1.1 IBM ResearchHealth Information Exchange Standards-based SolutionforRegional and National LevelPatient Centric Network Boaz Carmeli IBM Haifa Research Lab, Israel boazc@il.ibm.com February 21 2008 2002 IBM Corporation

2. IBM Research Worldwide 3000 researches in 8 research laboratories around the world dealing with extensive verity of research topicsEstab. 1995 Estab. 1961Estab. 1956Estab. 1986 Employees: 110 Employees: 1750Employees: 210Employees: 440 Estab. 1982 Employees: 180Estab. 1995Estab. 1972 Estab. 1998Employees: 40Employees: 350Employees: 80 2 National Health Record Standard Solution 2006 IBM CorporationUpdated 2/2/04 3. Haifa IT for Healthcare and Life Science Group13+ years of IT research in Healthcare & Life Science Extensive Information Technology and Computer Science skills Medical domain skills Imaging, Clinical Genomics, Interoperability Standards Practice courses, consultation & services (DICOM, IHE, HL7) Mainly in Europe Extensive SW development and architecting skills SOA and J2EE Deep knowledge in information integration and interoperabilityInvolvement in significant customer contracts and interactions Health Information Exchange (HIE) for NHIN Medical Imaging Repository at UCSF an Merck Public Health Affinity Domain at the Middle East (based on HIE) Complex Event Processing at the Nice hospital3 National Health Record Standard Solution 2006 IBM Corporation 4. Our Group Vision - from Data to Knowledge4 National Health Record Standard Solution 2006 IBM Corporation 5. AgendaThe ProblemIHE - Integrating the Healthcare EnterpriseIHE XDS - Cross Enterprise Document SharingAdditional IHE ITI ProfilesIBM Health Information ExchangeReal Life Experience5National Health Record Standard Solution 2006 IBM Corporation 6. The ProblemCreating health records at a regional or national level requireselectronic data exchange among healthcare organizationsIT systems within hospitals, HMOs, clinics and other care-deliveryorganizations become an integral part of the working environmentHealthcare organizations still lack the ability to share informationacross organization boundariesCross-enterprise data sharing implies the need for a standardsbased communication mechanism Without standards: No information exchange is expected to take place With standards: No single vendor is expected to dominate the market6 National Health Record Standard Solution 2006 IBM Corporation 7. AgendaThe ProblemIHE - Integrating the Healthcare EnterpriseIHE XDS - Cross Enterprise Document SharingAdditional IHE ITI ProfilesIBM Health Information ExchangeReal Life Experience7National Health Record Standard Solution 2006 IBM Corporation 8. IHE - Integrating the Healthcare EnterpriseIHE is a healthcare industry organization promotingcoordinated use of established standards to improvehealthcare IT system integrationIHE produces healthcare integration profiles which: Address a specific healthcare integration scenario Build upon one or more existing, established standards such as HL7 and DICOM Define constraints which limit the options available when using underlying standards8 National Health Record Standard Solution 2006 IBM Corporation 9. IHE Organizational Structure IHE (International) Strategic Development Committee Regional Deployment Global Development IHE North AmericaIHE Asia ChinaJapan RadiologyITLaboratory Canada InfrastructureUSAKorea TaiwanCardiology Patient Care Pathology Coordination IHE EuropeRadiationPatient Care Eye care, France GermanyItaly NetherlandsOncology Devices Quality, etc. Norway SpainSweden UKProfessional Societies / SponsorsContributing &ACC GMSIH COCIR SIRMESC JAHIS METI-MLHW ParticipatingACP SFR EAR-ECR BIR JIRAMEDIS-DCHIMSS SFILDRG EuroRecVendorsJRS JAMIRSNA9National Health Record Standard Solution 2006 IBM Corporation 10. History of IHE Domains Veterinary EndoscopyPathologyOver 100 vendors involved world-wide Pharmacy8 Technical FrameworksQuality Patient Care Devices (1)48 Integration ProfilesPatient Care Coordination (5)Testing at Connectathons world-wideRadiation Oncology (1)Demonstrations at major conferences world-wide Eye Care (3) Laboratory (6) Cardiology (7) IT Infrastructure for Healthcare (17)Radiology (18) (2003)(2004) Year 5Year 6(2007)Year 9 (2002) (2006) Year 4 Year 8 (2005) Year 7(1999) (2000)(2001)Year 1 Year 2Year 310National Health Record Standard Solution 2006 IBM Corporation 11. IHE Integration Profiles from IT Infrastructure DomainWhat is available and has been added in 2006/07 Clinical and PHR ContentSecurityPatient ID Mgmt Emergency ReferralsPHR Extracts/Updates Format of the Document Content ECG ReportDocumentvocabulary and associated coded Basic Patients PrivacyPatient Demographics Format of the DocumentContent Lab ResultsDocument Content Document and associated coded vocabularyConsentsQuery Format of the Establish Consents & Enable ContentScanned