Open Source’s Role in CONNECTing the Public and Private Sector Healthcare CommunitiesDavid Riley Contractor, ONC/FHACONNECT LeadGOSCON 2010October 27, 2010

A Nation’s Call to Action

“We’ll be on our way to computerizing all of

America’s medical records, which won’t just

eliminate inefficiencies, save billions of dollars and

create tens of thousands of jobs – but will save

lives by reducing deadly medical errors.”

– President Barack Obama, February 4, 2009

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The Current State of Affairs: A Disjointed, Expensive Healthcare System

• U.S. spent approx. $2.2 trillion on health care in

2007 ($7,421/person). This comes to 16.2% of GDP,

nearly twice the average of other developed

nations. (Source: www.whitehouse.gov)

• Only about 8% of the nation's 5,000 hospitals and

17% of its 800,000 physicians currently use the

electronic health record (EHR) systems envisioned

for the whole nation. Most of today’s systems are

still not interoperable. (Source: CNN)

• Due to lack of interoperable EHRs, tests are

duplicated, information is unavailable at the point

of care, public health information is difficult to track

and health organizations carry a heavy

administration burden.

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The American Recovery and Reinvestment Act

(ARRA) invests $19 billion in computerized

medical records that will help to reduce costs and

improve quality while ensuring patients’ privacy.

ARRA promotes the national agenda by helping:

Increase access to care

Improve quality of care

Decrease the costs of care

Promote meaningful use of EHRs

ARRA and the President’s reform agenda focus on buildingopen and transparent government.

The National Health IT Agenda

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Federal Health ArchitectureAdvancing the Agenda

FHA ensures federal participation in ONC-led initiatives such as the Nationwide Health Information

Network, Direct Project, EHR adoption, and CONNECT

• E-gov initiative managed by ONC within HHS • 26+ federal agencies participate in FHA

cc

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Nationwide Health Information Network Exchange and CONNECT

The Nationwide Health Information Network is a set of standards, services, and policies that enable secure health information exchange over the internet.

• Nationwide Health Information Network Exchange connects a diverse set of federal agencies and private organizations to securely exchange electronic health information using the Nationwide Health Information Network services. (For example: SSA – MedVirginia, DoD, VA and KP)

CONNECT is a federally funded and developed open source reference implementation of the Nationwide Health Information Network Exchange standards and services.

• CONNECT is using an effective public – private collaboration to create a secure, standard platform for health information exchange

• Nationwide Health Information Network Exchange participants save resources by using CONNECT instead of developing their own implementation of the Nationwide Health Information Network Exchange standards and services

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Transaction ProfilesUtilize exchange patterns for specific transactions

CMS CAREDoc Submission

CDC GIPSEHIEM

Discovery and Information Exchange ServicesRely on foundations to enable exchange patterns

Messaging, Security, & Privacy FoundationsEnable private, secure, and interoperable communication of health information

Messaging PlatformAuthorization Framework

MITA Eligibility Verification

Discovery Pull Push Pub/SubPatient

DiscoveryHIEMDoc

SubmissionServices Registry

Query & Retrieve Docs

Eligibility Verification

Operational InfrastructureRuntime systems that support the Nationwide Health Information Network Limited Production Exchange

Security Infrastructure(managed PKI)

Web Services Registry

Access Control Policy

Nationwide Health Information Network Exchange Specifications and Operational Infrastructure

CONNECT Open Source Software ProjectPublic/Private Collaboration Delivers Results

More than 2,000 organizations from the public and private sectors participate in the CONNECT open source community.

• Social Security Administration: Able to reduce disability determination processing time by 42% receiving data from MedVirginia using CONNECT

• Department of Defense and Department of Veterans Affairs: Using CONNECT as part of their Virtual Lifetime Electronic Records initiative to support lifelong health needs of active duty military and veterans

• Centers for Disease Control and Prevention: Using CONNECT to receive de-identified public health data from regional public health organizations

CONNECT in ActionOpen Collaborative

Focus on collaborative progress in health IT has won many awards, including the Wall Street Journal Innovation Award.

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Reform Objectives

Reform Objectives

Meaningful Use Objectives

Meaningful Use Objectives

Transparent Government Objectives

Transparent Government Objectives

CONNECTMeeting Multiple Objectives

CONNECT promotes the widespread adoption of interoperable health IT.

It uses nationally recognized standards, conventions and trust agreements, to address multiple complex objectives simultaneously.

CONNECT is a federally funded, Open Source software solution that is a:

• Platform for Participation

• Platform for Innovation

Planning and Approach

• Identify the participants involved in the exchange

• Identify a business and technical contact for each participant

• Have a kick-off meeting with all participants

• For each participant, determine readiness

– What does each participant need (hardware, software and services)?

