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Alabama - Health Information Exchange Leveraging the Nation-wide Health Information Network (NHIN). AL-HIE Stakeholders Primary Provider Pharmacy EMT Hospital/Clinic Health Organization/Center Payor Wellness Community Personal Health Records ….

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slide1

Alabama - Health Information Exchange

Leveraging the

Nation-wide Health Information Network

(NHIN)

  • AL-HIE Stakeholders
  • Primary Provider
  • Pharmacy
  • EMT
  • Hospital/Clinic
  • Health Organization/Center
  • Payor
  • Wellness Community
  • Personal Health Records

Alabama – Health Information Exchange

Alabama Medicaid

Initiative Director:

Kim Davis-Allen, Alabama Medicaid Agency

Kim.Davis-Allen@medicaid.alabama.gov

Presented By:

Thomas E Marshall, PhD, Auburn University thomasemarshall@gmail.com

slide2

NHIN Affiliations

The Certification Commission for Health Information Technology (CCHIT)

Health Information Technology Standards Panel (HITSP)

The Community is a federally-chartered commission that provides input and recommendations to HHS on how to make health records digital and interoperable and ensures that the privacy and security of those records are protected in a market-led way.

National eHealth Collaborative (NeHC)

The Health Information Security and Privacy Collaboration (HISPC)

Nationwide Health Information Network (NHIN) Architecture Projects

  • These five organizations
  • were created to reach the
  • goal of interoperability.

Introduction to NHIN and NHIN Connect and IHS - alaskatribalhealth.org

https://www.alaskatribalhealth.org/events/loader.cfm?csModule=security/getfile&pageid=5580

slide3

NHIN

What does it stand for:

Nation-wide Health Information Network

? Network of Health Information Networks

? Network of Health Information Organizations

? Network of Health Information Exchanges

What does NHIN mean to AL-HIE?

Standards, open interoperability, security, …

Continuity of Care Document

Improved Clinical Support

Community Health Awareness

Improved Health

Evidence-Based Medical Discoveries

Presentation Sources:

NHIN Enterprise Architecture, Kevin Puscas Version: 1.0

http://healthit.hhs.gov

NHIN University - http://www.nationalehealth.org/NHIN-U/

http://HITSP.org

slide4

The ultimate goal of the NHIN Reference Enterprise Architecture is to support the Health IT Business Cases. These Health IT Business Cases are implemented as interoperability orchestrations of the services provided by the Capability Framework, which are specified as bindings to the Technology Platform. The Technology Platform provides specifications for the implementation of the Operational Infrastructure. The Operational Infrastructure is defined and managed according to the policies, rules and governance practices defined in the Policy, Legal, and Governance Foundation.

LHIO

Driven by

Local Needs

Standard Interface &

Technology

NHIN

Community

Figure 2 - NHIN Enterprise Reference Architecture

Kevin Puscas

nhin technology
NHIN Technology
  • Open Source – Open for Innovation, not free
  • Service Oriented Architecture (SOA)
  • Web Services – Discovery, Interface Definition
  • Orchestrated service-based applications

Software Engineering Concepts:

  • High Cohesion – highly defined module focus
  • Loose Coupling – independence between modules
slide12

Gateway

Birmingham

AL–HIE Stakeholders Communicating via the NHINArchitecture

Gateway

Auburn

Medicaid

Gateway

  • AL-HIE Stakeholders
  • Primary Provider
  • Pharmacy
  • EMT
  • Hospital/Clinic
  • Health Organization/Center
  • Payor
  • Wellness Community
  • Personal Health Records

Gateway

Stakeholder

Mobile

slide13

CMS FED

TN Medicaid

Gateway

Gateway

Gateway

Birmingham

GA Medicaid

Gateway

Gateway

Auburn

Medicaid

Gateway

Gateway

MS Medicaid

Gateway

Mobile

AL–HIE Stakeholders Exchanging Health Information viaNHIN Gateways to the NHIN

slide14

NHIN Enterprise Architecture

The ultimate goal of the NHIN Reference Enterprise Architecture is to support the Health IT Business Cases. These Health IT Business Cases are implemented as interoperability orchestrations of the services provided by the Capability Framework, which are specified as bindings to the Technology Platform. The Technology Platform provides specifications for the implementation of the Operational Infrastructure. The Operational Infrastructure is defined and managed according to the policies, rules and governance practices defined in the Policy, Legal, and Governance Foundation.

LHIO

Driven by

Local Needs

Standard Interface &

Technology

NHIN

Community

Figure 2 - NHIN Enterprise Reference Architecture

Kevin Puscas

slide15

reflect complex information exchange flows targeted to specific healthcare scenarios

Emergency Responder-Electronic Health Record

Electronic Health Record – Lab Results

Medication Management

Consumer Empowerment-Consumer Access to Clinical Information

Consumer Empowerment- Registration and Medication History

Quality

Biosurveillance

- patient look-up,

- document query and retrieve, and

- event based mechanisms for specific information.

- services can be composed and choreographed into complex health care information exchanges.

Services Registry – technical information of services used to locate and utilize these services by other NHIN participating organizations UDDI

Security – public key infrastructure PKI

Operational Monitoring - … allows for timely managing any type of disruptions to the NHIN as a whole

Service Oriented Architecture approach

non-proprietary and implementation agnostic.

