, this aspect of the computing system is referred to as the front-end systems. The front-end systems also include the required operating systems (OS) and layered-product licenses necessary for the CEP environment to operate. Lastly, the computing system includes management and monitoring systems and software to monitor and report on system health, security, capacity and availability. Service Constraints In the event of an upgrade to the CEP, Cerner will contact users via at least five (5) business days in advance of the exact time of an upgrade. Users may experience some environment slowness during that time and it is suggested that they refrain from system usage during that time. Cerner makes every effort to limit the amount of scheduled upgrade time. Upgrades typically take place during Saturday overnight hours in the United States.

9 Service Levels Cerner provides world-class service and support to all clients who have licensed Cerner solutions and services. There are four approaches to tapping into this world-class service and support. 1. Cerner.com offers self-service functions that allow our clients the freedom and flexibility to access valuable information about their business relationship with Cerner including complete business transactions, research solutions issues, track on-going service records and connect with other clients and Cerner associates anytime. 2. The Client Care Contact Centre serves as a key component for the long-term business and service relationship between each client and Cerner. The Client Care Contact Centre is Cerner s first line of support to respond to clients requests for general Cerner information, training, Cerner events, financial, quotes and technology maintenance. The Client Care Contact Centre is staffed Monday through Friday, 0700h 1900h (holidays excluded). 3. The SolutionWorks organisation is Cerner s support organisation responsible for receiving and resolving service records that are non-critical in nature. Support Analysts exist in each solution and technical area and are trained to assess any reported issue and to provide a complete resolution or alternative for the reported issue. The SolutionWorks organisation is staffed Monday through Friday, 0700h 1900h (holidays excluded). 4. The Immediate Response Centre (IRC) is located in Kansas City, Missouri, and is staffed 24 hours per day, 365 days per year by systems-trained Support Analysts. The IRC is committed to providing clients with the fastest possible solution or workaround to any critical issue that impairs the immediate operation of a Cerner production system. A critical issue is defined as an issue that impacts patient care, or causes financial or operational issues. The IRC team is supplemented by domain experts from other Cerner support groups who are available on an on-call basis to provide further expertise when needed. Training Cerner shall provide this following with respect to Client training: CEP specific help content in electronic format, Training and curriculum materials, and Train-the-trainer sessions for the CEP Additional training may be acquired from Cerner in an additional engagement or expansion of services if required.

10 Ordering and Invoicing process The customer shall order the CEP from Cerner by signing the Call-Off Agreement and the Cerner Heathe Intent Services and Clinical Exchange Platform Agreement (including the Sales Order for CEP ). CEP set-up fee will be invoiced upon signature of the Cerner Heathe Intent Services and Clinical Exchange Platform Agreement and Sales Order for CEP. Support fees will be invoiced quarterly at the beginning of each calendar quarter, beginning upon the date the HIE record is accessed by the customer from a production environment (Go-Live). For any support s related to a partial calendar month the monthly support fee will be prorated according to the actual calendar days during which the support services were performed. The monthly support fee is subject to indexation as defined in Cerner template Sales Order for CEP. Termination Terms Upon termination or expiration of either the Term or the Cerner Heathe Intent Services and Clinical Exchange Platform Agreement Cerner will take measures to terminate the CEP which usually do not take longer than ten (10) working days. Upon termination, the Client shall pay any outstanding balance to Cerner. Any invoices that are sixty (60) days delinquent will result in service termination. Data Restoration / Service Migration The CEP holds shared data in a Cross Enterprise Document Sharing (XDS) repository. As a standards-based specification for managing the sharing of documents, systems that are compliant with such IHE Profile are able to access the data directly to render in the application as required. Technical Requirements The CEP web portal requires the use of a modern web browser. Cerner recommends using the latest version of Internet Explorer (IE9). We also support the last two versions of Internet Explorer (IE7 and 8), the latest version of Chrome (21), the latest version of Firefox (14) and the latest version of Safari. CEP is a rich web application and requires a high-speed Internet connection (i.e. a connection with data transfer speeds greater than or equal to 256 kb/s) for optimal performance.