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Goscon 2010

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Goscon 2010

  1. 1. Open Source’s Role in CONNECTing the Public and Private Sector Healthcare Communities David Riley Contractor, ONC/FHA CONNECT Lead GOSCON 2010 October 27, 2010
  2. 2. A Nation’s Call to Action “We’ll be on our way to computerizing all of America’s medical records, which won’t just eliminate inefficiencies, save billions of dollars and create tens of thousands of jobs – but will save lives by reducing deadly medical errors.” – President Barack Obama, February 4, 2009 2
  3. 3. The Current State of Affairs: A Disjointed, Expensive Healthcare System • U.S. spent approx. $2.2 trillion on health care in 2007 ($7,421/person). This comes to 16.2% of GDP, nearly twice the average of other developed nations. (Source: • Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the electronic health record (EHR) systems envisioned for the whole nation. Most of today’s systems are still not interoperable. (Source: CNN) • Due to lack of interoperable EHRs, tests are duplicated, information is unavailable at the point of care, public health information is difficult to track and health organizations carry a heavy administration burden. 3
  4. 4. The American Recovery and Reinvestment Act (ARRA) invests $19 billion in computerized medical records that will help to reduce costs and improve quality while ensuring patients’ privacy. ARRA promotes the national agenda by helping:  Increase access to care  Improve quality of care  Decrease the costs of care  Promote meaningful use of EHRs ARRA and the President’s reform agenda focus on building open and transparent government. The National Health IT Agenda 4
  5. 5. Federal Health Architecture Advancing the Agenda FHA ensures federal participation in ONC-led initiatives such as the Nationwide Health Information Network, Direct Project, EHR adoption, and CONNECT • E-gov initiative managed by ONC within HHS • 26+ federal agencies participate in FHA c 5
  6. 6. Nationwide Health Information Network Exchange and CONNECT The Nationwide Health Information Network is a set of standards, services, and policies that enable secure health information exchange over the internet. • Nationwide Health Information Network Exchange connects a diverse set of federal agencies and private organizations to securely exchange electronic health information using the Nationwide Health Information Network services. (For example: SSA – MedVirginia, DoD, VA and KP) CONNECT is a federally funded and developed open source reference implementation of the Nationwide Health Information Network Exchange standards and services. • CONNECT is using an effective public – private collaboration to create a secure, standard platform for health information exchange • Nationwide Health Information Network Exchange participants save resources by using CONNECT instead of developing their own implementation of the Nationwide Health Information Network Exchange standards and services 6
  7. 7. Transaction Profiles Utilize exchange patterns for specific transactions CMS CARE Doc Submission CDC GIPSE HIEM Discovery and Information Exchange Services Rely on foundations to enable exchange patterns Messaging, Security, & Privacy Foundations Enable private, secure, and interoperable communication of health information Messaging Platform Authorization Framework MITA Eligibility Verification Discovery Pull Push Pub/Sub Patient Discovery HIEM Doc Submission Services Registry Query & Retrieve Docs Eligibility Verification Operational Infrastructure Runtime systems that support the Nationwide Health Information Network Limited Production Exchange Security Infrastructure (managed PKI) Web Services Registry Access Control Policy Nationwide Health Information Network Exchange Specifications and Operational Infrastructure 7
  8. 8. CONNECT Open Source Software Project Public/Private Collaboration Delivers Results More than 2,000 organizations from the public and private sectors participate in the CONNECT open source community. • Social Security Administration: Able to reduce disability determination processing time by 42% receiving data from MedVirginia using CONNECT • Department of Defense and Department of Veterans Affairs: Using CONNECT as part of their Virtual Lifetime Electronic Records initiative to support lifelong health needs of active duty military and veterans • Centers for Disease Control and Prevention: Using CONNECT to receive de-identified public health data from regional public health organizations CONNECT in ActionOpen Collaborative Focus on collaborative progress in health IT has won many awards, including the Wall Street Journal Innovation Award. 8
  9. 9. Reform Objectives Meaningful Use Objectives Transparent Government Objectives CONNECT Meeting Multiple Objectives CONNECT promotes the widespread adoption of interoperable health IT. It uses nationally recognized standards, conventions and trust agreements, to address multiple complex objectives simultaneously. CONNECT is a federally funded, Open Source software solution that is a: • Platform for Participation • Platform for Innovation 9
