Standards-based Solution for National Level Document Sharing.
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Mr. Boaz Carmeli. Research Scientist and Manager of IT for Healthcare and Life Science. IBM Haifa Research Lab.

Mr. Boaz Carmeli. Research Scientist and Manager of IT for Healthcare and Life Science. IBM Haifa Research Lab.

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Standards-based Solution for National Level Document Sharing. Standards-based Solution for National Level Document Sharing. Presentation Transcript

  • 1 IBM Research Health Information Exchange Standards-based Solution for Regional and National Level Patient Centric Network Boaz Carmeli – IBM Haifa Research Lab, Israel boazc@il.ibm.com February 21 2008 © 2002 IBM Corporation
  • IBM Research Worldwide 3000 researches in 8 research laboratories around the world dealing with extensive verity of research topics Estab. 1995 Estab. 1961 Estab. 1956Estab. 1986 Employees: 110 Employees: 1750 Employees: 210Employees: 440 Estab. 1982 Employees: 180 Estab. 1995 Estab. 1972 Estab. 1998 Employees: 40 Employees: 350 Employees: 80 2 National Health Record – Standard Solution © 2006 IBM Corporation Updated 2/2/04
  • Haifa IT for Healthcare and Life Science Group 13+ years of IT research in Healthcare & Life Science – Extensive Information Technology and Computer Science skills – Medical domain skills – Imaging, Clinical Genomics, Interoperability – Standards Practice – courses, consultation & services (DICOM, IHE, HL7…) – Mainly in Europe – Extensive SW development and architecting skills – SOA and J2EE – Deep knowledge in information integration and interoperability Involvement in significant customer contracts and interactions – Health Information Exchange (HIE) for NHIN – Medical Imaging Repository at UCSF an Merck – Public Health Affinity Domain at the Middle East (based on HIE) – Complex Event Processing at the Nice hospital3 National Health Record – Standard Solution © 2006 IBM Corporation
  • Our Group Vision - from Data to Knowledge4 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience5 National Health Record – Standard Solution © 2006 IBM Corporation
  • The Problem Creating health records at a regional or national level requires electronic data exchange among healthcare organizations IT systems within hospitals, HMOs, clinics and other care-delivery organizations become an integral part of the working environment Healthcare organizations still lack the ability to share information across organization boundaries Cross-enterprise data sharing implies the need for a standards based communication mechanism – Without standards: No information exchange is expected to take place – With standards: No single vendor is expected to dominate the market6 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience7 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE - Integrating the Healthcare Enterprise IHE is a healthcare industry organization promoting coordinated use of established standards to improve healthcare IT system integration IHE produces healthcare integration profiles which: – Address a specific healthcare integration scenario – Build upon one or more existing, established standards such as HL7 and DICOM – Define constraints which limit the options available when using underlying standards8 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE Organizational Structure IHE (International) Strategic Development Committee Regional Deployment Global Development IHE North America IHE Asia China Japan Radiology IT Laboratory Canada Infrastructure USA Korea Taiwan Cardiology Patient Care Pathology Coordination IHE Europe Radiation Patient Care Eye care, France Germany Italy Netherlands Oncology Devices Quality, etc. Norway Spain Sweden UK Professional Societies / Sponsors Contributing & ACC GMSIH COCIR SIRM ESC JAHIS METI-MLHW Participating ACP SFR EAR-ECR BIR JIRA MEDIS-DC HIMSS SFIL DRG EuroRec Vendors JRS JAMI RSNA9 National Health Record – Standard Solution © 2006 IBM Corporation
  • History of IHE Domains Veterinary Endoscopy Pathology Over 100 vendors involved world-wide Pharmacy 8 Technical Frameworks Quality Patient Care Devices (1) 48 Integration Profiles Patient Care Coordination (5) Testing at “Connectathons” world-wide Radiation Oncology (1) Demonstrations at major conferences world-wide Eye Care (3) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17) Radiology (18) (2003) (2004) Year 5 Year 6 (2007) Year 9 (2002) (2006) Year 4 Year 8 (2005) Year 7(1999) (2000) (2001)Year 1 Year 2 Year 3 10 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE Integration Profiles from IT Infrastructure DomainWhat is available and has been added in 2006/07 Clinical and PHR Content Security Patient ID Mgmt Emergency Referrals PHR Extracts/Updates Format of the Document Content ECG ReportDocumentvocabulary