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Business Case for Adoption: Vendor Community
June 29, 2009
Copyright 2009. All Rights Reserved.
Google Open Source Programs Office
Daniel BerlinSenior Engilawyer
Copyright 2009. All Rights Reserved.
“”
The Goals of NHIN and Google are Complementary
The NHIN will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health.
Google’s mission is to organize the world's information and make it universally accessible and useful.
We now live in a world where you can get information at your fingertips on
virtually every topic known to mankind, yet the most important area of all —
our health — we can’t easily get the information when we need it. It’s time
to change this once and for all.
Vish Sankaran, FHA program director
Copyright 2009. All Rights Reserved.3Copyright 2009. All Rights Reserved.3
Google Health Embraces These “Rules of the Road”
Data Portability
Interoperability
Data Liquidity
Consumers control their data regardless of employers, health plans, or care providers.
Data owners should be able to securely exchange data with different systems in a consistent manner.
Data from different sources should move over networks with minimal costs, ‘friction’, and hassle.
Copyright 2009. All Rights Reserved.4
Google Fully Supports Free and Open Source – CONNECT is a Natural Fit
Google USES millions of lines of open source code
– More effective than writing it all ourselves
– Shares support costs for software
– Gain the improvements of everyone instead of just your own
Google RELEASES millions of lines of open source code
– Builds communities around software
– Faster and more effective development
– Give back something to the world
Copyright 2009. All Rights Reserved.5
Google Health Plans to Connect to NHIN
The health ecosystem requires an open, interoperable network
The value of the network is dependent upon the number of data providers and users in the network — the more providers and users, the more value (exponentially!).
Copyright 2009. All Rights Reserved.6
Google Health Plans to Connect to NHIN
The value of the network is dependent upon the number of data providers and users in the network — the more providers and users, the more value (exponentially!).
The health ecosystem requires an open, interoperable network
7Copyright 2009. All Rights Reserved.
Initiate Systems
Deanna Cagney
Director of Product Marketing
Copyright 2009. All Rights Reserved.
Initiate Systems, Inc.
Enabling healthcare providers and state/regional exchanges to connect, share, and securely use patient data within and across boundaries
•Industry standard for patient registry & health information exchange (HIE) solutions
•Proven experience in HIE and patient data management
– 76 Providers / IDNs and 40 health information exchanges
– Eight Canadian provinces, supporting the pan ‐Canadian electronic health record.
– Patient registry in Nationwide Health Information Network (NHIN II) and all four of the NHIN I demonstrations
•192 customers across 10 market segments
•Cited as ‘leader’ by Forrester & Gartner
“2009 KLAS Category Leader for EMPI”
“Leader at IHE Connectathon”
9Copyright 2009. All Rights Reserved.
The Challenges of Interoperability
Data ownership – how to stay up to date?
Need to manage and audit patient
privacy preferences
Availability and quality of data varies
Processes for data sharing inconsistent
FamilyHistory
PrescriptionHistory
ApprovedPhysicians
Unclear funding models for sharing
Patient Symptoms
TreatmentRecords
AdmissionHistory
ExamRecords
HealthData
10Copyright 2009. All Rights Reserved.
CONNECT: Addressing the Challenge
• Federated data model
• Common message choreography and data sets
• Patient privacy protection
• Open and interoperable
• EMPI at the foundation
ExchangeExchangeExchangeExchange
HospitalsHospitals
Hospital1
Hospital1
Hospital2
Hospital2
Hospital3
Hospital3
PharmaciesPharmaciesFamily
ServicesFamily
Services
Public HealthPublic Health
Social Programs
Social Programs
NHINNHIN
PayersPayers
11Copyright 2009. All Rights Reserved.
