RnR Presentation to ELR National Working Group


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Presentation by Eduardo Gonzalez Loumiet on the PHLIP RnR Hub to the ELR National Working Group on October 4, 2011

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  • Good afternoon and thank you to the ELR National Task Force members and leadership for providing the opportunity to share our story on the PHLIP Route-Not-Read Hub, it’s use for ELSM, in addition to other projects ongoing via the Hubs
  • As mentioned, I will focus the next few mins on the: RNR HUBs and 4 projects that use the RnR Hub for secure message transport and routing.
  • A little bit about the PHLIP RnR Hub Team. My name is Eddie Gonzalez Loumiet. I work at Uber Operations and am a contractor at the Florida Dept of Health in the data integration team. We are also contractors to the Association of Public Health labs and manage and maintain the Florida PHLIP RnR Hub. There is a second Hub, located in Nebraska, maintained by LabPoint. There are other members of the team like Bob Williams from Interalle and several members from the St John Group.
  • The RnR Hub, which stands for ROUTE NOT Read Hub is part of the Public Health Lab Interoperability Project, also known as PHLIP. I will briefly go through several slides for those that want a refresher on PHLIP.
  • PHLIP is a national resource of some of the best information and laboratory scientists, a collaboration among partners, a community focusing on expanding LIMS user communities, meeting the needs of public health on national notifiable diseases.
  • As mentioned PHLIP surfaced from the laboratory community with the mission to address the need to exchange laboratory orders and results electronically.  And as it matured, many more data exchange partners were expected to participate and apply the standardized content and message structure developed through the PHLIP workgroups.  Originally, to exchange data between these partners, a direct send PHINMS connection was recommended between each organization.  Although Direct Send is a feasible, secure method of exchanging data, the addition of each new node to the community results in exponential growth of direct connections and maintenance.  
  • The requirements pointed to the establishment of two interoperable Route not Read (RnR) hubs.  The established RnR workgroup developed a timeline to implement two RnR hubs, one at the Florida Department of Health and one at the Nebraska Public Health Laboratory.  The move towards utilizing a multi-hub architecture reduced the overhead of the Direct Send model by reducing the number of connections for intercommunication of nodes, ease the impact of firewall rules when connecting to trading partners and it makes maintenance tasks simpler, such as certificate management.  Dual interoperability techniques were developed during the project, one of these solutions is a web services approach to connect the two hubs.  Web Services is the basis of NwHIN’s connectivity strategy, so the use of this interoperability technique will position the PHLIP group to take advantage of and participate in national network activity.
  • Here is a quick list detailing the key factors of the RnR Hub, all promoting a secure and rapid implementation of electronic message exchange.
  • As of last week 27 states are in full production and actually 2 in parallel production.
  • In addition to ELSM, there are 3 other projects which leverage the RnR Hub for secure message transport.
  • Lets continue with the Pandemic Influenza Project….In 2008, the CDC released a Funding Opportunity for the Pandemic Influenza Grant. The goal of the grant was to pilot information exchange technologies and collaboration between different groups, like inter and intra state partners, the CDC, and international partners. Both Texas and Florida knew that in order to accomplish the requirements of the grant and to create a sustainable model, they had to partner. So they started with looking for a state with the same LIMS (common denominator). In this case, Florida and Texas both use LABWARE in addition to the fact that both states are similar in many ways like: natural disasters, similar population numbers and types, and immigration challenges.
  • The Goals of the project were to:Exchange of influenza lab data with:Local partnersOther statesFederal partnersInternational partnersExchange of lab test orders and resultsDevelop surge capacity model for Pan Flu testing
  • And of course, the main challengewas: how do we get these two silos of information exchange to exchange with each other? Two states located in different parts of the US. We needed a solution that would allow us to exchange information with a partner close to 900 miles away.
