Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Alean Kirnak, Software Partners

500 views

Published on

  • Be the first to comment

  • Be the first to like this

Alean Kirnak, Software Partners

  1. 1. Alean Kirnak, Software Partners LLC [email_address] November 2009 Copyright 2009 Software Partners LLC
  2. 2. <ul><li>2007-2008 PHDSC white paper: silos repeat functionality and don’t talk to each other </li></ul><ul><li>In 2008-2009, PHDSC developed a Service-Oriented Architecture White Paper with IHE </li></ul><ul><li>New standards offer new workflow possibilities and related cost savings </li></ul><ul><li>www.ihe.net </li></ul><ul><li>A Service-Oriented Architecture View of IHE Profiles, Kirnak, Moehrke, Painter. </li></ul>
  3. 3. <ul><li>Messages </li></ul><ul><li>Documents </li></ul><ul><li>Services  </li></ul>Copyright 2009 Software Partners LLC
  4. 4. <ul><li>Point-to-point communication </li></ul><ul><li>HL7 V2 Implementation Guides </li></ul><ul><li>MSH|^~&|XDSDEMO_ADT|XDSDEMO|SWPartner_PIX|SWPartner_PIX|200908301933||ADT^A04^ADT_A01|00000188|P|2.3.1|….   </li></ul>Copyright 2009 Software Partners LLC
  5. 5. Copyright 2009 Software Partners LLC
  6. 6. Copyright 2009 Software Partners LLC
  7. 7. Copyright 2009 Software Partners LLC
  8. 8. Copyright 2009 Software Partners LLC Identification Service Operation Description Register This operation inserts a Source ID/Entity ID pair and supplied Traits into the index with implicit linking to other matching Source ID/ Entity ID pairs, based on the configured internal matching algorithm. Update This operation updates the Traits stored in the index for the Entity identified by the supplied Source ID/Entity ID pair. List This operation retrieves all the Source ID/Entity ID pairs that are linked to the supplied Source ID/Entity ID pair. The operation can be filtered with the sourceConstraintSet property of the EISSearchQualifier to only return entities within specified Source domains. Query This operation provides the means to perform a broad search of all records in the index whose traits match some criteria in the supplied search criteria. Link This operation provides the means to create an explicit (as opposed to automatic) linking between two Source ID/Entity ID pairs in the index. Unlink This operation provides the means to create an explicit (as opposed to automatic) linking between two Source ID/Entity ID pairs in the index. Merge This operation provides the means to explicitly consolidate index Source ID/Entity ID pairs in the index.
  9. 9. Copyright 2009 Software Partners LLC
  10. 10. Web-based Application Registry Data Store Data Stores All Registry Application Functions: Identity Resolution Retrieval/Update of Data Decision Support Population Studies HL7 V2 Hospital #2 Clinic # 2 Hospital #1 user Clinic #1 user Other user Stakeholders Other user
  11. 11. Point to point: Hub: Bus: Copyright 2009 Software Partners LLC
  12. 12. <ul><li>Approximately 75 U.S. Immunization Information Systems (IISs) </li></ul><ul><li>Completely connected point-to-point IIS network: 74 * 75 / 2 = 2775 connections </li></ul><ul><li>Assume 200 regional provider EHRs per IIS: </li></ul><ul><li>200 * 75 = 15,000 connections </li></ul><ul><li>Each connection costs $10K-$30K per side </li></ul><ul><li>$40K each * 17,775 =$711,000,000 </li></ul>Copyright 2009 Software Partners LLC
  13. 13. <ul><li>Labs </li></ul><ul><li>Meds </li></ul><ul><li>Allergies </li></ul><ul><li>Problem Lists </li></ul><ul><li>Cancer Registries </li></ul><ul><li>Adverse Events </li></ul><ul><li>… etc. </li></ul><ul><li>Intra-enterprise communication </li></ul><ul><li>Provider-to-Provider communication </li></ul><ul><li>... </li></ul><ul><li>100 domains increases cost to $71,100,000,000 </li></ul>Copyright 2009 Software Partners LLC
  14. 14. <ul><li>Patient Identification </li></ul><ul><li>Maintenance of Connections </li></ul><ul><li>Data Models </li></ul><ul><li>Decision Support </li></ul><ul><li>Reporting </li></ul>Copyright 2009 Software Partners LLC
  15. 15. <ul><li>Providers are the producers of electronic health information </li></ul><ul><li>Patients are the consumers </li></ul><ul><li>Providers will not pay </li></ul>Copyright 2009 Software Partners LLC
  16. 16. <ul><li>Reduce number of connections through bus architecture </li></ul><ul><ul><li>SOA </li></ul></ul><ul><li>Create repeatable connections </li></ul><ul><ul><li>Plug and play standards like IHE </li></ul></ul><ul><li>Collapse common functionality </li></ul><ul><ul><li>Reuse infrastructure like Patient Identification </li></ul></ul><ul><li>Create common information model </li></ul><ul><ul><li>Use Continuity of Care Document </li></ul></ul><ul><li>Improve the delivery of information to consumers so payors will eventually pay </li></ul><ul><ul><li>To their other providers </li></ul></ul><ul><ul><li>To public health </li></ul></ul><ul><ul><li>To patients directly </li></ul></ul>Copyright 2009 Software Partners LLC
  17. 17. Services Other Service Security Data Transform Copyright 2009 Software Partners LLC Existing IIS Existing IIS Service Interfaces Identity Resolution Decision Support Retrieve and Update Hospital #2 Clinic #2 Hospital #1 EMR Clinic #1 EMR Internet Browser interface Existing IIS Master Person Index Document Repository Data Stores Document Registry