and associated coded Basic Patients Privacy Patient Demographics Format of the Document Content Lab ResultsDocument Content Document and associated coded vocabulary Consents Query Format of the Establish Consents & Enable Content Scanned Documents and associated coded vocabulary Access Control Format of the Document Content Patient Identifier Imaging Information Formatassociated coded Content and of the Document vocabulary Cross-referencing Format of theSummary Medical Document Content and(associated coded vocabulary Document Digital Map patient identifiers across Meds, Allergies, Pbs) Format of the Document Content Signature independent identification Attesting “true-copy and origin domains and associated coded vocabulary Health Data Exchange Audit Trail & Node Cross-Enterprise Authentication Other Document Sharing (XDS) Centralized privacy audit trail and node to node authentication to create a Request Form Registration, distribution and access across health enterprises of clinical secured domain. for Data Capture documents forming a patient External form with custom electronic health record import/export scripting Consistent Time Cross-Enterprise Document Notification of Coordinate time across networked Reliable Interchange (XDR) systems Document Availability Cross-Enterprise Document Notification of a remote provider/ health enterprise Media Interchange (XDM) 11 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE Profile Development Lifecycle 2Q/3Q 2006 1Q 2007 Testing at 1Q 2007 Connectathons Develop IHE technical Demonstrations specifications 2Q 2007 HIE v1.1 1Q 2006 Products Identify available with IHE standards (e.g. HL7, DICOM, IETF, OASIS) 4Q 2005 Document Use Timely access to Easy to integrate Case information products12 RequirementsRecord – Standard Solution National Health © 2006 IBM Corporation
  • Relevant IHE ITI Profiles XDS - Cross Enterprise Document Sharing – Specifies guidelines for sharing clinical documents across healthcare organization boundaries – XDS-I: XDS for Imaging PIX - Patient ID Cross Referencing – Specifies guidelines for cross-referencing a unique patient ID between healthcare organizations – Aka Master Patient Index (MPI) PDQ – Patient Demographics Query – Specifies guidelines for querying patient ID by demographic details ATNA - Audit Trail and Node Authentication – Specifies guidelines for security and auditing at both communication and application layers XUA – Cross Enterprise User Assertion – Provides a means to communicate claims about an authenticated principal (user, application, system) across enterprise boundaries13 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience14 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS Geographical Aspect & Terminology EHR-CR Clinical Affinity Domain An EHR-CR or Care-delivery Record A group of healthcare enterprises that abstracts the patient information managed have agreed to work together using a by the IT system or by the set of systems of common set of policies and share a Clinical Affinity Domain a single Care Delivery Organization common infrastructure of repositories and a registry EHR-CR EHR-CR Long Term Acute Care Care R -LR EH EHR-LR The documents shared by the EHR- CR and tracked by the registry form a EHR-CR EHR-CR longitudinal record for the patients PCPs & Clinics Diagnostic that received care among the EHR- CRs of the Clinical Affinity Domain Service15 National Health Record – Standard Solution © 2006 IBM Corporation
  • CAD - Clinical Affinity Domain A group of healthcare organizations that have agreed to share patient records along a set of operational, business and legal agreements : – Agreed-upon sharing policies – Single Patient ID Domain (CAD ID) – Common set of Codes – Unified terminology – Security & Access Control model/agreements16 National Health Record – Standard Solution © 2006 IBM Corporation
  • Cross Enterprise Document Sharing (XDS) Profile Establish the IT Infrastructure for an Affinity Domain Enables Care Delivery Organizations (CDOs) to cooperate in the care of a patient by sharing clinical records Patient Identity Source Patient Identity Feed [ITI-8] ↓ Query Registry [ITI-16] ← Document Registry Document Consumer ↑ Register Document Provide & Register Document Set [ITI-14] Set [ITI-15] Retrieve Document Document Source → Document Repository [ITI-17] ←17 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS Actors 1. Document Source – Produces and publishes documents – Responsible for sending documents and metadata to a repository 2. Document Consumer – Queries a registry for documents – Retrieves selected documents from one or more repositories 3. Document Registry – Maintains metadata about each registered document in a document entry – Includes a link to the document in the repository 4. Document Repository – Responsible for the persistent storage of documents – Assigns a URI to documents for subsequent retrieval by a consumer 5. Patient Identity Source – Provides a unique identifier for each patient and maintains a collection of identity traits18 National Health Record – Standard Solution © 2006 IBM Corporation
