NHIN Messaging Recommendations

1
NHIN Messaging Recommendations

• EHI Connecting Communities ForumApril 10, 2006
• Don Grodecki
• Browsersoft, Inc.

2
Messaging Design Goals

• Minimum Necessary to achieve the Maximum Benefit
• Dont make the cost of entry so high that few
  will participate
• Dont adopt emerging standards too early
• Dont get ahead of the implementation tools
• Use Web Services, SOAP, XML, SSL
• Platform Neutral

3
Only Two Messages

• ltNHINQuerygt
• ltNHINResponsegt
• Web Services are normally Query/Response
• Allow for generic payloads so that new data types
  will not affect the basic Messaging Standards
• Attachments can carry media types

4
XML Namespaces

• Namespaces are globally unique prefixes attached
  to XML tags to guarantee the uniqueness of the
  prefixtag combination
• lthttp//www.nhin.gov/messagingNHINQuerygt
• An alias is often defined for a Namespace
• xmlnsnhinWsa"http//www.nhin.gov/addressing"
• ltnhinWsaReplyTogt

5
XML Default Namespaces

• A Default Namespace can be declared
• ltQBP_Z01 xmlns"urnhl7-orgv2xml"gt
• The Default holds unless overridden with a
  specific prefix
• The Default holds until redefined by another
  default

6
Requestor Identification - SAML like

• ltSOAP-ENVHeadergt ltSecurity
  xmlns"http//www.nhin.gov/messaginggt
  ltQueryRequestorgt lthl7XCN.1gtjohnh_at_masha
  re.orglt/hl7XCN.1gt lthl7XCN.2gtJohnlt/hl7
  XCN.2gt lthl7XCN.3gtHalamkalt/hl7XCN.3gt
  . . . lt/QueryRequestorgt

7
ltNHINQuerygt Settings

• ltSOAP-ENVBodygt ltNHINQuery
  xmlns"http//www.nhin.gov/messaging"gt
  ltEvaluationSettingsgt ltMaxResponseIntervalgt
  10 lt/MaxResponseInterv
  algt ltIdentifyPatientgtyeslt/IdentifyPatientgt
  lt/EvaluationSettingsgt

8
ltNHINQuerygt Query

• ltNHINQuery xmlns"http//www.nhin.gov/messaging"gt
  . . . ltQuery format"HL7" version"2.4"gt
  ltQBP_Z01 xmlns"urnhl7-orgv2xml"gt
  ltMSHgtwhere fromlt/MSHgt ltQPDgtquery
  parameterslt/QPDgt ltPIDgtpatient
  IDlt/PIDgt ltRCPgtresponse controllt/RCPgt

9
ltNHINResponsegt

• ltNHINResponse xmlns"http//www.nhin.gov/messaging
  "gt ltResponse format"HL7" version"2.4"gt
  ltRSP_Z01 xmlns"urnhl7-orgv2xml"gt
  ltMSHgtwhere fromlt/MSHgt . . . the
  rest if HL7 response
• Always the ltResponsegt with ltMSHgt
• Additional ltResponsegt elements for non-HL7
  results, such as NCDPDP Scripts 8.1

10
Variations on HL7 v2.4

• ELINCS-HIE
• For Laboratory results
• supports others observations
• HL-7 V2.4
• Minor variation on California Healthcare
  Foundation's ELINCS implementation guides for
  results
• sub-set of labs are LOINC coded
• http//www.chcf.org/topics/chronicdisease/index.cf
  m?itemID111047

11
Recommendations Beyond HL7 v2.4

• NCPDP SCRIPT Standard
• For Medication History
• consistent with RxHUB and SureScripts formats
• Version 8.1
• http//www.ncpdp.org/

12
Asynchronous Pattern

• ISB lt-gt ISB communications is always Asynchronous
• Response to NHINQuery is always simple ACK
• ltRCP.1gtDeferredltRCP.1gt indicates Async
• NHINResponse is posted to supplied ReplyTo URL,
  after possible delay
• Response post is answered by simple ACK
• Responses are matched to Queries by MessageID

13
ReplyTo - WS-Addressing like

• ltSOAP-ENVHeader xmlnsnhinWsa"http//www.nhin.go
  v/addressing"gt ltnhinWsaMessageIDgt 12345
  lt/nhinWsaMessageIDgt ltnhinWsaReplyTogt
  ltnhinWsaAddressgt http//markle.regenstrie
  f.org/services/NHINQuery lt/nhinWsaAddressgt
  lt/nhinWsaReplyTogt

14
Mendocino Adoption - Architecture
15
Current Mendocino Implementation
16
Resources

• www.openhre.org
• News on Open Source and Health Records Exchange
• Downloads, for Papers and Software
• Web Links, for Demonstrations
• www.openhre.com
• www.mendocinohre.org
• info_at_browsersoft.com