OpenHIE’s Architecture and its ComponentsA whirlwind tour of the inner workings of OpenHIE’s standards-based health information exchange.

Derek Ritz, P.Eng., CPHIMS-CA

AeHIN Conference (Manila), August 2015

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Agenda

Introductions What is OpenHIE?

Who is OpenHIE? (the “community”) What does it do? (the “black box”)

How does it work? (the “clear box”) Where is it going next? Q&A

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Introductions

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What is OpenHIE?

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www.ohie.org

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Ok… but what does it do?

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Ready?Set?What OpenHIE is for… explained in 60 seconds or less!

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CommunicableDiseases

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CD database

CommunicableDiseases

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CD databases

CommunicableDiseases

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CD databases

CommunicableDiseases

NCDs

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CD databases

NCD databases

CommunicableDiseases

NCDs

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CD databases

NCD databases

CommunicableDiseases

NCDs

MCH databases

MCH

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CommunicableDiseases

NCDs

MCH

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CD databases

NCD databases

CommunicableDiseases

NCDs

MCH databases

MCH

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CD databases

NCD databases

CommunicableDiseases

NCDs

MCH databases

MCH

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CommunicableDiseases

NCDs

MCH

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CommunicableDiseases

NCDs

MCH

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Continuity of guideline-based care, over time and across multiple sites

Automatic generation of population indicators and metricsSupport transaction processing for UHC and CRVS

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How does OpenHIE

work?

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CR ILR SHR HMIS

FDHWD

ILTS

POS

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Point of Service (POS) – the applications that communicate with the HIE including mHealth apps,

EMRs, hospital EPRs, lab and pharmacy, etc.

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Interoperability Layer (IL) – manages all inbound communication from POS applications and orchestrates how

OpenHIE will do its work to satisfy them. The IL also provides centralized authentication, authorization and audit

logging services.

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Terminology Service (TS) – provides the canonical database of code sets and clinical ontologies and, where applicable,

can map between them.

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Client Registry (CR) – provides the definitive demographic data regarding subjects of care and cross-references local

client ID codes to the enterprise client ID (ECID).

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Health Worker Directory (HWD) - provides definitive demographic data and competency data regarding providers

of care and cross-references local provider ID codes to the enterprise provider ID (EPID).

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Facility Directory (FD) - provides definitive data about sites of care and the services provided at them; cross-references local

facility ID codes to the enterprise facility ID (EFID).

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of

a Health Worker Registry (HWR) and Facility Registry (FR).

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CR ILR SHR HMIS

FDHWD

ILTS

POS

FD FDHWDHWD

Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of

a Health Worker Registry (HWR) and Facility Registry (FR).

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Shared Health Record (SHR) – is a repository of person-centric health transactions indexed by ECID, EPID, EFID and

timestamp. The SHR provides a longitudinal health record; it may be used to generate an on-demand health summary

(care continuity) document.

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CR ILR SHR HMIS

FDHWD

ILTS

POS

Health Management Information System (HMIS) – the database of (aggregated) data elements and indicators that

support big data analytics, public health planning and decision making.

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CR ILR SHR HMIS

FDHWD

ILTS

POS

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OpenHIE’s transactions…

Save a new demographic record Query for a demographic record

1. Query by ID2. Query by fuzzy match

Update an existing demographic record Update inter-linked records Query for inter-linked records (Providers,

Facilities, Organizations, Services) Save client encounter document Query for client encounter documents

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OpenHIE’s transactions…

Save a new demographic record PIX ITI-8 Query for a demographic record

1. Query by ID PDQ ITI-212. Query by fuzzy match PDQ ITI-21

Update an existing demographic record PIX ITI-8 Update inter-linked records CSD ITI-74 Query for inter-linked records (Providers,

Facilities, Organizations, Services) CSD ITI-73 Save client encounter document XDS.b ITI-41 Query for client encounter documents XDS.b ITI-

18XDS.b ITI-43

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Save/Update demographic record

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-8

ITI-8

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Query demographic record(s)

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-21

ITI-21

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Update/Query inter-linked record(s)

ITI-74

ITI-73

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-74On a regular refresh cycle…

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-73

ITI-73

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Save client encounter document

ITI-41

ITI-9

ITI-73ITI-73

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-73(2)ITI-9 ITI-41

ITI-41

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Query client encounter document

ITI-18ITI-9

ITI-18

ITI-43ITI-43

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-9 ITI-18

ITI-18If document ID is unknown

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CR ILR SHR HMIS

FDHWD

ILTS

POS

ITI-43

ITI-43For each document ID

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Which documents?

