Anita Griner, Senior Project and Program ManagerCenters for Medicare & Medicaid Services

Nitin Jain, C-HIEP Executive Consultant (Contractor)Centers for Medicare & Medicaid Services

CMS’ C-HIEP Proof-of ConceptCMS Implementation of NHIN CONNECT

1

TUESDAY, 4:30 – 5:30PM

Session Objectives

1

C-HIEP OverviewC-HIEP Overview11

Technical ComponentsTechnical Components22

NHIN Integration into CMSNHIN Integration into CMS33

Challenges, Lessons Learned and Next Steps

Challenges, Lessons Learned and Next Steps

44

HIMSS 2010 2

What is C-HIEP?

17

• Proof-of-concept

• Align with national standards for data interoperability

• Move towards a uniform, harmonized data set

• Move towards enhancing the ability for communication and coordination of care across settings

ContinuityAssessmentRecord &Evaluation

CARE

ContinuityAssessmentRecord &Evaluation

CARE

HealthInformationExchangeProject

HIEP

HealthInformationExchangeProject

HIEP

HIMSS 2010 3

C-HIEP Participants

HIMSS 2010 420

CMS: Project OwnersContractor: TechnicalHIOs: Participants

C-HIEP CONOPS

Provider Settings:

1. Nursing Facilities (including skilled)

2. Home Health Agencies

3. Inpatient Rehab Centers

4. Long Term Care Hospitals

5. Acute Hospitals

6. Physicians Offices

7. Outpatient settings

Provider Settings:

1. Nursing Facilities (including skilled)

2. Home Health Agencies

3. Inpatient Rehab Centers

4. Long Term Care Hospitals

5. Acute Hospitals

6. Physicians Offices

7. Outpatient settings

HIMSS 2010 5

HIO

HIO

HIO

CMS

Technical Details

Data Interoperability:• HITSP C83 Content Specification

http://hitsp.org/ConstructSet_Details.aspx?&PrefixAlpha=4&PrefixNumeric=83

Exchange Interoperability:• NHIN Specification: Document Submission Service Interface Specification

(new “push” model)Based on: IHE CROSS-ENTERPRISE DOCUMENT RELIABLE MESSAGING (XDR)

• NHIN messaging platform and authorization framework components:Including: SOAP messaging, SAML Assertion, 2-way SSL

HIMSS 2010 6

C-HIEP Information Flow

HIMSS 2010 7

HIO

Physician

Encounter Summary

Validate Assessment

Data

DischargeSummary

CHIEPDatabase

Acknowledgement

LatentResponse

Document Submission

Authorize UserValidate Message

Security

CHIEP Assessment

Data Analytics

AnalyticsReporting &Dashboards

De-Identify CHIEP

Assessments

Create C-HIEP AssessmentDocuments

Check DuplicateCheck De-identificationCheck Patient EligibilityValidate MetadataValidate Document

Validate

Store Native DocTransform DocStore Data Objects

Persist

Build Accept/RejectResponseReturn Response

Reply

Long Term Care Hospital

Acknowledgement

C-HIEP 3 Zone Architecture

HIMSS 2010 8

NH

IN /

INT

ER

NE

T

Solaris

WAS

CHIEP Receipt Application (CRA)

MQL

R

Data Validation

& Business Rules

Data Transform-

ation

Data Storage

Audit & Logging Service

CR

UD

(JD

BC

)

Solaris

Glass Fish

CMS NHIN CONNECT Gateway

Inbound Request Handling

Outbound Response Handling

HTTP Server

Presentation Zone

Application Zone

Data Zone

HTTPS/POST

HTTPS/POST

Solaris

Glass Fish

CMS CONNECT Adapter

Document Submission Adapter

Audit/LoggingAdapter

Policy Engine Adapter

Co

nfi

gu

rati

on

Mo

du

le

Mes

sag

ing

AP

I MQR

L

Linux

WBI

MQL R

MQ LR

Linux

C-H

IEP

D

atab

ase

(OR

AC

LE

)

Audit Data

XML Document Repository

Metadata Registry

Care-Set Relational Data

Direct Submitting Provider

XML Gateway

C-HIEP Challenges to Date

Participants• Differences in technical maturity,

business models capabilities, and data availability/interoperability

Specifications• No “Push” NHIN Spec Available

(i.e. Query and Retrieve, HIEM)

• No existing HITSP specification aligned to CARE/C-HIEP data set

Policy• Privacy: Requirement to

de-identify C-HIEP data challenging for case-threading

• NHIN DURSA

Technical• Larger data volumes available than anticipated

• Maturity of NHIN & compatibility within CMS

HIMSS 2010 9

Next Steps

• Continue technical development and testing of C-HIEP components

• Production data submission from HIOs to begin summer ‘10

• Continued work on data set and standards for interoperability

• Gathering of lessons learned and re-aligned objectives for future phases of the CARE data set

HIMSS 2010 10

Thank You

11

The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase

does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal

Health Architecture or the Department of Health and Human Services.