Global Business Services Nationwide Healthcare Information Network Design

Global Business Services Nationwide Healthcare Information Network Design Decisions and Lessons Learned Dave “Casey” Webster IBM NHIN Chief Architect September 11, 2006

IBM Global Business Services IBM NHIN Architecture Design Decisions § Community-Centric – First build communities, then connect them – Communities determine where data is stored (centralized, locally, or both) – Lightweight, secure community hub provides basic services § Drive and conform to standards – Instantiation of IHE interoperability framework using Java/J 2 EE (www. ihe. net) – Clinical events stored as HL 7 CDA(r 2)-compliant documents § Provide security & privacy w/o sacrificing usability or research value – Anonymous/pseudonymous data that can be re-identified as needed/permitted – Support other data aggregates (registries, outcomes analysis, quality of care) § Practical – Scalable and cost-effective at every level of practice – Point-of-care performance is critical to adoption 2 HL 7 Plenary Session – Boca Raton – September 11, 2006

IBM Global Business Services IBM NHIN Architecture Patient Identification Registry Services PDQ (Demog) Access Control Authentication Authorization Patient Consent Support Services ATNA (Audit) URIs NHIN Interface Cross-Community: • Search/Retrieval • Policies/Security • Admin/Maintenance CT (Clock) Logging Community Services Biosurveillance PHR Portal XDS Community XDS Hospital or Physician Practice Interface Data Services Integration Engine or Data Source 3 Data Gateway Patient Lookup CDA Transform HL 7 Plenary Session – Boca Raton – September 11, 2006 Document Services Document Storage and Retrieval XDS Network Security PIX (ID Xref) Community Hub Document Locator

IBM Global Business Services Find Document (intracommunity) Action Sequence MPI Services Community Hub Document Locator Registry Services PDQ ‚ ƒ Security Services PIX URLs „ … µ † Document Services Document Storage and Retrieval 4 HL 7 Plenary Session – Boca Raton – September 11, 2006 XDS (CDA)

IBM Global Business Services Lessons Learned § Technology isn’t a significant barrier – Consumer readiness, politics, lack of universal standards are much more problematic § Politics can drive architecture – Substantial complexity and cost necessary to work around issues such as patient identification, provider authorization, state and local healthcare and privacy differences, etc. § It is difficult to effectively separate policy from functionality 5 HL 7 Plenary Session – Boca Raton – September 11, 2006

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