Business Case for Adoption:
Vendor Community
June 29, 2009
Copyright 2009. All Rights Reserved.
Google Open Source
Programs Office
Daniel Berlin
Senior Engilawyer
Copyright 2009. All Rights Reserved.
The Goals of NHIN and Google are
Complementary
The NHIN will enable health information to follow the
consumer, be available for clinical decision making, and
support appropriate use of healthcare information beyond
direct patient care so as to improve health.
Google’s mission is to organize the world's information and
make it universally accessible and useful.
“
We now live in a world where you can get information at your fingertips
on virtually every topic known to mankind, yet the most important area of
all — our health — we can’t easily get the information when we need it.
It’s time to change this once and for all.
Vish Sankaran, FHA program director
3
Copyright 2009. All Rights Reserved.
”
Google Health Embraces These
“Rules of the Road”
Data Portability
Consumers control their data regardless of
employers, health plans, or care providers.
Interoperability
Data owners should be able to securely exchange
data with different systems in a consistent manner.
Data Liquidity
4
Copyright 2009. All Rights Reserved.
Data from different sources should move over
networks with minimal costs, ‘friction’, and hassle.
Google Fully Supports Free and Open
Source – CONNECT is a Natural Fit
Google USES millions of
lines of open source code
Google RELEASES millions
of lines of open source code
– More effective than writing it all
ourselves
– Builds communities around
software
– Shares support costs for software
– Faster and more effective
development
– Gain the improvements of
everyone instead of just your own
5
Copyright 2009. All Rights Reserved.
– Give back something to the world
Google Health Plans to Connect to NHIN
The health ecosystem requires an
open, interoperable network
The value of the network is
dependent upon the number of data
providers and users in the network
— the more providers and users, the
more value (exponentially!).
6
Copyright 2009. All Rights Reserved.
Google Health Plans to Connect to NHIN
The health ecosystem
requires an open,
interoperable network
7
Copyright 2009. All Rights Reserved.
The value of the network is dependent upon
the number of data providers and users in the
network — the more providers and users, the
more value (exponentially!).
Initiate Systems
Deanna Cagney
Director of Product Marketing
Copyright 2009. All Rights Reserved.
Initiate Systems, Inc.
Enabling healthcare providers and state/regional
exchanges to connect, share, and securely use
patient data within and across boundaries
• Industry standard for patient registry & health
information exchange (HIE) solutions
• Proven experience in HIE and patient data
management
–
76 Providers / IDNs and 40 health information
exchanges
–
Eight Canadian provinces, supporting the pan
‐Canadian electronic health record.
–
Patient registry in Nationwide Health Information
Network (NHIN II) and all four of the NHIN I
demonstrations
• 192 customers across 10 market segments
• Cited as ‘leader’ by Forrester & Gartner
9
Copyright 2009. All Rights Reserved.
The Challenges of Interoperability
Processes for
data sharing
inconsistent
Family
History
Patient
Symptoms
Availability and
quality of data
varies
Health
Data
Treatment
Records
10
Copyright 2009. All Rights Reserved.
Admission
History
Approved
Physicians
Prescription
History
Unclear
funding
models for
sharing
Exam
Records
Data ownership –
how to stay up to
date?
Need to manage
and audit patient
privacy
preferences
CONNECT: Addressing the Challenge
Hospital
1
• Federated data model
• Common message
choreography and data sets
Hospital
2
Hospital
3
Exchange
Hospitals
• Patient privacy protection
Public Health
NHIN
• Open and interoperable
• EMPI at the foundation
11
Copyright 2009. All Rights Reserved.
Payers
Social
Programs
Pharmacies
Family
Services
Target Architecture (message from NHIN)
Legend
NHINC
Components
Customizable
Components
Replaceable
Components
NHIN
Message
EMPI:
What You Need
To Support HIE
Subject
Discovery
Subject
Discovery
Document
Query
xx
Sub.
