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Let’s Get Technical Group: April 17, 2020
Stephen Konya & Patrick Murta
Getting There FAST:
Barriers and Solutions for Adopting FHIR
In the NIC of Time…
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Agenda
Welcome, NIC Overview & New Participant Introductions
Today’s Webinar:
Topic: Getting There FAST: Barriers and Solutions for Adopting FHIR
Presenters:
Stephen Konya, Senior Innovation Strategist, Office of the National Coordinator for Health
IT (ONC)
Patrick Murta, Solution Architecture Fellow, Humana | FAST Initiative Chief Architect | Da
Vinci Operating Member
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Agenda
Upcoming Webinars:
• 04/24: It’s a WIN: A New Data-Driven Approach for Measuring Well-being –
Somava Saha
• 05/01: Interoperability Insights - State Health IT Connect Summit/SOC Institute
Collaboration (Gravity, DaVinci, Carin Alliance, Project Unify)
• 05/08: Getting Evidence into Practice: Lessons from the Opioid Crisis – Elisabeth Kato,
Roland Gamache, and Suchitra Iyer - Agency for Healthcare Research and Quality (AHRQ)
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What is the National Interoperability Collaborative (NIC)?
NIC is a “Community of Networks” designed to
increase collaboration within and across multiple
domains to improve health, safety, well-being and
operations.
We focus on Six Domains:
Human Services, Public Health, Education, Public Safety,
Emergency Medical Response, Health Care IT
"NIC is an idea whose time has come!"David Fukazawa, Managing Director of Kresge Foundation's Health Program
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NIC is collaboratively developing a National
Action Agenda over the next nine months.
It will serve as a roadmap to guide the design, development and
implementation of system-level, cross-domain
interoperability to advance SDOH post COVID19.
Getting There FAST: Barriers and Proposed Solutions for Scaling FHIR
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Presenters
PATRICK MURTA
Chief Interoperability Architect & Fellow, Humana
Chief Architect, FHIR at Scale Taskforce (FAST)
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STEPHEN KONYA
Senior Innovation Strategist, HHS/ONC
ONC Lead, FHIR at Scale Taskforce (FAST)
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Poll
What type of organization do you represent?
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• FAST Overview– What is FAST?– P2 FHIR to FAST– FAST Organization & Community Engagement– Collaborative Efforts
• Setting the Stage– API Overview– What is FHIR?– Why FHIR Adoption– Importance of Infrastructure
• FAST Progress & Proposed Solutions– Patient Journey– FAST Proposed Solutions– Identified Regulatory Barriers
• In Closing– FAST alignment with ONC Goals– Resources & How to Get Involved
Agenda
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The FHIR at Scale Taskforce (FAST), convened by the Office of the National Coordinator for Health IT (ONC), brings together a highly representative group of motivated healthcare industry stakeholders and health information technology experts.
What is FAST?
The group is set to identify HL7® Fast Healthcare Interoperability Resources (FHIR®) scalability gaps and possible solutions, analysis that will address current barriers and will accelerate FHIR adoption at scale.