EMPI:What You Need To Support HIE
NHIN
Subject Discovery
Doc Retrieve / Query
Document Subscription / Notifications
UDDI
Agency Adapter
NHINC Gateway
MPI Document Policy Subscription / Notifications
Standards and/or NHIE based messages
(hl7v3, xds, etc)
Transformation
Terminology
SDK Services
Other services
NHINC Service Components
Do
c Re
po
sitory
Do
c Re
gistry
MP
I
Po
licy En
gin
e
CP
P R
ep
osito
ry
Su
bscrip
tion
M
ana
ge
r
Target Architecture (message from NHIN)
NHIN Message Orchestration Components
LegendNHINC
ComponentsCustomizable Components
Message
Replaceable Components
Authroization/Messaging Framework
Patient Correlation Repository
Audit Repository
UDDI Document Cache
Subject Discovery
xx
xx xx
xx
Document Query
xx
xx xx
xx
Document Retrieve
xx
xx xx
xx
Sub. Management
xx
xx xx
xx
Notification Processing
xx
xx xx
xx
Audit Reporting
xx
xx xx
xx
UDDI Sharing
xx
xx xx
xx
Agency Integration Software
PerformancePerformancePerformancePerformance
Enterprise Master Enterprise Master Patient IndexPatient IndexEnterprise Master Enterprise Master Patient IndexPatient Index
Integration Integration Integration Integration
AccuracyAccuracyAccuracyAccuracy
SecuritySecuritySecuritySecurity
Stewardship/QualityStewardship/QualityStewardship/QualityStewardship/Quality
12Copyright 2009. All Rights Reserved.
Data Quality & ReportingData Quality & Reporting
Data StewardshipData Stewardship
Patient-Provider RelationshipsPatient-Provider Relationships
Enterprise Master Person IndexEnterprise Master Person Index
SecuritySecurity
IntegrationIntegration
Initiate CONNECT Initiate CONNECT Gateway AdapterGateway AdapterInitiate CONNECT Initiate CONNECT Gateway AdapterGateway Adapter
Initiate’s Contribution- Community & Technology
Initiate CONNECT Gateway Adapter
CONNECT Community Forum for Initiate Customers
CONNECT: Selecting the Right Solution
13Copyright 2009. All Rights Reserved.
A Connected Community Vision
Athens Regional
Baylor
CarolinasHealthCare
CatholicHealthcareWest
Cedars-Sinai
Children’sHospital
HealthServe
IowaHealth
PresbyterianHealth
LehighValley
LutherMidelfort
NorthwestComm. Hosp.
Ochsner
PeaceHealth
ProHealth
Providence
St. Josephof Orange
Sutter Health
Trinity Health
UC, Davis
UPH
UPMC
Anthem
BS of CA
BCBS ofKansas
Humana
Optum
UnitedHealth
WellPoint
Ingenix
Availity
LIPIXSpectra/Lab
Carespark
DCIPA
Long BeachNetwork
State of ND
Louisiana Rural
PAML
Sutter Health
UPH
LovelaceFoundation
VeteransAffairs (VA)Albertsons
Wal-Mart
Walgreens
CVS/Caremark
Kroger’s
Long’s Surescripts/RxHub
Surescripts/RxHub
Banner Health
CatholicHealthcare West
St. Alphonsus
Advocate
RockfordHospital
Ohio Health
UniversityCommunity
Sentara
NGHS
BJCMoses Cone
NCHICA
Riverside
DeaconessMaine General
Province of BC
CapitalHealthAuthority
CalgaryHealthRegion
Province ofNewfoundland
Province ofNew Brunswick
Province ofNova ScotiaEHealth
Ontario
Province ofSaskatchewan
Provinceof Manitoba
NORRad
Provinceof Alberta
LEGEND:
Providers & IDNs
Payers
Health Exchanges
Pharmacy & PBMs
Brooklyn RHIO
NYCLIX
IndependentHealthAssociation
Carefirst BCBS
Active Health
HACCNY
HIXNY
Bronx RHIO
UMass
Delta HealthAlliance
Intermountain
H Lee Moffitt
BCBS of MN
MN E-Health
Sandlot
OK HealthAuthority
WestPenn
ConemaughMemorial
14Copyright 2009. All Rights Reserved.
CONNECT: Business Value
Improve quality of care and patient
safety
Information at the right place at the
right time
Enable connected communities
to leverage existing investments
Maintain data ownership
Ensure trust and data integrity across
all participants
Increase adoption
Eliminate redundant actions
Break down data silos between federal
agencies and providers
Expand to citizen services
Improve Care& Safety
Share Information Across Silos
Achieve a Virtual Nationwide View
Reduce Costof Care
15Copyright 2009. All Rights Reserved.