  • Provide and Register Document Set A Document Source actor initiates the Provide and Register Document Set Transaction. For each document in the submitted set, the Document Source Actor provides both the documents and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction. Provide & Register Document Set [ITI-15] Document Source → Document Repository19 National Health Record – Standard Solution © 2006 IBM Corporation
  • Register Document Set A Document Repository actor initiates the Register Document Set transaction. This transaction allows a Document Repository Actor to register documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry. Document Registry ↑ Register Document Set [ITI-14] Document Repository20 National Health Record – Standard Solution © 2006 IBM Corporation
  • Query Registry The Query Registry transaction is issued by the Document Consumer Actor on behalf of a care provider to a Document Registry The Document Registry Actor searches the registry and returns a list of matching document entries including the locations and identifier of each document in the Document Repository Query Registry [ITI-16] ← Document Registry Document Consumer21 National Health Record – Standard Solution © 2006 IBM Corporation
  • Retrieve Document A Document Consumer Actor initiates the Retrieve Document transaction. The Document Repository will return the document that was specified by the Document Consumer Document Consumer Retrieve Document Document Repository [ITI-17] ←22 National Health Record – Standard Solution © 2006 IBM Corporation
  • Patient Identity Feed This is IHE ITI Transaction 8, defined as part of the Patient Identifier Cross- Referencing Integration Profile It conveys the patient identifier and corroborating demographic data. Its purpose in the XDS Integration Profile is to populate the registry with patient identifiers that have been registered for the affinity domain Patient Identity Source Patient Identity Feed [ITI-8] ↓ Document Registry23 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS Concepts The XDS registry is the cornerstone of the document sharing process – The source registers information to be exchanged in the registry – The registry only maintains metadata for the document (and not the document itself) – Clinical information is not exposed The XDS repository maintains the actual clinical document – Clinical documents can be kept within the enterprise’s repository or they can be transferred to another enterprise’s repository. – Allows for data encryption. Source initiates the sharing process and provides the clinical document and the associated metadata Consumer queries the registry and retrieve the data from the relevant repository24 National Health Record – Standard Solution © 2006 IBM Corporation
  • Single Registry Multiple Repositories Clinical Affinity Domain HMO Document Hospital Consumer Document Source Documents Registry Independent Document Repository25 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS – Key Features Foundation for health IT infrastructures – Shared Electronic Health Record, in a community, region, etc. Scalable architecture for document sharing – Between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems – Suitable for other healthcare domains such as Public Health and Clinical Trials Distributed – Each organization “publishes” clinical information for others to use – Actual documents may remain in the source system Easy access – Care providers are offered a means to query and retrieve clinical documents of interest – All transactions are based on industry and communication standards26 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS – Key Features Document centric – Published clinical data is organized into “clinical documents” using agreed standard document types (HL7-CDA/CCD, PDF, DICOM, etc.) Document content neutral – Document content is processed only by source and consumer systems. Infrastructure is generic Standardized registry attributes – Documents are described by a standardized set of attributes. – Standardized queries are supported by all vendors27 National Health Record – Standard Solution © 2006 IBM Corporation
  • Deployment Options Registry Source Consumer Repository EHR-CR EHR- EHR-CR EHR- Source Registry Consumer Repository EHR-CR EHR- EHR-CR EHR-28 National Health Record – Standard Solution © 2006 IBM Corporation