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P2 FHIR to FAST
Ecosystem
Tiger Team
Identified &
Prioritized 21+
Use CasesQ2/Q3 2018
Executive
Steering
Committee
Formed & 1st
MeetingQ4 2018
Oct 2017 – Payer + Provider (P2) FHIR Taskforce EstablishedOriginally focused on Payer/Provider collaboration
Q1 2018 – Taskforce Charter CreatedProblem: Ecosystem and infrastructure barriers prevent wide-scale adoption and deployment of FHIRPurpose: Address ecosystem barriers and accelerate adoption of FHIR for production exchange of clinical information between payers and providersNeed: Establish a national architecture for standardized exchange of information using FHIRScope: Establish ONC taskforce that leverages “tiger teams” to focus on near term, practical approaches for the standardized exchange of information using FHIR
Initial Tiger
Team Calls
CommencedQ2/Q3 2018
P2 Becomes FAST
Jan 2019Same mission, new
name to better reflect
work FAST is doing
and broader
stakeholder
engagement
Technical &
Regulatory
Barriers v1
PublishedQ2 2019
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Use Cases v1
PublishedQ2 2019
Possible
Solutions to
Tech BarriersQ3 2019
Recommendations
for Regulatory
BarriersOngoing
1st FAST 101
Webinar
Sept 12th
10amET
1st TLC
Virtual Webinar
End of Sept
2019
Companion
“Scalability”
Guides & PilotsTBD
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TIGER TEAMS IDENTIFY:• Use Cases
• Technical/Regulatory Barriers
• Core Capabilities
• Gap Analysis
FAST Organization & Community Engagement
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UPDATES
FEEDBACK
TECHNICAL LEARNING COMMUNITY (TLC)
EXECUTIVE STEERING COMMITTEE
(public-private mix)
COORDINATING COMMITTEE
(public-private mix)
SEVEN TIGER TEAMS
Ecosystem Use Cases
Identity
Security
Directory, Versioning and Scale
Exchange
Certification and Testing
Pilots
Information Sharing with TLC through:• Website• Periodic webinars• Newsletters• TLC Meetings• LinkedIn Group
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Collaborative Efforts Towards FHIR Adoption
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FHIR SOLUTIONS FOR VBC
SHARED Technical Challenges to
FHIR SCALABILITY Common Scalability Approaches
RAPID INDUSTRY ADOPTION OF FHIR-BASED SOLUTIONS
Patient & Provider Identity Management
Directory Services
Version Identification
Scale
Exchange Process/Metadata
Testing, Conformance & Certification
Security
INFRASTRUCTURE USE CASES
Payers/Providers
CORE DATA SERVICES
Provider/Provider
FHIR CONSUMER SOLUTIONS
Consumers
FUNCTIONAL USE CASES
OTHER COLLABORATIVE EFFORTS
NETWORK/CORE SERVICES
CONTRACTUAL ENFORCEMENT
CORE SERVICES
Poll
What is your familiarity with FHIR?
What is your organization’s status on FHIR?
FAST : Setting the Stage
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API Overview
APIs…• An API is a software intermediary which
allows applications to talk to each other
• APIs allow the capabilities or data of one computer program to be used by another
• Lego blocks of data
• Doesn’t matter what the underlying computer or technology is
• APIs are a foundational technology that drives modern computing and the API economy (Amazon, Netflix, Google, Facebook, EBay, YouTube, Twitter, & etc.)
• APIs enable innovation in an unprecedented manner
• APIs are not new… simplified, easy to use versions of them are
YOUR
APPTHEIR
APPAPI
REQUEST
DATA
DEVELOPERSwill access your assets through your API to build Mobile Apps and Web Apps based
on the data and software you share.
THE APIprovides universal access to whatever
assets you choose to share. Developers can "plug in" their apps and data.
ASSETSYour data and software
(and brand) become more valuable by being leveraged
by partners, developers, and third-party services.
END USERShave access to apps that
provide richer experiences by leveraging the data and
services of other apps.
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WHAT IS FHIR?
*Representational State Transfer (REST) defines a set of constraints used for creating web services
FHIR® — Fast Healthcare Interoperability Resources
• An HL7 next generation standard
• Helps two computer systems talk to each other
FHIR "resources" are standardized & reusable
• Patient, practitioner, organization, deviceRequest
FHIR supports common exchange methods
• REST*, messaging, documents and services
FHIR supports the spectrum of integration
• Mobile phone apps, EHR-based data sharing,
institutional solutions
FHIR helps with existing use cases & provides for future
innovation
Referral/ Consult
Patient Medical Record
HealthcareDirectory
Provider
Payers
CDS
Services (eg, DME, Imaging)
PublicHealth
Research
Data available in-workflow supports value-based care and population health management
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Why FHIR Adoption?