Documents and associated coded vocabularyAccess Control Format of the Document ContentPatient Identifier Imaging InformationFormatassociated coded Content and of the Document vocabularyCross-referencing Format of theSummary Medical Document Content and(associated coded vocabulary Document DigitalMap patient identifiers across Meds, Allergies, Pbs)Format of the Document ContentSignature independent identificationAttesting true-copy and origindomainsand associated coded vocabularyHealth Data Exchange Audit Trail & Node Cross-Enterprise Authentication OtherDocument Sharing (XDS) Centralized privacy audit trail and node to node authentication to create aRequest Form Registration, distribution and access across health enterprises of clinicalsecured domain. for Data Capturedocuments forming a patientExternal form with custom electronic health record import/export scripting Consistent TimeCross-Enterprise DocumentNotification of Coordinate time across networkedReliable Interchange (XDR)systemsDocument Availability Cross-Enterprise DocumentNotification of a remote provider/ health enterpriseMedia Interchange (XDM) 11 National Health Record Standard Solution 2006 IBM Corporation 12. IHE Profile Development Lifecycle2Q/3Q 20061Q 2007 Testing at1Q 2007 ConnectathonsDevelopIHEtechnicalDemonstrationsspecifications 2Q 2007 HIE v1.1 1Q 2006Products Identify available with IHE standards (e.g. HL7, DICOM, IETF, OASIS)4Q 2005Document Use Timely access toEasy to integrateCase information products12RequirementsRecord Standard Solution National Health 2006 IBM Corporation 13. Relevant IHE ITI Profiles XDS - Cross Enterprise Document Sharing Specifies guidelines for sharing clinical documents across healthcare organization boundaries XDS-I: XDS for Imaging PIX - Patient ID Cross Referencing Specifies guidelines for cross-referencing a unique patient ID between healthcare organizations Aka Master Patient Index (MPI) PDQ Patient Demographics Query Specifies guidelines for querying patient ID by demographic details ATNA - Audit Trail and Node Authentication Specifies guidelines for security and auditing at both communication and application layers XUA Cross Enterprise User Assertion Provides a means to communicate claims about an authenticated principal (user, application, system) across enterprise boundaries13National Health Record Standard Solution 2006 IBM Corporation 14. Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience14National Health Record Standard Solution 2006 IBM Corporation 15. XDS Geographical Aspect & Terminology EHR-CR Clinical Affinity Domain An EHR-CR or Care-delivery Record A group of healthcare enterprises that abstracts the patient information managed have agreed to work together using a by the IT system or by the set of systems ofcommon set of policies and share aClinical Affinity Domain a single Care Delivery Organization common infrastructure of repositories and a registry EHR-CREHR-CRLong Term Acute Care Care R -LR EH EHR-LR The documents shared by the EHR-CR and tracked by the registry form a EHR-CR EHR-CR longitudinal record for the patients PCPs & ClinicsDiagnosticthat received care among the EHR- CRs of the Clinical Affinity Domain Service15National Health Record Standard Solution 2006 IBM Corporation 16. CAD - Clinical Affinity Domain A group of healthcare organizations that have agreed to share patient records along a set of operational, business and legal agreements : Agreed-upon sharing policies Single Patient ID Domain (CAD ID) Common set of Codes Unified terminology Security & Access Control model/agreements16 National Health Record Standard Solution 2006 IBM Corporation 17. Cross Enterprise Document Sharing (XDS) ProfileEstablish the IT Infrastructure for an Affinity DomainEnables Care Delivery Organizations (CDOs) to cooperate in the care of apatient by sharing clinical records Patient Identity SourcePatient Identity Feed [ITI-8] Query Registry [ITI-16] Document Registry Document Consumer Register Document Provide & Register DocumentSet [ITI-14]Set [ITI-15]Retrieve Document Document Source Document Repository [ITI-17] 17 National Health Record Standard Solution 2006 IBM Corporation 18. XDS Actors 1. Document Source Produces and publishes documents Responsible for sending documents and metadata to a repository 2. Document Consumer Queries a registry for documents Retrieves selected documents from one or more repositories 3. Document Registry Maintains metadata about each registered document in a document entry Includes a link to the document in the repository 4. Document Repository Responsible for the persistent storage of documents Assigns a URI to documents for subsequent retrieval by a consumer 5. Patient Identity Source Provides a unique identifier for each patient and maintains a collection of identity traits18National Health Record Standard Solution 