Transcript TITLE Audio Seminar DATE
Session #300 Roundtable Discussion February 14, 2005
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STRATEGIC INFORMATION TECHNOLOGIES FOR SUCCESSFUL HEALTH INFORMATION EXCHANGE INITIATIVES
www.daksystemsconsulting.com
© 2005 Deborah Kohn
About Deborah Kohn, Facilitator
Facilitator – Roundtable Discussion: “The Impact of Web Services on Portal Development”, HIMSS Annual Conference and Exhibition, Orlando FL (February 2004) Facilitator – Roundtable Discussion: “Strategic Planning for Web Portal Development”, HIMSS Annual Conference and Exhibition, San Diego CA (February 2003) Facilitator – Roundtable Discussion: “Developing and Implementing a Web / Intranet Strategic Plan”, HIMSS Annual Conference and Exhibition, Atlanta GA (January 2002) Facilitator – Roundtable Discussion: “Developing an Intranet: How To Grow Your Own”, HIMSS Annual Conference and Exhibition, New Orleans LA (February 2001) Guest Editor – Journal of Healthcare Information Management: “Healthcare and the Web”, HIMSS, (Spring 2000) 2
Learning Objectives
1.
2.
3.
Define: a.
Regional Health Information Organizations (RHIOs) b.
c.
d.
Health Information Exchange & Interoperability (HIEI) National Health Information Network (NHIN) The “Federated” model for technology deployment Identify several, strategic, Internet-derived technologies that are being successfully deployed to exchange community-wide health information Understand the benefits of these technologies for RHIOs 3
RHIOs
Public and Private collaboratives that:
enable health information exchange in a “region”
are bigger and fewer than Local Health Information Infrastructures (LHIIs)
serve approximately 500,000 – 1,000,000 lives
service area concept, such as Emergency Medical Services (EMS)
are no larger than a state (OR, WY, IL, DE)
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HIEI
Health Information Exchange –
Interconnecting care
Interoperability (per HL7; per the IEEE Standard Computer Dictionary) –
The ability of two or more systems or components to exchange information and to use the information that been exchanged
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NHIN
Tying together all the RHIOs
an interconnected, interoperable, electronic health information infrastructure/network with the capacity to electronically exchange the information between and among all the electronic health records (EHRs) so that a complete, electronic health record can be assembled whenever and wherever a patient presents for care
The “ Medical Internet ”
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The “Federated” Model
The 5 Ds – Distinct, Distributed, Disparate, Decentralized Databases
The only Centralization occurs with an Enterprise-type Master Patient Index (EMPI) and, perhaps, Application Programming Interfaces (APIs)
Mirrors the “federal/federated” concept of the 50 state govs (Decentralization) reporting to the US gov (Centralization)
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Internet-derived Technologies
Peer-to-Peer Networking
Secure Messaging
Virtual Private Network
Web Portal
Web Services
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Peer-to-Peer Networking
A communications environment that allows all addressable devices (e.g., desktop and laptop computers) in the network to act as servers and securely share their files (any type of digital file – audio, coded, image, text, video) with all other authenticated and authorized users on the network.
•
This works by providing indexes to the files.
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Peer-to-Peer Networking
DESTINATION Only whole files are sent SOURCE Text Central Index Video Sound Lab Values Images
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Secure Messaging
A communications environment that allows all addressable devices (e.g., desktop and laptop computers) in the network to act as clients to a centralized server that securely stores and forwards files digital file – audio, coded, image, text, video).
(any type of
•
This allows authenticated and authorized users on the network to retrieve those files (online pull / offline push) when required.
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Path Info System
Secure Messaging
@ the End User’s Computer (e.g., the Physician’s Office)
HL7 Messages Lab Info System Transcription System
Interface Engine (if none, then Point-to-Point Interfaces)
Path Results Lab Results Med Rec Reports Rad Results ADT
Connection Engine
Rad Info System Data Transferred via TCP/IP Sockets
Connection Server For Storing
Healthcare Info System
@ the Hospital / Reference Lab / Payor Data Center
Internet Encrypted Internet Encrypted
Server For Storing & Forwarding
Replication
@ the Hosting Data Center
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Virtual Private Network
A private network that is configured within a public network, such as the Internet, providing encrypted point-to-point links (using SSL or IPsec).
•
This ensures that only authorized users can access the network and that the data cannot be intercepted.
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Virtual Private Network
Reference Lab Community Network Hub
Cisco 3015 VPN Access Concentrator Cisco 3040 Router
Internet
Cisco 2600 Router with VPN SW Broadband required
POP Site-to-Site VPN – Hub & Spoke
Lower cost, tunneled connections with VPN services, like SSL or IPSec encryption and QoS to ensure reliable throughput Cisco 2600 Router With VPN SW Broadband required
Home Health Agency Physician Provider Remote Access VPN
Secure, scalable, encrypted tunnels across a public Network; client software required 14
Web Portal
A single point of personalized access (i.e., an entryway) through which to find, organize, and deliver content*.
*Content is defined as information, applications, and services.
Content can be:
structured, such as relational data.
unstructured, such as emails, web pages, images, and text documents. 15
PAYOR INFORMATION
Claims, Eligibility, Referrals
PHYSICIAN OFFICE INFORMATION
Insurance Plans& Demographics Prescriptions, Medications, H&Ps, & Progress Notes Procedure & Diagnostic Codes
DIAGNOSTIC TEST INFORMATION
Reference Lab Orders and Results Imaging Center Orders and Results
Web Portal
PHYSICIAN PROVIDER
Secured Single Sign On Custom Views & Workflow (Inbox, Alerts)
PORTAL PATIENT-CENTRIC INFORMATION REPOSITORY
Custom Views & Workflow (Inbox, Alerts) Secured Single Sign On
ACUTE & POST ACUTE CARE FACILITY PROVIDER EQUIPMENT & SUPPLY INFORMATION
Purchase Orders and Order Status Online Catalogs
ACUTE & POST ACUTE CARE FACILITY INFORMATION
H&Ps, Discharge Summaries, ADT Data Laboratory, Radiology, Pathology Results
OTHER INFORMATION: Continuing Education Clinical Databases
MEDLINE, PDR, National Disease Registries CNBC, ESPN, Amazon, Travelocity 16
Web Services
An open, standardized way of integrating disparate, web-based applications – using
• • • •
eXtensible Markup Language (XML) to format / tag the data Simple Object Access Protocol (SOAP) to transfer the data Universal Description, Discovery, and Integration (UDDI) to list what services are available Web Services Description Language (WSDL) to describe the services available
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Web Services
CLIENT or PRESENTATION TIER BROWSER, PATIENT / PHYSICIAN PORTAL XML, HTTP SERVER or RULES TIER WEB APPLICATION SERVER FARM SERVICE-ORIENTED ARTCHITECTURE (SOA) FRAMEWORK Patient Access WS Physician Access WS Identity Manager WS ADT/Charge Capture WS Problem List WS Scheduling/ Charge Capture WS Order Entry Results WS Image Store WS XML, ODBC, HL7 DATA SOURCES TIER DATABASE SERVERS AND LEGACY PLATFORMS Text Document WS Siemens HIS NextGen EMR IDX RIS Amisys Managed Care Misys LIS GEMSIT MUSE ECG Stentor PACS SoftMed Transcription WEB SERVICES UDDI WSDL SOAP
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Internet-derived Technologies
BENEFITS FOR RHIOs
Are more “open” than proprietary Have a better chance of being widely implemented Reduce custom development time / costs Simplify user training / Promote physician usage Do not require centralized databases Take advantage of economies of scale and management of large networks
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