  • Registry and Repository Artifacts XDS Folder An XDS Folder allows document Submission Folder A sources to group the documents they Set submit with other related documents Submission Set A set of XDS documents registered Document together to a Document Repository Document Document concerning information related to Registry Entry 1 Entry 2 one care event of a single patient Document Entry A Document Entry contains all metadata for a specific XDS document and a link to the document’s repository location. Document XDS Document D D oc oc Repository An XDS Document is the smallest unit u u m m of information that may be provided to en en t t a Document Repository29 National Health Record – Standard Solution © 2006 IBM Corporation
  • Document & DocumentEntry Concept XDS paradigm is built around documents (and not around records) An XDS Document is a composition of clinical information that contains observations and services to be exchanged within the Affinity Domain Documents characteristics are defined by the HL7 CDA Standard – Persistence, Wholeness, Potential for Authentication An XDS Document is the smallest unit of information that may be provided to a Repository and be registered in the Registry – XDS does not provide mechanisms to access portions of a Document XDS Documents are required to be globally uniquely identified Each Clinical Document has set of metadata that describing it – This metadata is referred as XDS DocumentEntry – Most metadata attributes can be automatically generated form the clinical document by the Document Source – specially true for structured documents like CDA or DICOM30 National Health Record – Standard Solution © 2006 IBM Corporation
  • DocumentEntry Metadata Document Author Person, role, specialty Legend Patient Demographics Required Service Start and Stop Time Optional Document Creation Time Generated Legal Authenticator Title, comments, Identifiers Patient ID, Unique ID, entryUUID Kind of Document Class Code (e.g Prescription, Discharge Summary, Report) Type Code (more detail) Event Code Main clinical event (e.g. colonoscopy, appendectomy) Healthcare Facility Type Healthcare Facility Type Code and Display Name Practice Setting Type Practice Setting Code and Display Name Confidentiality Code Technical Details MIME Type; Format Code (e.g. CDA); Size; Hash; URI; Language Available Status Available, Deprecated31 National Health Record – Standard Solution © 2006 IBM Corporation
  • SubmissionSet Concepts Submission Set is related to care event(s) of a single patient An XDS Submission Set is created for each submission request – It is related to a single Document Source Actor Submission Set creates a permanent entry in the Registry – Submission Set includes one or more DocumentEntry object(s) – Submission Set may refer to already registered XDS Documents that have a relationship with the same care event – Submission Set includes the record of new XDS Folders creation. The Document Registry may be queried to find all documents registered in the same XDS Submission Set XDS provides complete flexibility to organization to relate Documents and Submission Sets to an encounter, a visit, an episode of care, or various workflow processes within clinical organization.32 National Health Record – Standard Solution © 2006 IBM Corporation
  • SubmissionSet Metadata Each of the attributes listed below is an attribute on the RegistryPackage object defining the Submission Set Legend Required Author – person, role, specialty, institution Optional Comment – Any string Generated Title – Title of this document serviceStartTime Submission time - Document submission Time Availability Status – Approved, Deprecated Coded elements–contentType (type of clinical activity) Identifier – Patient ID, Source ID, Unique ID, entryUUID33 National Health Record – Standard Solution © 2006 IBM Corporation
  • Folder Concepts The purpose of an XDS Folder is to provide a collaborative mechanism for several XDS Document Sources to group XDS Documents – Folders offer the Document Consumers a means to find all Document Entries placed in the same Folder. The following principles apply to an XDS Folder: – A Folder groups a set of XDS Documents related to the care of a single patient – One or more Document Source Actors may submit documents in a given Folder – A Folder may be created by a Document Source and/or predefined in an XDS Affinity Domain – The content of a Folder is qualified by a list of codes/meaning, – Source Actors may find existing Folders by querying the Document Registry – Folders in XDS may not be nested – The same documents can appear in more than one Folder – Folders have a globally unique identifier34 National Health Record – Standard Solution © 2006 IBM Corporation
  • Folder Metadata Legend codeList Required availabilityStatus (approved, deprecated) Optional entryUUID Generated uniqueId title comments lastUpdateTime patientId35 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience36 National Health Record – Standard Solution © 2006 IBM Corporation
