A Study of Health Information Exchange and Interoperability System Solutions

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A Study of Health Information Exchange and
Interoperability System Solutions
Anubhav Mathur Masters in Computer
Science Computer Science Engineering
Department University of Connecticut
anubhav.mathur_at_engr.uconn.edu http//www.engr.ucon
n.edu/anm13020 (908) 210 - 1660
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Overview

• What Is HIE?
• Key forms of HIE
• What is Interoperability
• Aspects of Interoperability
• Current State
• Problems
• Initiatives
• Solutions
• Core Issues
• Future Scope
• References

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What Is HIE?

• Secure access of patients vital medical
  information electronically
• Stakeholders Doctors,
• Nurses, Pharmacists,
• Other health care providers
• Patients!
• Advantages
• Improving the speed,
• Quality,
• Safety
• Cost of patient care.
• Example DIRECT Messaging System

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Key forms of health information exchange

• Directed Exchange ability to send and receive
  secure information electronically between care
  providers to support coordinated care
• Query-based Exchange ability for providers to
  find and/or request information on a patient from
  other providers, often used for unplanned care
• Consumer Mediated Exchange ability for patients
  to aggregate and control the use of their health
  information among providers 
• The foundation of standards, policies and
  technology required to initiate all three forms
  of health information exchange are complete,
  tested, and available today.

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Interoperability

• What is Interoperability?
• Ability of two or more systems or components to
  use the exchanged information.
• Fundamental Building Blocks
• Meaning through the use of standardized
  healthcare vocabularies,
• Structure by leveraging standards in HL7
• Transport using secure email protocols,
• Security through National Institute of Standards
  and Technology (NIST)-adopted encryption
  standards, and services through open, and
  accessible application programming interfaces
  (APIs).

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Aspects of Interoperability

• Transport
• More than one transport standards
• Standardization of data
• Vocabularies
• Terminologies
• Standards for structure

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Benefits of Interoperability

• For health professionals
• Improve access to health record data and health
  information anytime, anywhere.
• For patients
• Improve quality and safety of care by improving
  data exchange, the quality of data flow and
  access to information by health professionals
  thereby potentially reducing errors.
• For health managers
• Improve data collection and facilitate
  statistical and economic analysis.

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Benefits of Interoperability

• For health researchers
• Improve and increase the availability of medical
  data.
• For the healthcare technology industry
• Improve access to the healthcare market for more
  companies (SMEs in particular who may be limited
  in their ability to provide technologies which
  can integrate with an organisation's legacy
  systems).

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Current state

• Developments in the past 3-4 years in standards
  and technology.
• Development of HIEs and HIXs
• Transfer of financial information using X.12
  standards.
• Standards-based representation of information
  (CDA, CCD, CCDA)
• Communication
• IHE
• XDS
• Direct Project
• PHINMS
• eHealth Exchange

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Problems

• Not a one-size-fits-all solution.
• Home-grown and legacy applications, providing
  functionality across patient and infrastructure
  management, clinical care, administrative and
  financial domains.
• Pre-date the introduction of standards for
  information sharing.
• Closed in nature

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Problems

• Reluctance to change from traditional paper-based
  systems to electronic systems.
• Lack of specificity of healthcare standards and
  information sharing protocols
• Numerous incompatible terminologies and
  ontologies involved.
• Semantic interoperability major challenge.
• Amplification at the state or national level or
  when health systems attempt to manage a
  populations wellness and develop mechanisms to
  exchange population-level data.

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Current initiatives

• Government standardization initiatives
• Office of Science Technology (OST).
• Office of the National Coordinator for Health
  Information Technologys (ONC)
• Enable the health IT community to convene and
  rapidly prioritize health IT challenges.
• Develop and harmonize standards, specifications
  and implementation guidance to solve those
  challenges.
• Curate the set of standards and specifications
  that support interoperability and ensuring that
  they can be assembled into solutions for a
  variety of health information exchange scenarios.

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Current initiatives

• HITECH Act.
• Promoting the adoption and uptake of health
  information technology
• Ensure technical standards and specifications are
  in place to support this technology
• Critical to the development and success of a
  fully functional nationwide health IT ecosystem.

