Improving Health It Interoperability
- 1. Strategies for ImprovingHealth IT Architecture Interoperability WG: Paul Aneja EA CoP Paul Aneja John Fitzpatrick CDC EA CoP Co-Chair Enterprise Architecture CoP Vish Sankaran ONC FHA Sept 2, 2009 Craig Miller ONC NHIN Draft Work in Progress Sondra Renly IBM Research Paul.aneja@state.or.us Nancy Friedland IBM Linh Le State of NY
- 2. Agenda Topics What is Interoperability? How interoperable are current health IT systems? Key Health IT Interoperability Challenges Benefits of Increasing Health IT Interoperability Strategies for Improving Health IT Architecture Interoperability Break Out Groups Report Out from Break out groups Improving Interoperability through Effective Health IT Architectures 2
- 3. What is HealthIT Interoperability?
- 4. How do wedefine interoperability? Improving Interoperability through Effective Health IT Architectures 4
- 5. What is Interoperability? Interoperability generally refers to "the ability of two or more systems or components to communicate, to exchange data accurately, effectively, and consistently and to use the information that has been exchanged….” “In healthcare, the ability ‘to use the information that has been exchanged’ means not only that healthcare systems must be able to communicate with one another, but also that they must employ shared terminology and definitions.” Source: HL7 Coming to Terms Whitepaper Improving Interoperability through Effective Health IT Architectures 5
- 6. How interoperable arecurrent Health IT systems? Do all health IT systems store the same information, the same way (e.g. demographics)? Can patients move between providers/doctors and with their health history accessible? How do Health IT systems exchange data today? Do we have a common language that all business partners health IT systems speak? Interoperability between clinical and public health systems? How is security and privacy of consumers and protected health information managed across health IT systems? … Improving Interoperability through Effective Health IT Architectures 6
- 7. Why is HealthIT Interoperability important? Make improved health decisions based on all data Improve exchange of health information between health IT systems Access information across different systems, sectors, platforms Reduce cost and complexity Enable future ready solutions Continuity of care for patients Improving public health situational awareness Improving Interoperability through Effective Health IT Architectures 7
- 8. What are real-lifeexamples of good interoperability? Lets look the phone as an example What makes phones interoperable? Is it what material phone is made from? Is it the features, ringer, dial pad? Is it the shape, color? Calling parties have to be in the same geographic area? Is it the manufacturer? Improving Interoperability through Effective Health IT Architectures 8
- 9. Key Health ITInteroperability Challenges HIT is a extremely fast moving train with brand new concepts, architectures, needs, etc. Nature of “Enterprise” is changing – Clinical and PH and … Interoperability is complex and not well understood Difficult to coordinate across systems and organizations What do we want to make interoperable? What is the scope of interoperablity? Siloed health it systems in different groups and programs Data elements are not common across same type of Health IT systems Coordinating security and privacy of health IT systems Lack of coordinated standards in use by all HIE players Document based vs messaging based architecture choices Strategic architectural understanding and approach Cross HIT governance is a challenge Funding Improving Interoperability through Effective Health IT Architectures 9
- 10. Strategies for ImprovingHealth IT Architecture Interoperability
- 11. Interoperability Guiding Principles Adopt and leverage national HIT Architectures Adopt and leverage national HIT standards Reusable Shared Services based on Services Oriented Architecture (SOA) design principles Architect/Design with interoperability as a key requirement from start Create technology neutral architecture Stronger governance of Health IT across health organization “Enterprise Architect” role, to focus on common enterprise issues Improving Interoperability through Effective Health IT Architectures 11
- 12. Levels of HealthIT Interoperability Different levels of Health IT Interoperability 1. Not interoperable 2. Within same health organization 3. Regional HIE 4. Statewide HIE 5. National HIE 6. International Improving Interoperability through Effective Health IT Architectures 12
- 13. Public Health ITSystems Interoperability Typical PH IT Systems Immunization Disease Surveillance Vital Records Lab Systems Registries (Cancer, STD, TB, ) Environmental Health, Lead, … There are number of common functions across health systems Are PH IT Systems integrated with other Health systems? How to improve interoperability of the PH IT systems? Improving Interoperability through Effective Health IT Architectures 13
- 14. HIT Use Casesexample Improving Interoperability through Effective Health IT Architectures 14
- 15. Nationwide Health InformationNetwork Highly distributed: Patient health information is retained at the local health information exchange level Local autonomy: Each HIE must make their own determinations with respect to the release of patient information Focus only on inter- organizational health exchange: The NHIN does not attempt to standardize implementations of the NHIN services and interfaces, only the communications between HIEs Use public internet: The NHIN is not a separate physical network, but a set of protocols and standards that run on the existing internet infrastructure Platform neutral: The NHIN has adopted a stack (web services) that can be implemented using many operating systems and programming languages 15 Copyright 2009. All Rights Reserved. Effective Health IT Architectures Improving Interoperability through 15
