Building Regional and National Health Information Systems Mike LaRocca
Agenda What are the key use cases driving New York? What is the SHIN-NY NY and its architecture? What standards and protocols were chosen? What role does HealthShare play?
Abstract Use Cases Pull Model Push Model Analytics Clinician queries an HIE for a patient s s medical summary Patient queries an HIE for their, or dependents, summary Lab/Radiology results subscriptions Clinician-to to-clinician messaging Clinician-to to-patient messaging Public health notifications Healthcare trends by region, demographics, code, Quality reporting of participating facilities
Specific Use Cases, New York State Connecting New Yorkers and Clinicians Interoperable EHR for Medicaid Health Information Exchange for Public Health Quality Reporting for Outcomes
Agenda What are the key use cases driving New York? What is the SHIN-NY NY and its architecture? What standards and protocols were chosen? What role does HealthShare play?
What is the SHIN-NY? State Health Information Network for New York NYeC New York ehealth Collaborative Responsibilities include: Convening, educating and engaging key constituencies Developing statewide policy guidance Evaluating and establishing accountability measures for NY RHIOs Regional Health Information Organizations Focused on integrating large facilities within a community CHITAs Community Health IT Adoption Collaborations Analogous to national RHITECs Focused on integrating small practices within a community
What is the SHIN-NY Architecture? Consumers Consumers Little Bus Statewide Big Bus Little Bus Providers Community A Providers Community B Community-wide services can be promoted to statewide use Communities may retire internal services in favor of a statewide service Big bus mitigates traffic between little bus implementations
Connecting New Yorkers and Clinicians PHR Consumer Community Little Bus Statewide Big Bus PHR Provider EMR Provider Community B Community C Community A
Interoperable EHR for Medicaid Consumer Consumer Medication History eprescribing Community Little Bus Centralized access to Medication History and eprescribing services NCPDP and X12 payloads Medication History eprescribing Statewide Big Bus Medication History Surescripts eprescribin g Medication History Medicaid Eligibility Formulary Medication History State HIEs
Health Information Exchange for Public Health Community Little Bus Public Health Service CDR Community-wide CDR and PHS Inbound and outbound coordination with statewide service Patient de-identification and re- identification Inbound Notifications Statewide Big Bus Outbound Notifications Public Health Service
Quality Reporting for Outcomes Community Little Bus Quality Services CDR Community-wide CDR and QS Reports on service quality within a community Inbound and outbound coordination with statewide service Inbound Notifications Statewide Big Bus Outbound Notifications Quality Service
Agenda What are the key use cases driving New York? What is the SHIN-NY NY and its architecture? What standards and protocols were chosen? What role does HealthShare play?
CHIxP Messaging Patterns Consumer Community Little Bus Statewide Big Bus Provider Community A Provider Community B Community C WS-BaseNotification: Asynchronous messaging based on subscribe / notifyn WS-ReliableMessaging: Delivery assurances that include: At Least Once At Most Once Exactly Once In Order
Service Identification: UDDI v3.0 Consumer Little Bus Statewide Big Bus Service Registry Service Service Community A Universal Description, Discovery, and Integration, with responsibilities including: Provide end points for published web services Provide WS-Security Security configuration details (SAML, X.509, Username, Kerberos Profiles)
Patient Identification: PIXv3 and PDQv3 PIXv3 Patient Identity Cross-Referencing version 3 Traditionally thought of as an MPI Responsible for resolving demographics and identifiers across multiple Identity Sources within a single affinity domain (a single community is an example of a domain) Allows consumer applications to do deterministic queries PDQv3 Patient Demographics Query version 3 Allows consumer applications to do probabilistic queries
Document Identification and Retrieval: XDSb and XCA XDSb Document management within a single community Document Registry manages metadata Document Repositories manage content Based on ebxml Registry and Repository definitions XCA Document management across communities Leverages XDSb infrastructure Initiating Gateway represents requesting community Responding Gateway represents responding community
Primary Data Content Standards CCD Continuity of Care Document Patient summary data, encapsulated in CDA Constrained by HITSP C32 and IHE XPHR QRDA Quality Reporting Document Architecture Measures-based elements, encapsulated in CDA Three categories of reports: Individual Patient Multiple Patients Aggregation of measures for a population of patients
Other Content Standards HL7v2 Still the principle means through which legacy data sources integrate X12 Primarily seen in payer-based interactions, including patient eligibility and medication formulary checks NCPDP Pharmacy prescription content, including medications history and various eprescribing-related related transactions Adopted by Surescripts and some Medicaid systems
Security Standards User Authentication Node Authentication Authorization Encryption Auditing Interactive user authentication unspecified Web service authentication through SAML Token Profile Peer-to to-peer authentication through TLS Web service node authentication not used today User roles passed through SAML tokens Consent policies exchanged in XACML format Database encryption unspecified Network encryption through TLS IHE s s ATNA Secure Node auditing NHIN-style web service definitions
Agenda What are the key use cases driving New York? What is the SHIN-NY NY and its architecture? What standards and protocols were chosen? What role does HealthShare play?
Active HealthShare Projects in NY
HealthShare Services Pre-Built Capabilities RAD Raw Technology Pre-built capabilities for key RHIO functions HealthShare Customizable via business processes, adapters, rules, workflows, Extensible via powerful, object-based based rapid development environment Exchange Identification Terminology Specific Solution Consent Ensemble Security Access
Traditional HealthShare Deployment Consumer Consumer Search Retrieve Deliver Access Gateway Patients Clinicians Systems Subscriptions Policies Hub Edge Gateway Edge Gateway Retrieve ECR Retrieve ECR Data Provider Data Provider Data Provider Data Provider
HealthShare for New York State an SOA Consumer Consumer Consumer HealthShare Gateway SHIN-NY Big Bus Identification Services Data Services Security Services Consent Services Terminology Services HealthShare Enterprise Service Bus HealthShare Gateway ECR SHIN-NY Big Bus Provider Provider Provider Provider
HealthShare Core Modules Infrastructure Clinical Viewer Messaging Center Clinical Data Repository Identity Management Discrete services for as-is or customized use Component templates for common architectures Browser-based portal for longitudinal patient records Import and export of clinical summaries Interactive reporting and printing Secure messaging between systems and clinicians Referrals, consultations, and general messaging DeepSee-based warehouse for advanced analytics Core part of public health and quality reporting uses An IHE-conformant Master Person Index An object-oriented oriented toolkit for advanced development
Building Regional and National Health Information Systems Mike LaRocca