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Powerful Results. Delivered. OSEHRA Summit Topic: “Why Interoperability Is So Damn Hard” Presenter: Mario Hyland Senior Vice President, AEGIS @ Interopguy. September 5, 2014. 1. AEGIS.net, Inc. - Powerful Results. Delivered. SM. How Important is Patient Safety?. 2.

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slide1

Powerful Results. Delivered.

OSEHRA Summit

Topic: “Why Interoperability Is So Damn Hard”

Presenter: Mario Hyland

Senior Vice President, AEGIS

@Interopguy

September 5, 2014

1

AEGIS.net, Inc. - Powerful Results. Delivered.SM

how important is patient safety
How Important is Patient Safety?

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

introduction
Introduction
  • AEGIS has been supporting Interoperability Testing within the HealthIT space with VA/HHS (ONC).
  • HHS/ONC Nationwide Health Information Exchange (NwHIN) (IHE/HL7/OASIS-SAML)
  • Healtheway Compliance Testing Body (CTB) Certification process for the eHealth Exchange
  • OSEHRA Open Source Interoperability Work Group with a focus project of the DIL.
  • NIST HITECH Award HITTI
  • HL7 Conformance Testing Platform

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

challenges facing standards adoption
Challenges facing Standards Adoption

Definition of Interoperability (let’s agree to use IEEE).

  • Participants and Systems Not Ready for Certification or Accreditation
    • Dependence on Self-Attestation
  • Understanding the Standards and Specifications
    • Common (or Consensus based) Interpretation.
  • Conformance vs Interoperability
  • Syntactic vs Semantic Interoperability
  • Interoperability vs Continuous Interoperability

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

state of maturity healthit standards
State of Maturity HealthIT Standards

Topic: Open Source Development

Objective: Adherence to a Standard can be demonstrated thru implementation & testing

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

why interoperability is challenging
Why Interoperability is Challenging
  • Systems Interoperability Challenges
  • Organizational exchange of information
  • Interruption thru Implementation
  • Common Testing Approach (Happy Path)
  • Limited Exception Negative Testing (due to dependence on Peer-to-Peer testing)
  • Change (yes, there will be change)
  • Standards will be put under new intense pressure.

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

robustness principle
Robustness Principle
  • "Be conservative in what you send, be
  • liberal in what you accept"
  • http://en.wikipedia.org/wiki/Robustness_principle
  • Conservative – Happy Path
  • Liberal – Negative and Exception Path

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

how to mitigate interoperability risk
How to Mitigate Interoperability Risk
  • We offer a way to Mitigate Interoperability Risk
    • Because – you will face Interoperability Issues
  • Interoperability Strategies
  • Standards based Testing (feedback loop)
  • Test Early and Test Often
  • Infuse Interoperability into the Development Cycles thru TDD (Test Driven Development)
  • Embrace the goal of Continuous Interoperability thru process

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

how to integrate tdd into agile process
How to Integrate TDD into Agile Process

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

developers integration lab
Developers Integration Lab
  • Developers Integration Lab (DIL)
  • Self Service Bi-Direction message based test lab
  • Global accessibility 24x7/365 days
  • End-to-End Systems Testing
  • Beyond Happy Path
  • 70% Negative testing
  • Cloud Shared Service
  • Conformance &
  • Interoperability

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil architecture
DIL Architecture

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

standards view thru statistics
Standards view thru Statistics
  • 2013 - 1,387 Implemented Test Cases*:
  • 522 Conformance Rules applying over 36,000 checkpoints.
  • Over 77,391 Test Case Executions starting in April 2013
    • By Healtheway's CTB candidate participants and vendors.

1,113 Test Cases for NwHIN specifications

  • The DIL is Actively Exercising Health IT Standards.

*ONC S&I Framework ARRA project

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics
DIL Statistics
  • More than 200+ Organizations Registered on the DIL to test
  • 45 active Healtheway 2014 onboarding candidates (through Sept.)
  • Key Findings:
  • Neither vendors or participants are ready when they started certification testing.
  • 2-4+ month learning curve to demonstrate compliance to baseline specifications and required message conformance/interoperability expectations.

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics1
DIL Statistics
  • The DIL provides objective analysis of health information standards implementation and exchange problem areas:
  • DIL execution data record the root cause(s) of conformance/interoperability failures:
    • System/product failures
    • Test case definition defect
    • Specification lacks sufficient implementation guidance

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

industry approach to interoperability
Industry Approach to Interoperability
  • ONC Roadmap to Interoperability (10 Years)
  • Patient Privacy (Consent Policy & DS4P)
  • Unstructured vs Structured Data
  • Granularity
  • Data Providence
  • Leverage Existing HIT Infrastructure
  • FDASIA Report (Risk Management)
  • Jason Report (API Architecture)

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

osehra interoperability work group
OSEHRA Interoperability Work Group
  • goals:
  • Publish thought leadership pieces
  • Participate in speaking engagements
  • Contribute content to the OSEHRA public comment platform
  • Captures User Experiences and Technical Challenges
  • Support Rapid Integration of Standards
  • Influence technology, public policy, laws and regulations
  • Develop resources, tools and test labs

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

contact us
Contact Us -

AEGIS.net, Inc.

2275 Research Boulevard, Suite 500

Rockville, MD 20850

www.aegis.net

Mario Hyland

Senior Vice President

mario.hyland@aegis.net

(703) 893-6020 x707

(301) 529-5466 (c)

DUNS: 152858358 CAGE Code: 3YHD9

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics2
DIL Statistics
  • HIE participant learning curves vary widely. One example:
  • Early failures -> Learning - > Refinement -> Success

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics3
DIL Statistics
  • HIE participant learning curves vary widely. BEST CASE:
  • 2 calendar months from DIL registration to CTB test case results submission for CCHIT review/Healtheway CC onboarding approval.

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics4
DIL Statistics
  • Once past the system configuration learning curve, DIL Test Execution is FAST:
  • 12 MINUTES to actually execute the test cases required for Healtheway’s 2013 onboarding program.

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil statistics5
DIL Statistics
  • Product Vendor learning curve example:
  • Early failures -> Learning - > Refinement -> Success
  • Vendors should take more time—and make use of the DIL more extensively—than individual participants.

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

state hie sut
State HIE - SUT

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test account
DIL Test Account

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test scenario case
DIL Test Scenario/Case

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

state hie patient info sut
State HIE Patient Info (SUT)

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test results
DIL Test Results

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil exception reporting
DIL Exception Reporting

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil message debugging
DIL Message Debugging

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil message analyzer
DIL Message Analyzer

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test history
DIL Test History

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil role based features
DIL Role Based Features
  • Developers Integration Lab (DIL)
    • Test Users / Participants
    • Test Case Developers
    • Test Rules Engine
    • Community Representatives
    • Certification / Test Validation
    • DIL Administrator

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test case developer
DIL Test Case Developer

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil test rules engine
DIL Test Rules Engine

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil community rep
DIL Community Rep

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil certification validation
DIL Certification / Validation

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AEGIS.net, Inc. - Powerful Results. Delivered.SM

dil administration
DIL Administration

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AEGIS.net, Inc. - Powerful Results. Delivered.SM