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Session #300 Roundtable Discussion February 14, 2005 1 STRATEGIC INFORMATION TECHNOLOGIES FOR SUCCESSFUL HEALTH INFORMATION EXCHANGE INITIATIVES [email protected] www.daksystemsconsulting.com © 2005 Deborah Kohn About Deborah Kohn, Facilitator Facilitator – Roundtable Discussion: “The Impact of Web Services on Portal Development”, HIMSS Annual Conference and Exhibition, Orlando FL (February 2004) Facilitator – Roundtable Discussion: “Strategic Planning for Web Portal Development”, HIMSS Annual Conference and Exhibition, San Diego CA (February 2003) Facilitator – Roundtable Discussion: “Developing and Implementing a Web / Intranet Strategic Plan”, HIMSS Annual Conference and Exhibition, Atlanta GA (January 2002) Facilitator – Roundtable Discussion: “Developing an Intranet: How To Grow Your Own”, HIMSS Annual Conference and Exhibition, New Orleans LA (February 2001) Guest Editor – Journal of Healthcare Information Management: “Healthcare and the Web”, HIMSS, (Spring 2000) 2 Learning Objectives 1. Define: a. b. c. d. Regional Health Information Organizations (RHIOs) Health Information Exchange & Interoperability (HIEI) National Health Information Network (NHIN) The “Federated” model for technology deployment 2. Identify several, strategic, Internet-derived technologies that are being successfully deployed to exchange community-wide health information 3. Understand the benefits of these technologies for RHIOs 3 RHIOs Public and Private collaboratives that: enable health information exchange in a “region” are bigger and fewer than Local Health Information Infrastructures (LHIIs) serve approximately 500,000 – 1,000,000 lives service area concept, such as Emergency Medical Services (EMS) are no larger than a state (OR, WY, IL, DE) 4 HIEI Health Information Exchange – Interconnecting care Interoperability (per HL7; per the IEEE Standard Computer Dictionary) – The ability of two or more systems or components to exchange information and to use the information that been exchanged 5 NHIN Tying together all the RHIOs an interconnected, interoperable, electronic health information infrastructure/network with the capacity to electronically exchange the information between and among all the electronic health records (EHRs) so that a complete, electronic health record can be assembled whenever and wherever a patient presents for care The “Medical Internet” 6 The “Federated” Model The 5 Ds – Distinct, Distributed, Disparate, Decentralized Databases The only Centralization occurs with an Enterprise-type Master Patient Index (EMPI) and, perhaps, Application Programming Interfaces (APIs) Mirrors the “federal/federated” concept of the 50 state govs (Decentralization) reporting to the US gov (Centralization) 7 Internet-derived Technologies Peer-to-Peer Networking Secure Messaging Virtual Private Network Web Portal Web Services 8 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. 9 Peer-to-Peer Networking DESTINATION Text Only whole files are sent SOURCE Central Index Video Sound Lab Values Images 10 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. 11 Secure Messaging @ the End-User’s Computer (e.g., the Physician’s Office) Path Info System HL7 Messages Lab Info System Path Results Transcription System Rad Info System Interface Engine (if none, then Point-to-Point Interfaces) Internet Encrypted Lab Results Med Rec Reports Rad Results Connection Engine ADT Data Transferred via TCP/IP Sockets Connection Server For Storing Internet Encrypted Server For Storing & Forwarding Replication Healthcare Info System @ the Hosting Data Center @ the Hospital / Reference Lab / Payor Data Center 12 Virtual Private Network A private network that is configured within a public network, such as the Internet, providing encrypted point-to-point links (using SSL or IPsec). • This ensures that only authorized users can access the network and that the data cannot be intercepted. 13 Virtual Private Network Reference Lab Community Network Hub Cisco 2600 Router with VPN SW Broadband required Physician Provider Cisco 3015 VPN Access Concentrator Cisco 3040 Router Internet POP Remote Access VPN Secure, scalable, encrypted tunnels across a public Network; client software required Site-to-Site VPN – Hub & Spoke Lower cost, tunneled connections with VPN services, like SSL or IPSec encryption and QoS to ensure reliable throughput Cisco 2600 Router With VPN SW Broadband required Home Health Agency 14 Web Portal A single point of personalized access (i.e., an entryway) through which to find, organize, and deliver content*. *Content is defined as information, applications, and services. Content can be: - structured, such as relational data. - unstructured, such as emails, web pages, images, and text documents. 15 Web Portal EQUIPMENT & SUPPLY INFORMATION PAYOR INFORMATION PHYSICIAN PROVIDER Purchase Orders and Order Status Claims, Eligibility, Referrals Secured Single Sign On Online Catalogs PHYSICIAN OFFICE INFORMATION Insurance Plans& Demographics Prescriptions, Medications, H&Ps, & Progress Notes Procedure & Diagnostic Codes DIAGNOSTIC TEST INFORMATION Reference Lab Orders and Results Imaging Center Orders and Results Custom Views & Workflow (Inbox, Alerts) PORTAL ACUTE & POST ACUTE CARE FACILITY INFORMATION PATIENT-CENTRIC INFORMATION REPOSITORY H&Ps, Discharge Summaries, ADT Data Custom Views & Workflow (Inbox, Alerts) Laboratory, Radiology, Pathology Results Secured Single Sign On OTHER INFORMATION: Continuing Education Clinical Databases ACUTE & POST ACUTE CARE FACILITY PROVIDER MEDLINE, PDR, National Disease Registries CNBC, ESPN, Amazon, 16 Travelocity 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 17 Web Services CLIENT or PRESENTATION TIER BROWSER, PATIENT / PHYSICIAN PORTAL XML, HTTP SERVER or RULES TIER WEB APPLICATION SERVER FARM SERVICE-ORIENTED ARTCHITECTURE (SOA) FRAMEWORK Patient Access WS ADT/Charge Capture WS Physician Access WS Problem List WS Scheduling/ Charge Capture WS Identity Manager WS Order Entry Results WS Image Store WS Text Document WS WEB SERVICES UDDI WSDL SOAP XML, ODBC, HL7 DATA SOURCES TIER DATABASE SERVERS AND LEGACY PLATFORMS Siemens HIS IDX RIS Misys LIS Stentor PACS NextGen EMR Amisys Managed Care GEMSIT MUSE ECG SoftMed Transcription 18 Internet-derived Technologies BENEFITS FOR RHIOs Are more “open” than proprietary Have a better chance of being widely implemented Reduce custom development time / costs Simplify user training / Promote physician usage Do not require centralized databases Take advantage of economies of scale and management of large networks 19