Science Applications International Corporation
David Dobbs
Program Manager
Copyright 2009. All Rights Reserved.
SAIC Business Overview
Business Areas– Health– Energy– Environment– National Security – Critical Infrastructure
Our Successes– 40 years of continuous growth
» $10.1 billion in annual revenues for fiscal year 2009» FORTUNE 500® company - #266
– Highly skilled staff of professionals» Nearly 45,000 personnel worldwide» 10,000 employees with advanced degrees» 19,000 with security clearances
Copyright 2009. All Rights Reserved.17
74% With MoreThan 10 Years
14% With5–10 Years
12% With LessThan 5 Years
Higher Education
Experienced Staff
82% Technical Professionals
10% Managerial
8% Administrative
6% Ph.D.s
36% Master’sDegrees
58% Bachelor’s Degrees
53% Sciences
16% Humanities,Social Sciences
15% Engineering
16% Business,Economics/Law
Fortune 500 is a registered trademark of Time, Inc. in the U.S. and/or other countries.
Domain ExpertiseDomain Expertise
TechnologyTechnology
SolutionsSolutions
Health Solutions
• More than 1,900 employees
• Health domain expertise includes:
– MDs, PhDs, MPHs, RNs, DDSs, epidemiologists,
biostatisticians, psychologists, pharmacists,
radiologists, labratorians, informatics specialists,
biochemists, toxicologists, microbiologists
• Health IT specialists include:
– Enterprise architects, network, systems,
and security engineers, software
engineers/developers, web developers, network
administrators, database engineers,
software test engineers, configuration
and data management specialists
Copyright 2009. All Rights Reserved.18
U.S. Health IT Context
• National imperative for Health IT adoption
– Controlling costs
– Improving quality and patient outcomes
• Critical policy challenges1
– Driving the adoption of electronic health records (EHR)
– Making EHRs interoperable
– Ensuring EHRs help improve health care quality and efficiency
• Health information exchanges (HIEs) are connecting hospitals, clinics, and laboratories to share interoperable health information
Copyright 2009. All Rights Reserved.19
1- Summarized from D. Blumenthal, The Federal Role in Promoting Health Information Technology, The Commonwealth Fund, January 2009
Selected SAIC Health Information Exchange Projects
Project Stakeholders
BioSense
Public Health Situational Awareness through Health Information Exchanges
Military Health System’s (MHS) Composite Health Care System (CHCS)
VA/DoD Data Sharing Research & Development Departments of Veterans Affairs and Department of Defense
CDCCenters for
Disease Control
BioSense
MHSMilitary Health System
INHSInland
Northwest Health Services
WA DOHWashington
State Department of Health
VADepartment
of Veterans Affairs
DoDDepartment
of Defense
CDCCenters for
Disease Control
20Copyright 2009. All Rights Reserved.
CONNECT Business Drivers
• Sharing interoperable health information
– Enabled by a standards-based, agreed-upon architecture
– Extensible because it’s open source
• Adoption by health information exchanges (HIEs) and federal / state agencies for clinical data sharing
– Between HIEs to improve patient care
– Between HIEs and federal agency for reporting, quality and research
– Some states are beginning to adopt (such as Washington, Indiana, and New York)
• CONNECT adoption drives
exponential value– Increased access to distributed
health care information– Accelerated ability to improve patient
outcomes, public health and quality
Copyright 2009. All Rights Reserved.21
Time
Adoption / V
alue
CONNECT – Linking Health Care
22Copyright 2009. All Rights Reserved.
Clinics Pharmacies
Laboratories
Hospitals
SOA = service-oriented architecture
Radiology
State & LocalPublic Health
NHIN CONNECTSOA Platform
IHSIndian Health Service
SSASocial Security Administration
FDAFood and Drug Administration
CMSCenters for
Medicare and Medicaid Services
NIHNational
Institutes of Health
Health CareDelivery
Health CareData Users
CONNECT
MHSMilitary Health System
VADepartment
of Veterans Affairs
CDCCenters for
Disease Control
• Make electronic health records (EHRs) interoperable– Terminology Services to create semantically interoperable health care data
• Terminology subscriptions
• Standards-based encoding of health care data
• Encoding translation services
– Reliable Messaging for secure information delivery• Security – authentication, encryption, non-repudiation, HIPAA-compliant
• Reliability – guaranteed delivery, non-repudiation, audit logs, automated retries
• Use EHRs to improve health care quality and efficiency– Health Care Knowledge Base for analyzing EHR data
• Public health reportable conditions and outbreak alerts
• Centers for Medicare and Medicaid Services quality guidelines
• Clinical research support
• Adverse event identification
SAIC CONNECT Services
23Copyright 2009. All Rights Reserved.
