1 Toward a Service-Oriented Public Health Infrastructure Alean Kirnak, Software Partners LLC...
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Transcript of 1 Toward a Service-Oriented Public Health Infrastructure Alean Kirnak, Software Partners LLC...
2007-2008 PHDSC white paper: silos repeat functionality and don’t talk to each other
In 2008-2009, PHDSC developed a Service-Oriented Architecture White Paper with IHE
New standards offer new workflow possibilities and related cost savings
www.ihe.net A Service-Oriented Architecture View of IHE Profiles, Kirnak, Moehrke, Painter.
Point-to-point communication HL7 V2 Implementation Guides
MSH|^~\&|XDSDEMO_ADT|XDSDEMO|SWPartner_PIX|SWPartner_PIX|200908301933||ADT^A04^ADT_A01|00000188|P|2.3.1|….
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Identification ServiceOperati
on Description
Register
This operation inserts a Source ID/Entity ID pair and supplied Traits into the index with implicit linking to other matching Source ID/ Entity ID pairs, based on the configured internal matching algorithm.
Update This operation updates the Traits stored in the index for the Entity identified by the supplied Source ID/Entity ID pair.
List
This operation retrieves all the Source ID/Entity ID pairs that are linked to the supplied Source ID/Entity ID pair. The operation can be filtered with the sourceConstraintSet property of the EISSearchQualifier to only return entities within specified Source domains.
QueryThis operation provides the means to perform a broad search of all records in the index whose traits match some criteria in the supplied search criteria.
LinkThis operation provides the means to create an explicit (as opposed to automatic) linking between two Source ID/Entity ID pairs in the index.
UnlinkThis operation provides the means to create an explicit (as opposed to automatic) linking between two Source ID/Entity ID pairs in the index.
MergeThis operation provides the means to explicitly consolidate index Source ID/Entity ID pairs in the index.
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Web-based Application
Registry Data Store
Data Stores
All Registry Application Functions:
Identity Resolution
Retrieval/Update of Data
Decision Support
Population Studies
HL7 V2
Hospital #2
Clinic #2
Hospital #1 user
Clinic #1 user
Other user
Stakeholders
Other user
Approximately 75 U.S. Immunization Information Systems (IISs)
Completely connected point-to-point IIS network: 74 * 75 / 2 = 2775 connections
Assume 200 regional provider EHRs per IIS:200 * 75 = 15,000 connections
Each connection costs $10K-$30K per side $40K each * 17,775 =$711,000,000
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Labs Meds Allergies Problem Lists Cancer Registries Adverse Events …etc. Intra-enterprise communication Provider-to-Provider communication ... 100 domains increases cost to
$71,100,000,000
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Patient Identification Maintenance of Connections Data Models Decision Support Reporting
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Providers are the producers of electronic health information
Patients are the consumers
Providers will not pay
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Reduce number of connections through bus architecture◦ SOA
Create repeatable connections◦ Plug and play standards like IHE
Collapse common functionality◦ Reuse infrastructure like Patient Identification
Create common information model◦ Use Continuity of Care Document
Improve the delivery of information to consumers so payors will eventually pay◦ To their other providers◦ To public health◦ To patients directly
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Service Interfaces
Identity Resolution
Decision Support
Retrieve and Update
Hospital #2
Clinic #2
Hospital #1 EMR
Clinic #1 EMR
Internet
Browser interface
Existing IIS
Master Person Index
Document Repository
Data Stores
Document Registry
Services
Other Service
Security
Data Transform
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Existing IIS
Existing IIS
75 U.S. IISs Each connected to one Identification Service
running a standard interface: 75 connections 200 provider EHRs per IIS: 200 * 75 = 15,000 Averaging 30 installations each of 500 EHR
products = 500 + 75 = 575 Each connection costs $10K-$30K
◦ Service consumer only! $20K each * 575 =$11,500,000 total plug and play connections means:
For a single service i.e. Patient Identification
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Interoperability cost becomes function of:
# of service consumers * # of services
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3 services * 575 EHR flavors * 20K =
$34,500,000 vs $71,100,000,000
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Capability Patient Identification Data Retrieval and Update Decision SupportStandards Org HL7
Service SpecificationIdentification Service Functional
Model (SFM) Retrieve, Locate, Update SFM Decision Support SFMStandards Org OMG
Service Specification Identification Service Specification Retrieve, Locate, Update Tech SpecDecision Support Service
SpecProfile Org IHESOA Profile SOA White PaperProfile Org IHE
Immunization Profile PIX/PDQ POIZ ScopeImmunization
ContentImmunization
Content
Request for Clinical
Guidance (Immunization
Content payload)
Profile Org AIRA/CDC
Immunization Profile
In progress: 2.5 Implementation
Guide
In progress: 2.5 Implementation
Guide
Immunization Profile
2.3.1 Implementation
Guide
2.3.1 Immunization
Implementation Guide
Standards Org HL7
Original Standard Version 2Version 3 Patient Admin messaging Version 2
Version 3 Immunization
(POIZ) messaging
Version 3 Care Record CDA
Version 3 Care Record CDA
Version 3 Care Record
messaging
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2. Primary Care Provider, State 2
IHE Infrastructure
Immunization Information System (IIS)
1. Primary Care Provider, State 1
PHIN 2009 - IHE Interoperability Showcase Public Health Immunization Scenario
Decision Support Service
Yellow Card Service
3. Infrastructure
4. Local Public Health Dept. State 2
An 18 month-old patient without immunization record visits PCP11. PCP1 queries the local EMR 2. EMR queries IIS (QED)3. IIS returns immunization to EMR 4. PCP1 receives list of immunizations via EMR 5. Immunizations are administered 6. PCP1 updates EMR 7. EMR updates IHE Registry & Repository (XDS-MS, IC) and IIS (HL7
2.3.1) via Gateway
The same patient, now a 5 year-old, visits PCP2 in a different state, again without an immunization record
1. PCP2 queries EMR 2. EMR queries the HIE (PIX, PDQ, XDS-MS)3. HIE returns immunization to EMR 4. PCP2 receives list of immunizations via EMR 5. Immunizations are administered6. PCP2 updates EMR 7. EMR updates IHE Registry & Repository (XDS-MS, IC) and IIS (HL7 2.3.1) via the Gateway
<<Explanation of IHE Infrastructure, Gateway, Immunization Information System, Decision Support Service and Yellow Card Service. >>
A measles outbreak is occurring in a large county in State 2. The child’s parent calls the local health department to confirm the child’s measles immunization status
1. Epidemiologist authenticates using a Identity Service Provider (TP 20, C19)
2. Authenticated epidemiologist queries the HIE using child’s name, gender, and birthday (PDQ)
3. IHE Infrastructure returns a list of matching records4. Epidemiologist selects appropriate record; request for immunization
records sent, then results returned (XDS, IC)5. Request for immunization recommendations (IDSS) , results returned6. Yellow Card requested and returned as PDF to be printed and mailed
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Education◦ Little understanding of SOA yet
Broader View◦ Groups like HITSP must take the broad view◦ “SOA Governance”
Overcoming status quo thinking◦ Vested interests in preserving inefficient approaches
Funding◦ Support innovative approaches as well as status quo
Collective Action
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