IBM Global Business Services IBM NHIN Architecture Leveraging

IBM Global Business Services IBM NHIN Architecture Leveraging Standards and Industry Initiatives Kevin Julier KJulier@us. ibm. com Casey Webster Casey. Web@us. ibm. com Fostering a Nationwide Healthcare Infrastructure 4/10/2006 | Casey Webster and Kevin Julier © 2006 2005 IBM Corporation

IBM Global Business Services The NHIN Prototype – Communities Community Partners § Fishkill, New York – Taconic Health Information Network & Community (THINC) – Dr. John Blair – 2, 300 physicians supporting 700, 000 patients – Shared data using Healthvision § Research Triangle, North Carolina – North Carolina Healthcare Information and Communications Alliance (NCHICA) – Holt Anderson – Competitive, high-tech urban environment § Rockingham County, North Carolina – Also members of NCHICA – Rural environment with North Carolina and Virginia patients – Small, competitive practices and hospitals 2 4/10/2006 | Casey Webster and Kevin Julier

IBM Global Business Services Guiding Principles § Community-Centric – Document repositories normalize and store clinical data within a community – Can be hosted by individual hospitals/practices and/or shared within the community – Community hub provides MPI, document locator, security and support services – The community hub is the gateway to other communities § Drive and conform to standards – Instantiation of IHE interoperability framework (XDS, PIX/PDQ, ATNA & CT profiles) – Clinical events stored as HL 7 CDA(r 2)-compliant documents – Cross-community search & retrieval – J 2 EE implementation is hardware & software vendor agnostic (JDBC, JMS, EJB) – WS-*, SAML and related standards for authentication, authorization, and security § Provide security & privacy w/o sacrificing usability or research value – Anonymous/pseudonymous data that can be re-identified as needed/permitted – Supports other data aggregates (registries, biosurveillance, outcomes analysis, quality of care) § Practical – Scalable and cost-effective at every level of practice – Point-of-care performance is critical to adoption 3 4/10/2006 | Casey Webster and Kevin. Julier © 2006 IBM Corporation

IBM Global Business Services Leveraging Integrating the Healthcare Enterprise (IHE) Work • IBM team has implemented these IHE integration profiles • XDS – Cross-Enterprise Document Sharing • Supports saving, registering, querying and retrieving documents across enterprises but within an administrative domain • PIX – Patient Identifier Cross-referencing • Supports cross referencing of patient identifiers across domains • PDQ – Patient Demographics Query • Supports query for patients given a minimal set of demographic criteria (e. g. ID or partial name) returning all the demographics and a patient identifier within a domain • ATNA – Audit Trail and Node Authentication • Supports auditing and secure communications • CT – Consistent Time • Supports consistent time across multiple systems 4 4/10/2006 | Casey Webster and Kevin Julier

IBM Global Business Services IHE XDS (Cross Enterprise Document Sharing) Profile The XDS integration profile enables a number of healthcare enterprises belonging to a clinical affinity domain to cooperate in the care of a patient by sharing clinical records in the form of documents as they proceed with their patient’s care delivery activities Patient Identity Source (PIX) Patient Identity Feed [ITI-8] ↓ Document Registry Query Registry [ITI-16] ← Document Consumer ↑ Register Document Set [ITI-14] Document 5 Provide & Register Document Set [ITI-15] Document Source → 4/10/2006 | Casey Webster and Kevin Julier Repository Retrieve Document [ITI-17] ←

IBM Global Business Services Patient Identity Cross Reference Manager (PIX) Msg Format HL 7 Protocol MLLP (TCP Sockets) Patient Identity Feed [ITI-8] (async) PIX Query [ITI-9] (sync) Msg Format HL 7 Protocol MLLP (TCP Sockets) Patient Identity Source (PIX) Msg Format HL 7 Protocol MLLP (TCP Sockets) Patient Identity Feed [ITI-8] (async) Document Registry (XDS) Document Source (XDS) Msg Format eb. XML Protocol SOAP over HTTP w/Attachments Protocol 4/10/2006 | Casey Msg Format HL 7 Protocol MLLP (TCP Sockets) Msg Format SQL Protocol SOAP over HTTP w/Attachments Query Registry [ITI-16] (sync) Document Consumer (XDS) Register Document Set [ITI-14] (sync) Provide and Register Document Set [ITI-15] (sync/async) Msg Format 6 PIX Query [ITI-9] (sync) Document Repository (XDS) eb. XML, specific docs to store SOAP over HTTP or SMTP w/Attachments Webster and Kevin Julier Retrieve Document [ITI-17] (sync) Msg Format Specific docs retrieved Protocol HTTP

IBM Global Business Services Community Architecture MPI Services Registry Services PDQ Access Control XDR NHIN Interface CAD Search/Retrieval CAD Policies/Security Admin/Maintenance Qo. S Authentication Authorization Patient Consent Support Services ATNA Logging CT Community Services Biosurveillance PHR Portal Community XDS Hospital or Physician Practice Interface Data Services Integration Engine or Data Source 7 HL 7 Gateway Transform / Translate IHE Adapter 4/10/2006 | Casey Webster and Kevin Julier Document Services Document Storage and Retrieval XDS Security Services PIX Community Hub Document Locator

IBM Global Business Services Cross-Community Interaction § All cross-community interactions are brokered through the NHIN interface, using other community services as needed § Authentication and authority uses a federated model, with trust relationships established at the NHIN level § Cross-community patient lookup is based on demographic matching – Identity is established by matching demographic data between the local and remote PDQ databases, with a conservative threshold – IBM research is working on open issues such as patient mobility, multi-resident patients (“snowbirds”), directed searches, and undirected bounded searches § Cross-community document retrieval is an extension of intra-community retrieval, dependent on obtaining a patient match in the second community § Will utilize the new IHE “XDS Federation” integration profile as it develops 8 4/10/2006 | Casey Webster and Kevin Julier

IBM Global Business Services Questions? 9 4/10/2006 | Casey Webster and Kevin Julier