SUN Microsystems, Inc.
Catharine Evans
Director, SunFederal
Copyright 2009. All Rights Reserved.
Significant Drivers for Health Information Exchange
77%
60%
44%
37%
29%
21%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Pr ovide rine fficie ncie sd ue to lack o f
data to s upp or tpatie n t car e
Ris inghe althcar e
cos ts
Availab ility ofg r an t fu ndi n g
Incr e as e dnational
atte n tion on HITand HIE
Pub lic h e alths ur ve illance
ne e ds
De m and fo rpe r fo r m ancein for m ation
History in Healthcare with Thousands of Clients Worldwide
Prominent Healthcare Clients
Innovation Experience Knowledge
Sun's Strength in Healthcare
25Copyright 2009. All Rights Reserved.
Sun's Open Source in CONNECT
27Copyright 2009. All Rights Reserved.
Caregiver Mobility with
Security
NHIN
Health Information Exchange
ComplianceSecure
DataManagement
PayerEfficiency
Integration with infrastructure,
SOA and composite
applications
CONNECT
Privacy, identity management,
access control, fraud detection
and activity monitoring
Information lifecycle
management & identity
management
Business and clinical
transformation through secure, instant access
to patient information
Consumer-centric
approach to healthcare
delivery, care management and business
workflow
Sun in Healthcare
GlassfishHealth– HL7 Binding Components
– Master Patient Index
– OpenSSO integration with HTTP BC
– PIX/PDQ support
– XDS/XCA
– Advanced Graphical Mapper (HL7, etc)
– NC PDP
– XACML Support
– Open SSO - graphical support of XSPA policies
Sun's Healthcare Pack:Supported Architecture for CONNECT
28Copyright 2009. All Rights Reserved.
• Sun's Product Support – 7x24 Support
• Indemnified
• Sun Professional Service Offerings – CONNECT– Setting up the CONNECT
Environment
– Assisting the MPI configuration
– Integration Support
Sun's Healthcare Pack:Supported Architecture for CONNECT
29Copyright 2009. All Rights Reserved.
Vangent, Inc.
Jeanne O’Kelley
Senior Vice President
Technology Excellence Center
Copyright 2009. All Rights Reserved.
Business Case for Adoption
• CONNECT– Instantiation of Health Standards
• Open Source– Government/Industry Collaboration
• Customer Support– Federal Agencies
– State and Local
– Commercial
Copyright 2009. All Rights Reserved.31
XDS.b – An Essential Part of CONNECT Gateway Capability
Copyright 2009. All Rights Reserved.32
Supports federated document repositories anda document registry that create a longitudinal record of
patient information within a healthcare community
Diagram Source: FHA CONNECT Software Architecture Document, 31 March 2009Diagram Source: FHA CONNECT Software Architecture Document, 31 March 2009
Authorized CaseFollow-up
Health InformationEvent Messaging
Retrieve DocumentsSubject
DiscoveryQuery for
Documents
Query Audit LogQuery Audit LogConsumer Preferences ProfileConsumer Preferences Profile
Authorization FrameworkAuthorization FrameworkNHIE Services RegistryNHIE Services Registry
Messaging PlatformMessaging Platform
XDS.b “Plug and Play” CONNECT Gateway Integration
Copyright 2009. All Rights Reserved.33
AGENCY AAGENCY A
CONNECTCONNECTSolutionSolution
CONNECTCONNECTSolutionSolution
CONNECTCONNECTSolutionSolution
CONNECTCONNECTSolutionSolution
XDS.bXDS.bRegistryRegistryXDS.bXDS.b
RegistryRegistry
XDS.bXDS.bRepositoryRepository
XDS.bXDS.bRepositoryRepository
ExistingAgency
System(s)
ExistingAgency
System(s)
Locate Patient
Records
Locate Patient
RecordsLocate Patient
RecordsLocate Patient
Records
Locate Patient Records
Locate Patient Records
Retrieve Patient Records
Retrieve Patient Records
Retrieve Patient Records
Retrieve Patient Records Retrieve
Patient Records
Retrieve Patient
Records
Store Patient
Records
Store Patient
Records
AGENCY BAGENCY B
Register Patient Records
Register Patient Records
IHE/HITSP compliant solution that unleashes EHR data from agency systems and makes data available for use over the NHIN
IHE/HITSP compliant solution that unleashes EHR data from agency systems and makes data available for use over the NHIN
Health Information ExchangeOpen Source (HIEOS)Released in “Open Source”
Vangent’s XDS.b implementation is available in “open source”– Is scheduled to be part of CONNECT’s September release
– Part of Vangent’s Health Information Exchange Open Source (HIEOS) project available at the following URL: http://kenai.com/projects/hieos
– Includes:
• Wiki Site
– Architecture Description
– Setup and Configuration Guide
• Discussion Forums
• Mailing Lists
• Issue Tracker
• Software Source Code
34Copyright 2009. All Rights Reserved.
