HIE Interoperability and NHIN CSE 5810 Prof Steven

HIE, Interoperability, and NHIN CSE 5810 Prof. Steven A. Demurjian, Sr. Computer Science & Engineering Department The University of Connecticut 371 Fairfield Road, Box U-255 Storrs, CT 06269 -2155 steve@engr. uconn. edu http: //www. engr. uconn. edu/~stev e (860) 486 - 4818 Copyright © 2014 by S. Demurjian, Storrs, CT. SWEA 1

Objective of Presentation m CSE m 5810 Health Information Change a Growing Concern Many Efforts are Ongoing/In Progress q Standards a Concern to Address Data Exchange q Many Efforts in Play Ø NHIN (www. nist. gov/healthcare/testing/nhin. cfm) Ø CONNECT www. connectopensource. org/ Ø DIRECT (wiki. directproject. org) Ø Biosurviellance m m We’ll Review Many Efforts by “Leveraging” Existing Materials and Progress See set of PPTs on web page: SWEA 2

Towards a Nationwide Health Information Network (NHIN) Where Should We Be in 2014 n Building a NHIN ¨ ¨ ¨ NHIN-2004 NHIN-2005 -2006 NHIN-2007

US National HIT Strategic Plan On July 21, 2004 the Department of Health and Human Services (DHHS) announced the decade of health information technology for “delivering consumer–centric and information-rich health care. ” The vision is to build a National* Health Information Network (NHIN) of regional health information exchanges formed by health care providers who will utilize electronic health record systems. * Original term “National” has been changed on “Nationwide” in January 2006 Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

DHHS’ Framework for Health Information Technology: Building a NHIN will be based on: Electronic Health Record Systems (EHRS) that will enable Regional Health Information Exchanges (RHIEs) organized via Regional Health Information Organizations (RHIOs) Thompson TG and Brailer DJ. The Decade of Heath Information Technology to Deliver Consumer-centric and Information-rich Health Care. Framework for Strategic Action. US DHHS, July 21, 2004.

President’s Strategic Framework for HIT

US Nationwide Health Information Network Provider Record Laboratory Results Specialist Records Returned Requests for Records Another RHIO Authorized RHIO Inquiry Patient data to other RHIO Index of where patients Temporary Aggregate have records Patient History RHIO Source: Jennie Harvell. The Decade of Health Information Technology – Framework for Strategic Actions. MMIS Conference, September 2004

US Health Information Network - 2014 Source: Dr. Peter Elkin, Mayo Clinic, MN

Source: Dr. Peter Elkin, Mayo Clinic, MN, 2006 RHIOs as NHIN Components

Nationwide Health Information Network (NHIN) Emerging data shows the value that standardized health information exchange will provide to all stakeholders: ¨Healthcare purchasers and payers ¨Hospitals and other healthcare providers ¨Laboratories ¨Practicing clinicians ¨Public health Source: John Glaser, Janet Marchibroda, Jim Schuping. CCBH. Washington, D. C. December 6 -7, 2004 URL: www. ehealthinitiative. com

Building a NHIN On November 15, 2004 Office of National Coordinator for Health Information Technology (ONC), Department of Health and Human Services (DHHS), released THE REQUEST FOR INFORMATION (RFI) on the Development and Adoption of a “National” Health Information Network Over 500 responses from various healthcare stakeholders has been submitted. URL: http: //www. dhhs. gov

PHDSC Model: PHDSC Model for Electronic Health Record-based Data Exchange RHIO EHR-PH Info Exchange

NHIN Development Process In October 2005 DHHS Office of National Coordinator (ONC) awarded several NHIN contracts ($65 M) as follows: n n Standards Harmonization EHR Certification NHIN Architecture Prototypes Health Information Security and Privacy URL: http: //www. hhs. gov/healthit/ahic. html