2006 IBM Corporation 19. Provide and Register Document Set A Document Source actor initiates the Provide and Register Document Set Transaction. For each document in the submitted set, the Document Source Actor provides both the documents and the corresponding metadata to the Document Repository. The Document Repository is responsible to persistently store these documents, and to register them in the Document Registry using the Register Documents transaction. Provide & Register DocumentSet [ITI-15] Document Source DocumentRepository19National Health Record Standard Solution 2006 IBM Corporation 20. Register Document Set A Document Repository actor initiates the Register Document Set transaction. This transaction allows a Document Repository Actor to register documents with a Document Registry, by supplying metadata about each document to be registered. This document metadata will be used to create an XDS Document Entry in the registry.Document Registry Register DocumentSet [ITI-14]Document Repository20National Health Record Standard Solution 2006 IBM Corporation 21. Query Registry The Query Registry transaction is issued by the Document Consumer Actor on behalf of a care provider to a Document Registry The Document Registry Actor searches the registry and returns a list of matching document entries including the locations and identifier of each document in the Document Repository Query Registry [ITI-16] Document RegistryDocument Consumer21National Health Record Standard Solution 2006 IBM Corporation 22. Retrieve Document A Document Consumer Actor initiates the Retrieve Document transaction. The Document Repository will return the document that was specified by the Document ConsumerDocument Consumer Retrieve Document Document Repository[ITI-17] 22National Health Record Standard Solution 2006 IBM Corporation 23. Patient Identity Feed This is IHE ITI Transaction 8, defined as part of the Patient Identifier Cross- Referencing Integration Profile It conveys the patient identifier and corroborating demographic data. Its purpose in the XDS Integration Profile is to populate the registry with patient identifiers that have been registered for the affinity domain Patient Identity SourcePatient Identity Feed [ITI-8] Document Registry23 National Health Record Standard Solution 2006 IBM Corporation 24. XDS Concepts The XDS registry is the cornerstone of the document sharing process The source registers information to be exchanged in the registry The registry only maintains metadata for the document (and not the document itself) Clinical information is not exposed The XDS repository maintains the actual clinical document Clinical documents can be kept within the enterprises repository or they can be transferred to another enterprises repository. Allows for data encryption. Source initiates the sharing process and provides the clinical document and the associated metadata Consumer queries the registry and retrieve the data from the relevant repository24 National Health Record Standard Solution 2006 IBM Corporation 25. Single Registry Multiple RepositoriesClinical Affinity DomainHMODocumentHospitalConsumerDocumentSourceDocuments Registry Independent Document Repository25 National Health Record Standard Solution 2006 IBM Corporation 26. XDS Key Features Foundation for health IT infrastructures Shared Electronic Health Record, in a community, region, etc. Scalable architecture for document sharing Between private physicians, clinics, long term care, pharmacy, acute care with different clinical IT systems Suitable for other healthcare domains such as Public Health and Clinical Trials Distributed Each organization publishes clinical information for others to use Actual documents may remain in the source system Easy access Care providers are offered a means to query and retrieve clinical documents of interest All transactions are based on industry and communication standards26 National Health Record Standard Solution 2006 IBM Corporation 27. XDS Key Features Document centric Published clinical data is organized into clinical documents using agreed standard document types (HL7-CDA/CCD, PDF, DICOM, etc.) Document content neutral Document content is processed only by source and consumer systems. Infrastructure is generic Standardized registry attributes Documents are described by a standardized set of attributes. Standardized queries are supported by all vendors27National Health Record Standard Solution 2006 IBM Corporation 28. Deployment OptionsRegistrySource Consumer Repository EHR-CR EHR-EHR-CR EHR- SourceRegistry Consumer RepositoryEHR-CREHR-EHR-CREHR-28 National Health Record Standard Solution 2006 IBM Corporation 29. Registry and Repository ArtifactsXDS Folder An XDS Folder allows document Submission Folder A sources to group the documents they Set submit with other related documentsSubmission