  18. 18. <ul><li>75 U.S. IISs </li></ul><ul><li>Each connected to one Identification Service running a standard interface: 75 connections </li></ul><ul><li>200 provider EHRs per IIS: 200 * 75 = 15,000 </li></ul><ul><li>Averaging 30 installations each of 500 EHR products = 500 + 75 = 575 </li></ul><ul><li>Each connection costs $10K-$30K </li></ul><ul><ul><li>Service consumer only! </li></ul></ul><ul><li>$20K each * 575 =$11,500,000 total </li></ul><ul><li>plug and play connections means: </li></ul><ul><li>For a single service i.e. Patient Identification </li></ul>Copyright 2009 Software Partners LLC
  19. 19. Copyright 2009 Software Partners LLC
  20. 20. <ul><li>Interoperability cost becomes function of: </li></ul><ul><li># of service consumers * # of services </li></ul>Copyright 2009 Software Partners LLC
  21. 21. <ul><li>3 services * 575 EHR flavors * 20K = </li></ul><ul><li>$34,500,000 vs $71,100,000,000 </li></ul>Copyright 2009 Software Partners LLC
  22. 22. Copyright 2009 Software Partners LLC Capability Patient Identification Data Retrieval and Update Decision Support Standards Org HL7 Service Specification Identification Service Functional Model (SFM) Retrieve, Locate, Update SFM Decision Support SFM Standards Org OMG Service Specification Identification Service Specification Retrieve, Locate, Update Tech Spec Decision Support Service Spec Profile Org IHE SOA Profile SOA White Paper Profile Org IHE Immunization Profile PIX/PDQ   POIZ Scope Immunization Content Immunization Content Request for Clinical Guidance (Immunization Content payload) Profile Org AIRA/CDC Immunization Profile In progress: 2.5 Implementation Guide   In progress: 2.5 Implementation Guide         Immunization Profile 2.3.1 Implementation Guide   2.3.1 Immunization Implementation Guide       Standards Org HL7 Original Standard Version 2 Version 3 Patient Admin messaging Version 2 Version 3 Immunization (POIZ) messaging Version 3 Care Record CDA Version 3 Care Record CDA Version 3 Care Record messaging
  23. 23. 2. Primary Care Provider, State 2 IHE Infrastructure Immunization Information System (IIS) 1. Primary Care Provider, State 1 PHIN 2009 - IHE Interoperability Showcase Public Health Immunization Scenario Decision Support Service Yellow Card Service 3. Infrastructure 4. Local Public Health Dept. State 2 <ul><li>An 18 month-old patient without immunization record visits PCP1 </li></ul><ul><ul><li>1. PCP1 queries the local EMR </li></ul></ul><ul><ul><li>2. EMR queries IIS (QED) </li></ul></ul><ul><ul><li>3. IIS returns immunization to EMR </li></ul></ul><ul><ul><li>4. PCP1 receives list of immunizations via EMR </li></ul></ul><ul><ul><li>5. Immunizations are administered </li></ul></ul><ul><ul><li>6. PCP1 updates EMR </li></ul></ul><ul><ul><li>7. EMR updates IHE Registry & Repository (XDS-MS, IC) and IIS (HL7 2.3.1) via Gateway </li></ul></ul><ul><li>The same patient, now a 5 year-old, visits PCP2 in a different state, again without an immunization record </li></ul><ul><ul><li>1. PCP2 queries EMR </li></ul></ul><ul><ul><li>2. EMR queries the HIE ( PIX, PDQ, XDS-MS) </li></ul></ul><ul><ul><li>3. HIE returns immunization to EMR </li></ul></ul><ul><ul><li>4. PCP2 receives list of immunizations via EMR </li></ul></ul><ul><ul><li>5. Immunizations are administered </li></ul></ul><ul><ul><li>6. PCP2 updates EMR </li></ul></ul><ul><ul><li>7. EMR updates IHE Registry & Repository (XDS-MS, IC) and IIS (HL7 2.3.1) via the Gateway </li></ul></ul><<Explanation of IHE Infrastructure, Gateway, Immunization Information System, Decision Support Service and Yellow Card Service. >> <ul><li>A measles outbreak is occurring in a large county in State 2. The child’s parent calls the local health department to confirm the child’s measles immunization status </li></ul><ul><ul><li>Epidemiologist authenticates using a Identity Service Provider (TP 20, C19) </li></ul></ul><ul><ul><li>Authenticated epidemiologist queries the HIE using child’s name, gender, and birthday (PDQ) </li></ul></ul><ul><ul><li>IHE Infrastructure returns a list of matching records </li></ul></ul><ul><ul><li>Epidemiologist selects appropriate record; request for immunization records sent, then results returned (XDS, IC) </li></ul></ul><ul><ul><li>Request for immunization recommendations (IDSS) , results returned </li></ul></ul><ul><ul><li>Yellow Card requested and returned as PDF to be printed and mailed </li></ul></ul>Copyright 2009 Software Partners LLC
  24. 24. <ul><li>Education </li></ul><ul><ul><li>Little understanding of SOA yet </li></ul></ul><ul><li>Broader View </li></ul><ul><ul><li>Groups like HITSP must take the broad view </li></ul></ul><ul><ul><li>“ SOA Governance” </li></ul></ul><ul><li>Overcoming status quo thinking </li></ul><ul><ul><li>Vested interests in preserving inefficient approaches </li></ul></ul><ul><li>Funding </li></ul><ul><ul><li>Support innovative approaches as well as status quo </li></ul></ul><ul><li>Collective Action </li></ul>Copyright 2009 Software Partners LLC
  25. 25. “ The Internet disrupted the music business; Google disrupted the media…. Buzzwords such as “Health Care 2.0”, … could soon acquire real meaning.” - The Economist, Oct 25, 2008 Copyright 2009 Software Partners LLC

×