Introduction to HIE

1. HEALTH INFORMATION
EXCHANGE
(HIE)

2. There are currently three key forms of he HIE :
Directed Exchange:
Directed exchange gives health care providers the ability to electronically send and receive secure information
such as laboratory orders and results, patient referrals, or discharge summaries – to other health care providers
involved in a patient’s care over the Internet via encrypted, secure, and reliable messaging.
Query-Based Exchange:
Query Based Exchange gives health care providers the ability to find and/or request information on a patient
from other providers and is often used for unplanned/emergency care.
Consumer Mediated Exchange:
Consumer medicated exchange gives patients the ability to aggregate and manage their health information on
the Internet. When in control of their own health information, patients can help transfer information between
providers, correct inaccurate demographic, medical, or billing information, and track and monitor their own
health.
Types of HIE

3. 3
Patient Apps
Provider EMR
systems
District Hospitals
CHC
PHC
Subcenter/HWC
Public Health
Vertical Programs
Pharmacies/Labs/
Imaging Centers
Data Standardization (MDDS & EHR Standards )
Core Layers - Patient Identification,Anonymizer, Consent, Security
Interoperability layer - Service Bus
(Services,Routing,Transformation,Mediations,Messaging,Security,Queuing&Staging)
EHR Repository
EHR Repository
EHR Registry Record Locator
Service
EHR Repository
EHR Repository
EHR Registry
Record Locator
Service
Federated Query
Exchange
1
Exchange
2
PHR
Disease Registry
Facility
Registry
Provider
Registry
Frontline Workforce
Registry
Drugs Registry Master Person Index
HIEAF Continuum of Care Integrated Model
Stakeholders
Payers
Business
Functions
Multiple federated
Exchanges, each
exchange has
multiple
repositories
Enabling registries
Messaging
Patient owned, maintained
instances (cloud based Medical
DigiLocker)
Public Health Reporting
Claims Adjudication
Through HCP
Fraud Detection Disease Management
Clinical Pathways Referral Network TeleHealth
Federated Data Lake
Data warehouses
(Central, State)
Business
Architecture
Applications
Architecture
Data
Architecture

4. How does the proposed PHR work?
Health ID and
Consent from
user
PHR
(real-time data aggregation)
Hospital
Diagnost
ic lab
Clinic
Health
Data
Access
Fiduciaries
(HDAF)
Health Data stays with providers (or TSPs) and is
pulled together on demand with consent into a
longitudinal record
• Providers integrate with
HDAFs using std Open APIs
• Documents use embedded
schemas - Initially we expect
items already digitized and
currently given to patients
• Diagnostic reports, Discharge
summaries. Over time -
prescriptions, primary care
encounters will come in

5. 5
Provider
Systems
Provider
TMS
Payer
TMS
Payer
Systems
PHR
(API +
Repositories) Beneficiary
Patient
EHR Repos
Fiduciary 1
EHR Repos
Fiduciary 2
EHR Registry
Facility Registry (C )
Provider Registry
(Doctors) (S + C)
Payer
Registry (S + C)
Drug Registry (C ) for
claim approvals
Payments (benefits &
contributions for
beneficiaries) (S +C )
Beneficiary (Patient)
Registry (S + C)
Health
Claims
Platform
Claim
Transaction
Pathways using
eObjects
Claim
Adjudication
System
Routing
FHIR Compliant
eObject, messaging Clinical docs
External System
External Repository
HIEAF component
HIEAF supporting Registry
EConsent Objects
HIEAF API Services – Provider-Payer
Clinical info exchange
Registry lookup to tag or
validate record with global IDs
Record locator service
Registration of record
metadata into registry
Registries
Claims info
Legend

6. Interoperability Layer
Mobile
Applications
Clinical
Record
Systems
Hospital
Information
Systems
Registry of
Health
Facilities
Registry of
Clients
Health
Management
IS (HMIS)
Personal Health
Records
Repository
Registry of
Health
Terms
Registry of
Health
Workers
Laboratory
Information
Systems
M&E
Applications
India’s
FR
EMPI Medical
Digilocker
3M or open
source
Terminology
server
India’s
HWR
Mobile First
Apps &
Telemedicine
SEA HDIS
products/
Provider TMS
SEA HDIS
products/
Provider TMS
Lab systems
Commcare