DHHS NHIN Contracts Standards Harmonization - Harmonize the health care and technology standards used in health information interchange to address gaps and conflicts in current standards n EHR Certification - Set forth certification criteria for the many electronic health care record products and technologies currently available on the market n NHIN Prototypes - Develop and evaluate prototypes for the network architecture to assess the feasibility of developing a national health information network prototype n Privacy - Address privacy and security policy questions affecting the exchange of health information. Work resulting from each of these projects will be used by HHS to develop and refine the business case for establishing the network. n

FHA Presentation to HIMSS National Capital Area Chapter January 15, 2009 Vish Sankaran Program Director Federal Health Architecture

Phase 1 2004 – 2008 Foundation for Health Information Exchange Established In April, 2004 • • Executive Order 13335: Office of the national coordinator created Executive Order 13410: Federal federal agencies required to implement HHS Secretary recognized standards and cost & quality transparency In the last four years, ONC worked with Federal, States and private sector to: • • Harmonize interoperable standards Create Health IT certification for functionality, security, and interoperability Launch the Nationwide Health Information Network Address Policy variations The Tipping Point for Phase 2 is now at hand 16

President-elect Obama’s Commitment to Electronic Health Systems The goal is not to move from “paper silos” to “electronic silos” The goal is an electronic health system that supports and requires the movement of interoperable health information supporting: In a January 9, 2009 speech at George Mason University "To improve the quality of our healthcare while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America’s medical records are computerized. ” • Continuity of Care • Population Needs (pandemics and other disasters) • Bench to Bedside Research • Disability Determination 17

FHA Mission “Secure Exchange of Interoperable Health Information” Working together to provide the tools and solutions to support the development and exchange of interoperable health information within the federal government and with the tribal, state, local and private sector, thereby, enabling better care, increased efficiency, and improved access to care for American citizens. Effective Government 18

Agency Concept of Operations 1 Business Priorities 2 Architect Solutions 3 Plan Investments 4 Implement Solutions 5 Measure Progress FHA can provide guidance / support in any phase of your operations. 19

2009 Vision Agencies Collaborate to Reform Healthcare through IT Reform Health. Care VISION Improve Quality GOALS Increase Access Reduce Costs POPULATIONS… Elderly Veterans Military Native Americans Disabled Children Underserv ed STAKEHOLDERS State, Local, Private State Agencies Local Agencies Providers Health IT Vendors Payers Others…. . COLLABORATION Federal Programs PROCESS Solutions RESULT Business Needs Architect Investment Implement Improved Performance 20

The Nationwide Health Information Network Health Bank or PHR Support Organization State and Local Gov Community Health Centers SSA Community #1 VA Common “Dial Tone” & Chain of trust Do. D Labs FDA CDC Integrated Delivery System Pharmacies Community #2 The Internet Standards, Specifications and Agreements for Secure Connections 21

CONNECT: Tools for Information Exchange FHA’s CONNECT Initiative provides three related tools to enable organizations to connect to the NHIN: – The Gateway, which implements the core services defined by the NHIN – Enterprise Service Components, which provide robust tools for indexing patient identities, maintaining patient health documents, implementing business rules for authorizing the release of medical information and more – The Software Development Kit (SDK), which enables developers to customize the Gateway and add or replace enterprise service components 22

CONNECT 2008 Progress 2008 March 2008 CONNECT development started Sep 2008 3 agencies demonstrated HIE with private sector 2009 Dec 2008 6 agencies demonstrated HIE with private sector 2009 Plan to include all health agencies by end of year Collaboration you can be proud of! 23

CONNECT Roadmap: 2008 -2011 2008 • Participate in NHIN Trial Implementations • Develop first release of the Federal NHIN Gateway • Demonstrate value of connecting to the NHIN for agencies 2009 • Move selected agencies into production using NHIN • Use of NHIN to solve agency needs and improve performance • Distribute Gateway software to facilitate NHIN solution development by marketplace 2010 • Expand the set of agency programs using the NHIN • Begin the process of transitioning to gateway software provided by the marketplace 2011 • Complete process of transitioning to gateway software provided by the marketplace • Support every agency that performs health-related information exchanges using the NHIN 24