Comprehensive data integration
Promote progressive FHIR adoption
Reduce redundancy and duplication
Improve in-workflow data exchange to support value-based care and population health
CMS and ONC rules call for widespread APIs adoption using FHIR to enable consumers access to their health data
Drive innovation through data accessibility
Unlock new capabilities through API/ service methodologies
Improve consistency as an impetus for accelerating clinical data exchange
Reduce costs and time needed for infrastructure so it can be spent on patient care
Industry value levers for FHIR adoption:
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Tying to Reality and Making Practical via CMS & ONC Rules
Mandating FHIR and consumer mediation as foundations of an integrated, competitive, and innovation friendly ecosystem.
/CMS/ONC proposes rules that align with market forces and reflect industry trends.
They provide yet another dimension to the interoperability inflection point we are in.
CMS Rule (CMS-9115-P)
• Patient access through standards based FHIR APIs
• Information exchange and care coordination across payers
• API based provider directories
• Care coordination through trusted exchange networks
ONC Rule (RIN 0955-AA01)
• Implements information blocking provision of Cures Act (and 7 exceptions)
• Standards based APIs
• Certification criteria
• Content specifications
Member Empowered
Standards Based
Open APIs
Care Coordination Across Payers and Providers
Innovation
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Lack of Consistent Infrastructure Impacts Flow
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Well-Planned Infrastructure Creates Efficiency
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Poll
How familiar are you with the challenges of clinical
healthcare data exchange at scale?
FAST : Challenges and Proposed Solutions
Patient Journey - Today
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Sophisticated technology exists but without consistent data integration, phone and fax are still the default
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Patient Journey - Ideal
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Real-time data exchange removes the need for phone calls and faxes, streamlining the entire interaction.
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Patient Journey - Challenges
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We want to identify and address the barriers for data exchange to happen consistently, for every transaction, specifically FHIR transactions
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REQUESTING SYSTEM RECEIVING SYSTEM
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
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Example FHIR Transaction Journey
DIRECTORY
CHALLENGE: There are multiple places to find endpoints.Is there a place I can go to find all of them?
SOLUTION: Directory services approach for endpoint discovery
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
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Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
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REQUESTING SYSTEM RECEIVING SYSTEM
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Example FHIR Transaction Journey
EXCHANGE
CHALLENGE: Enabling transaction exchange
SOLUTION: Exchange and meta data approach
DIRECTORY
Transaction Information (eg, Header)
Appropriately Configured
2
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
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1
REQUESTING SYSTEM RECEIVING SYSTEM
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Example FHIR Transaction Journey
EXCHANGE
CHALLENGE: A way to measure conformance to the standard
SOLUTION: Conformance & certification approach
DIRECTORY
Receives Transaction,
Validates Requestor, Validates Version
3
CONFORMANCE & CERTIFICATION
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
Transaction Information (eg, Header)
Appropriately Configured
2
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1 2
REQUESTING SYSTEM
3
RECEIVING SYSTEM
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Example FHIR Transaction Journey
VERSIONING
EXCHANGE
CONFORMANCE & CERTIFICATION
CHALLENGE: A way to communicate and manage multiple versions
SOLUTION: Versioning approach
DIRECTORY
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
Transaction Information (eg, Header)
Appropriately Configured
Receives Transaction,
Validates Requestor, Validates Version
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1 2
REQUESTING SYSTEM
3
RECEIVING SYSTEM
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Example FHIR Transaction Journey
CONFORMANCE & CERTIFICATION
DIRECTORY
EXCHANGE
VERSIONING
Performs Patient Matching and Sends
Back Not Found If Unable To Do So
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IDENTITY
CHALLENGE: How can a requestor and receiver uniquely identify the patient/member?
SOLUTION: Identity matching approach
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
Transaction Information (eg, Header)
Appropriately Configured
Receives Transaction,
Validates Requestor, Validates Version
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1 2
REQUESTING SYSTEM
3
RECEIVING SYSTEM
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Example FHIR Transaction Journey
IDENTITY
CONFORMANCE & CERTIFICATION
SECURITY
4
DIRECTORY
EXCHANGE
VERSIONING
Authenticates FHIR User’s
Role
5a
Filters Out Data That Does Not
Have Consent
5b
CHALLENGE: How can the industry ensure only “right to know” requestors access data and patient consent is followed?
