Transcript Initiate Systems, Inc.

Strategic Information
Technologies for RHIOS
The Health Information
Technology Summit West
Concurrent Session 5.01
March 8, 2005 - 2:00PM
Lorraine Fernandes, RHIA
Senior Vice President Healthcare
Initiate Systems, Inc.
Deborah Kohn, RHIA,
CHE, CPHIMS
Principal
Dak Systems Consulting
© 2005 Initiate Systems, Inc.
© 2005 Dak Systems Consulting
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
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The “Federated” Model
 Is NOT the fully integrated,
monolithic, centralized
database model
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The “Federated” Model
 Is NOT the fully integrated,
monolithic, centralized
database model
 Is the “5D” Model…
1. Distinct,
2. Distributed,
3. Disparate,
4. Decentralized,
5. Databases
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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)
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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
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Strategic Technologies
 Identity Management/EMPIs
 Peer-to-Peer Networking
 Secure Messaging
 Virtual Private Network
 Web Portal
 Web Services
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Identity
Management
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Accurate Patient Identification Serves as
Electronic Health Record (EHR) Foundation
Electronic Health Record (EHR)
EHR
Foundation
Elements:
 Improve
patient care
and reduce
medical risks
ROI
 Realize return
on investment
for strategic
IT initiatives
 Improve
customer
service with
reduced risk
 Comply
with
regulations
 Enhance
operational
productivity
and efficiency
ROI
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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
655-55-1234
Ms. K. Jones
[email protected]
1000 Main St.
Katherine J. Jones
Catherine Lamb
555-55-1234
Katherine J. Jones
555-55-1234
Newark
NJ
07114-2435
Newark
NJ
07144-3645
(201) 123-4576
(201)123-4567
1000 Main St.
© 2005 Dak Systems Consulting / Initiate Systems, Inc.
Newark
NJ
07144-3645
(201)123-4567
[email protected]
[email protected]
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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)
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Architecture: Option One
Regional
Identity Hub
Source 1
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Source 2
Source n
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Architecture: Option Two
Regional
Identity Hub
3rd
Party
EMPI
Electronic
Master
Person
Index
(EMPI)
Local EMPI
Source 1
Source 2
Source
n
Source 1 Source 2
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Source 1
Source
n
Source n
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National View Architecture Model
Example: From Within the Hubs
 Regional Hubs with Peer-to-Peer communications
for sharing and retrieving patient information
across provinces
Source 1
Source 2
Regional
Identity Hub
Regional
Identity Hub
Regional
Identity Hub
Source
3rd
Party
EMPI
n
Regional
Identity Hub
Source 1 Source 2 Source
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Regional
Identity Hub
n
Source 1 Source 2 Source
Regional
Identity Hub
Regional
Identity Hub
Source 1 Source 2 Source n
Source 1 Source 2 Source n
Source 1
Source
n
n
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Federated Identity Management Approach
Patient
data
sources
Source 1
Source 2
Source 3
Source 4
Source 5
Source 6
Source 7
Source 8
Sourcen
Identity
Hub
Source 1
339110
Rob Johnson
Source 6
760020
Bobby Johnson 20 West Madison
Source 4
20227899 Bob Johnson
Source 3
22909
Robert Johnson
Source 5
86490
Rob Johnson
200 W. Madison St.
200 W. Madison St.
Dynamic
enterprise
view
…
Robert Johnson
…
…
…
Linkage
Set
200 W. Madison St.
Baltimore, MD
Trusted system
of record
21217 South Main St. …
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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
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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
Sound
Lab Values
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Video
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
Lab Results
Interface
Engine
Med Rec Reports
(if none, then
Rad Results
Point-to-Point
Interfaces)
ADT
Rad Info System
Data Transferred
via TCP/IP
Sockets
Internet
Encrypted
Connection
Engine
Connection
Server
for
Storing
Healthcare Info System
Internet
Encrypted
Server
For
Storing
&
Forwarding
Replication
@ 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 pointto-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 3015 VPN
Access
Concentrator
Cisco 3040
Router
Cisco 2600 Router
with VPN SW
Broadband
required
Physician Provider
P
O
P
Internet
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
Remote Access VPN
Secure, scalable, encrypted
tunnels across a public
Network; client software
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, & deliver Content*)
*Content is defined
as information,
applications,
& services
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Content can be:
 Structured, such
as relational data
 Unstructured, such
as emails, web pages,
images, & text documents
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Web Portal
PAYOR INFORMATION
PHYSICIAN PROVIDER
EQUIPMENT & SUPPLY
INFORMATION
Claims, Eligibility,
Referrals
Secured Single Sign-On
Purchase Orders
& Order Status
Custom Views & Workflow
(Inbox, Alerts)
Online Catalogs
PHYSICIAN OFFICE
INFORMATION
PORTAL
Insurance Plans &
Demographics
Prescriptions, Medications,
H&Ps, & Progress Notes
PATIENT-CENTRIC
INFORMATION
REPOSITORY
Procedure &
Diagnostic Codes
DIAGNOSTIC TEST
INFORMATION
Reference Lab
Orders & Results
ACUTE & POST ACUTE
CARE FACILITY
INFORMATION
H&Ps, Discharge
Summaries, ADT Data
Laboratory, Radiology,
Pathology Results
Custom Views & Workflow
(Inbox, Alerts)
Secured Single Sign-On
ACUTE & POST ACUTE CARE
FACILITY PROVIDER
Imaging Center
Orders & Results
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OTHER INFORMATION:
Continuing Education
Clinical Databases
MEDLINE, PDR, National
Disease Registries
CNBC, ESPN,
Amazon, Travelocity
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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 ARCHITECTURE (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
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
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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
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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
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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
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Questions / Answers
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Contact Information
Lorraine Fernandes, RHIA
Senior Vice President –
Healthcare Practice
Deborah Kohn, RHIA,
CHE, CPHIMS
Principal
Initiate Systems, Inc.
Dak Systems Consulting
800.369.1315
650.345.9900
[email protected]
[email protected]
www.initiatesystems.com
www.daksystemsconsulting.com
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