Based on the use of web services

NHIN Enterprise Reference Architecture

… underlying organizational and cooperative constructs required to create a virtual information exchange network among the participating NHIOs. Including Data Use and Reciprocal Support Agreement (DURSA)

slide16

NHIN Operational Architecture

Static View of the NHIN Operational Architecture

hitsp
HITSP
  • http://HITSP.ORG
  • IS 01
  • Electronic Health Record (EHR) Laboratory Results ReportingThe Electronic Health Records Laboratory Results Reporting Interoperability Specification defines specific standards to support the interoperability between electronic health records and laboratory systems and secure access to laboratory results and interpretations in a patient-centric manner.
  • IS 02
  • BiosurveillanceThe Biosurveillance Interoperability Specification defines specific standards that promote the exchange of biosurveillance information among healthcare providers and public health authorities.
  • IS 03
  • Consumer EmpowermentThe Consumer Empowerment and Access to Clinical Information via Networks Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via networks.
hitsp1
HITSP
  • IS 04Emergency Responder Electronic Health Record (ER-EHR)The Emergency Responder Electronic Health Record Interoperability Specification defines specific standards required to track and provide on-site emergency care professionals, medical examiner/fatality managers and public health practitioners with needed information regarding care, treatment or investigation of emergency incident victims.
  • IS 05Consumer Empowerment and Access to Clinical Information via MediaThe Consumer Empowerment and Access to Clinical Information via Media Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via physical media or secure email exchange.
  • IS 06QualityThe Quality Interoperability Specification defines specific standards needed to benefit providers by providing a collection of data for inpatient and ambulatory care and to benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients.
  • IS 07Medication ManagementThe Medication Management Interoperability Specification defines specific standards to facilitate access to necessary medication and allergy information for consumers, clinicians, pharmacists, health insurance agencies, inpatient and ambulatory care, etc.
hitsp standard processes
IS 04Emergency Responder Electronic Health Record (ER-EHR)

IS 05Consumer Empowerment and Access to Clinical Information via Media

IS 06Quality

IS 07Medication Management

IS 08Personalized Healthcare

IS 09Consultations and Transfers of Care

IS 10Immunizations and Response Management

IS 11Public Health Case Reporting

IS 12Patient – Provider Secure Messaging

IS 77Remote Monitoring

IS 91Maternal and Child Health

IS 92Newborn Screening

IS 98Medical Home

IS 107EHR-CentricThis Interoperability Specification consolidates all information exchanges and standards that involve an EHR System amongst the thirteen HITSP Interoperability Specifications in place as of the February 13, 2009 enactment of the American Recovery and Reinvestment Act (ARRA). This Interoperability Specification is organized as a set of HITSP Capabilities, with each Capability specifying a business service that an EHR system might address in one or more of the existing HITSP Interoperability Specifications (e.g., the Communicate Hospital Prescriptions Capability supports electronic prescribing for inpatient prescription orders). Greater detail on these Capabilities is provided as part this Interoperability Specification, with their underlying HITSP constructs referenced in the Complete Library on HITSP.org.

IS 158Clinical ResearchThe Clinical Research Interoperability Specification covers clinical research in all its forms as it interoperates with healthcare systems, particularly EHRs. The specification spans two industries, healthcare and clinical research, and incorporates standards from healthcare (HL7 and IHE) and research (CDISC). The design leverages existing HITSP constructs and communication methodologies where applicable, and lays out new constructs as needed. The design also leverages the current players in the clinical research industry such as Electronic Data Capture (EDC) systems and research registries.

HITSP Standard Processes
slide20

Gateway

Birmingham

AL–HIE Stakeholders Exchanging Health Information via the NHINArchitecture

Gateway

Auburn

Medicaid

Gateway

  • AL-HIE Stakeholders
  • Primary Provider
  • Pharmacy
  • EMT
  • Hospital/Clinic
  • Health Organization/Center
  • Payor
  • Wellness Community
  • Personal Health Records

Gateway

Stakeholder

Mobile

slide21

Nation-wide NHIN

Technology Infrastructure

Authorization

Consumer

Preferences

Document

Query &

Retrieval

Data

Transform

Service

Discovery

Message

Platform

Adaptor

Web

Service

Subject

Identity

Audit

Log

Master

Subject

Index

Data

Store

NHIN

Service

Registry

NHIN

Gateway

Alabama

As

NHIO

Enterprise Service Bus

Other NHIOs

Authorization

Engine

slide22

CMS FED

TN Medicaid

Gateway

Gateway

Gateway

Birmingham

GA Medicaid

Gateway

Gateway

Auburn

Medicaid

Gateway

Gateway

MS Medicaid

Gateway

Mobile

AL–HIE Stakeholders Exchanging Health Information viaNHIN Gateways to the NHIN

slide23

NHIN Affiliations

The Certification Commission for Health Information Technology (CCHIT)

Health Information Technology Standards Panel (HITSP)

The Community is a federally-chartered commission that provides input and recommendations to HHS on how to make health records digital and interoperable and ensures that the privacy and security of those records are protected in a market-led way.

National eHealth Collaborative (NeHC)

The Health Information Security and Privacy Collaboration (HISPC)

Nationwide Health Information Network (NHIN) Architecture Projects

  • These five organizations
  • were created to reach the
  • goal of interoperability.

Introduction to NHIN and NHIN Connect and IHS - alaskatribalhealth.org

https://www.alaskatribalhealth.org/events/loader.cfm?csModule=security/getfile&pageid=5580

23

slide25

AL-HIE Leveraging the NHINImproved Health Care Value Through eHealth Collaboration

CMS FED

TN Medicaid

LHIO

Driven by

Local Needs

GA Medicaid

Birmingham

Standard Interface &

Technology

Auburn

MS

Medicaid

AL Medicaid

NHIN

Community

NHIN Enterprise Reference Architecture

Kevin Puscas

Mobile