The Federal Health Architecture

1. The Federal Health Architecture Efforts to Strengthen Healthcare Communities Dr. Lauren Thompson, Director December 13, 2012

2. Federal Health Architecture:Background Federal Health Architecture (FHA) program was established as an OMB E-GovLine of Business (LoB) • To support federal activities related to the development and adoption of health IT standards • To ensure that agencies seamlessly and securely exchange health data with other agencies, other government entities, and with other public and private organizations Over time, FHA’s focus and scope has expanded • To emphasize federal advancement of the national agenda for health IT • To provide enterprise architecture, standards adoption, tools and communication support

3. Federal Health Architecture: Participation FHA ensures federal participation in initiatives such as the Nationwide Health Information Network, the Direct Project, EHR adoption and CONNECT • E-gov initiative managed by ONC within HHS • Many federal agencies participate

4. Federal Health Architecture: Key Initiatives Nationwide Health Information Network (NwHIN) Exchange is now eHealth Exchange • Transitioned from ONC federal program to a public/private collaboration • HealtheWay, a non-profit, is supporting eHealth Exchange operations • Testing and onboarding • Maintaining DURSA, and operating policies and procedures • Service registry and digital certificates CONNECT open source • CONNECT code on GitHub, sprint sessions open • Engaging open source community through Code-A-Thons, encouraging code contributions • Developing CONNECT 4.0, incorporating Direct specifications • Incorporation into VLER Health for DoD and VA HIE activities

5. Federal Health Architecture: Key Initiatives RESTful Health Exchange (RHEx) • An open source project, sponsored by FHA • Demonstrated simple, secure, standards-based Web technologies for health information exchange Two Pilots • Telemedicine & Advanced Technology Research Center (TATRC) • Use Case: Consult/Referral • Secure Person to Person exchange • OpenID Connect for distributed user authentication • HealthInfoNet • Use Case: Populate clinical data repository with patient data from EHR at small health care provider in medically underserved area to Maine HIE • Secure Machine to Machine exchange • OAuth2 for service to service authentication

6. Federal Health Architecture: Key Initiatives New Governance • More strategic alignment within and across federal partner agencies • Greater transparency and enhanced communications • Commitment to fulfilling original intent of FHA as E-Gov Line of Business Strategy Planning • FHA Strategic Plan nearing completion • FHA Line of Business (LoB) Service Plan delivered to OMB Interoperability Architecture • Identify current and planned data exchanges among federal agencies and partners • Develop FHA public-facing portal • Align with standards harmonization efforts (e.g. Standards and Interoperability Framework) • Demonstrate exchange methods beyond Direct and SOA – RHExpilots

7. Federal Health Architecture:FHA Strategic Plan – (2013-2015) A federal health information technology environment that is interoperable with the private sector and supports the President’s health information technology plan enabling better care, increased efficiency, and improved population health

8. Federal Health Architecture: FHA Strategic Goals • Improve exchange of health data among the federal government and private sector healthcare providers by establishing a unified federal voice on health data exchange interoperability • Encourage adoption of interoperability specifications resulting in active data exchange in the federal health community • Align federal policies in health data exchange to use the federal government’s combined influence as a payer, provider, and public health guardian to improve the healthcare system

9. Federal Health Architecture: Federal Interoperability Landscape Nationwide Health Information Network Standards & Specs Enterprise architecture is about understanding all of the different elements that make up the enterprise and how those elements interrelate. CMS exchange Non-federal exchanges Exchanges (eHealth Exchange, etc.) CDC exchange VA exchange SSA exchange DoD exchange

10. The Platform for Secure Health Information Exchange CONNECT:

11. CONNECT CONNECT is an open-source solution to support health information exchange (HIE) CONNECT uses NwHIN standards both Exchange and Direct to ensure doctors, community hospitals and hospital systems, and Regional Health Information Organizations and HIEs can exchange health information securely and easily CONNECT can be used to: • Set up a HIE within an organization • Exchange data with other HIEs • Set up a Direct Health Information Service Provider

12. About CONNECT • Open source license • Open release planning, sprint review and planning sessions • Community contributions • Bug reports + fixes • Feature requests + implementations • Documentation • Custom or specialized components • FHA-sponsored product management, curation, support, development

13. What CONNECT Does • Provides the connection between existing health information systems to health data exchanges • Supports multiple usage environments • Delivers foundational functionality necessary for supporting interoperability • Secure messaging services • The framework for request justification of electronic health information for a patient • Registry services to discover exchange participant existence and connection information • Patient preferences about sharing their electronic health information

14. CONNECT Enables Interoperability • Find a patient based on demographic information • Locate a patient’s electronic health information • Retrieve specific electronic health information associated with a subject or patient

15. CONNECT Enables Interoperability • Submit patient-specific information without the need for a request or query • Submit non-patient-specific documents • Provide a publish/subscribe capability for ongoing feeds • Exchange of health based SMTP messages per Direct specs • Fully functional out of the box but flexible for customization for environmental and use case needs

16. NwHIN Technical Specifications:Finding, acquiring, + sharing health information Do you have information on Jane Doe? NwHIN/Direct specifications EMR

17. Direct Project Specifications:Simple health information transport I’m sending you infoon Jane Doe Direct specifications

18. Why a Platform? Flexible architecture • Allows CONNECT to build out, and make available, the health information exchange methods and use cases we’ve discussed at this meeting • NwHIN Exchange specifications • Direct (secure email) transport • Whatever’s next: • Benefits discovery? Pre-approval? Quality? Etc. Single product • Do you really want to install and maintain separate products for your distinct exchange needs? Pooled efforts • Open source license and development allows community engagement, collaboration, contribution • Needs are better met through openness, participation, + interaction

19. Who Uses CONNECT?Anyone who wants to exchange health data A sampling of the CONNECT community.

20. Listening to the Community • What do you need? • Why are you here? • What is your mission? • What are your challenges?