Management
Document
Retrieve
xx
xx
xx
xx
xx
xx
xx
Notification
Processing
xx
xx
xx
xx
Audit
Reporting
xx
xx
xx
xx
UDDI
Sharing
xx
xx
xx
xx
xx
xx
xx
xx
xx
xx
NHINC Service Components
Patient
Correlation
Repository
Audit
Repository
UDDI
Document
Cache
Performance
Integration
UDDI
NHIN Message Orchestration Components
xx
Accuracy
Doc Retrieve /
Query
NHINC Gateway
Authroization/Messaging Framework
xx
Enterprise Master
Patient Index
Document
Subscription /
Notifications
Standards and/or
NHIE based messages
(hl7v3, xds, etc)
MPI
Subscription /
Notifications
Policy
Document
Agency Adapter
Security
SDK Services
Agency Integration Software
Subscription
Manager
CPP Repository
Policy Engine
MPI
Copyright 2009. All Rights Reserved.
Doc Registry
12
Transformation
Doc Repository
Stewardship/Quality
Terminology
Other services
CONNECT: Selecting the Right Solution
Initiate’s ContributionCommunity & Technology
Enterprise Master Person Index
Patient-Provider Relationships
Initiate CONNECT
Gateway Adapter
CONNECT Community
Forum for Initiate
Customers
13
Copyright 2009. All Rights Reserved.
Integration
Initiate CONNECT
Gateway Adapter
Security
Data Stewardship
Data Quality & Reporting
A Connected Community Vision
Capital
Health
Authority
Province of BC
Province of
Newfoundland
Province of
Saskatchewan
Calgary
Health
Region
Province
of Alberta
Province
of Manitoba
PAML
NORRad
Province of
New Brunswick
Providence
State of ND
Maine General
Deaconess
Peace
Health
MN E-Health
BCBS of MN
DCIPA
St. Alphonsus
United
Health
Surescripts/
Optum
RxHub
Long’s
Sutter HealthSutter Health
Catholic
Healthcare
West
Intermountain
BS of CA
Iowa
Health
Ingenix
UC, Davis
Albertsons
Children’s
Hospital
BCBS of
Kansas
St. Joseph
of Orange
Luther
Midelfort
Independent Active Health
HealthServe
EHealth Health
HACCNY
Ontario Association
UMass
HIXNY
CVS/Caremark
Bronx RHIO
Carefirst BCBS
Conemaugh Lehigh
Rockford
Brooklyn RHIO
Memorial
Valley
Hospital
NYCLIX
Ohio Health West
Advocate
Spectra/Lab LIPIX
Penn
Walgreens
Kroger’s
Veterans
Northwest
UPMC
Affairs (VA)
Comm. Hosp.
Surescripts/
RxHub
Anthem
Sentara
BJC
LEGEND:
Riverside
Moses Cone
Humana
Trinity Health
ProHealth
Carespark
OK Health
Authority
Cedars-Sinai
WellPoint
Catholic
Healthcare West
Presbyterian
Health
NCHICA
Carolinas
HealthCare
Delta Health NGHS
Alliance
Lovelace
Foundation
Long Beach
Network
Pharmacy & PBMs
Baylor
Sandlot
Availity
Louisiana Rural
Ochsner
H Lee Moffitt
University
Community
Copyright 2009. All Rights Reserved.
Payers
Health Exchanges
Athens Regional
14
Providers & IDNs
Wal-Mart
Banner Health
UPH UPH
Province of
Nova Scotia
CONNECT: Business Value
Share Information
Across Silos
Break down data silos
between federal
agencies and providers
Expand to citizen
services
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Copyright 2009. All Rights Reserved.
Achieve a Virtual
Nationwide View
Enable connected
communities
to leverage existing
investments
Maintain data
ownership
Reduce Cost
of Care
Improve Care
& Safety
Ensure trust and
data integrity across
all participants
Improve quality of
care and patient
safety
Increase adoption
Information at the
right place at the
right time
Eliminate redundant
actions
Science Applications
International Corporation
David Dobbs
Program Manager
Copyright 2009. All Rights Reserved.
