WEDNESDAY, 3:30 – 3:50PM
NHIN Specifications
Richard Kernan, NHIN Specification Lead (Contractor),
Office of the National Coordinator for Health IT
Karen Witting, Contractor to the North Carolina Healthcare
Information and Communications Alliance (NCHICA), NHIN Specifications Factory
NHIN Specification Framework
Service Oriented Architecture (SOA) approach results in a
framework of NHIN Specifications
• Modular design, based largely on IHE Technical Framework
• NHIN specifications instantiated in a NHIN Gateway
• Scope covers inter-gateway exchange only
• Implementations may vary to accommodate business needs
HIMSS 2010
2
NHIN Specification Framework
Transaction Profiles
Utilize exchange patterns for specific transactions
CMS CARE
Doc Submission
CDC GIPSE
HIEM
MITA
Eligibility Verification
Discovery and Information Exchange Services
Rely on foundations to enable exchange patterns
Discovery
Patient
Discovery
Pull
Services
Registry
Query &
Retrieve Docs
Eligibility
Verification
Push
Pub/Sub
Doc
Submission
HIEM
Messaging, Security, & Privacy Foundations
Enable private, secure, and interoperable communication of health information
Messaging Platform
Authorization
Framework
Designates Pilot Use
HIMSS 2010
3
Messaging, Security, and Privacy Foundations
Messaging Platform
defines how NHIN nodes must
authenticate each other and
encrypt the information
exchanged between them
• SOAP 1.2 over HTTP
• WSDL 1.1, WS-Addressing 1.0, WS-Policy 1.5
Leverages widely-used standards
for message transport and security
• Public Key Infrastructure (PKI) to encrypt, creating
secure channel using TLS; mutual authentication
• X.509 certificates as basis for node authentication
• AES-128 bit encryption
• Messages headers digitally signed
WS-I Basic
WS-I Security
Messaging, Security, & Privacy Foundations
Enable private, secure, and interoperable communication of health information
Messaging Platform
HIMSS 2010
Authorization
Framework
4
Messaging, Security, and Privacy Foundations
Authorization Framework describes how nodes
must provide each other with information needed
to inform local authorization decisions
Local Autonomy
• Decision to release information is that of the
responding node; must be supplied with
information characterizing request initiator
Local Accountability
• Initiating node accountable for accuracy of info
provided to responder
SAML 2.0 Assertion
•
•
•
•
•
Contained in SOAP Header security element
Authentication Statement
Attribute Statement
Authorization Decision Statement (O)
Digitally Signed
Messaging, Security, & Privacy Foundations
Enable private, secure, and interoperable communication of health information
Messaging Platform
HIMSS 2010
Authorization
Framework
5
Discovery and Information Exchange Services
• Services Registry Interface – means for nodes to interact with UDDI Registry
for node and endpoint discovery
• Patient Discovery – provides a means for a NHIN node to query another to
determine if it is a source of information for a specific patient
• Query & Retrieve Docs – an exchange pattern that allows NHIN nodes
to locate and retrieve patient-specific clinical documents held by other
NHIN nodes
Discovery and Information Exchange Services
Rely on foundations to enable exchange patterns
Discovery
Services
Registry
Pull
Patient
Discovery
Query &
Retrieve Docs
Eligibility
Verification
Push
Pub/Sub
Doc
Submission
HIEM
Designates Pilot Use
HIMSS 2010
6
Discovery and Information Exchange Services
• Eligibility Verification – an exchange pattern that allows NHIN nodes to
determine if a patient is eligible for health plan coverage
• Document Submission – a push mechanism that allows an initiating NHIN
node to send one or more documents for a given patient to a receiving node
• Health Information Event Messaging (HIEM) – a publish/subscribe exchange
pattern that allows a NHIN node to establish a subscription to information
held by another node for periodic exchange
Discovery and Information Exchange Services
Rely on foundations to enable exchange patterns
Discovery
Services
Registry
Pull
Patient
Discovery
Query &
Retrieve Docs
Eligibility
Verification
Push
Pub/Sub
Doc
Submission
HIEM
Designates Pilot Use
HIMSS 2010
7
Transaction Profiles
Continuity Assessment
Record and Evaluation
(CARE)
Geocoded Interoperable
Population Summary
Exchange (GIPSE)
Describes how Document
Submission service may be
used to exchange CMS
CARE data for transfer-ofcare scenarios (C-HIEP)
Exchange of CDC GIPSE data
using the HIEM service for
population health
biosurveillance purposes
(CDC Pilot)
MITA Medicaid Eligibility
Verification
Defines how CAQH CORE
may be used to perform
administrative Medicaid
eligibility verification
transactions using the NHIN
(HIMSS Demo)
Transaction Profiles
Utilize exchange patterns for specific transactions
CMS CARE
Doc Submission
CDC GIPSE
HIEM
MITA
Eligibility Verification
Designates Pilot Use
HIMSS 2010
8
WEDNESDAY, 3:30 – 3:50PM
NHIN Scenarios
Scenario 1: New Patient
Identify Target NHIN Nodes
New Patient
Search for NHIN Nodes in
local states
List of local NHIN Nodes and
electronic information
exchange services available
HIMSS 2010
10
Scenario 1: New Patient
Discover Source of Patient Information
New Patient
Search for NHIN
Nodes in local states
List of local NHIN Nodes and electronic
information exchange services available
Request each target NHIN
Node identify a local
matching patient
Identify which target NHIN
Nodes which
have a matching patient
HIMSS 2010
11
Scenario 1: New Patient
Search for Relevant Documents
Identify which target NHIN Nodes
which have a matching patient
Each NHIN Node responds with
queried documents for patient match
List of documents available for
the new patient
HIMSS 2010
12
Scenario 1: New Patient
Retrieve Specific Documents
List of documents available for
the new patient
Request documents of interest
Clinical content needed to support the new
patient is available to the provider
HIMSS 2010
13
Scenario 2: Submit Patient CARE Summary
Sent to CMS
NHIN Node
Patient
released
Continuity Assessment
Record and Evaluation
(CARE) document
generated
Document
delivered
to CMS
Document verification
returned to sender
CMS
HIMSS 2010
14
Thank You
The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase
does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal
Health Architecture or the Department of Health and Human Services.
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