direct and the nationwide health information network session 11 april 13, 2011
TRANSCRIPT
Direct and the Nationwide Health Information Network
Session 11
April 13, 2011
Agenda
• What is the Nationwide Health Information Network?– What health information exchange scenarios will the Nationwide Health Information
Network help address? – What are the tools in the Nationwide Health Information Network toolkit?– How does Direct fit into the Nationwide Health Information Network toolkit?
• What are the clinical Use Cases for health information exchange?– How can Direct be used to enable a variety of use cases?– How can other tools address more complex use cases?
• How will Direct work at scale?
• MEDfx Presentation: Integrating Direct and CONNECT– Mark Bamberg, VP Research and Development, MEDfx
• Q&A
• Poll2
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What is the Nationwide Health Information Network?• A set of policies, standards and
services that enable the Internet
to be used for secure and
meaningful exchange of health
information to improve health and
health care.
• Enables a variety of health
information exchange
scenarios – from less complex to
very robust
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What scenarios will the Nationwide Health Information Network help address?
• Each health information exchange scenario requires a different “tool” from the Nationwide Health Information Network “toolkit”; e.g., Direct, Exchange, etc.
• Each tool must be used in conjunction with a coherent set of: – Standards– Services– Policies– Trust Fabric
DirectedExchange
Directed Exchange with Value-Added Intermediaries
Longitudinal data access across settings of care within a community
Cross-Community Access
Scenarios
Less Complex
Very Robust
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What are the tools in the Nationwide Health Information Network toolkit?
DirectedExchange
Directed Exchange with Value-Added Intermediaries
Longitudinal data access across settings of care within a community
Cross-Community Access
Less Complex
Very Robust
Scenarios Tools
Direct
Query for Documents
Document Submission*
Patient Discovery
Retrieve Documents
* Not currently in Nationwide Health Information Network toolkit
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How does Direct fit into the Nationwide Health Information Network toolkit?
The Direct Project provides HIEs with a low cost way to enable simple push messaging to their healthcare constituents
The Direct Project doesn’t replace other ways information is exchanged electronically today, but it might augment them
The Direct Project supports speedy adoption and simple use cases (e.g., provider referrals), but other methods of exchange might be better suited for other scenarios (e.g., real-time population health statistics)
The Direct Project was designed to coexist gracefully with existing protocols for data exchange, e.g., web services, client-server, etc.
The Direct Project seeks to replace slow, inconvenient, and expensive methods of exchange (e.g., paper and fax) and provide a future path to advanced interoperability.
Though not technically incorporated yet, Direct Project specifications are expected to be incorporated into the NwHIN specifications
Health information exchange:a puzzle with many pieces
Cross-Community Access Directed
Exchange
Longitudinal Data Access across a
CommunityDirected Exchange with
Valued-Added Intermediaries
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How can Direct be used to enable a variety of use cases?
Exchange Mechanism
Use Case Sequence of Direct Messages
One-way Directed Exchange
Simple Referral • Provider Provider: Clinical Summary
Lab Results Report • Lab Provider: Lab Results Report
Public Health Report from Labs
• Lab ELR System: Reportable Lab Test Results
Public Health Report from Providers
• Provider IIS: Reportable Disease Diagnoses
Two-way Directed Exchange
Hospital Admit/Discharge
• Hospital Primary Care: ADT Notification• Primary Care Hospital: Clinical Summary
Immunization Request
• EHR HISP/IIS: ADT Notification• HISP/IIS EHR: Updated Immunization
Closed Loop Referral • PCP Specialist: CCD/CCR• Specialist PCP: Updated CCD/CCR
Medical Home Update
• Medical Home EHR: Longitudinal Record Update• HIE Medical Home: Gap in Care, Updated Record
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How can other tools address more complex use cases?Tools Sequence of Actions
Patient Discovery • Initiating Gateway Responding Gateway: Request to indicate whether the community has knowledge of a patient matching a set of demographic criteria
• Responding Gateway Initiating Gateway: patients with matching demographics known by the responding community
Query for Documents
• Initiating Gateway Responding Gateway: request for document communities associated with a particular patient
• Responding Gateway Initiating Gateway: communities with documents associated with that patient
Retrieve Documents
• Initiating Gateway Responding Gateway: request to a community for documents associated with a particular patient
• Responding Gateway Initiating Gateway: documents associated with that patient
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How will Direct work at scale?
• Scalable Trust: – Standards-based certificates
– Policies for issuance of certificates
• Scalable Directories: – DNS-based Directories at first
– Interoperable statewide directories with certificate
lookup next
• Upcoming S&I Framework initiatives targeted
at both of these topics
MEDfx Presentation
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Presentation Goals
• Involvement with Direct• Involvement with CONNECT• Evolution of the Direct / CONNECT integration• How the integrated solution works
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Involvement with Direct
• MEDfx involved from beginning in CONNECTathons• Joined Direct in September 2011
– Implementation Group– Reference Implementation WG– Implementation Geographies WG
• Provided Install for Java Bare Metal Direct Reference Implementation
• Initiates Direct Project Pilot for Virginia Region– MEDfx, Verizon, MedVirginia, and Dominion– Supports Referral to Patient Centered Medical Home– Integrated support with Lifescape Portal
• Demonstrates Direct / CONNECT solution at HIMSS 2011
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Involvement with CONNECT• SSA Disability Claims Use Case
– MedVirginia provides C32 to SSA via the NwHIN• Proprietary NwHIN Gateway
– July 2009 MEDfx integrates MedViriginia with CONNECT 2.0– Supports
• SubjectDiscovery• DocQuery• DocRetreive
• CHIEP– MedVirginia submits C83 to CMS for Patient Discharge Events– Upgrades to CONNECT 2.4– July 2010 MedVirgina goes into production– Supports
• Patient Discovery• DocQuery• DocRetrieve• XDS.b
– Provide and Register Document Set– Retrieve Document
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Involvement with CONNECT cont.
• Virtual Lifetime Electronic Record (VLER)– MedVirginia provides full NwHIN support to VA and DoD– Supports SSA, VA and Dod with single CONNECT instance– Adds Centra as subordinate HIE through MedVirginia
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CONNECT 2.0 Deployment
MedVirginiaPortal
HTTPS
Solution 1 CONNECTSSANwHIN
Subject DiscoveryDocument Query
Document Retrieve
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CONNECT 2.4 Deployment
MedVirginiaPortal
HTTPS
Solution 1 CONNECTSSA NwHIN
Patient DiscoveryDocument Query
Document Retrieve
VA
DoD
CMSXDS.b
Provide And Register Document Set
Review Document
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Legacy Integration
SMTPMedVirginiaHISP
MedVirginiaPortal
SMTPS SSL
HTTPS
DominionHISP
DominionPortal
SMTPS SSL
HTTPS
Interchange
Lifescape
Solution 1
CONNECTfx
Interchange
Lifescape
Solution 1
DOD
VA
SSA
NwHIN
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Target Architecture
SMTPHISP 1
MedVirginiaSolution2
Portal
SMTPS SSL
HTTPS
HISP 2
VerizonLifescape
Portal
SMTPS SSL
HTTPS
Interchange
Lifescape
Oracle HTBOracle OHMPI
CONNECTfx
Interchange
Lifescape
DOD
VA
SSA
NwHIN
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Capabilities
• RIM HL7v3 CDR• Documents available via CONNECT• Ability to shred Documents into CDR via Direct• Ability to share Direct Sourced Documents• Ability to share C32 with content from structured
Direct Sourced Documents• Low overhead installation • Scalable
Q&A
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Poll