7. Disease Surveillance based on HIE- Architecture

8. Proposed Health Information Network
Facility1 Facility2 Facility3 Facility1 Facility2 Facility3
Block
1
Block 2
Nutrition
National
Reproductive
& Child
Health Portal
National
Disease
Programs
e.g. Malaria,
IDSP, NACO
Hospital
Information
Systems,
EMR
State Health
Programs
e.g. EMRI,
eMamta,
HMIS, DHIS
Birth,
Deaths
Private
Sector
HDD (Co-Directory
lookups)
Registry
Lookup APIs
MDDS ~ concept
translation layer
Terminology
lookups
E-Object
Modellers
FHIR
APIs
State Health Information Exchange
Data Lake
Disease
Registry
State
Registry
Indicator
Registry
Payment
Registry
Patient
Registry-UID
Service
Registry
Patient
Private and Govt. e.g.
NHPS, ESI, PM-JAY, JSY
Payers
Providers
Private
Sector
MOHFW
District
Admin
State
HQ
Reprod.& Child
Health
Directorates e.g.
Malaria, IDSP, NACO
Claim
portal
Block 1

9. HIEAF Conceptual Data Architecture
Source
Systems
Analysis
Dashboards &
Report
HIEEAF Data Architecture
Data Operations, Quality, Security, Privacy
Metadata Management
Data Governance
9
HIEAF Data Lake
The data lake is implemented as a federated architecture: State-managed data lakes, and a Centrally
managed Data Lake
Central Data
Lake
State Data Lake
Complete patient data from
originating systems:
Provider/Hospital repositories
Payer repositories
Fiduciary repositories
Transactions at Point-of-care
systems
Health Claims Platform
Other ancillary Healthcare
applications
Anonymized data
Relevant data
subset
Modeling and trend analysis,
prediction using Machine
Learning
Visualization of
insights through
HIEAF dashboards
or consuming
applications

10. Building out a Data Lake: Key Aspects
& Potential technology solutions
10
Data
Sources
Data
Onboarding
Data
Integration
Discovery &
Exploration
Visualization
& Analytics
Data Training
& Intelligence
Microsoft
Cognitive
Services
Azure ML
Azure application Insights

11. HIEAF Federated Data Lake
11
Hospital
Info systems
Payer
Claim
Repositories
Fiduciary
Repository
Data Sources
CCDS
NRCH
(Natl Child Health &
Repro. Portal)
Hospital POC
Beneficiary
App/Portal
State Data Lake
Central Data Lake
Beneficiary/
Patient
Provider
Health Care
worker
Payer
NHA Policy
Maker
State Health
Agency Data
Scientist
Data Models &
Algorithms
Metadata Management Tool
Data Onboarding & Integration Discovery &
Exploration
Others…
Data subset
from each state
ingested into
the central data
lake
Operational
or
Field
Data
Historical
Data
Visualization
& Analytics
Data Training &
Intelligence
Dashboarding
Reporting
Machine
Learning Module
Data
ingestion
through
pipelines
Each state maintains their own data sets
Annotations, metadata maintained throughout the information supply chain to ensure data lineage
Executive
dashboards,
reports
Data schemas
created DW
DM DM
Training data
sets
Governance Tool
Clearly defined
data stewardship
Data Security & Privacy Services
Role and level-based access
controls
Data Services Bus
Data for consuming
Applications e.g. PMJAY Insights, Fraud
Analytics,
National Data Warehouse
DW
DM
DM
Existing
Data
Warehouses
Data
Marts
E
ETL (Extraction,
Transformation, Loading)
ELT (Extraction, Loading,
Transformation)
L
L
L
L
L
E
Q
Q
Q
Q
Q
Q
Q
Q
E
L
L
Q
 Analytics Supply Chain  Illustrative
User Communities
Stakeholders
Modules at the
State Level and
at the Centre
Modules at the State Level and at the Centre
Health Claims
Platform
L
L
Existing Data
Warehouse infra
Search
Others:
PMJAY HEM,
PMJAY TMS
PMJAY Call Ctr
Mera PMJAY app
Policy
Frameork
Data
anonymized Minimal data
for analysis
Patient
complete data
at origin
Q
Data Quality Check &
Feedback Loop
Data component
Relational Data Repository
External System

12. THANKS!
Dr Pankaj Gupta
Head – ACCESS Health Digital
digital.health@accessh.org
Twitter: @pankajguptadr, @accesshdigital
LinkedIn: drpankajgupta, accesshdigital