Transcript TITLE Audio Seminar DATE

Session #300
Roundtable Discussion
February 14, 2005
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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)
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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
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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)
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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
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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”
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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)
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Internet-derived Technologies
 Peer-to-Peer Networking
 Secure Messaging
 Virtual Private Network
 Web Portal
 Web Services
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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.
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Peer-to-Peer Networking
DESTINATION
Text
Only whole
files are sent
SOURCE
Central
Index
Video
Sound
Lab Values
Images
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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.
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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
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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.
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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
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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.
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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,
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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
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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
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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
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