Private sector and Government Must Care Data flow in our health care systems is a must for the coming years • Government – Ensure interoperability is in agency business and strategic plans. • Systems integrators: Support the federal, state, private providers and public health agencies transformation towards interoperability. Leverage the CONNECT tools as a means to integrate existing health information systems. • Product vendors: Create unique HIE solutions for the health marketplace by adding value on the CONNECT solution, or create your own products that provide NHIN services. For this transformation to succeed, all of us must participate 25

What is Direct? m CSE 5810 m Allow individuals, providers and organizations to share information with best practices that have trust and privacy considerations Health Information Service Provider (HISP) q Manage security/transport for directed exchange q Organizational model that performs HISP functions q Works to send/receive to organization or individual q Legal Business Associate Agreements with HIPAA q Includes all data collection, use, retention, and disclosure policies 26 SWEA 26

One Possible Architecture CSE 5810 SWEA 27

Biosurveillance Use Case Transmit essential ambulatory care and emergency department visit, resource utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized anonymized format to authorized Public Health Agencies with less than one day lag time. Source: HITSP Meeting, Arlington VA, September 20, 2006

AHIC Biosurveillance Use Case

Biosurveillance AHIC-ONC BIO Consolidated Use Case HITSP Patient-level data to Public Health Message-based Submission Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Pseudonymize Message-based Scenario Component Encounter Msg Lab Report Message Radiology Msg Terminology Standards HCPCS HL 7 V 3 CPT HL 7 V 2. 5 CCC SNOMED-CT ICD 9/10 LOINC NCCLS UCUM UB-92 URL FIPS 5 -2 HAVE Base Std HL 7 V 2. 5 ADT^xxx Base Std HL 7 V 2. 5 ORU^R 01 IHE XDS IHE PIX PDQ Component Base Std HL 7 QBP^Q 23 RSP^K 23 Anonymize Component Lab Terminology Base Std LOINC SNOMEDCT Base Std ISO DTS/ 25237 HIPAA DICOM Base Std ISO 15000 eb. RS 2. 1/3. 0 Base Std HL 7 V 2. 5

Biosurveillance AHIC-ONC BIO Consolidated Use Case Patient-Level Data to Public Health Document-based Submission HITSP Biosurveillance – Patient-level and Resource Utilization Interoperability Specification Transaction Package Consumer/Patient Id X-ref Transaction Package Manage Sharing of Docs Document-based Scenario Transaction Notif of Doc Availability IHE XDS-I Base Std HL 7 QBP^Q 23 RSP^K 23 Transaction Pseudonymize IHE NAV IHE XDS IHE PIX PDQ Component Lab Report Document Component Anonymize Component Lab Terminology Base Std DICOM Base Std LOINC SNOMEDCT IHE XDS-MS Base Std HL 7 CDA r 2 IHE XDS-LAB Terminology Standards HCPCS HL 7 V 3 CPT HL 7 V 2. 5 CCC SNOMED-CT ICD 9/10 LOINC NCCLS UCUM UB-92 URL FIPS 5 -2 HAVE Base Std ISO DTS/ 25237 HIPAA DICOM Base Std ISO 15000 eb. RS 2. 1/3. 0 Base Std HL 7 V 2. 5

Event Detection EHRS Neighboring Jurisdictions Hospital State Public Health Surveillance System 1 - Report/retrieve symptoms, diagnosis & medication prescription data from EMRs Ambulatory Care 4 – Order pathogen test 2 – Data mining of EMR notes 3 – Notify on increased number of cases & recommend to order pathogen test 5 – Report test results 7 – Report on the positive case electronically & by phone Local Public Health Surveillance System DHHS 6 – Report positive test result electronically & by phone Media Laboratory Pharmacy Response Team P U B L I C