SetA set of XDS documents registered Document together to a Document RepositoryDocumentDocument concerning information related to Registry Entry 1 Entry 2 one care event of a single patient Document EntryA Document Entry contains allmetadata for a specific XDS documentand a link to the documents repositorylocation. DocumentXDS DocumentD Dococ Repository An XDS Document is the smallest unit u u mmof information that may be provided toen en tta Document Repository29 National Health Record Standard Solution 2006 IBM Corporation 30. Document & DocumentEntry Concept XDS paradigm is built around documents (and not around records) An XDS Document is a composition of clinical information that contains observations and services to be exchanged within the Affinity Domain Documents characteristics are defined by the HL7 CDA Standard Persistence, Wholeness, Potential for Authentication An XDS Document is the smallest unit of information that may be provided to a Repository and be registered in the Registry XDS does not provide mechanisms to access portions of a Document XDS Documents are required to be globally uniquely identified Each Clinical Document has set of metadata that describing it This metadata is referred as XDS DocumentEntry Most metadata attributes can be automatically generated form the clinical document by the Document Source specially true for structured documents like CDA or DICOM30 National Health Record Standard Solution 2006 IBM Corporation 31. DocumentEntry Metadata Document Author Person, role, specialty Legend Patient DemographicsRequired Service Start and Stop Time Optional Document Creation TimeGenerated Legal Authenticator Title, comments, Identifiers Patient ID, Unique ID, entryUUID Kind of DocumentClass Code (e.g Prescription, Discharge Summary, Report) Type Code (more detail) Event CodeMain clinical event (e.g. colonoscopy, appendectomy) Healthcare Facility TypeHealthcare Facility Type Code and Display Name Practice Setting Type Practice Setting Code and Display Name Confidentiality Code Technical Details MIME Type; Format Code (e.g. CDA); Size; Hash; URI; Language Available StatusAvailable, Deprecated31 National Health Record Standard Solution 2006 IBM Corporation 32. SubmissionSet Concepts Submission Set is related to care event(s) of a single patient An XDS Submission Set is created for each submission request It is related to a single Document Source Actor Submission Set creates a permanent entry in the Registry Submission Set includes one or more DocumentEntry object(s) Submission Set may refer to already registered XDS Documents that have a relationship with the same care event Submission Set includes the record of new XDS Folders creation. The Document Registry may be queried to find all documents registered in the same XDS Submission Set XDS provides complete flexibility to organization to relate Documents and Submission Sets to an encounter, a visit, an episode of care, or various workflow processes within clinical organization.32 National Health Record Standard Solution 2006 IBM Corporation 33. SubmissionSet Metadata Each of the attributes listed below is an attribute on the RegistryPackage object defining the Submission Set Legend RequiredAuthor person, role, specialty, institution OptionalComment Any string Generated Title Title of this document serviceStartTime Submission time - Document submission Time Availability Status Approved, Deprecated Coded elementscontentType (type of clinical activity) Identifier Patient ID, Source ID, Unique ID, entryUUID33 National Health Record Standard Solution 2006 IBM Corporation 34. Folder Concepts The purpose of an XDS Folder is to provide a collaborative mechanism for several XDS Document Sources to group XDS Documents Folders offer the Document Consumers a means to find all Document Entries placed in the same Folder. The following principles apply to an XDS Folder: A Folder groups a set of XDS Documents related to the care of a single patient One or more Document Source Actors may submit documents in a given Folder A Folder may be created by a Document Source and/or predefined in an XDS Affinity Domain The content of a Folder is qualified by a list of codes/meaning, Source Actors may find existing Folders by querying the Document Registry Folders in XDS may not be nested The same documents can appear in more than one Folder Folders have a globally unique identifier34National Health Record Standard Solution 2006 IBM Corporation 35. Folder Metadata Legend codeList Required availabilityStatus (approved, deprecated) OptionalentryUUID Generated uniqueId title comments lastUpdateTime patientId35 National Health Record Standard Solution 2006 IBM Corporation 36. Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience36National Health Record Standard Solution 2006 IBM Corporation 37. Patient Demographics Query (PDQ) Find patients matching a given set of demographics Search may be based on combination of: name,address, phone number, gender, date of birth, race,marital status, birth place, citizenship idPatientPatient Key PDQ Actors:Demographics ConsumerDemographicsSupplier Patient Demographics Supplier Patient Demographics Database containing patient demographics andQuery: QBP^Q22corresponding patient identifiers Patient Demographics Responds to queries for patient information Response: RSP^K22 Patient Demographics Consumer Typically an EHR or PHR application that supportslookup of patient information based on a partialset of demographics37National Health Record Standard Solution 2006 IBM Corporation 38. PDQ Example Query:Rupert, Adrian PDQ Consumer (an EHR) Patient Demographics Supplier Response: Rupert, Adrian Gender: Male Date of Birth: 09/24/1932 Address: 1342 Main Street Chatfield, MN Patient Id: 13579 Rupert, Adrien Gender: Female Date of Birth: 03/21/1961 Address: 58 1st Avenue Stewartville, MN Patient Id: 2468 Rupert, Ade Gender: Female Date of Birth: 01/14/1982 Address: 2525 Broadway Rochester, MN Patient Id: 4A78X38National Health Record Standard Solution 2006 IBM Corporation 39. Patient Identifier Cross-Referencing (PIX) Find various identifiers for the same patient for example: I know a patients id within a community clinic I need to find corresponding patient id within a given hospital Key PIX actors: Patient Identifier Cross Reference Manager (PIX Manager) Maintains cross reference between corresponding patient ids fromdifferent domains based on matching patient demographics Patient Identity Source Existing application within a hospital or clinic that is responsible forassignment and management of patient ids Provides Patient Identity Feed for the PIX Manager Patient Identifier Cross Reference Consumer An application which has an id for a patient in one domain andwishes to determine corresponding CAD ID Or ID in a different domain39 National Health Record Standard Solution 2006 IBM Corporation 40. PIX Transactions Patient Identity Source Hospital Patient Identifier Cross Patient IdentityReference Consumer Source(an EHR application)ClinicLi Wang09/24/1932A87631MaleM8354673993PIX QueryLi Wang1435509/24/1932A87631 M8354673993 Male A87631 M835467399314355 Patient IdentityL-716 14355 L-716A87631 L-716 Patient identifier CrossSourceReference ManagerHospitalPatient Identity SourceLi Wang 09/24/1932Clinic MaleLi Wang09/24/1932 M8354673993MalePatient Identity Feeds40National Health Record Standard Solution 2006 IBM Corporation 41. Audit Trail and Node Authentication (ATNA) ATNA provides a secure healthcare information infrastructure by prescribing how to: Secure systems Ensure access control to protected healthcare information Secure the network Only trusted systems are allowed to exchange protected healthcareinformation Encrypted exchange of information also supported Track data access All access to and movement of protected healthcare information isaudited Key ATNA Actors: Centralized Audit Record Repository Collects all Audit Trail events into a centralized place Provides a mean to investigate PHI access breaches41 National Health Record Standard Solution 2006 IBM Corporation 42. ATNA Within A Healthcare Network Example: Using an EHR application to retrieve a discharge summary from a local hospitalAudit login Encrypt datato EHRduringtransportSecured System Secured System HospitalDischarge Summary Header Secure network Discharge SummaryHeader ClinicFamily History Family History Body MedicationsImmunizationsBody Medications ImmunizationsVital SignsVital SignsAllergiesAllergies Authenticate Authenticaterequesting target clinic hospitalCentralAudit import of Audit Export ofdata from hospital Audit Trial data into clinicrepository Repository EHR42National Health Record Standard Solution 2006 IBM Corporation 43. Cross-Enterprise User Assertion (XUA)New profile defined this year by IHE ITI and successfullytested during the last Connectathon (January 2008)Designed to support user level authentication Provides a means to communicate claims about anauthenticated principal (user, application, system) in transactions that cross enterprise boundariesBased on an Web Services enabled environment Uses WS-Trust and SAML for communicating principalattributes Comes into play only within XDS.b supported environment ITI 18 Stored Query transaction ITI 43 Retrieve Document transaction43National Health Record Standard Solution 2006 IBM Corporation 44. XUA Actors X-Service User A system making a services request of an X-Service Provider e.g., an XDS.b Document Consumer issuing a query to the XDS.bRegistry X-Service Provider A system providing a service that requires an X-User Assertion e.g., XDS.b Registry, XDS.b Repository X-Assertion Provider A SAML Identity Provider (IDP) or WS-Trust Security