Harris CorporationDr. Bart J. Harmon
Chief Medical Officer
Copyright 2009. All Rights Reserved.
CONNECT: Addressing Integrator Motivation and Challenges
• A part of the new Health Ecosystem
• Current work is developing the freely available CONNECT services, providing Help Desk Support and Engineering Services
• Supported government agency participation in the December, 2008 NHIN Forum
• Culture, tool sets and partners vary widely across various institutions and Health Information Exchanges, creating slightly different challenges when supporting each entity
Copyright 2009. All Rights Reserved.36
Why does an integrator want to work in this space?
Reasons for supporting CONNECT:• Helping establish part of a new health ecosystem where entities
compete on value and customer service rather than controlling information
• Based on national standards
• Enabling providers
• Empowering patients
• Streamlining payors
• Supporting the protectors
• Opportunity to work in a space where we will have a chance to be useful as long as we are helpful
Copyright 2009. All Rights Reserved.37
CONNECT’s Value for an Integrator
Converting waste into value via information availability –Supporting fundamental transformation in
– Clinical processes
– Health business processes
– Surveillance processes
– Lighten the burden of run-away health costs on the economy
– Provide quality care to more people
– Put individual people more in control of their health information and health experience
Many entities will want help with these services, to include integration support
Platform on which to re-purpose technologies from other areas of expertise into the health space
Copyright 2009. All Rights Reserved.38
RelayHealth, SpartanburgRegional Health System, NXT Health
Partnership to Provide Continuityof Care for Wounded Warriors
Chris Ingersoll
Director, Interoperability Product Management
Copyright 2009. All Rights Reserved.
CONNECT: Addressing RelayHealth’s Goals
• RelayHealth’s Business Drivers– Maximize the breadth of longitudinal information that can be provided to
health systems, physicians and patients
– Prepare health system customers for transformation caused by ARRA and health reform – The need to share and exchange clinical information
– Provide improved access, support and continuity of care for military personnel receiving private sector health care
• RelayHeath’s Current HIE Offerings– Clinical health record viewer
– Integrated patient PHR with secure messaging
– Referrals and patient health record sharing
– Results and clinical documentation distribution
– Clinician messaging amongst physicians and members of a Care Team
Copyright 2009. All Rights Reserved.40
RelayHealth-Spartanburg Partnership
Spartanburg Regional Health System• Network of hospitals and physician offices across five
counties in SC• “Hospital of the Future”: recipient of Congressional
Special Interests projects
NXT Health• Non-profit research and design organization affiliated
with SRHS• Undergoing study of health record sharing between
military and private health systems through Spartanburg’s grant
Partnered with RelayHealth • Demonstrate Spartanburg physician and patient access
to medication history, allergies, and diagnoses data from DoD
• Project funded by Spartanburg and McKesson managed through TATRC
• Three developers for two months
41Copyright 2009. All Rights Reserved.
Demonstration Use Case
42Copyright 2009. All Rights Reserved.