  • Patient Demographics Query (PDQ) Find patients matching a given set of demographics – Search may be based on combination of: name, address, phone number, gender, date of birth, race, marital status, birth place, citizenship id Patient Patient Key PDQ Actors: Demographics Consumer Demographics Supplier – Patient Demographics Supplier Patient Demographics – Database containing patient demographics and Query: QBP^Q22 corresponding patient identifiers Patient Demographics – Responds to queries for patient information Response: RSP^K22 – Patient Demographics Consumer – Typically an EHR or PHR application that supports lookup of patient information based on a partial set of demographics37 National Health Record – Standard Solution © 2006 IBM Corporation
  • PDQ Example Query: Rupert, Adrian PDQ Consumer (an EHR) Patient Demographics Supplier Response: Rupert, Adrian Gender: Male Date of Birth: 09/24/1932 Address: 1342 Main Street Chatfield, MN Patient Id: 13579 Rupert, Adrien Gender: Female Date of Birth: 03/21/1961 Address: 58 1st Avenue Stewartville, MN Patient Id: 2468 Rupert, Ade Gender: Female Date of Birth: 01/14/1982 Address: 2525 Broadway Rochester, MN Patient Id: 4A78X38 National Health Record – Standard Solution © 2006 IBM Corporation
  • Patient Identifier Cross-Referencing (PIX) Find various identifiers for the same patient – for example: – I know a patient’s id within a community clinic – I need to find corresponding patient id within a given hospital Key PIX actors: – Patient Identifier Cross Reference Manager (PIX Manager) – Maintains cross reference between corresponding patient ids from different domains based on matching patient demographics – Patient Identity Source – Existing application within a hospital or clinic that is responsible for assignment and management of patient ids – Provides Patient Identity Feed for the PIX Manager – Patient Identifier Cross Reference Consumer – An application which has an id for a patient in one domain and wishes to determine corresponding CAD ID – Or ID in a different domain39 National Health Record – Standard Solution © 2006 IBM Corporation
  • PIX Transactions Patient Identity Source Hospital Patient Identifier Cross Patient Identity Reference Consumer Source (an EHR application) Clinic Li Wang 09/24/1932 A87631Male M8354673993 PIX Query Li Wang 1435509/24/1932 A87631 M8354673993 Male A87631 M8354673993 14355 Patient Identity L-716 14355 L-716 A87631 L-716 Patient identifier Cross Source Reference Manager Hospital Patient Identity Source Li Wang 09/24/1932 Clinic Male Li Wang 09/24/1932 M8354673993Male Patient Identity Feeds40 National Health Record – Standard Solution © 2006 IBM Corporation
  • Audit Trail and Node Authentication (ATNA) ATNA provides a secure healthcare information infrastructure by prescribing how to: – Secure systems – Ensure access control to protected healthcare information – Secure the network – Only trusted systems are allowed to exchange protected healthcare information – Encrypted exchange of information also supported – Track data access – All access to and movement of protected healthcare information is audited Key ATNA Actors: – Centralized Audit Record Repository – Collects all Audit Trail events into a centralized place – Provides a mean to investigate PHI access breaches41 National Health Record – Standard Solution © 2006 IBM Corporation
  • ATNA Within A Healthcare Network Example: Using an EHR application to retrieve a discharge summary from a local hospital Audit login Encrypt data to EHR during transport Secured System Secured System Hospital Discharge Summary Header Secure network Discharge Summary Header Clinic Family History Family History Body Medications Immunizations Body Medications Immunizations Vital Signs Vital Signs Allergies Allergies Authenticate Authenticate … … requesting target clinic hospital Central Audit import of Audit Export of data from hospital Audit Trial data into clinic repository Repository EHR42 National Health Record – Standard Solution © 2006 IBM Corporation
  • Cross-Enterprise User Assertion (XUA) New profile defined this year by IHE ITI and successfully tested during the last Connectathon (January 2008) Designed to support user level authentication – Provides a means to communicate claims about an authenticated principal (user, application, system) in transactions that cross enterprise boundaries Based on an Web Services enabled environment – Uses WS-Trust and SAML for communicating principal attributes – Comes into play only within XDS.b supported environment – ITI – 18 Stored Query transaction – ITI – 43 Retrieve Document transaction43 National Health Record – Standard Solution © 2006 IBM Corporation