Token Service(STS) X-Assertion Provider is currently out of scope as an IHE actor44 National Health Record Standard Solution 2006 IBM Corporation 45. Regional Level Policies Each affinity domain is qualified to set the sharing policies Which document and data to share Not all clinical documents are required for the regional or national level Where to keep original documents Under the generating organization or at the center Which terminologies and coding schemes to use Translation from the CDO terminology to the Affinity Domain terminology Which access control policies to set Which user interfaces and end-client applications to use Access to data is possible from anywhere and is based on Internettransactions Physician and Patient portals45 National Health Record Standard Solution 2006 IBM Corporation 46. Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience46National Health Record Standard Solution 2006 IBM Corporation 47. IBM HIE Solution Architecture47National Health Record Standard Solution 2006 IBM Corporation 48. IBM HIE XDS Registry Serves as searchable index of patient medical records within a healthcare community Supports latest features outlined by IHE XDS and ATNA profiles Register Document Set (ITI-14, ITI-42) Registry Stored Query (ITI-18) Patient Identity Feed (ITI-8) ATNA Secure Node and Record Audit Event (ITI-20) Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base & Network Deployment)Network Deployment supports multi-server clustering for load balancing and failover DB2 Universal Database (v8.2) Provide support for Oracle if needed IBM XDS Document Registry deployed in 2 of 4 U.S. Government NHIN projects48National Health Record Standard Solution 2006 IBM Corporation 49. IBM HIE XDS Registry ATNA Generated EventsPatient Identity FeedHL7 v3 over Web ServicesPatient Identity Feed XDS Document Registry JDBC XDS DocumentJMSHL7 v2 over MLLPMLLP(J2EE Application)Registry DatabaseAdapter (Document Metadata)Register Document Set, Registry Stored QueryXDS.a - SOAP over HTTPXDS.b - Web ServicesWebSphere Application Server DB2 Universal Database 49National Health Record Standard Solution 2006 IBM Corporation 50. IBM HIE XDS Repository Data store for clinical documents being shared within a healthcare community Supports both centralized (hosted) architecture and federated architecture Supports latest features outlined by IHE XDS and ATNA profiles: Provide and Register Document Set (ITI-15, ITI-41) Retrieve Document (ITI-17, ITI-43) ATNA Secure Node and Record Audit Event (ITI-20) Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base and Network Deployment) Several back-end data storage models supported File system (simple, low cost option) DB2 Universal Database v9 (integrated, XML/relational data store) DB2 Content Manager v8.3 (robust, highly scalable document management system) Deployed in 2 of the 4 U.S. Government sponsored NHIN projects50 National Health Record Standard Solution 2006 IBM Corporation 51. IBM HIE XDS RepositoryFile System ATNA GeneratedLocal or Events DistributedProvide and Register Document Set File SystemSOAP with Attachments over HTTP Storage OptionsGMASXDS Retrieve Document Document Repository HTTP/MTOM(J2EE Application)Document DB2 Management Content System ManagerWebSphere Application ServerDB2 UDB XML/RelationalData Model51National Health Record Standard Solution 2006 IBM Corporation 52. IBM HIE ATNA Audit Record Repository Repository for audit events generated by systems handling PHI within a healthcare network Supports ATNA Record Audit Event (ITI-20) interface to other healthcare applications BSD Syslog protocol for data transport (RFC 3164) Supports both RFC 3881 and IHE Provisional audit record formats Support for reliable transport for audit massages (Currently not included in IHE) Web-based tool provided to query audit data Based on IBMs Data Discovery and Query Builder product (DDQB) Build and execute canned or ad hoc audit queries Based on proven, scalable IBM middleware WebSphere Application Server (v6, Base & Network Deployment)Network Deployment supports multi-server clustering for load balancing and failover DB2 Universal Database (v8.2)52National Health Record Standard Solution 2006 IBM Corporation 53. IBM HIE ATNA Audit RepositoryData Discovery and Query Builder HTTP Web-Based Audit Query/ReportingInterfaceJDBC ATNA Audit Record Database Record Audit Event (Audit Information) BSD SyslogJMS ATNA AuditJDBC AuditInterceptorRecord Repository WebSphere Application Server DB2 UDB53National Health Record Standard Solution 2006 IBM Corporation 54. IBM HIE Audit Query Interface54 National Health Record Standard Solution 2006 IBM Corporation 55. IBM HIE XUA X-Assertion Provider Serves as a WS-Trust Security Token Service (STS), creates and validates SAML assertions Supports WS-Trust 1.3 and WS-Trust 2005/02 Interoperates