SAIC Business Overview
Our Successes
Business Areas
–
–
–
–
–
–
Health
Energy
Environment
National Security
Critical Infrastructure
40 years of continuous growth
» $10.1 billion in annual revenues for fiscal year 2009
» FORTUNE 500® company - #266
–
Highly skilled staff of professionals
» Nearly 45,000 personnel worldwide
» 10,000 employees with advanced degrees
» 19,000 with security clearances
Experienced Staff
12% With Less
Than 5 Years
74% With More
Than 10 Years
8% Administrative
10% Managerial
14% With
5–10 Years
82% Technical
Professionals
6% Ph.D.s
36% Master’s
Degrees
Higher Education
58% Bachelor’s
Degrees
53% Sciences
17
Copyright 2009. All Rights Reserved.
16% Humanities,
Social Sciences
15% Engineering
16% Business,
Economics/Law
Fortune 500 is a registered
trademark of Time, Inc. in
the U.S. and/or other
countries.
Health Solutions
• More than 1,900 employees
• Health domain expertise includes:
– MDs, PhDs, MPHs, RNs, DDSs, epidemiologists,
biostatisticians, psychologists, pharmacists,
radiologists, labratorians, informatics specialists,
biochemists, toxicologists, microbiologists
Solutions
• Health IT specialists include:
– Enterprise architects, network, systems,
and security engineers, software
engineers/developers, web developers, network
administrators, database engineers,
software test engineers, configuration
and data management specialists
18
Copyright 2009. All Rights Reserved.
Technology
Domain Expertise
U.S. Health IT Context
• National imperative for Health IT adoption
– Controlling costs
– Improving quality and patient outcomes
• Critical policy challenges1
– Driving the adoption of electronic health records (EHR)
– Making EHRs interoperable
– Ensuring EHRs help improve health care quality and efficiency
• Health information exchanges (HIEs) are connecting hospitals,
clinics, and laboratories to share interoperable health information
1- Summarized from D. Blumenthal, The Federal Role in Promoting Health Information Technology, The Commonwealth Fund, January 2009
19
Copyright 2009. All Rights Reserved.
Selected SAIC Health Information
Exchange Projects
Project
Stakeholders
CDC
BioSense
Public Health Situational
Awareness through Health
Information Exchanges
Military Health System’s (MHS)
Composite Health Care System
(CHCS)
VA/DoD Data Sharing Research
& Development
Departments of Veterans Affairs
and Department of Defense
20
Copyright 2009. All Rights Reserved.
Centers for
Disease
Control
CDC
Centers for
Disease
Control
BioSense
INHS
Inland
Northwest
Health
Services
WA DOH
Washington
State Department
of Health
MHS
Military
Health
System
VA
Department
of Veterans
Affairs
DoD
Department
of Defense
CONNECT Business Drivers
• Sharing interoperable health
information
– Enabled by a standards-based,
agreed-upon architecture
– Extensible because it’s open source
• Adoption by health information
exchanges (HIEs) and federal / state
agencies for clinical data sharing
– Between HIEs to improve patient
care
– Between HIEs and federal agency
for reporting, quality and research
– Some states are beginning to adopt
(such as Washington, Indiana, and
New York)
21
Copyright 2009. All Rights Reserved.
• CONNECT adoption drives
exponential value
– Increased access to distributed
health care information
– Accelerated ability to improve patient
outcomes, public health and quality
CONNECT – Linking Health Care
VA
MHS
Health Care
Delivery
Department
of Veterans
Affairs
Hospitals
Clinics
Pharmacies
Military
Health
System
Radiology
IHS
Indian
Health
Service
CONNECT
NHIN
CONNECT
SOA Platform
Laboratories
CDC
SSA
Centers for
Disease
Control
Social Security
Administration
Health Care
Data Users
22
Copyright 2009. All Rights Reserved.