  10. 10. Planning and Approach • Identify the participants involved in the exchange • Identify a business and technical contact for each participant • Have a kick-off meeting with all participants • For each participant, determine readiness – What does each participant need (hardware, software and services)? – What systems do they have? – What method of exchanges can be supported? • Create a template with the exchanges 10
  11. 11. Exchange Template From To Document Method Comments Public Health Hospital Lab Result Push Content? Provider Public Health Immunization Report Publish, Subscribe State Standard Report Provider Public Health Lab Result Query/Response Hospital Public Health NDC Codes Push National Standard Public Health CDC GIPSE Publish, Subscribe Nationwide Health Information Network Profile Note: This table will identify the adapter work to be achieved. There is potential for re-use.11
  12. 12. Draw a Picture of Your Exchange 12
  13. 13. Planning and Approach (cont.) • Set priorities by document/exchange type(s) – Some will be easier than others depending upon readiness review – We have templates available to assist with this information gathering 13
  14. 14. Timeframes • Two Gateways – Publish and Subscribe (fastest) – Document Push (faster) – Query/Response (not so fast) • Requires ability to ID patients uniquely • Requires ability to ID documents • Requires ability to retrieve the documents • Six months for initial project • Three months for next release 14
  15. 15. Cost and Skills • CONNECT software is open source • Business partners offer configuration and support • Available as an “appliance” (approx 5K list) • Adapter work depends on specific systems • Skills – Business Analyst, Health Information Exchanges and Standards – Development, Java Skills, Healthcare Knowledge – Testing and Support, SOAP UI 15
  16. 16. CONNECT: An Open Source Community • CONNECT Code is Released Under the New BSD License • Release as Open Source April 2009 • CONNECT Open Source Community Announcement June 2009 • CONNECT Community Events – CONNECT Training Seminars/Webinars – CONNECT Code-A-Thons • CONNECT Community Focus – Getting organizations into production exchanging health information • Nationwide Health Information Network Exchange based production • Non-Nationwide Health Information Network Exchange based production 16
  17. 17. Test/Demo ProductionFederal Adopters Centers for Disease Control & Prevention Centers for Medicare & Medicaid Services OFM (esMD) OCSQ (PQRI) OCSQ (C-HIEP) CMSO (MITA Claims Submission) Department of Defense Department of Homeland Security Department of Veterans Affairs Food and Drug Administration Federal Communications Commission Indian Health Service National Cancer Institute National Disaster Medical System Social Security Administration 2010* 2010* 2010* 2010* 2010* 2010* 2010* 2010-2011* 2010-2011* 2010* 2010 2009 2010* 2010* 2009 CONNECT and Nationwide Health Information Network * Planned Nationwide Health Information Network/CONNECT Implementation Status 17
  18. 18. Test/Demo ProductionNon-Federal Adopters Center for Healthy Communities, Wright State University, Healthlink Central Virginia Health Network/MedVirginia Community Health Information Collaborative (CHIC) Emdeon EPIC HealthBridge Indiana State Department of Health Iowa Department of Public Health Iowa Health Systems Kaiser Permanente MedVirginia MEDNET in Partnerships Community Health Information Collaborative (aka HIE-Bridge) LACIE –Lewis and Clark Information Exchange Emdeon Hielix – Phase 1 Contract for the State of North Dakota Statewide HIE New York State Department of Health Orange County ER Connect Redwood MedNet Regenstrief Institute, Inc. Southeastern Michigan Health Association Thayer County Health Services **Winner of CMIO Magazine Health Innovation Award** 2010 Washington State Department of Health 2010* 2010* 2009 2010* 2010* 2010-2011* 2009 2010-2011* 2010* 2010-2011* 2010-2011* 2010* 2009 2009 2010* 2010* 2010* 2010 2010-2011* 2010-2011* 2009 2010* CONNECT CONNECT and Nationwide Health Information Network * Planned Nationwide Health Information Network/CONNECT Implementation Status 18
  19. 19. Vendors Solutions with CONNECT 19 Reflection Technologies
  20. 20. Two Major CONNECT Components Important to You! • The Gateway handles interoperability between other gateways • The Adapter (a “program”) handles operability with the organization and system providing the information. The adapter has tools to help with: – Master Person Index – Document Repository – Integration Tools – Policy Management 20
  21. 21. CONNECT Adapter: Organizational SOA Starter Kit Enterprise Service Components: – Master Patient Index – Policy Engine – Redaction Engine – Audit Services – Document Registry/ Document Repository – Subscription Repository – Re-identification Service – Entity Integration Services – SDK Services 21
  22. 22. CONNECT Architecture Message from Nationwide Health Information Network 22
  23. 23. CONNECT Architecture Message to Nationwide Health Information Network 23
  24. 24. CONNECT Community Portal 24