  • XUA Actors X-Service User – A system making a services request of an X-Service Provider – e.g., an XDS.b Document Consumer issuing a query to the XDS.b Registry X-Service Provider – A system providing a service that requires an X-User Assertion – e.g., XDS.b Registry, XDS.b Repository X-Assertion Provider – A SAML Identity Provider (IDP) or WS-Trust Security Token Service (STS) – X-Assertion Provider is currently out of scope as an IHE actor44 National Health Record – Standard Solution © 2006 IBM Corporation
  • Regional Level Policies Each affinity domain is qualified to set the sharing policies Which document and data to share – Not all clinical documents are required for the regional or national level Where to keep original documents – Under the generating organization or at the center Which terminologies and coding schemes to use – Translation from the CDO terminology to the Affinity Domain terminology Which access control policies to set Which user interfaces and end-client applications to use – Access to data is possible from anywhere and is based on Internet transactions – Physician and Patient portals45 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience46 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE Solution Architecture47 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS Registry Serves as searchable index of patient medical records within a healthcare community Supports latest features outlined by IHE XDS and ATNA profiles Register Document Set (ITI-14, ITI-42) Registry Stored Query (ITI-18) Patient Identity Feed (ITI-8) ATNA Secure Node and Record Audit Event (ITI-20) Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base & Network Deployment) Network Deployment supports multi-server clustering for load balancing and failover DB2 Universal Database (v8.2) Provide support for Oracle if needed IBM XDS Document Registry deployed in 2 of 4 U.S. Government NHIN projects48 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS Registry ATNA Generated Events Patient Identity Feed HL7 v3 over Web ServicesPatient Identity Feed XDS Document Registry JDBC XDS Document JMSHL7 v2 over MLLP MLLP (J2EE Application) Registry Database Adapter (Document Metadata) Register Document Set, Registry Stored Query XDS.a - SOAP over HTTP XDS.b - Web Services WebSphere Application Server DB2 Universal Database 49 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS Repository Data store for clinical documents being shared within a healthcare community Supports both centralized (hosted) architecture and federated architecture Supports latest features outlined by IHE XDS and ATNA profiles: Provide and Register Document Set (ITI-15, ITI-41) Retrieve Document (ITI-17, ITI-43) ATNA Secure Node and Record Audit Event (ITI-20) Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base and Network Deployment) Several back-end data storage models supported File system (simple, low cost option) DB2 Universal Database v9 (integrated, XML/relational data store) DB2 Content Manager v8.3 (robust, highly scalable document management system) Deployed in 2 of the 4 U.S. Government sponsored NHIN projects50 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS Repository File System ATNA Generated Local or Events DistributedProvide and Register Document Set File SystemSOAP with Attachments over HTTP Storage Options GMAS XDS Retrieve Document Document Repository HTTP/MTOM (J2EE Application) Document DB2 Management Content System Manager WebSphere Application Server DB2 UDB XML/Relational Data Model51 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE ATNA Audit Record Repository Repository for audit events generated by systems handling PHI within a healthcare network Supports ATNA Record Audit Event (ITI-20) interface to other healthcare applications BSD Syslog protocol for data transport (RFC 3164) Supports both RFC 3881 and IHE Provisional audit record formats Support for reliable transport for audit massages (Currently not included in IHE) Web-based tool provided to query audit data Based on IBM’s Data Discovery and Query Builder product (DDQB) Build and execute canned or ad hoc audit queries Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base & Network Deployment) Network Deployment supports multi-server clustering for load balancing and failover DB2 Universal Database (v8.2)52 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE ATNA Audit Repository Data Discovery and Query Builder HTTP Web-Based Audit Query/Reporting Interface JDBC ATNA Audit Record Database Record Audit Event (Audit Information) BSD Syslog JMS ATNA Audit JDBC Audit Interceptor Record Repository WebSphere Application Server DB2 UDB53 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE Audit Query Interface54 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XUA X-Assertion Provider Serves as a WS-Trust Security Token Service (STS), creates and validates SAML assertions Supports WS-Trust 1.3 and WS-Trust 2005/02 Interoperates with other Security Token Services Based on proven, scalable IBM middleware Tivoli Federated