SOLUTION: Security approach for authorization & authentication
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
Transaction Information (eg, Header)
Appropriately Configured
Receives Transaction,
Validates Requestor, Validates Version
Performs Patient Matching and Sends
Back Not Found If Unable To Do So
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1 2
REQUESTING SYSTEM
Requesting System Receives Data
7
Generates & Returns FHIR
Response
3 5a 5b 6
RECEIVING SYSTEM
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Example FHIR Transaction Journey
IDENTITY
CONFORMANCE & CERTIFICATION
SECURITY
PILOTS
4
DIRECTORY VERSIONINGEXCHANGE
DIRECTORY
EXCHANGE
VERSIONING
PCP needs information from Payer
Payer receives PCP request
PCP views patient information
Patient visits Primary Care Physician (PCP)
Formulates FHIR
Request
Looks Up the FHIR Endpoint for Recipient
Transaction Information (eg, Header)
Appropriately Configured
Receives Transaction,
Validates Requestor, Validates Version
Performs Patient Matching and Sends
Back Not Found If Unable To Do So
Authenticates FHIR User’s
Role
Filters Out Data That Does Not
Have Consent
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Directory Services Identity Security
Testing, Conformance, & Certification Versioning Scaling
Known Technical Barriers
1
4
5
6
2
2
3
2
2
3
1 2 3
4 5 6
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RecommendedInfrastructure Solutions
FAST Solutions
FAST Solution Input• Tiger Teams• TLC• SME
ProposedInfrastructure Solutions
Tiger Teams
Standards Process Regulation
Evaluation, Feedback, and Pilots
Ecosystem Use Case
Identity
Directory, Version & Scale
Testing & Certification
Exchange Process
Security Pilots
Ecosystem Use Cases
Core Capabilities
Technical Barriers
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Operationalize Solutions
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FHIR Adoption - Technical Challenges & FAST Proposed Solutions
ProposedInfrastructure Solutions
CHALLENGE: How do we enable consistent and reliable transaction exchange?
PROPOSED SOLUTIONS: - Reliable Routing with Metadata Across Intermediaries- Reliable Routing Across Intermediaries Using Destination Specific Endpoints
CHALLENGE: A way to measure conformance to the standard
PROPOSED SOLUTION: ONC FHIR Testing and Certification Program
CHALLENGE: How do we manage permissions & security across millions of patients/payers/providers?
PROPOSED SOLUTIONS: - Trusted Dynamic Client Registration- Tiered OAuth- UDAP Authentication & Authorization
DIRECTORYCHALLENGE: There are multiple places to find endpoints.Is there a place I can go to find all of them?
PROPOSED SOLUTION: A national solution for FHIR Endpoint Discovery
CHALLENGE: How can a requestor and receiver uniquely identify the patient/member?
PROPOSED SOLUTIONS: - Mediated Patient Matching- Collaborative Patient Matching- Distributed Identity Management
DIRECTORY, VERSIONS AND SCALE
IDENTITY
EXCHANGE PROCESS
TESTING & CERTIFICATION
SECURITY
VERSIONSCHALLENGE: A way to communicate and manage multiple versions
PROPOSED SOLUTION: Supporting multiple production versions of FHIR
SCALECHALLENGE: How can a high volume of FHIR transactions be consistently and predictably exchanged in a hybrid exchange model?
PROPOSED SOLUTION: Requirements for FHIR RESTful exchange intermediaries
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FAST Vision of The Future
A National Solution for FHIR Endpoint DiscoveryThe model incudes an API-enabled national source for validated directory information available to any local directory or workflow. The directory contains entity and individual information to determine endpoint relationships. Also, endpoint information will include supported IG’s, trust frameworks, meta data requirements, etc.
Supporting Multiple Production Versions of FHIRMoving forward, most resources, extensions, & profiles will be normative. The FHIR version supported by a partner will be available as part of directory services endpoint discovery and as part of the FHIR servers' conformance statement. In addition, all FHIR artifacts provide version number as part of the exchange. New versions will be backwards compatible for normative content.
