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Slide 0 EHR SD RM - EHR Way Forward Future State Reference Architecture Alean Kirnak Cochair for...
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Slide 1 EHR SD RM - EHR Way Forward Future State Reference Architecture Alean Kirnak Cochair for Public Health and Emergency Response January 19, 2009 Constructing a Future State Reference Architecture for Immunizations
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Transcript of Slide 0 EHR SD RM - EHR Way Forward Future State Reference Architecture Alean Kirnak Cochair for...
Slide 1EHR SD RM - EHR Way Forward Future State Reference Architecture
Alean KirnakCochair for
Public Health and Emergency ResponseJanuary 19, 2009
Constructing a Future State Reference Architecture for Immunizations
Slide 2EHR SD RM - EHR Way Forward … Future State Reference Architecture
HITSP and Immunization Use Case# Capability Patient Identification Data Retrieval and Update Decision Support
1 Standards Org HL7
2 Service SpecificationIdentification Service
Functional Model Retrieve, Locate, Update SFM Decision Support SFM
3 Standards Org OMG
4 Service SpecificationIdentification Service
Specification Retrieve, Locate, Update Spec Decision Support Service Spec5 Profile Org IHE6 SOA Profile SOA White Paper7 Profile Org IHE
8 Immunization Profile
PIX/PDQ
SC110PIX/PDQ
SC110
Query for Existing
Data (QED)
CAP123 SC113
Immunization Content (IC)
CAP119 CAP133 SC112
Request for Clinical
Guidance
CAP133 (IC payload)
9 Profile Org American Immunization Registry Association/CDC
10 Immunization ProfileDraft: 2.5 Impl Guide
Draft: 2.5 Impl Guide
11 Immunization Profile
2.3.1 Impl Guide
CAP131 CAP132 SC115
2.3.1 Impl Guide
CAP131 CAP132 SCII5
12 Standards Org HL7
13 Original Standard V2
V3 Patient Admin
messaging V2
V3 Care Record
messaging
V3 (POIZ) Immunization
messagingV3 Care
Record CDA
V3 Care Record
messagingV3 POIZ
messaging
Slide 3EHR SD RM - EHR Way Forward … Future State Reference Architecture
Immunization Use Case - Simplified# Capability Patient Identification Data Retrieval and Update Decision Support
1 Standards Org HL7
2 Service SpecificationIdentification Service
Functional Model Retrieve, Locate, Update SFMDecision Support
SFM
3 Standards Org OMG
4 Service SpecificationIdentification Service
Specification Retrieve, Locate, Update SpecDecision Support
Service Spec
5 Profile Org IHE
6 SOA Profile SOA White Paper
7 Profile Org IHE/American Immunization Registry Association/CDC
8 Immunization Profile
PIX/PDQ
SC110PIX/PDQ
SC110
Future Draft: 2.5 Impl Guide
Query for Existing
Data (QED)
CAP123 SC113
Immunization Content (IC)
CAP119 CAP133 SC112
Request for Clinical Guidance
CAP133 (IC payload)
12 Standards Org HL7
13 Original Standard V2
V3 Patient Admin
messaging V2
V3 Care Record
messagingV3 Care
Record CDAV3 Care Record
messaging
Slide 4EHR SD RM - EHR Way Forward … Future State Reference Architecture
Immunization Use Case WithinHL7 SAEAF ECCF Specification Stack
# Patient Identification Data Retrieval and Update Decision Support
1 Enterprise View (Service Functional Models)
2Identification Service
Functional Model Retrieve, Locate, Update SFM Decision Support SFM
3 Computational View (Service Definitions)
4Identification Service
Specification Retrieve, Locate, Update SpecDecision Support
Service Spec
5 Information View (Payloads)
6
PIX/PDQ
SC110PIX/PDQ
SC110
Future Draft: 2.5 Impl
Guide
Query for Existing
Data (QED)
CAP123 SC113
Immunization Content (IC)
CAP119 CAP133 SC112
Request for Clinical Guidance
CAP133 (IC payload)
7 Implementation View (Vendor Implementations)8 Base Standard
9 V2V3 Patient Admin msg V2
V3 Care Record msg
V3 Care Record CDA V3 Care Record mesg
Slide 5EHR SD RM - EHR Way Forward … Future State Reference Architecture
Service DefinitionRef: A Service-Oriented Architecture (SOA) View of IHE Profiles IHE 2009