CMS
State & Local
Public Health
Centers for
Medicare and
Medicaid
Services
NIH
National
Institutes of
Health
FDA
Food and Drug
Administration
SOA = service-oriented architecture
SAIC CONNECT Services
• Make electronic health records (EHRs) interoperable
– Terminology Services to create semantically interoperable health care data
• Terminology subscriptions
• Standards-based encoding of health care data
• Encoding translation services
– Reliable Messaging for secure information delivery
• Security – authentication, encryption, non-repudiation, HIPAA-compliant
• Reliability – guaranteed delivery, non-repudiation, audit logs, automated retries
• Use EHRs to improve health care quality and efficiency
– Health Care Knowledge Base for analyzing EHR data
• Public health reportable conditions and outbreak alerts
• Centers for Medicare and Medicaid Services quality guidelines
• Clinical research support
• Adverse event identification
23
Copyright 2009. All Rights Reserved.
SUN Microsystems, Inc.
Catharine Evans
Director, SunFederal
Copyright 2009. All Rights Reserved.
Sun's Strength in Healthcare
History in Healthcare with Thousands of Clients Worldwide
Prominent Healthcare Clients
Significant Drivers for Health Information Exchange
90%
77%
80%
70%
60%
60%
50%
44%
37%
40%
29%
21%
30%
20%
10%
0%
P r o v id e r
in e f f ic ie n c ie s
d u e t o la c k o f
d ata to s u p p o r t
p a t ie n t c a r e
Innovation
25
Copyright 2009. All Rights Reserved.
Ris in g
h e a lt h c a r e
co s ts
Experience
A v a ila b ilit y of
g r a n t f u n di n g
In c r e a s e d
n a t io n a l
a t t e n t io n o n HIT
a n d HIE
P u b lic h e a lt h
s u r v e illa n c e
ne e ds
De m a n d f o r
p e r fo r m an ce
in f o r m a t io n
Knowledge
Sun's Open Source in CONNECT
Sun in Healthcare
Health
Information
Exchange
Integration with
infrastructure,
SOA and
composite
applications
Compliance
Privacy, identity
management,
access control,
fraud detection
and activity
monitoring
Secure
Data
Management
Caregiver
Mobility with
Security
Information
lifecycle
management
& identity
management
Business and
clinical
transformation
through secure,
instant access
to patient
information
CONNECT
NHIN
27
Copyright 2009. All Rights Reserved.
Payer
Efficiency
Consumercentric
approach to
healthcare
delivery, care
management
and business
workflow
Sun's Healthcare Pack:
Supported Architecture for CONNECT
GlassfishHealth
– HL7 Binding Components
– Master Patient Index
– OpenSSO integration with HTTP BC
– PIX/PDQ support
– XDS/XCA
– Advanced Graphical Mapper (HL7, etc)
– NC PDP
– XACML Support
– Open SSO - graphical support of XSPA
policies
28
Copyright 2009. All Rights Reserved.
Sun's Healthcare Pack:
Supported Architecture for CONNECT
• Sun's Product Support
– 7x24 Support
• Indemnified
• Sun Professional Service
Offerings – CONNECT
– Setting up the CONNECT
Environment
– Assisting the MPI configuration
– Integration Support
29
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Vangent, Inc.
Jeanne O’Kelley
Senior Vice President
Technology Excellence Center
Copyright 2009. All Rights Reserved.
Business Case for Adoption
• CONNECT
– Instantiation of Health Standards
• Open Source
– Government/Industry Collaboration
• Customer Support
– Federal Agencies
– State and Local
– Commercial
31
Copyright 2009. All Rights Reserved.
XDS.b – An Essential Part of
CONNECT Gateway Capability
Supports federated document repositories and
a document registry that create a longitudinal record of
patient information within a healthcare community
Consumer Preferences Profile
Subject
Discovery
Query Audit Log
Query for
Documents
Retrieve Documents
Health Information
Event Messaging
Authorized Case
Follow-up
NHIE Services Registry
Authorization Framework
Messaging Platform
32
Copyright 2009. All Rights Reserved.
Diagram Source: FHA CONNECT Software Architecture Document, 31 March 2009
XDS.b “Plug and Play”
CONNECT Gateway Integration
AGENCY B
AGENCY A
Locate Patient
Records
CONNECT
Solution
Locate
Patient
Records
Retrieve
Patient
Records
CONNECT
Solution
XDS.b
Registry
Locate
Patient
Records
Existing
Agency
System(s)
Register Patient
Records
Store
Patient
Records
Retrieve Patient
Records
XDS.b
Repository
Retrieve
Patient
Records
IHE/HITSP compliant solution that unleashes EHR data from agency
systems and makes data available for use over the NHIN
33
Copyright 2009. All Rights Reserved.