- 16. HIT Standards forInteroperability Enterprise Health IT Architecture leverages HIT Standards for number of reasons including Creating a reusable architecture Improve standardization Increase future adaptability Improve integration across HIT systems … Momentum and progress on HIT standards has increased substantially What are the “right” standards for what purpose? Improving Interoperability through Effective Health IT Architectures 16
- 17. HIT Standards forInteroperability Key Health IT Standards Organizations HIT Standards Committee HITSP IHE HL7 PHDSC … Improving Interoperability through Effective Health IT Architectures 17
- 18. Improving Interoperability throughEffective Health IT Architectures 18
- 19. HIT Standards forInteroperability Structured Electronic Clinical Messaging Eligibility, Benefits Quality Measure Data Exchange Documents HL7 v2.5.1 and Referrals Reporting Standards HL7 v.3 CDA or Immunization & ASC Z12 v.4010A1, CCD for summary rec Vaccination updates NCPDP Scrip v5.1 and CMS PQRI Registry only: HL7 v2.3.1 CAQH CORE Phase I XML Spec & II Clinical Problems & Laboratory Tests Units of Measure Vocabulary Procedures PHIN VADS Standards ICD 9 & ICD 10 LOINC UCUM SNOMED CT Cross Document Clinical • Electronic Health Interoperability Sharing Record - Centric IS Lab Reporting Patient Demographic Specifications XDR.b Medical Summary Query •Exchange Architecture & & Profiles Emergency Referral Patient Identifier Harmonization Cross Referencing Communications SOA Communication Standards TCP/IP WS-* and REST WSDL SOAP … Improving Interoperability through Effective Health IT Architectures 19
- 20. Reusable Shared Servicesin Health IT (using SOA) Why do we have so many separate or silo systems? And there are common functions/services in many of systems Lets change the paradigm of building new health systems to reusing shared services Challenges: What reusable services are needed for Health Information Exchanges? How can Service Oriented Architecture principles be applied throughout the Enterprise Architecture? Improving Interoperability through Effective Health IT Architectures 20
- 21. Reusable Shared Servicesin Health IT (using SOA) Here is a starting list of potential HIE reusable services… HIE Immunization PH Case Get Enrollment Validation Reusable Reporting Health Records Shared Demographic Services Service Patient Authentication Matching Eligibility Secure Check Personal Health Get Immunization Allergy Messaging Record Update Records Check What other Shared Services are needed? Improving Interoperability through Effective Health IT Architectures 21
- 22. Privacy and Security Support national privacy & security standards. Create standards by which data can be shared and adopt one set of clearly defined privacy standards. Implement standardized measures to safeguard protected health information (PHI). Security & Access Control Authentication Identity Management Transport Privacy HL7 v3 RBAC Kerberos Network Auth v5 LDAP XDS.b SAML EUA End User Authentication Personal White Pages WS-Trust v1.7 WS- Security OASIS XACML (2015) Challenges: How many states have common Directory/LDAP that apps use? Diversity of standards for security and privacy Improving Interoperability through Effective Health IT Architectures 22
- 23. Health IT ArchitectureInteroperability Framework EHR Biosurve PH Immuniz Newborn Emerge Personal Health IT illance Case ation Screenin ncy ized Reportin g Respond Healthca Use Cases g er EHR re National HIE National Health NHIN Connect Information Architecture Network PH Case Immunization Allergy Get Secure HIE Reusable Enrollment Reporting Health Records Validation Check Messaging Shared Eligibility Personal Health Get Immunization Demographic Patient Check Authentication Services Record Update Records Service Matching Structured Electronic Clinical Messaging Eligibility, Benefits and Quality Measure Data Exchange Documents HL7 v2.5.1 Referrals Reporting Immunization registries & ASC Z12 v.4010A1, Standards HL7 v.3 CDA or Vaccination updates only: NCPDP Scrip v5.1 and CMS PQRI Registry XML CCD for summary records HL7 v2.3.1 CAQH CORE Phase I & II Spec Clinical Problems & Laboratory Tests Units of Measure PHIN VADS Vocabulary Procedures Standards ICD 9 & 10 LOINC UCUM SNOMED CT Access Control Authentication Identity Management Transport Security & HL7 v3 RBAC Kerberos Network Auth v5 LDAP XDS.b Privacy SAML EUA End User Authentication Personal White Pages WS-Trust v1.7 WS- Security OASIS XACML (2015) Communications SOA Communication TCP/IP WS-* and REST Standards WSDL SOAP … HIE Infrastructure SOA PHRs Repository HIT HIE Exchange solution ESB Google, MS, WebMD, HIE Document Index Infrastructure HIE Exchange Services Registry HIE Document HIE Adapters Repository … Improving Interoperability through Effective Health IT Architectures 23
- 24. Conference Sessions ofinterest Interoperability showcase Federal Health Architecture PHDSC Service Oriented Architecture for Public Health NAPHIT-PHDSC session Sept 2 Wed 5:30-8pm Improving Interoperability through Effective Health IT Architectures 24
- 25. Questions & Answers ImprovingInteroperability through Effective Health IT Architectures 25
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- 27. Lets Form into3 Breakout Groups Each Breakout Group to address: Top 3 things to increase interoperability Interoperability Top Challenges Key Interoperability Solutions 3 Breakout Groups Health IT Architectures Health IT Standards Shared Services in Health IT Improving Interoperability through Effective Health IT Architectures 27
- 28. Breakout Groups ReportOut Improving Interoperability through Effective Health IT Architectures 28