with other Security Token Services Based on proven, scalable IBM middleware Tivoli Federated Identity Manager (v6.1)Supports both WS-Trust and SAML IBM HIE XUA X-Assertion Provider was tested with several vendors during the last IHE Connectathon (January 2008) Currently out of scope as IHE actor55National Health Record Standard Solution 2006 IBM Corporation 56. IBM HIE XUA X-Assertion ProviderAuthentication Service (LDAP) Get SAML Assertion SOAP 1.1, SOAP 1.2 Underlying Systems WS-Trust 2005/02, WS-Trust 1.3 Persistent Validate SAML Assertion XUA X-Assertion Provider Storage SOAP 1.1, SOAP 1.2(Web Service Application)(DB2 UDB) WS-Trust 2005/02, WS-Trust 1.3Authorization Service (Tivoli Access Manager)Tivoli Federated Identity Manager56 National Health Record Standard Solution 2006 IBM Corporation 57. IBM HIE XDS-I Imaging Document SourceXDS-I (XDS for Imaging)Variation of XDS to support sharing of medical imagesImaging document source actor is responsible for:Registration of medical images and reports within an XDScommunityRetrieval of medical images and reportsVia DICOM or WADO (Web Access to DICOM Object)Can be conceived as a DICOMXDS converterPrevent copying of large data chunks within the AffinityDomainSubset of IBMs Content Manager Offering (CMO)57National Health Record Standard Solution 2006 IBM Corporation 58. IBM HIE XDS-I Imaging Document SourceIHE XDS-I Profile XDSRepositoryDICOM DICOMXDS-IXDS-I XDS-I Document Document XDSConsumerSource Registry PIX/PDQAudit Repository Manager Server58 National Health Record Standard Solution 2006 IBM Corporation 59. Eclipse Open Healthcare Framework (OHF) The Eclipse Foundation Open source community whose projects are focused on providing an extensible development platform and application frameworks for building software. www.eclipse.org The Eclipse Open Healthcare Framework (OHF) Project within Eclipse formed for the purpose of expediting healthcare informatics technology. Extensible frameworks and tools which emphasize the use of existing and emerging standards Encourages interoperable open source infrastructure Lowers integration barriers www.eclipse.org/ohf59National Health Record Standard Solution 2006 IBM Corporation 60. OHF and IBM HIEOHF is complementary technology to the IBM HIE Infrastructure developed by IBM and other industry partners. OHF tooling helps vendors implement the standards so they can continue to focus on making better products. Two options: Java libraries and Web Services OHF software was used with the HIE Solution in the US NHIN Project and the PHAD project for MECIDS60 National Health Record Standard Solution 2006 IBM Corporation 61. Eclipse OHF Java and Web Service Adapters61National Health Record Standard Solution 2006 IBM Corporation 62. Agenda The Problem IHE - Integrating the Healthcare Enterprise IHE XDS - Cross Enterprise Document Sharing Additional IHE ITI Profiles IBM Health Information Exchange Real Life Experience62National Health Record Standard Solution 2006 IBM Corporation 63. HIE Involvement in Healthcare Industry Events IBM has been a strong supporter of industry events aimed at validation or our HIE solution and demonstration of IHE profiles and the underlying standards they are based upon IHE Connectathon North America January 2006 HIMSS IHE Interoperability Showcase February 2006 RSNA IHE Demonstration November 2006 IHE Connectathon North America January 2007 HIMSS IHE Interoperability Showcase February 2007 ACC IHE Interoperability Showcase March 2007 Zorg and ICT 2007 (Netherlands) IHE Demonstration March 2007 IHE Connectathon Europe April 2007 Canada eHealth Conference IHE Interoperability Showcase May 2007 World of Health IT Conference (Vienna Oct 2007) IHE Interoperability Showcase IBM providing internet-accessible reference implementation of IHE infrastructure profiles (HIE) for ISV testing/demonstration for past 2+ years.63National Health Record Standard Solution 2006 IBM Corporation 64. IHE Connectathon Test Partners (part 1 of 2)Audit RepositoryDoc Registry Doc Repository openEMR/OHF Accenture xx Acuoxx Agfaxx xx Alert xx x Allscriptsxx xx Ashvins x Axolotl x Bell Canada xx Bluewarexx xx Canon x CapMedxx xx Caribel Cegedim xx Cernerx x CGI x CompassCarex x Convergence x CPSIxx DataProcessingxx x Dianoemax Dictaphone x x Eclipsys xx EDL xx Epicxx Eselxx x Etiamx x Forcare xx xx GEClinisoft, RIS xClinisoft, Muse, RISx HIPAAT x x HXTIx x IcoServexx x ICW x Infinitt x x Initiatex x Intersystems x x Kodak xx xx64 National Health Record Standard Solution 2006 IBM Corporation 65. IHE Connectathon Test Partners (part 2 of 2) Audit RepositoryDoc RegistryDoc RepositoryopenEMR/OHF McKessonx x Medasys x x x MedCommonsx x x MediNotes x xx Mediwarex x MedQuist Medosx MIE x Misys x x x Moreau-Labbeerx NDMAx x NextGen x xx NISTx Obrieng x Philips x PracticePartner x xx Quadramed x Quovadx x