Strategic Information Technologies for RHIOS

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1 Strategic Information Technologies for RHIOS The Health Information Technology Summit West Concurrent Session 5.01 March 8, :00PM Lorraine Fernandes, RHIA Senior Vice President Healthcare Initiate Systems, Inc. Deborah Kohn, RHIA, CHE, CPHIMS Principal Dak Systems Consulting 2005 Initiate Systems, Inc Dak Systems Consulting

2 Agenda I. The Federated model for technology deployment II. Strategic technologies that are being deployed successfully to exchange community-wide health information III. Benefits of these technologies for RHIOs IV. Questions / Answers 2

3 The Federated Model Is NOT the fully integrated, monolithic, centralized database model 3

4 The Federated Model Is NOT the fully integrated, monolithic, centralized database model Is the 5D Model Distinct, Distributed, Disparate, Decentralized, Databases 4

5 The Federated Model Mirrors the federal/federated concept of the 50 state govs (Decentralization) reporting to the US gov (Centralization) Centralization ONLY occurs with an Enterprise-type Master Person Index (EMPI, aka Identity Management) for demographic data, and, perhaps, with Application Programming Interfaces (APIs) 5

6 The Federated Model Technical Overview Physician requests patient clinical information using a PDA or browser The request is transmitted to the Connection Service Utility (CSU) The CSU sends a request/response message to retrieve the patient clinical information The CSU gathers and formats the patient clinical information The patient clinical information is transmitted (PUSH/PULL) to the physician requestor and formatted to the appropriate device 6

7 Strategic Technologies Identity Management/EMPIs Peer-to-Peer Networking Secure Messaging Virtual Private Network Web Portal Web Services 7

8 Identity Management 8

9 Accurate Patient Identification Serves as Electronic Health Record (EHR) Foundation EHR Foundation Elements: Electronic Health Record (EHR) ROI Improve patient care and reduce medical risks Realize return on investment for strategic IT initiatives Improve customer service with reduced risk Comply with regulations Enhance operational productivity and efficiency ROI 9

10 Identity Management & EMPI technology Enables quality of care and interoperability initiatives among local, regional and national healthcare entities Accurately find, link, index, maintain and provide secure access to patient records within and across sources to promote collaboration and provide the foundation for electronic health records All without forcing you to do lots of programming, move large quantities of data, standardize schemas, or manage patient identifiers Kate Lamb Ms. K. Jones 1000 Main St. Newark NJ (201) Katherine J. Jones Newark NJ Catherine Lamb (201) Katherine J. Jones Main St. Newark NJ (201)

11 EMPI technology for RHIOs Patient identification based upon demographic matching required for data sharing systems Equate MRNs from participating systems Doesn t rely on SSN or other identifiers Applicable to homogeneous and heterogeneous environments Requirements for the identification component Accurate probabilistic matching On demand real-time or batch Non-invasive operates independently of existing systems Supports a federated model for data interchange (i.e., only demographic data are centralized not clinical data) 11

12 Architecture: Option One Regional Identity Hub Source 1 Source 2 Source n 12

13 Architecture: Option Two Regional Identity Hub Local EMPI 3 rd Party EMPI Electronic Master Person Index (EMPI) Source 1 Source n Source 1 Source 2 Source n Source 1 Source 2 Source n 13

14 National View Architecture Model Example: From Within the Hubs Regional Hubs with Peer-to-Peer communications for sharing and retrieving patient information across provinces Regional Identity Hub Regional Identity Hub Regional Identity Hub Source 1 Source 2 Source n Regional Identity Hub Regional Identity Hub Regional Identity Hub 3rd Party EMPI Regional Identity Hub Source 1 Source n Source 1 Source 2 Source n Source 1 Source 2 Source n Source 1 Source 2 Source n Source 1 Source 2 Source n 14

15 Federated Identity Management Approach Patient data sources Source 1 Source 2 Source 3 Source 4 Source 5 Source 6 Source 7 Source 8 Source n Identity Hub Source Rob Johnson 200 W. Madison St. Dynamic enterprise view Source 6 Source Bobby Johnson 20 West Madison Bob Johnson 200 W. Madison St. Linkage Set Robert Johnson 200 W. Madison St. Baltimore, MD Source 3 Source Robert Johnson Rob Johnson South Main St. Trusted system of record 15

16 Key Components for RHIOs & Data Linkage Interoperability Vendor agnostic Maintains local level MRN Accuracy Uses existing demographic data elements Algorithm should be based upon community population Single or dual threshold model Secure Access Role-based security Data governance controlled by members Collaboration Enables portals to display location and types of records Enables portals to display clinical data assembled across facilities 16

17 Peer-to-Peer Networking A communications environment that allows all addressable devices (e.g., desktop and laptop computers) in the network to act as SERVERS and securely share their files (any type of digital file audio, coded, image, text, video) with all other authenticated and authorized users on the network This works by providing indexes to the files 17

18 Peer-to-Peer Networking Destination Text Only whole files are sent Sound Central Index Video Source Cholesterol 148 Hemoglobin 15.1 Glucose 86 Lab Values Images 18