Health Information Exchange
Open Source (HIEOS)
Released in “Open Source”
Vangent’s XDS.b implementation is available in “open
source”
– Is scheduled to be part of CONNECT’s September release
– Part of Vangent’s Health Information Exchange Open Source (HIEOS)
project available at the following URL: http://kenai.com/projects/hieos
– Includes:
• Wiki Site
– Architecture Description
– Setup and Configuration Guide
• Discussion Forums
• Mailing Lists
• Issue Tracker
• Software Source Code
34
Copyright 2009. All Rights Reserved.
Harris Corporation
Dr. Bart J. Harmon
Chief Medical Officer
Copyright 2009. All Rights Reserved.
CONNECT: Addressing Integrator
Motivation and Challenges
• A part of the new Health Ecosystem
• Current work is developing the
freely available CONNECT
services, providing Help Desk
Support and Engineering Services
• Supported government agency
participation in the December, 2008
NHIN Forum
• Culture, tool sets and partners vary
widely across various institutions
and Health Information Exchanges,
creating slightly different challenges
when supporting each entity
36
Copyright 2009. All Rights Reserved.
Why does an integrator want to work
in this space?
Reasons for supporting CONNECT:
• Helping establish part of a new health ecosystem where entities
compete on value and customer service rather than controlling
information
• Based on national standards
• Enabling providers
• Empowering patients
• Streamlining payors
• Supporting the protectors
• Opportunity to work in a space where we will have a chance to be
useful as long as we are helpful
37
Copyright 2009. All Rights Reserved.
CONNECT’s Value for an Integrator
Converting waste into value via information availability –
Supporting fundamental transformation in
– Clinical processes
– Health business processes
– Surveillance processes
– Lighten the burden of run-away health costs on the economy
– Provide quality care to more people
– Put individual people more in control of their health information
and health experience
Many entities will want help with these services, to include
integration support
Platform on which to re-purpose technologies from other
areas of expertise into the health space
38
Copyright 2009. All Rights Reserved.
RelayHealth, Spartanburg
Regional Health System,
NXT Health
Partnership to Provide Continuity
of Care for Wounded Warriors
Chris Ingersoll
Director, Interoperability Product Management
Copyright 2009. All Rights Reserved.
CONNECT:
Addressing RelayHealth’s Goals
• RelayHealth’s Business Drivers
– Maximize the breadth of longitudinal information that can be provided to
health systems, physicians and patients
– Prepare health system customers for transformation caused by ARRA and
health reform – The need to share and exchange clinical information
– Provide improved access, support and continuity of care for military personnel
receiving private sector health care
• RelayHeath’s Current HIE Offerings
– Clinical health record viewer
– Integrated patient PHR with secure messaging
– Referrals and patient health record sharing
– Results and clinical documentation distribution
– Clinician messaging amongst physicians and members of a Care Team
40
Copyright 2009. All Rights Reserved.
RelayHealth-Spartanburg Partnership
Spartanburg Regional Health System
• Network of hospitals and physician offices across
five counties in SC
• “Hospital of the Future”: recipient of Congressional
Special Interests projects
NXT Health
• Non-profit research and design organization
affiliated with SRHS
• Undergoing study of health record sharing
between military and private health systems
through Spartanburg’s grant
Partnered with RelayHealth
• Demonstrate Spartanburg physician and patient
access to medication history, allergies, and
diagnoses data from DoD
• Project funded by Spartanburg and McKesson
managed through TATRC
• Three developers for two months
41
Copyright 2009. All Rights Reserved.
Demonstration Use Case
2. Dr. Smith receives
webVisit, indicates in
RelayHealth that he
has Sonja’s consent to
view DoD data
4. Dr. Smith notes a possible
medication allergy, prescribes
new medication and schedules
in-person appt
EHR
webVisit
Sgt. Sonja
1. Sgt Sonja, recently
returned home, develops
an infected rash from
lingering burn wound.