  • This is another diagram, which emphasizes the RNR HUB in the middle. As I mentioned in my previous slide, if Texas is overwhelmed in a surge situation, they can send lab orders to Florida to be resulted. Those orders would be created in their LabWare, picked up by the Rhapsody integration engine and placed in a directory for PHINMS to pick up and send to Florida via the Florida PHLIP RnR Hub. The Florida PHINMS, polls the PHLIP RnR Hub and will pick up the orders to then be resulted in Florida’s LabWare and routed back to Texas to update their LIMS.As you can also see in this diagram, once a state or trading partner is on the PHLIP Florida RnR Hub, they have the capability to exchange electronically with any other states or trading partners on the Hub, like for example, in this diagram, Virginia and the CDC shown here.
  • As you can see from this diagram, he ETOR project is also working collaboratively with the CDC PHLISSA group with the goal of increasing turnaround time and reducing steps for laboratorians.
  • A fourth additional project that is leveraging the PHLIP Florida RnR Hub is the FDOH ELR initiative. Chapter 64D-3 of the Florida Administrative Code (FAC) requires that healthcare providers and laboratories in Florida electronically report the laboratory results of notifiable diseases and conditions to the Florida Department of Health. The department’s established procedure is known as Electronic Laboratory Reporting, or ELR. The FloridaDepartmentof Health has a very experienced ELR Team that uses the electronically submitted data for the purpose of disease surveillance. DOH supports the Health Level Seven (HL7) version 2.3.1 and 2.5.1 standard for electronic results submission
  • In regards to data transmission of the notifiable diseases, the Florida Department Of Health currently supports a number of mechanisms for data transport of laboratory results including:sFTPPHIN-MS Direct-SendVPN Dedicated Circuit Each one of these options has its benefits and some have costs. With the launch of the PHLIP Florida RnR Hub, we have been working with some of the new Florida ELR partners, taking advantage of this new technology and managed and streamlined processes. As mentioned earlier, once a trading partner is on the Hub, that trading partner, with minimal effort, can send and receive messages to any other trading partners on the Hub, which is a tremendous value.
  • Here you have a diagram of the different ELR partners currently registered or being registered on the PHLIP Florida RnR Hub for ELR and information exchange. As you can see by all 4 projects, the PHLIP RnR Hubs are an innovative and secure way to exchange information. You often get industry experts talking about how the future of health technology will be a network of information exchange, well, as you just heard, its going on today, thanks to many of you and the PHLIP community.
  • So what's next? The momentum is there…amazing milestones are met….we are registering more and more trading partners and slowly creating and maturing that PHLIP goal that was mentioned earlier, creating a national interoperable lab system. We are now focusing on: Registering all state public health labs on the RnR Hub Continuing to collaborate with Federal, State, and Local public health departments in addition to private health care providers and labsCoordinate with the Public Health Laboratory Solutions and Solution Architecture (PHLISSA) project Continue developing interoperability between Direct and PHINMS Continuing development of the PHLIP architecture, with the expectation that the RnR Hub will serve as a connection to both the NwHIN and the State Health Information Networks.
  • Once again, I am honored to represent an amazing group of experts like APHL, Florida Dept of Health and several others shown here.
  • Here are additional resources on PHLIP and the RNR Hub…and we will make sure these slides are online for your future reference.
  • Please feel free to contact me if you have any questions.
  • RnR Presentation to ELR National Working Group

    1. 1. PHLIP Route-Not-Read Hub<br />National ELR Working Group | October 4, 2011<br />
    2. 2. The Plan<br />
    3. 3. The Team<br />Florida RnR Hub Team<br /><ul><li>Frans de Wet
    4. 4. John Butler
    5. 5. Eddie Gonzalez Loumiet</li></ul>Nebraska RnR Hub Team<br /><ul><li>Jim Svoboda
    6. 6. John Glock
    7. 7. Bob Williams
    8. 8. PHLIP Assistance Teams</li></li></ul><li>Public Health Laboratory Interoperability Project(PHLIP) <br />PHIN-MS Route-Not-Read Hub <br />(RnR Hub)<br />
    9. 9. What is PHLIP?<br /><ul><li>A National Resource: Information and laboratory scientists at the state and federal level addressing highly complex technical issues critical to public health.