19 Secure Messaging A communications environment that allows all addressable devices (e.g., desktop and laptop computers) in the network to act as CLIENTS to a centralized server that securely stores and forwards files (any type of digital file audio, coded, image, text, video) This allows authenticated and authorized users on the network to retrieve those files (online pull / offline push) when required 19

20 Secure the End-User s Computer (e.g., the Physician s Office) Path Info System HL7 Messages Lab Info System Transcription System Interface Engine (if none, then Point-to to-point Interfaces) Path Results Lab Results Med Rec Reports Rad Results ADT Connection Engine Internet Encrypted Rad Info System Data Transferred via TCP/IP Sockets Connection Server for Storing Internet Encrypted Server For Storing & Forwarding Replication Healthcare Info the Hosting Data the Hospital / Reference Lab / Payor Data Center 20

21 Virtual Private Network A private network that is configured within a public network, such as the Internet, providing encrypted pointto-point links (using SSL or IPsec) This ensures that only authorized users can access the network and that the data cannot be intercepted 21

22 Virtual Private Network Reference Lab Community Network Hub Cisco 3015 VPN Access Concentrator Cisco 3040 Router Site-to to-site VPN Hub & Spoke Lower cost, tunneled connections with VPN services, like SSL or IPSec encryption and QoS to ensure reliable throughput Internet Cisco 2600 Router with VPN SW Broadband required Cisco 2600 Router With VPN SW Broadband required P O P Physician Provider Remote Access VPN Secure, scalable, encrypted tunnels across a public Network; client software required Home Health Agency 22

23 Web Portal.a single point of personalized access (i.e., an entryway through which to find, organize, & deliver Content*) *Content is defined as information, applications, & services Content can be: Structured, such as relational data Unstructured, such as s, web pages, images, & text documents 23

24 Web Portal PAYOR INFORMATION PHYSICIAN PROVIDER EQUIPMENT & SUPPLY INFORMATION Claims, Eligibility, Referrals PHYSICIAN OFFICE INFORMATION Insurance Plans & Demographics Prescriptions, Medications, H&Ps, & Progress Notes Procedure & Diagnostic Codes DIAGNOSTIC TEST INFORMATION Reference Lab Orders & Results Imaging Center Orders & Results Secured Single Sign-On Custom Views & Workflow (Inbox, Alerts) PORTAL PATIENT-CENTRIC INFORMATION REPOSITORY Custom Views & Workflow (Inbox, Alerts) Secured Single Sign-On ACUTE & POST ACUTE CARE FACILITY PROVIDER Purchase Orders & Order Status Online Catalogs ACUTE & POST ACUTE CARE FACILITY INFORMATION H&Ps, Discharge Summaries, ADT Data Laboratory, Radiology, Pathology Results OTHER INFORMATION: Continuing Education Clinical Databases MEDLINE, PDR, National Disease Registries CNBC, ESPN, Amazon, Travelocity 24

25 Web Services An open, standardized way of integrating disparate, web-based applications using extensible Markup Language (XML) to format / tag the data Simple Object Access Protocol (SOAP) to transfer the data Universal Description, Discovery, and Integration (UDDI) to list what services are available Web Services Description Language (WSDL) to describe the services available 25

26 Web Services CLIENT or PRESENTATION TIER Browser, Patient / Physician Portal XML, HTTP SERVER or RULES TIER Web Application Server Farm SERVICE-ORIENTED ARCHITECTURE (SOA) FRAMEWORK Patient Patient Access Access WS WS ADT/Charge Problem Capture WS WS List List WS WS Physician Physician Access Access WS WS Scheduling/ Order Charge Entry Results Capture WS WS WS WS Identity Identity Manager Manager WS WS Text Image Document Store WS WS WS WS WEB SERVICES UDDI WSDL SOAP DATA SOURCES TIER Database Servers & Legacy Platforms Siemens HIS IDX RIS Misys LIS Stentor PACS NextGen EMR Amisys Managed Care GE MUSE ECG SoftMed Transcription 26

27 Identity Management s Benefits for RHIOs Instantly and accurately locates and links all the records about patients across the RHIO Supports the federated model Provides attribute-based linking Data are shared without losing individual identifiers Does not require a national identifier Utilizes existing data sharing vehicles Supports ongoing real-time updates Provides comprehensive view Secure source and attribute level Responds to requests on demand Scales to population volumes 27

28 Other Technologies Benefits for RHIOs Support the Federated model Are more open than proprietary Have a better chance of being widely implemented Reduce custom development time / costs 28

29 Other Technologies Benefits for RHIOs Simplify user training / promote physician usage Do not require centralized databases Take advantage of economies of scale and management of large networks 29

30 Questions / Answers 30

31 Contact Information Lorraine Fernandes, RHIA Senior Vice President Healthcare Practice Initiate Systems, Inc Deborah Kohn, RHIA, CHE, CPHIMS Principal Dak Systems Consulting

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