She fills out online
consultation to Dr. Smith,
her private sector PCP
42
Copyright 2009. All Rights Reserved.
RelayHealth
Health Summary Manager
Dr. Smith
CONNECT
DoD Test Server
(Harris)
3. Via CONNECT, DoD
data is added to Sonja’s
RelayRecord
Personal Health Record
Sgt. Sonja
5. Sonja receives message,
sees that her PHR has
been updated with DoD
health data
Health Summary Viewer
Physician view
Patient consent
designation
Allergies from DoD
Medications from
SureScripts, DoD,
patient entered, and
physician entered
Diagnosis from DoD
43
Copyright 2009. All Rights Reserved.
Personal Health Record
Patient view
The data that the
physician pulled from
DoD can be viewed by
the online patient.
44
Copyright 2009. All Rights Reserved.
Selecting the Right Technology for
RelayHealth
Demonstration goals:
– Data integration: Automated load of
health summary data into
RelayHealth through CCD
Long-term goal:
– Plug RelayHealth network into the
NHIN
– Connectivity: Ability to pull data
from a federal facility
CONNECT Gateway provided
connectivity
– Successful integration from .NET
environment
– Took care of plumbing, allowed us to
focus on data integration and
presentation changes
– Good documentation and support
45
Copyright 2009. All Rights Reserved.
CONNECT’s potential as a
complete network-network
connectivity solution
– Comprehensive functional scope
– Open-source
– Federal adoption
Value of CONNECT for RelayHealth,
Spartanburg and NXT Health
RelayHealth
– More connectivity means higher quality care and better patient outcomes
– SaaS model: low costs to provide this connectivity to all of our customers
– Step towards providing comprehensive care for our men and women in uniform accessing
private sector health care
Spartanburg Regional Health System
– Recognition as the National test site for connectivity of patient record systems
– Serves as a model for data sharing within the larger civilian community
– Potential to expand RelayHealth personal health record capabilities to patient population
NXT Health
– Use this interoperability model and apply it to other research projects within the larger
context of the patient room of the future
– Serves as a proof of concept phase to assist in recruiting potential partners for continuation
of research efforts
46
Copyright 2009. All Rights Reserved.
Cisco’s ‘Medical Data Exchange’
(MDES) Solution
Greg Pippin
Solution Architect
Copyright 2009. All Rights Reserved.
Market Drivers & Current Environment
Drivers
Current Environment
– Cost reductions and avoidance
– Manual fax, copy
– Lost productivity
– Burn and transport CD ($10/CD)
– Interoperability of patient data
exchange
– Multi-system log-ins
– Data is needed locally but
stored centrally
– Importation of unstructured
data into structured data
48
Copyright 2009. All Rights Reserved.
– Point to point proprietary
interfaces
– Proprietary health information
exchanges (HIE)
Medical Data Exchange – Enabling
The Method Patient Centric Access
System A
System B
DICOM
HL7 v 2.5
HL7 v 2
HL7 v 3
ISO 10781
IETF
EDI
XML
SOAP
Network Broker
49
Copyright 2009. All Rights Reserved.
IHE
Network Broker
Solution Benefits
Cost Reduction
– Eliminate $10/CD & associated labor
– CD burner maintenance costs
Improve Productivity
– Interoperability between systems reduces
efficient record access
– Reduce retests & rescans
Improve Quality of Care
– Reduce delays in patient care
– Address incomplete information for
treatment decisions
– Reduce delays in patient care
50
Copyright 2009. All Rights Reserved.
Medical Data Exchange Enables Patient
Centric Integration & Access of Records
• Enables interoperability between
disparate systems
• Enables the network as the platform
for secure & standards based access
& exchange
• Eliminates the need for manual
transport of records & images
• Standards based (IHE) based PACS
& EMR access
• Common patient identifier with
network based IHE Cross Reference
Manager & XDSi
51
Copyright 2009. All Rights Reserved.
What is the Medical Data Exchange
Solution?