– What systems do they have?

– What method of exchanges can be supported?

• Create a template with the exchanges

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Exchange Template

From To Document Method Comments

Public Health Hospital Lab Result Push Content?

Provider Public Health Immunization Report

Publish, Subscribe

State Standard Report

Provider Public Health Lab Result Query/Response

Hospital Public Health NDC Codes Push National Standard

Public Health CDC GIPSE Publish, Subscribe

Nationwide Health

Information Network Profile

Note: This table will identify the adapter work to be achieved. There is potential for re-use.11

Draw a Picture of Your Exchange

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Planning and Approach (cont.)

• Set priorities by document/exchange type(s)

– Some will be easier than others depending upon readiness review

– We have templates available to assist with this information gathering

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Timeframes

• Two Gateways– Publish and Subscribe (fastest)

– Document Push (faster)

– Query/Response (not so fast)

• Requires ability to ID patients uniquely

• Requires ability to ID documents

• Requires ability to retrieve the documents

• Six months for initial project

• Three months for next release

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Cost and Skills

• CONNECT software is open source

• Business partners offer configuration and support

• Available as an “appliance” (approx 5K list)

• Adapter work depends on specific systems

• Skills

– Business Analyst, Health Information Exchanges and Standards

– Development, Java Skills, Healthcare Knowledge

– Testing and Support, SOAP UI

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CONNECT: An Open Source Community

• CONNECT Code is Released Underthe New BSD License

• Release as Open Source April 2009

• CONNECT Open Source Community Announcement June 2009

• CONNECT Community Events

– CONNECT Training Seminars/Webinars

– CONNECT Code-A-Thons

• CONNECT Community Focus– Getting organizations into production

exchanging health information

• Nationwide Health Information Network Exchange based production

• Non-Nationwide Health Information Network Exchange based production

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Test/Demo ProductionFederal Adopters

Centers for Disease Control & Prevention

Centers for Medicare & Medicaid Services

OFM (esMD)

OCSQ (PQRI)

OCSQ (C-HIEP)

CMSO (MITA Claims Submission)

Department of Defense

Department of Homeland Security

Department of Veterans Affairs

Food and Drug Administration

Federal Communications Commission

Indian Health Service

National Cancer Institute

National Disaster Medical System

Social Security Administration

2010*

2010*

2010*

2010*

2010*

2010*

2010*

2010-2011*

2010-2011*

2010*

2010

2009

2010*

2010*

2009

CONNECT and Nationwide Health Information Network * Planned

Nationwide Health Information Network/CONNECT Implementation Status

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Test/Demo ProductionNon-Federal Adopters

Center for Healthy Communities, Wright State University, Healthlink

Central Virginia Health Network/MedVirginia

Community Health Information Collaborative (CHIC)

Emdeon

EPIC

HealthBridge

Indiana State Department of Health

Iowa Department of Public Health

Iowa Health Systems

Kaiser Permanente

MedVirginia

MEDNET in Partnerships

Community Health Information Collaborative (aka HIE-Bridge)

LACIE –Lewis and Clark Information Exchange

Emdeon

Hielix – Phase 1 Contract for the State of North Dakota Statewide HIE

New York State Department of Health

Orange County ER Connect

Redwood MedNet

Regenstrief Institute, Inc.

Southeastern Michigan Health Association

Thayer County Health Services **Winner of CMIO Magazine Health Innovation Award** 2010

Washington State Department of Health

2010*

2010*

2009

2010*

2010*

2010-2011*

2009

2010-2011*

2010*

2010-2011*

2010-2011*

2010*

2009

2009

2010*

2010*

2010*

2010

2010-2011*

2010-2011*

2009

2010*

CONNECT CONNECT and Nationwide Health Information Network * Planned

Nationwide Health Information Network/CONNECT Implementation Status

Vendors Solutions with CONNECT

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Reflection Technologies

Two Major CONNECT Components Important to You!

• The Gateway handles interoperability between other gateways

• The Adapter (a “program”) handles operability with the organization andsystem providing the information. The adapter has tools to help with:

– Master Person Index

– Document Repository

– Integration Tools

– Policy Management

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CONNECT Adapter:Organizational SOA Starter Kit

Enterprise Service Components:

– Master Patient Index

– Policy Engine

– Redaction Engine

– Audit Services

– Document Registry/Document Repository

– Subscription Repository

– Re-identification Service

– Entity Integration Services

– SDK Services

CONNECT ArchitectureMessage from Nationwide Health Information Network

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CONNECT ArchitectureMessage to Nationwide Health Information Network

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CONNECT Community Portalconnectopensource.org

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