Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information...

Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange

Linh H. Le, MD, MPH; Ivan J. Gotham, PhD; Lori Evans, MPH, MPP; Dale Morse, MD, MS; John Fuhrman; John Brady (New York State Department of Health); Farzad Mostashari, MD, MPH; Nicholas Soulakis, MS (NYC Department of Health and Mental Hygiene); LeRoy Jones (GSI Health); Mark Ciampa, MS, PMP (Booz Allen Hamilton)

Universal Public Health Node (UPHN):An Evolution of Health Information Exchange in New York

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Why a new architecture for Health Information Exchange (HIE) for Public Health in New York

Unprecedented investment in HIE from New York State with HIE for Public Health as one of clinical investment priorities

Support from CDC new initiative for Enhancing Public Health Capabilities Through Health Information Exchanges

Need to move from uncoordinated, point to point communications to a common, bi-directional health information exchange for public health

Need to take advantage of and comply with the Statewide Health Information Network - New York (SHIN-NY) architecture and national standards for healthcare interoperability

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Evolution of Health Information Exchange (HIE) for Public Health In New York

Hospitals

Pharmacies

Physicians

Clinics

Labs

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Payers

Patients

Public Health

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CDA

HL 7 2.4

HL 7 2.3

HL 7 2.5

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X12

cvs

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UPHN

HospitalsPharmacies

Physicians

ClinicsLabs

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Payers

Patients

RHIOs

Public Health

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Critical Challenges

How can information from different HIEs be integrated?

How can we move from a one-way to bilateral exchange of information from clinical systems to public health?

How can we exchange data in a timely, secure and standardized manner?

How can we achieve our above goals while protecting patient privacy to the greatest extent possible?

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What is the Universal Public Health Node

A collection of services and operational policies designed to fulfill designated biosurveillance and public health reporting objectives by exchange of data, bi-directionally between RHIOs and public health agencies

A subset of the architecture for the Statewide Health Information Network of New York (SHIN-NY), and complies with its architectural parameters for full compatibility with other SHIN-NY domains beyond public health

Based on a service-oriented architectural paradigm (SOA), implemented through web services operating through an enterprise service bus (ESB)

Developed as part of a statewide collaboration process with active participation across public and private sectors under leadership from NYSDOH

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Overarching Architecture Principles

Integration of Public Health Reporting Across Multiple HIEs– Exchange of data for public health in a standard manner– Collaborative Development of Consensus Implementation Guide

Enabling Bidirectional Flow of Information and Intelligence– Public Health Participation in RHIO data exchange as equal partners, providing

and receiving information as needed– Dynamic Querying Capabilities

Ensuring Patient Privacy– Implement and Enforce of Privacy & Security Standards– Minimum Data Necessary - Filtering, Anonymizing, Aggregating

Compliant with not only the SHIN-NY architecture, but also the national standards for healthcare interoperability– UPHN is a HITSP-compliant and HITSP-consistent architecture – UPHN also leverages the work of the NHIN effort in its architectural framework

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UPHN Primary Functionalities

Patient Query: allow public health to query and receive responses for data about and individual patient based on query parameters

Line List Query: enable public health to request and receive patient-level data for specific disease conditions

Anonymize/Re-identify Query: enable the linkable de-identification and re-identification back to identified data as needed for public health investigation

Analytic Query: enable public health to receive data based on predefined queries for counts of specific disease conditions

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Public Health Scenarios

Public Health Investigation

311 Patient Locator

Tuberculosis (TB) All Points Bulletin (APB)

Influenza Surveillance

Syndromic Surveillance

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Public Health Investigation

In response to a suspect or confirmed case report of public health significance, public health authorities can query multiple RHIOs using a standard interface and receive additional clinical information regarding past medical history, treatment, etc

Data SourcesPublic Health

RHIOs

Send request for data about certain patientsGet available data for requested patients

Return data for requested patients

Patient Query

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311 Patient Locator

In case of emergency, public authorities can query multiple RHIOs using a standard interface and receive information regarding recent encounters/ admissions, which could help in locating and tracking missing persons.


RHIOs



Patient Query

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Tuberculosis (TB) All Points Bulletin (APB

In case of an imminent public health threat posed by an individual with contagious condition who has been lost to public health follow-up (e.g., XDR TB, SARS case)


RHIOs



Patient Query

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Influenza Surveillance

For regular surveillance and in response to an influenza outbreak, RHIOs would send patient care and hospital resource data to the public health authority.

Get available data for requested case definition


RHIOs

Return data for requested case definition

Line List Query

Data Sources

Public Health

RHIOs

Anonymize/Re-identify Query

Send request for data with certain case defintion

Send request for identified data with pseudomized linker

Return identified data

Send anonimized data with pseudomized linkerRe-identify record using pseudomized linker

Get identified record

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Syndromic Surveillance

To monitor the rate of outpatient, ED and inpatient encounters for respiratory and gastrointestinal illnesses. As more specific information regarding the illness is obtained, public health can distribute an updated query to partner RHIOs specifying case definition and other parameters relevant to this outbreak. The RHIOs modify their aggregation and reporting system to incorporate this new query.

Get data based on pre-defined query definition

Data Sources

Public Health

RHIOs

Analytic Query

Send aggregated data based on pre-defined criteria

Send updated query definitionGet data with updated query definition

Return aggregated data with updated criteria

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Key System Components

Enterprise Service Bus (ESB)

Service Registry and Discovery

Common communication and transport protocols

Standardized messaging format and vocabulary

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Enterprise Service Bus (ESB)

The SHIN-NY ESB is a federated (or “distributed”) ESB, allowing multiple physical ESB instantiations to be exposed as one logical instantiation

An integrated physical instantiation of the SHIN-NY ESB is referred to as a SHIN-NY ESB node

UPHN ESB is a domain-specific ESB node, exclusively handling public health services and transactions

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Service Registry and Discovery

UPHN ESB will maintain a restricted service registry using UDDI v2.0.4 as documented in the NHIN Messaging Platform Specification

The service registry will keep both endpoint servers addresses and Web Services Description Language (WSDL) service definitions

Copies of the registry that are kept in synch via replication or another appropriate means with other ESBs within the SHIN-NY

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Common communication and transport protocols

UPHN supports the communication and transport protocols specified in the NHIN Interface Specification – Messaging Platform v1.9– Common transport layer for all messages using SOAP 1.2 over HTTP

– Messages between UPHNs will be secure from end to end by the use of encryption as well as addressing within messages

– Message envelope will support assertions about security and trust between UPHNs

– Authentication will use X.509 certificates issued by a common trusted certificate authority

– All messages will be digitally signed for purposes of authentication and non-repudiation

– Use WS-ReliableMessaging as a baseline message exchange pattern to ensure acknowledgement of all communications (uni- or bidirectional)

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Standardized messaging format and vocabulary

Fully comply with HITSP Interoperability Specification for Biosurveillance

HL7 2.5 is implemented initially

HL7 3.0 will be used when become more broadly used

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Contact Information

Linh Le, M.D., MPHResearch ScientistNew York State Department of HealthBureau of Healthcom Network Systems Management800 North Pearl, Albany, NY 12204Phone: 518-473-1809Email: [email protected]

Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information...

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