Identity Manager (v6.1) Supports both WS-Trust and SAML IBM HIE XUA X-Assertion Provider was tested with several vendors during the last IHE Connectathon (January 2008) Currently out of scope as IHE actor55 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XUA X-Assertion Provider Authentication Service (LDAP) Get SAML Assertion SOAP 1.1, SOAP 1.2 Underlying Systems WS-Trust 2005/02, WS-Trust 1.3 Persistent Validate SAML Assertion XUA X-Assertion Provider Storage SOAP 1.1, SOAP 1.2 (Web Service Application) (DB2 UDB) WS-Trust 2005/02, WS-Trust 1.3 Authorization Service (Tivoli Access Manager) Tivoli Federated Identity Manager56 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS-I Imaging Document Source XDS-I (XDS for Imaging) Variation of XDS to support sharing of medical images Imaging document source actor is responsible for: Registration of medical images and reports within an XDS community Retrieval of medical images and reports Via DICOM or WADO (Web Access to DICOM Object) Can be conceived as a DICOM<->XDS converter Prevent copying of large data chunks within the Affinity Domain Subset of IBM’s Content Manager Offering (CMO)57 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM HIE XDS-I Imaging Document Source IHE XDS-I Profile XDS Repository DICOM DICOM XDS-I XDS-I XDS-I Document Document XDS Consumer Source Registry PIX/PDQ Audit Repository Manager Server58 National Health Record – Standard Solution © 2006 IBM Corporation
  • Eclipse Open Healthcare Framework (OHF) The Eclipse Foundation – Open source community whose projects are focused on providing an extensible development platform and application frameworks for building software. – www.eclipse.org The Eclipse Open Healthcare Framework (OHF) – Project within Eclipse formed for the purpose of expediting healthcare informatics technology. – Extensible frameworks and tools which emphasize the use of existing and emerging standards – Encourages interoperable open source infrastructure – Lowers integration barriers – www.eclipse.org/ohf59 National Health Record – Standard Solution © 2006 IBM Corporation
  • OHF and IBM HIE OHF is complementary technology to the IBM HIE Infrastructure developed by IBM and other industry partners. OHF tooling helps vendors implement the standards so they can continue to focus on making better products. – Two options: Java libraries and Web Services OHF software was used with the HIE Solution in the US NHIN Project and the PHAD project for MECIDS60 National Health Record – Standard Solution © 2006 IBM Corporation
  • Eclipse OHF – Java and Web Service Adapters61 National Health Record – Standard Solution © 2006 IBM Corporation
  • Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience62 National Health Record – Standard Solution © 2006 IBM Corporation
  • HIE Involvement in Healthcare Industry Events IBM has been a strong supporter of industry events aimed at validation or our HIE solution and demonstration of IHE profiles and the underlying standards they are based upon – IHE Connectathon North America – January 2006 – HIMSS – IHE Interoperability Showcase – February 2006 – RSNA – IHE Demonstration – November 2006 – IHE Connectathon North America – January 2007 – HIMSS – IHE Interoperability Showcase – February 2007 – ACC – IHE Interoperability Showcase – March 2007 – Zorg and ICT 2007 (Netherlands) – IHE Demonstration – March 2007 – IHE Connectathon Europe – April 2007 – Canada eHealth Conference – IHE Interoperability Showcase – May 2007 – World of Health IT Conference (Vienna Oct 2007) – IHE Interoperability Showcase IBM providing internet-accessible reference implementation of IHE infrastructure profiles (HIE) for ISV testing/demonstration for past 2+ years.63 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE Connectathon Test Partners (part 1 of 2) Audit Repository Doc Registry Doc Repository openEMR/OHF Accenture x x Acuo x x Agfa x x x x Alert x x x Allscripts x x x x Ashvins x Axolotl x Bell Canada x x Blueware x x x x Canon x CapMed x x x x Caribel Cegedim x x Cerner x x CGI x CompassCare x x Convergence x CPSI x x DataProcessing x x x Dianoema x Dictaphone x x Eclipsys x x EDL x x Epic x x Esel x x x Etiam x x Forcare x x x x GE Clinisoft, RIS x Clinisoft, Muse, RIS x HIPAAT x x HXTI x x IcoServe x x x ICW x Infinitt x x Initiate x x Intersystems x x Kodak x x x x64 National Health Record – Standard Solution © 2006 IBM Corporation
  • IHE Connectathon Test Partners (part 2 of 2) Audit Repository Doc Registry Doc Repository openEMR/OHF McKesson x x Medasys x x x MedCommons x x x MediNotes x x x Mediware x x MedQuist Medos x MIE x Misys x x x Moreau-Labbeer x NDMA x x NextGen x x x NIST x Obrieng x Philips x PracticePartner x x x Quadramed x Quovadx x x x Rogan x RVC x Santeos x x x Sectra Siemens x x x x Sillage x x Smwaidr2i x x SoftMedical x x x Solinfo x x x Sovera x x SQLI x x x SRDC x x x Synapsis x x x Tiani-Spirit x x x x Visus Total Vendors Tested 47 38 39 2565 National Health Record – Standard Solution © 2006 IBM Corporation
