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A Study of Health Information Exchange and Interoperability System Solutions


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Title: A Study of Health Information Exchange and Interoperability System Solutions

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

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

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.

  • 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

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

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.

Benefits of Interoperability
  • For health researchers
  • Improve and increase the availability of medical
  • 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

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-based representation of information
    (CDA, CCD, CCDA)
  • Communication
  • IHE
  • XDS
  • Direct Project
  • eHealth Exchange

  • 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

  • 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.

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
  • 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.

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.

  • Solutions
  • For HIE

  • 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.

  • 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

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.

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.

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.

  • 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.

  • 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

  • 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.

  • Solutions
  • For Interoperability
  • Problem

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)
  • IHE integration statements are prepared and
    published by a vendor to list the IHE profiles
    supported by a specific release of a specific

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
  • Has received major support world-wide National
    regional projects, NHIN contractors, US EHR
    Vendor Assoc., complements Connecting for Health

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
  • Offer a consistent, standards-based and
    functional record sharing for EHRs, PHRs other
    IT Systems

  • 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

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
  • Universal use of LOINC would solve this problem,
    and there is momentum to move in this direction

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

  • 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.

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

Core Issues
  • Without interoperability, fundamental data and
    information such as patient records can't easily
    be shared across and sometimes within
  • 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.

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.

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.

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

  • Thank you
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