    10. 10. A Collaboration: commitment to utilize NwHIN IT architecture options for the exchange of electronic laboratory data at all levels of public health laboratories.
    11. 11. A Community: tosupport and expand LIMS user communities, creating a process that can be applied to other highly complex problems
    12. 12. Products and Publications: Documentation of decisions made, fiscal and human resources needed, and lessons learned. Development and dissemination of Vocabulary and Messaging guides to meet the needs of the Public Health Laboratory “harmonized” list of LOINC and SNOMED codes for nationally notifiable diseases (NND’s).
    13. 13. A Success: The realization of common goals and national priorities in a production environment.</li></li></ul><li>PHLIPVision<br />Achieve bi-directional laboratory data exchange <br /><ul><li>State public health labs (SPHL) with CDC labs
    14. 14. SPHLs with local partners</li></ul>Which will<br /><ul><li>Improve data quality and accessibility
    15. 15. Improve data sources for active surveillance
    16. 16. Develop and test future system approaches
    17. 17. Create a Strengthened collaborative environment for public health</li></ul>National Interoperable Laboratory System<br />
    18. 18. PHLIP Building Blocks<br />National collaborative process<br />Provide detailed vocabulary implementation guidelines<br />Build PHL capability for electronic test ordering and result reporting<br />Develop data exchange architecture options using the PHINMS<br />Establish a process to help labs increase messaging capability<br />PHLIP Florida RnR Hub Team<br />
    19. 19. What is PHINMS?<br /><ul><li>Public Health Information Network – Messaging System
    20. 20. Provides public health applications a common platform for message transport
    21. 21. Secure and reliable over the Internet
    22. 22. Standards-based -“De-facto” standard for secure message transport
    23. 23. Available at no cost to users
    24. 24. Applications using PHINMS include: BioSense, ELR, LRN, NBS,NND, NHSN, LabCorp, PerSe, Foodborne, BSIO, PHLIP
    25. 25. Used by Public Health Information Network Certification (PHIN)
    26. 26. 8-year old product deemed “mission critical” by CDC
    27. 27. Over 700 PHIN-MS nodes used in U.S.</li></li></ul><li>Direct Send Model<br />Multiple Senders to Multiple Receivers = exponential growth of connections and maintenance<br />
    28. 28. Solution<br />RnR Hub <br />
    29. 29. What is the RnR Hub?<br /><ul><li>The RnR Hub focuses on reducing the overhead of the PHINMS Direct Send model
    30. 30. A PHINMS receiver is not required for bi-directional messaging
    31. 31. Additional firewall configuration is not typically required for each Trading Partner – infrastructure needs are low
    32. 32. Facilitates rapid implementation of electronic message exchange
    33. 33. Low deployment costs for partners - Ability to send pre-configured install “package”
    34. 34. Reduction of management burden
    35. 35. Message routing
    36. 36. Certificate management
    37. 37. Hardware and bandwidth needs
    38. 38. Once on the RnR Hub, you can exchange</li></ul>Information with all others on the RnR Hub<br /><ul><li>Centralized Support provided by the RnR</li></ul>Hub Team<br />
    39. 39. PHLIP Use Case 1 – ELSM<br />Influenza – Electronic Laboratory Surveillance Message<br /><ul><li>Goal: All states sending Influenza results via the PHLIP HL7 Message to CDC
    40. 40. New states to complete readiness assessment and agree to PHLIP decisions
    41. 41. All states to provide Influenza reporting metrics
    42. 42. PHLIP Assistance Teams to deliver onsite and virtual support and PHLIP Program Management to provide oversight.
    43. 43. Future: additional PHLIS agents as prioritized by CDC</li></ul>PHLIP Route-Not-Read Hub<br />HL7 Test Result<br />HL7 Test Result<br />State Public Health Lab (SPHL)<br />CDC – Influenza Division<br />Message Format: HL7 2.3.1 ORU <br />Contents: Influenza Laboratory Results (WHO Global Influenza Surveillance Network)<br />
    44. 44.
