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Improving Health It Interoperability
1. Strategies for Improving Health IT Architecture
Interoperability
WG:
Paul Aneja EA CoP
Paul Aneja John Fitzpatrick CDC EA CoP
Co-Chair Enterprise Architecture CoP Vish Sankaran ONC FHA
Sept 2, 2009 Craig Miller ONC NHIN
Draft Work in Progress Sondra Renly IBM Research
Paul.aneja@state.or.us Nancy Friedland IBM
Linh Le State of NY
2. Agenda Topics
What is Interoperability?
How interoperable are current health IT systems?
Key Health IT Interoperability Challenges
Benefits of Increasing Health IT Interoperability
Strategies for Improving Health IT Architecture
Interoperability
Break Out Groups
Report Out from Break out groups
Improving Interoperability through Effective Health IT Architectures 2
4. How do we define interoperability?
Improving Interoperability through Effective Health IT Architectures 4
5. What is Interoperability?
Interoperability generally refers to "the ability of two or more
systems or components to communicate, to exchange data
accurately, effectively, and consistently and to use the
information that has been exchangedâŠ.â
âIn healthcare, the ability âto use the information that has been
exchangedâ means not only that healthcare systems must be
able to communicate with one another, but also that they must
employ shared terminology and definitions.â
Source: HL7 Coming to Terms Whitepaper
Improving Interoperability through Effective Health IT Architectures 5
6. How interoperable are current Health IT systems?
Do all health IT systems store the same information, the same
way (e.g. demographics)?
Can patients move between providers/doctors and with their
health history accessible?
How do Health IT systems exchange data today?
Do we have a common language that all business partners
health IT systems speak?
Interoperability between clinical and public health systems?
How is security and privacy of consumers and protected health
information managed across health IT systems?
âŠ
Improving Interoperability through Effective Health IT Architectures 6
7. Why is Health IT Interoperability important?
Make improved health decisions based on all data
Improve exchange of health information between health IT
systems
Access information across different systems, sectors, platforms
Reduce cost and complexity
Enable future ready solutions
Continuity of care for patients
Improving public health situational awareness
Improving Interoperability through Effective Health IT Architectures 7
8. What are real-life examples of good interoperability?
Lets look the phone as an example
What makes phones interoperable?
Is it what material phone is made from?
Is it the features, ringer, dial pad?
Is it the shape, color?
Calling parties have to be in the same geographic area?
Is it the manufacturer?
Improving Interoperability through Effective Health IT Architectures 8
9. Key Health IT Interoperability Challenges
HIT is a extremely fast moving train with brand new concepts, architectures,
needs, etc.
Nature of âEnterpriseâ is changing â Clinical and PH and âŠ
Interoperability is complex and not well understood
Difficult to coordinate across systems and organizations
What do we want to make interoperable? What is the scope of
interoperablity?
Siloed health it systems in different groups and programs
Data elements are not common across same type of Health IT systems
Coordinating security and privacy of health IT systems
Lack of coordinated standards in use by all HIE players
Document based vs messaging based architecture choices
Strategic architectural understanding and approach
Cross HIT governance is a challenge
Funding
Improving Interoperability through Effective Health IT Architectures 9
11. Interoperability Guiding Principles
Adopt and leverage national HIT Architectures
Adopt and leverage national HIT standards
Reusable Shared Services based on Services Oriented Architecture
(SOA) design principles
Architect/Design with interoperability as a key requirement from start
Create technology neutral architecture
Stronger governance of Health IT across health organization
âEnterprise Architectâ role, to focus on common enterprise issues
Improving Interoperability through Effective Health IT Architectures 11
12. Levels of Health IT Interoperability
Different levels of Health IT Interoperability
1. Not interoperable
2. Within same health organization
3. Regional HIE
4. Statewide HIE
5. National HIE
6. International
Improving Interoperability through Effective Health IT Architectures 12
13. Public Health IT Systems Interoperability
Typical PH IT Systems
Immunization
Disease Surveillance
Vital Records
Lab Systems
Registries (Cancer, STD, TB, )
Environmental Health,
Lead,
âŠ
There are number of common functions across health systems
Are PH IT Systems integrated with other Health systems?
How to improve interoperability of the PH IT systems?
Improving Interoperability through Effective Health IT Architectures 13
14. HIT Use Cases example
Improving Interoperability through Effective Health IT Architectures 14
15. Nationwide Health Information Network
Highly distributed: Patient
health information is retained at
the local health information
exchange level
Local autonomy: Each HIE
must make their own
determinations with respect to
the release of patient information
Focus only on inter-
organizational health
exchange: The NHIN does not
attempt to standardize
implementations of the NHIN
services and interfaces, only the
communications between HIEs
Use public internet: The NHIN
is not a separate physical
network, but a set of protocols
and standards that run on the
existing internet infrastructure
Platform neutral: The NHIN has
adopted a stack (web services)
that can be implemented using
many operating systems and
programming languages
15
Copyright 2009. All Rights Reserved. Effective Health IT Architectures
Improving Interoperability through 15
16. HIT Standards for Interoperability
Enterprise Health IT Architecture leverages HIT Standards for
number of reasons including
Creating a reusable architecture
Improve standardization
Increase future adaptability
Improve integration across HIT systems
âŠ
Momentum and progress on HIT standards has increased
substantially
What are the ârightâ standards for what purpose?