EHR
RelayHealthHealth Summary Manager
webVisit Personal Health Record
DoD Test Server(Harris)
DoD Test Server(Harris)
CONNECT
1. Sgt Sonja, recently returned home, develops an infected rash from lingering burn wound. She fills out online consultation to Dr. Smith, her private sector PCP
1. Sgt Sonja, recently returned home, develops an infected rash from lingering burn wound. She fills out online consultation to Dr. Smith, her private sector PCP
Sgt. Sonja Dr. Smith Sgt. Sonja
2. Dr. Smith receives webVisit, indicates in RelayHealth that he has Sonja’s consent to view DoD data
2. Dr. Smith receives webVisit, indicates in RelayHealth that he has Sonja’s consent to view DoD data
3. Via CONNECT, DoD data is added to Sonja’s RelayRecord
3. Via CONNECT, DoD data is added to Sonja’s RelayRecord
5. Sonja receives message, sees that her PHR has been updated with DoD health data
5. Sonja receives message, sees that her PHR has been updated with DoD health data
4. Dr. Smith notes a possible medication allergy, prescribes new medication and schedules in-person appt
4. Dr. Smith notes a possible medication allergy, prescribes new medication and schedules in-person appt
Health Summary ViewerPhysician view
43Copyright 2009. All Rights Reserved.
Patient consent designation
Medications from SureScripts, DoD, patient entered, and physician entered
Diagnosis from DoD
Allergies from DoD
Personal Health RecordPatient view
The data that the physician pulled from DoD can be viewed by the online patient.
44Copyright 2009. All Rights Reserved.
Demonstration goals:
– Data integration: Automated load of health summary data into RelayHealth through CCD
– Connectivity: Ability to pull data from a federal facility
CONNECT Gateway provided connectivity
– Successful integration from .NET environment
– Took care of plumbing, allowed us to focus on data integration and presentation changes
– Good documentation and support
Long-term goal:
– Plug RelayHealth network into the NHIN
CONNECT’s potential as a complete network-network connectivity solution
– Comprehensive functional scope
– Open-source
– Federal adoption
Selecting the Right Technology for RelayHealth
Copyright 2009. All Rights Reserved.45
Value of CONNECT for RelayHealth, Spartanburg and NXT Health
RelayHealth
– More connectivity means higher quality care and better patient outcomes
– SaaS model: low costs to provide this connectivity to all of our customers
– Step towards providing comprehensive care for our men and women in uniform accessing private sector health care
Spartanburg Regional Health System
– Recognition as the National test site for connectivity of patient record systems– Serves as a model for data sharing within the larger civilian community– Potential to expand RelayHealth personal health record capabilities to patient population
NXT Health
– Use this interoperability model and apply it to other research projects within the larger context of the patient room of the future
– Serves as a proof of concept phase to assist in recruiting potential partners for continuation of research efforts
Copyright 2009. All Rights Reserved.46
Cisco’s ‘Medical Data Exchange’(MDES) Solution
Greg Pippin
Solution Architect
Copyright 2009. All Rights Reserved.
Market Drivers & Current Environment
Drivers
– Cost reductions and avoidance
– Lost productivity
– Interoperability of patient data
exchange
– Data is needed locally but
stored centrally
– Importation of unstructured
data into structured data
Current Environment
– Manual fax, copy
– Burn and transport CD ($10/CD)
– Multi-system log-ins
– Point to point proprietary
interfaces
– Proprietary health information
exchanges (HIE)
48Copyright 2009. All Rights Reserved.
Medical Data Exchange – Enabling The Method Patient Centric Access
Copyright 2009. All Rights Reserved.49
System A
DICOM
HL7 v 2
ISO 10781
EDI
SOAP
System B
HL7 v 2.5
HL7 v 3
IETF
XML
IHENetwork Broker Network Broker
Solution Benefits
Cost Reduction– Eliminate $10/CD & associated labor
– CD burner maintenance costs
Improve Productivity – Interoperability between systems reduces
efficient record access
– Reduce retests & rescans
Improve Quality of Care– Reduce delays in patient care
– Address incomplete information for treatment decisions
– Reduce delays in patient care
50Copyright 2009. All Rights Reserved.