Cisco AXP
Network module
Cisco ISR
Router
+
Globally leading SW solution for
IHE based medical data exchange
Cisco and Tiani-Spirit offering a joint Medical Data Exchange Platform
consisting of the ‘Spirit’ IHE SW stack based on the globally standardized IHE
framework.
Tiani Spirit-AXP runs on the Application eXtension Platform inside Cisco’s
Integrated Services Router (ISR+AXP). It connects general practitioner’s
systems, pharmacy software systems & hospital information systems with the
eHealth infrastructure.
52
Copyright 2009. All Rights Reserved.
Federated Data Distribution
Enables Scaling
• Interoperability is based on a federated concept
• Avoids copying all data centrally (Cross Reference Manager)
• Retains data where it was produced originally.
• Data is kept as well on a regional level for redundancy purposes (orange level)
• IHE‚ Cross Reference Manager enables communications between the regions
(red) or countries (white)
Cross-Community
Level
(scalable to any
hierarchic level)
Community
(Cross-Enterprise)
Level
Responding
Gateway
PIX+
PIX/PDQ
XDS
(Repository,
Registry)
Responding
Gateway
Initiating
Gateway
Spirit
Archive
Spirit Central Adapter (SCA)
Enterprise
Level
53
Copyright 2009. All Rights Reserved.
Spirit Local Adapter (SLA)
Spirit
Archive
IHE Client, Legacy Client
DICOM
Client
MDES Reference in Wels Healthcare
(Austria)
Prior Environment
• 64 sub-systems in one hospital
• Organizational environment
constantly changing
• Unscalable
• Difficult to integrate GP’s into the
hospital environment
• 1500 proprietary data interfaces
• Multiple patient Indexes
“
Tiani Spirit software, based on Cisco and Intel technology has enabled us to substantially
raise the level of information where it is needed and when it is needed, to help our
doctors in their effort to provide the best care possible for our patients.
Dr. Walter Aichinger, Chief Physician of the Klinikum Wels-Grieskirchen
54
Copyright 2009. All Rights Reserved.
”
MDES Value Proposition:
Better & More Cost-effective Care
• Improve productivity
– Clinicians can access records from different institutions in a simple
and straightforward manner
• Lower cost
– Avoid redundant clinical tests or procedures w/ access to this data
• Improve patient care
– Diagnosis & treatment plans w/ a more holistic view of a patient's
record
• Avoid Costs
– Eliminate the need for production of CD's to transport images
55
Copyright 2009. All Rights Reserved.
CONNECT and Mirth Gateway –
Streamlining NHIN Connectivity
Gary Teichrow
Vice President and Chief Architect
Mirth Corporation
Copyright 2009. All Rights Reserved.
Who is Mirth Corporation?
Mission:
•
Mirth Corporation delivers standards-based
open source infrastructure tools and services for
healthcare
•
We reduce the time, cost and technology barriers to
information exchange in healthcare, leveling the HIT
playing field for healthcare organizations of all sizes
Vital Stats:
•
Launched in 1993, focused since 1999 on Health IT
•
Incubator of open source Mirth Project – 70,000
downloads worldwide
•
Provide OSS, support, professional services, purposebuilt appliances
•
Technology partner to leading HIEs and HIE Vendors
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CONNECT: Addressing Real World
HIE Interconnect Challenges
• How to connect Orange County ConnectCare with
Long Beach Network for Health?
– OC and LBNH HIEs wanted to share health information
– Each used different software with different capabilities
• Possible Opportunity using NHIN interface
– LBNH had NHIN gateway as an NHIN trial cooperative participant
– OC interested in using the NHIN interface, but needed software
• Challenges
– Not enough time to develop custom NHIN gateway for OC
– No apparent commercial NHIN gateway software available
– Limited budget to perform the work
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Selecting the Right Solution for
OC/LBNH
• Possible Solution with CONNECT
– CONNECT 2.0 released during analysis phase of project
– Provided OSS solution to OC NHIN gateway requirement
• Scope of Work
– Download and understand software
– Port to Linux and PostgreSQL
– Adaptor integration (ER Connect, Mirth
Match, Mirth Connect)
• Solution
– Use Mirth Connect (integration engine) as
glue between ER Connect (OC) and NHIN
CONNECT adaptor layer
– Download to demo in less than a month
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CONNECT in Action:
One Success Leads to Another
California eHealth Collaborative Statewide NHIN Demo
Participants
• Kaiser Permanente (KP NHIN Gateway)
• Long Beach Network for Health
(MedPlus/FirstGateways)
• Orange County ConnectCare (CONNECT)
• Redwood MedNet (CONNECT)
• Santa Cruz HIE(Axolotl)
Redwood MedNet connects to NHIN for demo
• Mirth Corporation implemented CONNECT at
Redwood MedNet
• Integrated to Mirth Results
• Up and running in 3 days!