  • NHIN Architecture Prototype Project Vision A nation-wide standards based network that will allow connectivity of existing and future systems for providers and affiliated stakeholders ONC Objectives IBM Approach Develop and evaluate prototypes for an interoperable NHIN architecture Maximize existing resources & systems - Maximize existing resources to achieve - Maximize existing resources to achieve widespread interoperability among health care SW applications, (e.g. EHRs) widespread interoperability among health care SW applications, (e.g. EHRs) Spur technical innovation for nationwide sharing of health information Be community centric - In patient care and public health settings - In patient care and public health settings Achieve interoperability between SW applications and networks Be interoperable between software - Communicate and exchange information in an applications and networks accurate, effective, useful, manner - Communicate and exchange information Promote collaboration between HHS health IT in an accurate, effective, useful, manner contractors - Develop Compliance Certification process Be security & privacy compliant - Develop Standards Harmonization process - Develop Privacy and Security solutions for - Develop Compliance Certification process interoperable health information exchange - Develop Standards Harmonization process - Develop Privacy and Security solutions for interoperable health information exchange66 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM Healthcare Marketplace Partners Each vendor must demonstrate information exchange within and between three distinct community healthcare markets Mid-Hudson Valley, NY (THINC) – Taconic Healthcare Information Network and Community (THINC) THINC – Mid-Hudson Valley: evolving RHIO with shared data at HealthVision hub – 2,300 physicians supporting 700,000 patients Research Triangle, NC (NCHICA) – Competitive, high-tech urban environment Rockingham County, NC – Hospitals: Duke, WakeMed, UNC, Rex (UNC Health) Danville, VA (NCHICA) – Practices, Public Health, Pharmacies Rockingham County, NC and Danville, VA (NCHICA) – Rural environment with NC and VA patients – Hospitals: Morehead Memorial, Annie Penn (Moses Cone Health System) Research Triangle, – Practices, Public Health, Pharmacies NC (NCHICA)67 National Health Record – Standard Solution © 2006 IBM Corporation
  • IBM NHIN Phase 1 Participants THINC Mid Hudson Valley Research Triangle Rockingham County, NC Kingston Hospital Pinehurst, NC Danville, VA St. Francis Hospital Duke University Health Morehead Memorial Hospital Vassar Brothers System Eden Internal Medicine Healthcare Medical Center Durham Medical Center Pulmonary, Allergy and Asthma Providers Physician Practices FirstHealth of the Carolinas Clinic of Danville Hudson Valley Primary Care Moore Free Care Clinic Moses Cone Health System Bridge Street Family Medicine Pinehurst Medical Family Tree OB/GYN Springside Medical Associates Pinehurst Surgical Moses Cone Internal Medicine Rabi Sinha, MD Southern Pines Women’s Center Residency Program Hudson River Community Health CapMed (PHR) Possibility Forge (openEMR) Medical Application Allscripts (Touchworks 11™) Vendors McKesson (Horizon WP Physician Portal™) GE Centricity MediTech Medical Service Spectrum Lab Lab Corp Providers SureScripts® Custom Patient Registration, Provider Registration, and Provider Notification Services Custom Security Services Core Services Initiate Identity Hub™ Software IBM Healthcare Collaborative Network IBM Heath Information Exchange (XDS Repository & Registry, FQS, OHF Bridge, ARR) Infrastructure IBM Tivoli IBM WebSphere® DataPower IHE Integration Profiles (ATNA, XDS, PIX, PDQ, XDS MS) Standards HL7 / ASTM (CDA / CCD) SAML, SSL/TLS, X509, Web Services Security (SAML / SOAP / Trust Language)68 National Health Record – Standard Solution © 2006 IBM Corporation
  • XDS Projects – Worldwide Netherlands Lower Austria Italy Hilversum (Conto Corrente Salute) UK CfH Leeuwarden(Radiology WF) Amsterdam France Denmark (Funen) Italy (Veneto) Quebec, Toronto, DMP Spain (Aragon) Alberta, British Columbia Austria Canada Infoway VITL-Vermont Boston Medical Center - MA Philadelphia HIE CPHIC – Pennsylvania CareSpark – TN & VA South Africa CHINA-Shanghai Malaysia CHINA-MoH JAPAN-Nagoya THINC- New York Imaging Info Sharing Lab results sharing Imaging Info Sharing NCHICA – N. Carolina 69 National Health Record – Standard Solution © 2006 IBM Corporation
  • ‫תודה‬ Hebrew (Toda) Grazie Italian Thai Traditional Chinese Obrigado Merci Brazilian Portuguese French Russian Gracias Spanish Danke Arabic German Simplified Chinese Japanese70 National Health Record – Standard Solution © 2006 IBM Corporation