Medical Data Exchange Enables Patient Centric Integration & Access of Records
• Enables interoperability between disparate systems
• Enables the network as the platform for secure & standards based access & exchange
• Eliminates the need for manual transport of records & images
• Standards based (IHE) based PACS & EMR access
• Common patient identifier with network based IHE Cross Reference Manager & XDSi
Copyright 2009. All Rights Reserved.51
Cisco and Tiani-Spirit offering a joint Medical Data Exchange Platform consisting of the ‘Spirit’ IHE SW stack based on the globally standardized IHE framework.
Tiani Spirit-AXP runs on the Application eXtension Platform inside Cisco’s Integrated Services Router (ISR+AXP). It connects general practitioner’s systems, pharmacy software systems & hospital information systems with the eHealth infrastructure.
What is the Medical Data Exchange Solution?
Copyright 2009. All Rights Reserved.52
+
Cisco AXP Network module
Cisco ISR Router
Globally leading SW solution forIHE based medical data exchange
Federated Data Distribution Enables Scaling
• Interoperability is based on a federated concept
• Avoids copying all data centrally (Cross Reference Manager)
• Retains data where it was produced originally.
• Data is kept as well on a regional level for redundancy purposes (orange level)
• IHE‚ Cross Reference Manager enables communications between the regions (red) or countries (white)
Copyright 2009. All Rights Reserved.53
PIX/PDQXDS
(Repository,Registry)
Spirit Central Adapter (SCA)
Spirit Local Adapter (SLA)Spirit
Archive
DICOMClient
IHE Client, Legacy Client
SpiritArchive
PIX+Responding
Gateway
EnterpriseLevel
Community(Cross-Enterprise)Level
Cross-CommunityLevel(scalable to anyhierarchic level)
RespondingGateway
InitiatingGateway
MDES Reference in Wels Healthcare (Austria)
Prior Environment• 64 sub-systems in one hospital
• Organizational environment constantly changing
• Unscalable
• Difficult to integrate GP’s into the hospital environment
• 1500 proprietary data interfaces
• Multiple patient Indexes
Tiani Spirit software, based on Cisco and Intel technology has enabled us to substantially
raise the level of information where it is needed and when it is needed, to help our
doctors in their effort to provide the best care possible for our patients.
Dr. Walter Aichinger, Chief Physician of the Klinikum Wels-Grieskirchen
Copyright 2009. All Rights Reserved.54
“”
MDES Value Proposition:Better & More Cost-effective Care
• Improve productivity
– Clinicians can access records from different institutions in a simple and straightforward manner
• Lower cost
– Avoid redundant clinical tests or procedures w/ access to this data
• Improve patient care
– Diagnosis & treatment plans w/ a more holistic view of a patient's record
• Avoid Costs
– Eliminate the need for production of CD's to transport images
Copyright 2009. All Rights Reserved.55
CONNECT and Mirth Gateway –Streamlining NHIN Connectivity
Gary Teichrow
Vice President and Chief Architect
Mirth Corporation
Copyright 2009. All Rights Reserved.
Who is Mirth Corporation?
Mission:• Mirth Corporation delivers standards-based
open source infrastructure tools and services for healthcare
• We reduce the time, cost and technology barriers to information exchange in healthcare, leveling the HIT playing field for healthcare organizations of all sizes
Vital Stats:• Launched in 1993, focused since 1999 on Health IT
• Incubator of open source Mirth Project – 70,000 downloads worldwide
• Provide OSS, support, professional services, purpose-built appliances
• Technology partner to leading HIEs and HIE Vendors
Copyright 2009. All Rights Reserved.57
CONNECT: Addressing Real World HIE Interconnect Challenges
• How to connect Orange County ConnectCare with Long Beach Network for Health?