    45. 45. RnR in Action<br />2. Pandemic Influenza<br />3. ETOR Salmonella <br />4. Electronic Lab Reporting in Florida<br />
    46. 46.
    47. 47. Pan Flu Project: Goals<br /><ul><li>Exchange of influenza lab data with:
    48. 48. Local partners
    49. 49. Other states
    50. 50. Federal partners
    51. 51. International partners
    52. 52. Exchange of lab test orders and results
    53. 53. Develop surge capacity model for Pan Flu testing</li></ul> <br />
    54. 54. DISTANCE from Tallahassee to AUSTIN = 868 MILES<br />
    55. 55.
    56. 56. Use Case 2 – ETOR Service Requests<br />State to CDC – Electronic Test Order and Result<br /><ul><li>HL7 Test Order from State Public Health Lab (PHL) to CDC Lab(s)
    57. 57. HL7 Test Result from CDC Lab(s) to State PHL
    58. 58. Limited Scope Production phase includes Salmonella and Bacillus anthracis</li></ul>PHLIP Route-Not-Read Hub<br />HL7 Test Order<br />HL7 Test Order<br />HL7 Test Result<br />HL7 Test Result<br />State Public Health Lab (SPHL)<br />CDC Labs<br />Salmonella & BRRAT<br />Message Format:<br /><ul><li>Order = HL7 2.6 ORM
    59. 59. Result = HL7 2.6 OUL</li></ul>Contents: Salmonella & Bacillus Anthracis Orders and Results<br />Status: In progress<br />
    60. 60. SPHL to CDC<br /><ul><li>Bi-directional Test Orders and Results
    61. 61. Designed to replace “DASH” form and faxed results
    62. 62. Test orders directly from State LIMS
    63. 63. Reduces Steps for Laboratorians
    64. 64. Increases quality of data, immediate validation of order
    65. 65. Automatic confirmation of receipt of order
    66. 66. Test results directly from CDC LIMS
    67. 67. Automatic Update of State LIMS
    68. 68. Preliminary, Final and Amended results
    69. 69. Increases quality of data
    70. 70. Faster turn-around</li></ul>PHLIP Route-Not-Read Hub<br />HL7 Test Order<br />HL7 Test Order<br />HL7 Test Result<br />HL7 Test Result<br />State Public Health Lab (SPHL)<br />CDC<br />Salmonella<br />Lab<br />
    71. 71. Electronic Lab Reporting<br /><ul><li> Chapter 64D-3 of the Florida Administrative Code
    72. 72. Notifiable diseases and conditions
    73. 73. Disease surveillance
    74. 74. HL7</li></li></ul><li>Electronic Lab Reporting<br />Data Transmission: <br /><ul><li>sFTP
    75. 75. PHIN-MS
    76. 76. VPN
    77. 77. Dedicated Circuit </li></li></ul><li>
    78. 78. What’s Next?<br /><ul><li> Register all state public health labs on the RnR Hub
    79. 79. Continue to collaborate with Federal, State, and Local public health departments in addition to private health care providers and labs
    80. 80. Continue to work on additional use cases like Salmonella
    81. 81. Coordinate with the Public Health Laboratory Solutions and Solution Architecture (PHLISSA) project
    82. 82. Continue developing interoperability between Direct and PHINMS
    83. 83. Continue development of the PHLIP architecture, with the expectation that the RnR Hub will serve as a connection to both the NwHIN and the State Health Information Networks.</li></li></ul><li>Teamwork<br />
    84. 84. Additional Resources<br />http://bit.ly/PHLIP-Info<br />http://bit.ly/PHLIP-FLASH<br />http://bit.ly/PHINMS<br />http://bit.ly/RNR-1<br />http://bit.ly/RNR-2<br />
    85. 85. Contact Information<br />Eduardo “Eddie” Gonzalez Loumiet<br />Team Leader – Florida RnR Hub<br />eddie@uberops.com<br />(850) 766 – 5338<br />