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Section Template ID Reference

Visit Summary Flow sheet 1.3.6.1.4.1.19376.1.5.3.1.1.11.2.2.2 3.3.2.5

History of Surgical Procedures 1.3.6.1.4.1.19376.1.5.3.1.1.16.2.2

Coded Antenatal Testing and Surveillance

1.3.6.1.4.1.19376.1.5.3.1.1.21.2.5.1 3.3.2.4

Allergies and Other Adverse Reactions

1.3.6.1.4.1.19376.1.5.3.1.3.13 3.3.2.3

Medications 1.3.6.1.4.1.19376.1.5.3.1.3.19 3.3.2.12

Care Plan 1.3.6.1.4.1.19376.1.5.3.1.3.31

Advance Directives 1.3.6.1.4.1.19376.1.5.3.1.3.34 or 1.3.6.1.4.1.19376.1.5.3.1.3.35

3.3.2.2

Problems 1.3.6.1.4.1.19376.1.5.3.1.3.6 3.3.2.1

Vital Signs 1.3.6.1.4.1.19376.1.5.3.1.3.25 or 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.2

3.3.2.17

Family History 1.3.6.1.4.1.19376.1.5.3.1.3.14 or 1.3.6.1.4.1.19376.1.5.3.1.3.15

3.3.2.9

Social History 1.3.6.1.4.1.19376.1.5.3.1.3.16 or 1.3.6.1.4.1.19376.1.5.3.1.3.16.1

3.3.2.15

Results 1.3.6.1.4.1.19376.1.5.3.1.3.27 or 1.3.6.1.4.1.19376.1.5.3.1.3.28

3.3.2.7

History of Present Illness 1.3.6.1.4.1.19376.1.5.3.1.3.4

History of Past Illness 1.3.6.1.4.1.19376.1.5.3.1.3.8 3.3.2.10

Pregnancy History 1.3.6.1.4.1.19376.1.5.3.1.1.5.3.4 3.3.2.14

Immunizations 1.3.6.1.4.1.19376.1.5.3.1.3.23 3.3.2.11

Procedures 2.16.840.1.113883.10.20.1.12 3.3.2.15

Supported HL7 CDA

Document Sections

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Supported CDA documents…

Name Short Template IdMedical Documents MD 1.3.6.1.4.1.19376.1.5.3.1.1.1Medical Summaries MS 1.3.6.1.4.1.19376.1.5.3.1.1.2History and Physical HP 1.3.6.1.4.1.19376.1.5.3.1.1.16.1.4Antepartum History and Physical APHP 1.3.6.1.4.1.19376.1.5.3.1.1.16.1.1Antepartum Summary APS 1.3.6.1.4.1.19376.1.5.3.1.1.11.2 Sharing Laboratory Results XD-LAB 1.3.6.1.4.1.19376.1.3.3Antepartum Laboratory APL 1.3.6.1.4.1.19376.1.5.3.1.1.16.1.2 Antepartum Education APE 1.3.6.1.4.1.19376.1.5.3.1.1.16.1.3 Labor(sic) and Delivery Summary LDS 1.3.6.1.4.1.19376.1.5.3.1.1.21.1.2Maternal Discharge Summary MDS 1.3.6.1.4.1.19376.1.5.3.1.1.21.1.3Referral Summary RS 1.3.6.1.4.1.19376.1.5.3.1.1.3 Discharge Summary DS 1.3.6.1.4.1.19376.1.5.3.1.1.4Immunization Content IC 1.3.6.1.4.1.19376.1.5.3.1.1.18.1.2

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What’s next for OpenHIE?

Aggregate Data Exchange (ADX) – IHE profile for submitting data element & indicator content to the HMIS

Mobile Alert Communication Management (mACM) – IHE profile for sending unstructured messages to human recipients

On-demand Document (ODD) – XDS.b option to create a CDA on-the-fly… implemented by OpenSHR but not yet tested at CAT

Basic consent management (opt-out, no BTG) Other features based on Architecture Meetings…

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Thank you.