– OC and LBNH HIEs wanted to share health information
– Each used different software with different capabilities
• Possible Opportunity using NHIN interface
– LBNH had NHIN gateway as an NHIN trial cooperative participant
– OC interested in using the NHIN interface, but needed software
• Challenges
– Not enough time to develop custom NHIN gateway for OC
– No apparent commercial NHIN gateway software available
– Limited budget to perform the work
Copyright 2009. All Rights Reserved.58
Selecting the Right Solution for OC/LBNH
• Possible Solution with CONNECT
– CONNECT 2.0 released during analysis phase of project
– Provided OSS solution to OC NHIN gateway requirement
• Scope of Work
– Download and understand software
– Port to Linux and PostgreSQL
– Adaptor integration (ER Connect, MirthMatch, Mirth Connect)
• Solution
– Use Mirth Connect (integration engine) asglue between ER Connect (OC) and NHIN CONNECT adaptor layer
– Download to demo in less than a month
Copyright 2009. All Rights Reserved.59
CONNECT in Action: One Success Leads to Another
California eHealth Collaborative Statewide NHIN DemoParticipants
• Kaiser Permanente (KP NHIN Gateway)
• Long Beach Network for Health (MedPlus/FirstGateways)
• Orange County ConnectCare (CONNECT)
• Redwood MedNet (CONNECT)
• Santa Cruz HIE(Axolotl)
Redwood MedNet connects to NHIN for demo• Mirth Corporation implemented CONNECT at
Redwood MedNet
• Integrated to Mirth Results
• Up and running in 3 days!
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CONNECT in Action: …and Another
HealthBridge and Redwood MedNet Interstate DemoParticipants• HealthBridge
– 24 hospitals in KY, OH and IN– 5000+ physicians at 700+ practices– 25 million results delivered in 2008– 17 local health departments– National, hospital and physician office labs– 70+ EMR feeds to MD practices– Interfaces with 25+ EMR vendors– 70+ HIS/Data inbound connections
• Redwood MedNet HIE– Mendocino, Lake and Sonoma Counties– 4 rural hospitals– 3 independent laboratories– 2 local health departments– FQHCs, RHCs, and private practices– Long Term Care
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NHIN
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What’s Next: Mirth Gateway –How You Can Leverage CONNECT
Mirth Gateway ApplianceReady-to-run appliance based on OSS stack• CONNECT (OSS NHIN gateway)
• Mirth Match (OSS EMPI)
• Mirth Connect (OSS interface engine)
Accelerates NHIN Deployment• Simplified setup and configuration
• Simplified administration and monitoring
• Automated patch management
• Physical or virtual appliance
Mirth Connect simplifies “last mile”• Channel-based connectors ease integration
• Connect to NHIN via HL7, database, web services, FTP/SFTP/file system
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NHIN
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Jericho Systems Corporation
Brendon Unland
President and Founder
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Historical Analogy:Transcontinental Railroad
• Engineering Marvel of 19th Century
• Began 1862: Finished 1869
• Shortened Trip of 5 monthsto 5 Days
• Extreme Technical Challenges
• Ingenius Collaboration Between Government and Business
• Necessity of Standards
• Bound the Nation Revolutionizing Population and Economy
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Jericho Systems’ Current Business Model
• Founded in 2002
• Security Decisioning Software and Services
– Primary Clients are U.S. DoD, Intelligence Community, and Federal Agencies
– SOA-enabled Products Incorporate Open Standards: SAML, XACML,WS-Security
– Flagship Product: EnterSpace Decisioning Service (EsDS) Includes Policy Decision Point (PDP)
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Jericho Systems’Current Business Model
Traditional Software Business ModelLicenses
Maintenance
Professional Services
Move into Health Care Market
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Jericho Systems’Health Care Background
Participated in Cross-Enterprise Security and Privacy Authorization (XSPA) Demo at HIMSS 09
• Demonstrated OASIS Advanced
Privacy, Consent, Access Control--
Beyond Opt in/ Opt out
• Functionality Moving into Future
CONNECT Solution Release
Component of Flagship Product Utilized
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• Policy Decision Point (PDP)
• XACML Compliance
• Logging
Jericho Systems’Health Care Business Model
• Embrace Open Source: Donate EnterSpace Health Care Community Edition for Inclusion into CONNECT Solution
• Potential Cloud Offering
• Provide Professional Services including:
– SOA-centric Identity and Access Management Consulting
– Standards Compliant Integration
– Policy Engineering for Security & Privacy
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EnterSpace Continuum for Health Care
Cheyenne, Wyoming: 1882 and Now
Conclusion:CONNECT Community
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Opportunity to Join
Community that: •Impacts and Improves the Future
•Profits Those that Labor for the
Community
CONNECT Seminar
Presentations are Available
for Download Online at http://www.connectopensource.org
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