Event Monitoring EHRS Neighboring Jurisdictions 3 - Monitor ER visits & hospitalizations data from EMRs 1 – Send health alert Ambulatory Care 4 – Order pathogen test 2 - Monitor newly diagnosed cases & vaccination data from EMRs State Public Health Surveillance System 9 – Send updates on the event 6 – Send order to activate emergency vaccination Local Public Health Surveillance System 5 – Report test results 7 – Order/ Supply vaccine Lab Hospital 8 – Monitor vaccine supplies Pharmacy 10 – Send health alert to the public DHHS Media Response Team P U B L I C

Event Management EHRS Neighboring Jurisdictions 3 - Monitor ER visits, hospitalizations data from EMRs & utilization data 1 – Send Outbreak updates Ambulatory Care 4 – Order pathogen test 2 - Monitor newly diagnosed cases & vaccination data from EMRs State Public Health Surveillance System 9 – Send outbreak updates 6 – Send Rapid Flu Test Kits 10 – Send outbreak updates to the public Local Public Health Surveillance System 5 – Report test results 9 – Activate coordinated response 7 – Deliver vaccine Lab Hospital 8 – Monitor vaccine supplies Pharmacy Response Team DHHS Media P U B L I C

Cardiovascular Disease (CVD) Surveillance Payor Hospital EHRS 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan Ambulatory Care 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 11 – Send reports 12– Conduct Surveys (BRFSS) 5 – Monitor Treatment 2 – Order cholesterol test 3 – Report test results 7 – Report Data to Schools State Public Health Surveillance System Local CVD Surveillance System 10 – Conduct Health Education DHHS 6 – Fill Prescription 8– Coordinate Care Media Laboratory Pharmacy School P U B L I C

Hospital Asthma Surveillance Payor EHRS 1 – Conduct Routine Check-ups 4 – Prescribe Medication and Treatment Plan Ambulatory Care 9 - Monitor ER visits, hospitalizations data from EMRs & utilization data 11 – Send reports 5 – Monitor Treatment 2 – Order allergen test 3 – Report test results 7 – Report Data to Schools State Public Health Surveillance System 12– Conduct Surveys (BRFSS) Local Asthma Surveillance System 10 – Conduct Health Education DHHS 6 – Fill Prescription 8– Coordinate Care Media Laboratory Pharmacy School P U B L I C

EHR-PH System Prototype for Interoperability Public Health Surveillance Clinical Care in 21 st Century Health Care System Hospital of Birth ADTBirth Record Newborn Screening Test Hearing Screening Test Immunization Administration State Health Department HL 7 2. 4 HL 7 3. 0 Newborn Screening Registry HL 7 3. 0 EHR-PH Info Exchange HL 7 3. 0 HL 7 2. 4 Immunization Registry HL 7 2. 4 HL 7 3. 0 HL 7 2. 4 J 2 EE External Laboratory Hearing Screening Registry HTB J 2 EE Communicable Disease Registry Wrtwertghghgghhghg Wrtwrtghghgh Wtrwtrghgg Wrtwertghghgghhghg Wrtwrtghghghghgh Aadkalfjkaldkfjalkdjflajh Wtrwtrghgg jkhjkhjkhk Wrtwrtghghgh flkdjghghghgh Aadkalfjkaldkfjalkdjflajk flkdjghghghghg fhjfghjfh Healthcare Transaction Viewer HTB – Health Transaction Base Source: Orlova, et al. HIMSS 2005, Dallas TX, February 13 -17, 2005 and AMIA, Washington DC, November, 2005

EHR-PH System Prototype forfor. Interoperability EHR-PH System Prototype Interoperability Health Surveillance Clinical Care in 21 st. Health in 21 st Century. Care Health. System Care. Public System Our Prototype ¨ Shows how interoperability between healthcare systems can be achieved with a standards-based infrastructure ¨ Is built upon existing systems in clinical care and public health programs ¨ Enables electronic data reporting from a clinical setting to multiple public health systems ¨ Enables translation of customized standards into HL 7 3. 0 messaging standard ¨ Links clinical and public health systems to provide a continues view of the patient record across the systems involved