Improving Interoperability through Effective Health IT Architectures 16
17. HIT Standards for Interoperability
Key Health IT Standards Organizations
HIT Standards Committee
HITSP
IHE
HL7
PHDSC
âŠ
Improving Interoperability through Effective Health IT Architectures 17
19. HIT Standards for Interoperability
Structured Electronic Clinical Messaging Eligibility, Benefits Quality Measure
Data Exchange Documents HL7 v2.5.1 and Referrals Reporting
Standards HL7 v.3 CDA or Immunization & ASC Z12 v.4010A1,
CCD for summary rec Vaccination updates NCPDP Scrip v5.1 and CMS PQRI Registry
only: HL7 v2.3.1 CAQH CORE Phase I XML Spec
& II
Clinical Problems & Laboratory Tests Units of Measure
Vocabulary Procedures
PHIN VADS
Standards ICD 9 & ICD 10
LOINC UCUM
SNOMED CT
Cross Document Clinical âą Electronic Health
Interoperability Sharing Record - Centric IS
Lab Reporting Patient Demographic
Specifications XDR.b Medical Summary Query âąExchange
Architecture &
& Profiles Emergency Referral Patient Identifier Harmonization
Cross Referencing
Communications SOA
Communication
Standards TCP/IP WS-* and REST
WSDL
SOAP
âŠ
Improving Interoperability through Effective Health IT Architectures 19
20. Reusable Shared Services in Health IT
(using SOA)
Why do we have so many separate or silo systems?
And there are common functions/services in many of systems
Lets change the paradigm of building new health systems to
reusing shared services
Challenges:
What reusable services are needed for Health Information
Exchanges?
How can Service Oriented Architecture principles be applied
throughout the Enterprise Architecture?
Improving Interoperability through Effective Health IT Architectures 20
21. Reusable Shared Services in Health IT
(using SOA)
Here is a starting list of potential HIE reusable servicesâŠ
HIE Immunization
PH Case Get
Enrollment Validation
Reusable Reporting Health Records
Shared Demographic
Services Service Patient
Authentication
Matching
Eligibility Secure
Check Personal Health Get Immunization Allergy Messaging
Record Update Records Check
What other Shared Services are needed?
Improving Interoperability through Effective Health IT Architectures 21
22. Privacy and Security
Support national privacy & security standards.
Create standards by which data can be shared and adopt one
set of clearly defined privacy standards.
Implement standardized measures to safeguard protected
health information (PHI).
Security & Access Control Authentication Identity Management Transport
Privacy HL7 v3 RBAC Kerberos Network Auth v5 LDAP XDS.b
SAML EUA End User Authentication Personal White Pages
WS-Trust v1.7
WS- Security
OASIS XACML (2015)
Challenges:
How many states have common Directory/LDAP that apps use?
Diversity of standards for security and privacy
Improving Interoperability through Effective Health IT Architectures 22
23. Health IT Architecture Interoperability Framework
EHR Biosurve PH Immuniz Newborn Emerge Personal
Health IT illance Case ation Screenin ncy ized
Reportin g Respond Healthca
Use Cases g er EHR re
National HIE National Health NHIN Connect
Information
Architecture Network
PH Case Immunization Allergy Get Secure
HIE Reusable Enrollment
Reporting Health Records
Validation Check Messaging
Shared Eligibility Personal Health Get Immunization Demographic Patient
Check Authentication
Services Record Update Records Service Matching
Structured Electronic Clinical Messaging Eligibility, Benefits and Quality Measure
Data Exchange Documents HL7 v2.5.1 Referrals Reporting
Immunization registries & ASC Z12 v.4010A1,
Standards HL7 v.3 CDA or Vaccination updates only: NCPDP Scrip v5.1 and CMS PQRI Registry XML
CCD for summary records HL7 v2.3.1 CAQH CORE Phase I & II Spec
Clinical Problems & Laboratory Tests Units of Measure PHIN VADS
Vocabulary Procedures
Standards ICD 9 & 10
LOINC UCUM
SNOMED CT
Access Control Authentication Identity Management Transport
Security & HL7 v3 RBAC Kerberos Network Auth v5 LDAP XDS.b
Privacy SAML EUA End User Authentication Personal White Pages
WS-Trust v1.7
WS- Security
OASIS XACML (2015)
Communications SOA
Communication
TCP/IP WS-* and REST
Standards WSDL
SOAP
âŠ
HIE Infrastructure SOA PHRs Repository
HIT HIE Exchange solution
ESB Google, MS, WebMD, HIE Document Index
Infrastructure HIE Exchange
Services Registry HIE Document
HIE Adapters Repository
âŠ
Improving Interoperability through Effective Health IT Architectures 23
24. Conference Sessions of interest
Interoperability showcase
Federal Health Architecture
PHDSC Service Oriented Architecture for Public Health
NAPHIT-PHDSC session Sept 2 Wed 5:30-8pm
Improving Interoperability through Effective Health IT Architectures 24
27. Lets Form into 3 Breakout Groups
Each Breakout Group to address:
Top 3 things to increase interoperability
Interoperability Top Challenges
Key Interoperability Solutions
3 Breakout Groups
Health IT Architectures
Health IT Standards
Shared Services in Health IT
Improving Interoperability through Effective Health IT Architectures 27
28. Breakout Groups Report Out
Improving Interoperability through Effective Health IT Architectures 28