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• Solutions
• For HIE

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CONNECT

• Open source software solution developed by over
  20 federal agencies that organizations can use to
  securely link their existing health IT systems
  into the NwHIN.

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Advantages

• Open source and free for download. This improves
  adaptability among various HIEs
• Coordinates care across public and private care
  sectors. Providers will have access to medical
  records throughout the continuum of care,
  regardless of whether the treatment facilities
  are in the government or private sector
• Speeds the dissemination of clinical and
  scientific research results to government,
  industry and the scientific community to benefit
  population health
• Improves regulation of pharmaceutical products
  and medical devices through faster, more
  comprehensive and more accurate detection of
  adverse drug events

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NwHIN Exchange

• The NwHIN Exchange is a collection of standards,
  protocols, legal agreements, specifications and
  services that enables the secure exchange of
  health information over the internet.
•   

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NwHIN Exchange

• Advantages
• The NwHIN Exchange has methods to perform
  universal patient lookup, document discovery and
  retrieval, and exchange between organizations and
  federal agencies (VA, DOD, CDC, SSA, plus 22
  others). The organizations entering into an
  exchange with those federal agencies are
  typically sizable HIOs, HIEs or large IDNs.

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NwHIN Exchange

• Disadvantages
• Participation currently limited to federal health
  agencies and healthcare organizations under ONC
  contract and other recipients of federal grants.
• Most individual providers/small practices have
  limited technical resources.
• Since many providers will not be able to
  participate in the NwHIN Exchange, they still
  need a model to help them reach Stage 1
  Meaningful Use (MU) requirements.
• Development geared toward large HIOs/IDNs before
  the HITECH Act/Meaningful Use criteria existed.
  In order to provide a simpler option to help
  providers meet basic MU requirements.

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NwHIN DIRECT

• The set of standards, policies and services that
  enable simple, secure transport of health
  information between authorized care providers.
• NwHIN Direct enables standards-based health
  information exchange in support of core Stage 1
  MU measures, including communication of summary
  care records, referrals, discharge summaries and
  other clinical documents in support of continuity
  of care and medication reconciliation, and
  communication of laboratory results to providers.

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HISP

• Used by the DIRECT project, to describe the
  management of security and transport for directed
  exchange and an organizational model
• Performs HISP functions on behalf of the sending
  or receiving organization or individual.
• Separate business organization from the sending
  and receiving organization required to have
  contractually binding legal Business Associate
  Agreements (BAAs) with HIPAA Covered Entities
  with the sender or receiver of directed exchange
  of Personally Identifiable Information.
• Must include all data collection, use, retention,
  and disclosure policies (including rights
  reserved but not exercised) in other service
  agreements.

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DIRECT

• Advantages
• DIRECT is based on Open source software,
  therefore it promotes community participation in
  the development and maintenance of the system .
• It offers customizability and adaptability
• Security is implemented a thorough vetting system
  to ensure all providers who use the system are
  actually who they say they are.

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• Solutions
• For Interoperability
• Problem

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Integrating the Healthcare Enterprise

• Integrating the Healthcare Enterprise (IHE)
• Initiative by the healthcare industry to improve
  the way computer systems share information.
• Established in 1998 by a consortium of
  radiologists and information technology (IT)
  experts.
• IHE integration statements are prepared and
  published by a vendor to list the IHE profiles
  supported by a specific release of a specific
  product.

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Cross-enterprise Document Sharing

• Cross-Enterprise Document Sharing minimizes
  clinical/admin data management by the
  infrastructure. Transparency Ease of Evolution
• Patients/consumers have guaranteed portability
  and providers may share information without
  concerns of aggregation errors.Digital Documents
  Patients and providers empowerment
• Supports both centralized and decentralized
  repository architectures. Ease of federation
  nationally. Flexible privacy, Flexibility of
  configurations
• Has received major support world-wide National
  regional projects, NHIN contractors, US EHR
  Vendor Assoc., complements Connecting for Health
  RLS.

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Why is IHE-XDS a breakthrough ?