x x Rogan x RVC x Santeos x xx Sectra Siemens x x xx Sillage xx Smwaidr2i x x SoftMedical x x x Solinfo x xx Soverax x SQLIx xx SRDCx xx Synapsisx x x Tiani-Spiritx x xx Visus Total Vendors Tested47 3839 2565National Health Record Standard Solution 2006 IBM Corporation 66. NHIN Architecture Prototype Project VisionA nation-wide standards based network that will allow connectivity of existing and future systems for providers and affiliated stakeholders ONC Objectives IBM Approach Develop and evaluate prototypes for an interoperable NHIN architecture Maximize existing resources & systems- Maximize existing resources to achieve- Maximize existing resources to achievewidespread interoperability among health careSW applications, (e.g. EHRs)widespread interoperability among healthcare SW applications, (e.g. EHRs) Spur technical innovation for nationwide sharing of health information Be community centric- In patient care and public health settings- In patient care and public health settings Achieve interoperability between SW applications and networks Be interoperable between software- Communicate and exchange information in an applications and networksaccurate, effective, useful, manner- Communicate and exchange information Promote collaboration between HHS health ITin an accurate, effective, useful, manner contractors- Develop Compliance Certification process Be security & privacy compliant- Develop Standards Harmonization process- Develop Privacy and Security solutions for- Develop Compliance Certification processinteroperable health information exchange - Develop Standards Harmonizationprocess- Develop Privacy and Security solutionsfor interoperable health informationexchange66 National Health Record Standard Solution 2006 IBM Corporation 67. IBM Healthcare Marketplace Partners Each vendor must demonstrate information exchange within and between three distinct community healthcare markets Mid-Hudson Valley, NY (THINC) Taconic Healthcare Information Network and Community (THINC)THINC Mid-Hudson Valley: evolving RHIO with shared data at HealthVision hub 2,300 physicians supporting 700,000 patients Research Triangle, NC (NCHICA) Competitive, high-tech urban environmentRockingham County, NC Hospitals: Duke, WakeMed, UNC, Rex (UNC Health) Danville, VA (NCHICA) Practices, Public Health, Pharmacies Rockingham County, NC and Danville, VA (NCHICA) Rural environment with NC and VA patients Hospitals: Morehead Memorial, Annie Penn (Moses Cone Health System) Research Triangle, Practices, Public Health, Pharmacies NC (NCHICA)67 National Health Record Standard Solution 2006 IBM Corporation 68. IBM NHIN Phase 1 ParticipantsTHINC Mid Hudson ValleyResearch TriangleRockingham County, NCKingston HospitalPinehurst, NCDanville, VASt. Francis HospitalDuke University Health Morehead Memorial HospitalVassar Brothers System Eden Internal Medicine HealthcareMedical CenterDurham Medical CenterPulmonary, Allergy and Asthma ProvidersPhysician Practices FirstHealth of the CarolinasClinic of DanvilleHudson Valley Primary Care Moore Free Care ClinicMoses Cone Health SystemBridge Street Family MedicinePinehurst MedicalFamily Tree OB/GYNSpringside Medical AssociatesPinehurst Surgical Moses Cone Internal MedicineRabi Sinha, MD Southern Pines Womens CenterResidency ProgramHudson River Community HealthCapMed (PHR)Possibility Forge (openEMR) Medical ApplicationAllscripts (Touchworks 11)Vendors McKesson (Horizon WP Physician Portal)GE CentricityMediTechMedical Service Spectrum LabLab CorpProviders SureScriptsCustom Patient Registration, Provider Registration, and Provider Notification ServicesCustom Security Services Core ServicesInitiate Identity Hub SoftwareIBM Healthcare Collaborative NetworkIBM Heath Information Exchange (XDS Repository & Registry, FQS, OHF Bridge, ARR) Infrastructure IBM TivoliIBM WebSphere DataPowerIHE Integration Profiles (ATNA, XDS, PIX, PDQ, XDS MS) StandardsHL7 / ASTM (CDA / CCD)SAML, SSL/TLS, X509, Web Services Security (SAML / SOAP / Trust Language)68 National Health Record Standard Solution 2006 IBM Corporation 69. XDS Projects Worldwide NetherlandsLowerAustriaItalyHilversum (Conto Corrente Salute) UK CfHLeeuwarden(Radiology WF) Amsterdam France Denmark (Funen)Italy (Veneto) Quebec, Toronto,DMP Spain (Aragon)Alberta, British Columbia AustriaCanada Infoway VITL-VermontBoston Medical Center - MA Philadelphia HIE CPHIC Pennsylvania CareSpark TN & VA South Africa CHINA-ShanghaiMalaysiaCHINA-MoH JAPAN-Nagoya THINC- New York Imaging Info Sharing Lab results sharingImaging Info Sharing NCHICA N. Carolina69National Health Record Standard Solution 2006 IBM Corporation 70. Hebrew (Toda) Grazie ItalianThai Traditional Chinese ObrigadoMerci Brazilian Portuguese French RussianGracias SpanishDankeArabic German Simplified ChineseJapanese70National Health Record Standard Solution 2006 IBM Corporation