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CONNECT in Action:
…and Another
HealthBridge and Redwood MedNet Interstate Demo
Participants
• HealthBridge
–
–
–
–
–
24 hospitals in KY, OH and IN
5000+ physicians at 700+ practices
25 million results delivered in 2008
17 local health departments
National, hospital and physician office labs
– 70+ EMR feeds to MD practices
– Interfaces with 25+ EMR vendors
– 70+ HIS/Data inbound connections
• Redwood MedNet HIE
–
–
–
–
–
–
Mendocino, Lake and Sonoma Counties
4 rural hospitals
3 independent laboratories
2 local health departments
FQHCs, RHCs, and private practices
Long Term Care
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NHIN
What’s Next: Mirth Gateway –
How You Can Leverage CONNECT
Mirth Gateway Appliance
Ready-to-run appliance based on OSS stack
• CONNECT (OSS NHIN gateway)
• Mirth Match (OSS EMPI)
NHIN
• Mirth Connect (OSS interface engine)
Accelerates NHIN Deployment
• Simplified setup and configuration
• Simplified administration and monitoring
• Automated patch management
• Physical or virtual appliance
Mirth Connect simplifies “last mile”
• Channel-based connectors ease integration
• Connect to NHIN via HL7, database, web services, FTP/SFTP/file system
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Jericho Systems Corporation
Brendon Unland
President and Founder
Copyright 2009. All Rights Reserved.
Historical Analogy:
Transcontinental Railroad
• Engineering Marvel of 19th Century
• Began 1862: Finished 1869
• Shortened Trip of 5 months
to 5 Days
• Extreme Technical Challenges
• Ingenius Collaboration Between
Government and Business
• Necessity of Standards
• Bound the Nation Revolutionizing
Population and Economy
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Jericho Systems’
Current Business Model
• Founded in 2002
• Security Decisioning Software
and Services
– Primary Clients are U.S. DoD,
Intelligence Community, and Federal
Agencies
– SOA-enabled Products Incorporate
Open Standards: SAML, XACML,
WS-Security
– Flagship Product: EnterSpace
Decisioning Service (EsDS) Includes
Policy Decision Point (PDP)
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Jericho Systems’
Current Business Model
Traditional Software Business Model
Licenses
Maintenance
Professional Services
Move into Health Care Market
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Jericho Systems’
Health Care Background
Participated in CrossEnterprise Security and
Privacy Authorization (XSPA)
Demo at HIMSS 09
• Demonstrated OASIS Advanced
Privacy, Consent, Access Control-Beyond Opt in/ Opt out
• Functionality Moving into Future
CONNECT Solution Release
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Component of Flagship
Product Utilized
• Policy Decision Point (PDP)
• XACML Compliance
• Logging
Jericho Systems’
Health Care Business Model
EnterSpace Continuum for Health Care
• Embrace Open Source: Donate
EnterSpace Health Care
Community Edition for Inclusion
into CONNECT Solution
• Potential Cloud Offering
• Provide Professional Services
including:
– SOA-centric Identity and Access
Management Consulting
– Standards Compliant Integration
– Policy Engineering for Security
& Privacy
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Conclusion:
CONNECT Community
Opportunity to Join
Community that:
•Impacts and Improves the Future
Cheyenne, Wyoming: 1882 and Now
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•Profits Those that Labor for the
Community
CONNECT Seminar
Presentations are Available
for Download Online at
http://www.connectopensource.org
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