21. How to use CONNECT:A solution to support meeting MU requirements The exchange of health data and interoperability is a key theme and requirement of meaningful use • ONC National Coordinator Dr. FarzadMostashari states “…as we look toward meaningful use Stage 3, we will monitor the ease with which EPs [eligible professionals], eligible hospitals, and CAHs [critical access hospitals] engage in electronic exchange, especially across different vendors…” • Goal of a national health IT system is to make sure "information follows the patient regardless of geographic, organizational, or vendor boundaries” • ONC remains dedicated to the idea of health information exchange without borders, across different ….areas of care, but also across different technologies

22. How to use CONNECT:A solution to support meeting MU requirements • CONNECT provides the functionality to meet exchange requirements for meaningful use for example • Providing a summary of care record to another care setting for a referred patient with suggest standard of Direct Project protocols • Receiving clinical lab-test results for incorporation into an EHR as structured data • Provide patients with ability to download and transmit their health information • Capability to submit electronic data to immunization registries • Capability to submit electronic surveillance and reportable laboratory results data to public health agencies • Electronic submission of clinical quality measures reporting requirements • CONNECT is fully functional out of the box but flexible for customization for environmental and use case needs

23. How to use CONNECTHealth Information Exchange Infrastructure • Low cost solution that is open source and maintained by fellow adopters • CONNECT provides multiple migration paths for exchange adoption and abilities to meet interoperability requirements • Direct transport, Exchange transport or both • One implementation allows for exchange with two different transport protocols increasing exchange opportunities • CONNECT is a platform that can be easily extended to support the new underlying specifications • CONNECT is a health exchange platform that is flexible to support an evolving exchange environment • A solution that complies with requirements and specifications associated with MU and established Exchanges • Flexible for implementing into an adopters established infrastructure and environment

24. CONNECT Building BlocksHow CONNECT enables exchange Any Health Organization / Provider EHR/HIE System System that wishes to CONNECT with other health information sources CONNECT Regional Health Information Organizations Government sponsored facilities Master Patient Index System (MPI) EHR/HIE Implementation Adapter Service Creates/sends messages to CONNECT and receives/processes and responds to messages from CONNECT Disease-orientedcare networks Document Registry Federation of enterprises (hospitals and care providers) Document Repository Other Communitiesof Care Policy Engine

25. CONNECT Building Blocks:Tailoring your implementation CONNECT provides the health information exchange (HIE) key building blocks: • Provides an integrated implementation which provides functionality and access to interoperate with other partners • CONNECT sits between the HIE infrastructure systems Exchanges for example the eHealth Exchange or Direct participating partners • CONNECT sends messages to the exchange and receives messages from the network on behalf of the HIE • CONNECT provides reference adapters for guidance but allows for the customization of the adapters to tailor processing messages to and from CONNECT and the HIE systems • To further build only what is needed CONNECT allows for the deployment of only the services needed to support desired use cases

26. Next CONNECT Events December 31, 2012 (11am) Next sprint review + planning meeting January 2, 2013 CONNECT 4.0 Beta Release February 11, 2012CONNECT 4.0 Release Mid-February, 2013 CONNECT User Group Meeting

27. More Details on CONNECT 4.0 Release info: Requirements artifacts: Design approach documents: JIRA: Forums: https://developer.connectopensource.org/display/CONNECTWIKI/Release+4.0+-+In+Progress https://developer.connectopensource.org/display/CONNECTWIKI/Requirements+Artifacts https://developer.connectopensource.org/display/CONNECTWIKI/CONNECT+4.0+Design+Approaches http://issues.connectopensource.org http://www.connectopensource.org/developer-resources/forums/developer-forum

28. Federal Health Architecture: Stay connected, communicate and collaborate • Browse the ONC website at: healthIT.govclick the Facebook “Like” button to add us to your network • Contact us at: onc.request@hhs.gov • Subscribe, watch, and share: • @ONC_HealthIT, @ONC_FHA, • @CONNECT_Project • http://www.youtube.com/user/HHSONC • Health IT and Electronic Health Records • http://www.scribd.com/HealthIT/ • http://www.flickr.com/photos/healthit Health IT Buzz Blog

29. Federal Health Architecture: More about Federal Health IT Initiatives ONC website: www.healthit.gov/nhin Direct Project website: www.directproject.org S&I Framework wiki: http://wiki.siframework.org CONNECT website: www.connectopensource.org eHealth Exchange: http://healthewayinc.org/

30. Thankyou!