• Sharing of digital documents as attested by the
  source, meets the most urgent needs. A proven
  healthcare community data-sharing paradigm
  (Message feeding to web servers hinders use of
  EHRs PHRs).
• Efficient to support all types of Health IT
  Systems (IDNs, Hospitals, Ambulatory, Pharmacy,
  Payers, Diagnostics Centers, etc.) and all types
  of information (summaries, meds, images, lab
  reports, ECGs, etc.), structured and
  unstructured.
• Offer a consistent, standards-based and
  functional record sharing for EHRs, PHRs other
  IT Systems

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LOINC

• The Logical Observation Identifiers Names and
  Codes (LOINC) standard codes for use
  in databases are often used in IHE profiles.
• Applies universal code names and identifiers
  to medical terminology related to electronic
  health records. 
• Assist in the electronic exchange and gathering
  of clinical results
• Example laboratory tests, clinical observations,
  outcomes management and research

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Current State

• Currently most clinical laboratories and other
  diagnostic services use HL7 to send their results
  electronically from their reporting systems to
  their care systems
• Most labs, however, identify tests in these
  messages by means of their internal code values
• Care systems must either use the internal codes
  provided by laboratory or map to LOINC or local
  codes
• Universal use of LOINC would solve this problem,
  and there is momentum to move in this direction

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Advantages

• Improved communication in integrated health
  delivery networks
• Supports aggregated electronic health records
• Permits automatic transfer to public health
  authorities of case reports for reportable
  diseases
• Improved transfer of payment particularly claims
  attachments
• Supports reduction of errors

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DICOM

• The standard for Digital Imaging and
  Communications in Medicine.
• Developed by the National Electrical
  Manufacturers Association (NEMA) in conjunction
  with the American College of Radiology (ACR).
• Covers most image formats for all of medicine.
• Specification for messaging and communication
  between imaging machines.

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Features of DICOM

• NETWORK PROTOCOL
• DICOM incorporates negotiation to permit peers to
  agree on the functions to be performed
• MESSAGE ENCODING
• DICOM defines 24 data types (V2.0 had 4)
• DICOM message encoding includes JPEG compression
• DICOM supports multiple character repertoires
• OBJECT DATA MODEL
• DICOM is based on a completely specified data
  model
• DICOM includes a robust UID mechanism
• DATA DICTIONARY
• DICOM includes a large number of new data
  elements
• SERVICE CLASSES
• DICOM defines classes of service for specific
  applications (e.g. image management, printing)
  and conformance levels

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Core Issues

• Without interoperability, fundamental data and
  information such as patient records can't easily
  be shared across and sometimes within
  enterprises.
• Achieving interoperability in a domain where
  information technologies, where they have been
  deployed in routine practice, may not have been
  designed to support it.
• Many standards to support interoperability are
  only just now being developed - after many HIT
  systems have been installed.

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Core Issues

• Where HIT standards do exist they may also
  compete, making interoperability more difficult
  to achieve.
• A lot of computerized clinical data are stored in
  ageing legacy systems in proprietary formats
  which are difficult for other systems to access,
  re-represent and transfer for (re)use. (The use
  of proprietary formats may also lock customers
  into specific information systems.)
• Implementation of interoperable health
  information systems may require a high degree of
  technical expertise not readily available to
  small organisations in particular.

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Future Work

• The Artemis project aims to support
  "interoperability of medical information systems
  through semantically enriched Web services.
• Ability to aggregate and share lifelong EHRs for
  patients with multiple stakeholders
• Potential in using combined clinical datafrom
  EHRs, patient health record systems (PHR) and
  wireless medical sensor devices
• Clinical research to analyze trends within
  patient populations for more effective research,
  and to evolve evidence-based care protocols.

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References

• http//www.sgsmp.ch/dicom/parisot1.pdf
• http//www.hcup-us.ahrq.gov/datainnovations/clinic
  aldata/FL20LOINCIntroductionHammond.pdf
• http//dicom.nema.org/
• http//www.sciencedaily.com/releases/2006/01/06010
  3182421.htm
• IST Results. "Building Interoperability Into
  Medical Information." ScienceDaily. ScienceDaily,
  4 January 2006. ltwww.sciencedaily.com/releases/200
  6/01/060103182421.htmgt.

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• Thank you