Slide 6EHR SD RM - EHR Way Forward … Future State Reference ArchitectureCopyright 2009 Software Partners LLC
6
Meet in the Middle**Anna Orlova, Josh Painter, Alean Kirnak, “A SOA View of IHE Profiles” working drafts
Slide 7EHR SD RM - EHR Way Forward … Future State Reference Architecture
Cost Effectiveness Proposition
Target cost function of healthcare IT connectivity
# of service consumers * # of services
Slide 8EHR SD RM - EHR Way Forward … Future State Reference Architecture
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
Point to Point Messaging Economics
8Copyright 2009 Software Partners
Slide 9EHR SD RM - EHR Way Forward … Future State Reference Architecture
Labs Meds Allergies Cancer Registries Joint Replacement Registries Chronic Disease Registries Adverse Event Reporting …etc. Intra-enterprise communication Provider-to-Provider communication ... 100 domains increases cost to $71,100,000,000
Expand to Multiple Domains
9Copyright 2009 Software Partners
Slide 10EHR SD RM - EHR Way Forward … Future State Reference Architecture
Schools Drug stores Airports …
Growth of Points of Care
10
Copyright 2009 Software Partners
Slide 11EHR SD RM - EHR Way Forward … Future State Reference Architecture
Tethered Untethered Wireless devices …
Growth of Personal Health Records
11
Copyright 2009 Software Partners
Slide 12EHR SD RM - EHR Way Forward … Future State Reference Architecture
Bus architecture Plug-and-play connections Common information model
How to Solve?
12
Copyright 2009 Software Partners
Slide 13EHR SD RM - EHR Way Forward … Future State Reference Architecture
Bus architecture– Build common carrier once– Hide routing, translation
Plug and play connections– Eliminates cost on one side of each connection
Common information model– multiple platform-specific models for a single platform-
independent model– Basis for passing data from service to service
Cost Reduction Opportunities
13
Copyright 2009 Software Partners
Slide 14EHR SD RM - EHR Way Forward … Future State Reference Architecture
75 IISs each accessing one service 15,000 EHRs, 500 products @ 30 installations
ea = 500 connections Cost @$20K is per service consumer only
$20K * (500 + 75) =$11,500,000 + cost of carrier
Drive down the $20K
Cost Reduction Opportunities
14
Copyright 2009 Software Partners
Slide 15EHR SD RM - EHR Way Forward … Future State Reference Architecture
Meaningful Use Rules and Regs# Capability Patient Identification Data Retrieval and Update Decision Support1 Standards Org HL7
2 Service SpecificationIdentification Service
Functional Model Retrieve, Locate, Update SFM Decision Support SFM3 Standards Org OMG
4 Service SpecificationIdentification Service
Specification Retrieve, Locate, Update SpecDecision Support Service
Spec5 Profile Org IHE6 SOA Profile SOA White Paper7 Profile Org IHE
8 Immunization Profile
PIX/PDQ
SC110PIX/PDQ
SC110
Query for Existing
Data (QED)
CAP123 SC113
Immunization Content (IC)
CAP119 CAP133 SC112
Request for Clinical
Guidance CAP133 (IC
payload) 9 Profile Org American Immunization Registry Association/CDC
10 Immunization ProfileDraft: 2.5 Impl Guide
Draft: 2.5 Impl Guide
11 Immunization Profile
2.3.1 Impl Guide
CAP131 CAP132 SC115
2.3.1 Impl Guide
CAP131 CAP132 SCII5
12 Standards Org HL7
13 Original Standard V2V3 Patient Admin msg V2
V3 Care Record msg
V3 (POIZ) Immunization
msgV3 Care
Record CDA
V3 Care Record
messagingV3 POIZ
messaging
Slide 16EHR SD RM - EHR Way Forward … Future State Reference Architecture
Proposed Meaningful Use Comments
Propose use of service interfaces to satisfy need for transport layer standards for immunizations
Fill gaps in immunization standards– Include immunizations in medical summary
– Use CAP133 Immunization Content in Table 2A
– Include immunizations in decision support clausesNote the immunization use case includes patient identification