Requirements for FHIR RESTful Exchange IntermediariesThe ecosystem will support a mixed model (point to point, gateways, and intermediary). Performance and availability requirements will need to be established and all other dimensions of FAST will need to operate as planned.
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FAST Vision of The Future
Reliable Routing with Metadata Across Intermediaries Reliable Routing Across Intermediaries Using Destination SpecificGiven that the future includes both point to point, gateway, and intermediaries, the model ensures reliable routing across one or many hops since the FHIR artifact carries its routing identifiers.
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FAST Vision of The Future
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Mediated Patient MatchingCollaborative Patient MatchingDistributed Identity ManagementThe FAST proposals for identity include models to reliably match patients in real-time using contemporary technologies including FHIR. Proposed solutions including near real-time patient matching using FHIR match operations (mediated patient matching), collaborative patient matching in which patient identifier is assigned and participants agree on usage and cross-walks models, and a network of trusted identity matching services (patient matching with FHIR match and local and global identifiers with future support for patient and payer).
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FAST Vision of The Future
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Trusted Dynamic Client RegistrationAuthentication & AuthorizationAgile, reliable, secure access is foundational to the ecosystem of the future. The FAST model supports the ability for dynamic yet trustworthy access to data. A trusted ecosystem enabled by proposed solutions including dynamic client registration and client token request and JWT based client authorization and authentication.
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FAST Vision of The Future
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ONC FHIR Testing and CertificationThe model includes a proposal for testing platform and a certification authority to validate base FHIR conformance & FAST criteria conformance.
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FAST Vision of The Future
A National Solution for FHIR Endpoint DiscoveryThe model incudes an API-enabled national source for validated directory information available to any local directory or workflow. The directory contains entity and individual information to determine endpoint relationships. Also, endpoint information will include supported IG’s, trust frameworks, meta data requirements, etc.
Supporting Multiple Production Versions of FHIRMoving forward, most resources, extensions, & profiles will be normative. The FHIR version supported by a partner will be available as part of directory services endpoint discovery and as part of the FHIR servers' conformance statement. In addition, all FHIR artifacts provide version number as part of the exchange. New versions will be backwards compatible for normative content.
Requirements for FHIR RESTful Exchange IntermediariesThe ecosystem will support a mixed model (point to point, gateways, and intermediary). Performance and availability requirements will need to be established and all other dimensions of FAST will need to operate as planned.
Reliable Routing with Metadata Across Intermediaries Reliable Routing Across Intermediaries Using Destination SpecificGiven that the future includes both point to point, gateway, and intermediaries, the model ensures reliable routing across one or many hops since the FHIR artifact carries its routing identifiers.
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Mediated Patient Matching | Collaborative Patient Matching | Distributed Identity ManagementThe FAST proposals for identity include models to reliably match patients in real-time using contemporary technologies including FHIR. Proposed solutions including near real-time patient matching using FHIR match operations (mediated patient matching), collaborative patient matching in which patient identifier is assigned and participants agree on usage and cross-walks models, and a network of trusted identity matching services (patient matching with FHIR match and local and global identifiers with future support for patient and payer).
ONC FHIR Testing and CertificationThe model includes a proposal for testing platform and a certification authority to validate base FHIR conformance & FAST criteria conformance.
Trusted Dynamic Client Registration | Authentication & AuthorizationAgile, reliable, secure access is foundational to the ecosystem of the future. The FAST model supports the ability for dynamic yet trustworthy access to data. A trusted ecosystem enabled by proposed solutions including dynamic client registration and client token request and JWT based client authorization and authentication.
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Potential Regulatory Barriers
Patient Identifier
Data Blocking
HIPAA Minimum Necessary
Regulatory Mandate for a Single Named Standard
HIPAA Transactions Requiring X12
Use of NPPES as the Repository for Endpoints
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Poll
Do these barriers and the evolving solutions seem on track?
In Closing
1) ONC is focused on connecting healthcare and health data through a national interoperable Health IT infrastructure.
2) ONC is working to reduce the regulatory and administrative burden related to the use of health IT, including EHRs.
3) ONC is working on ways to give clinicians more time to focus on what matters – caring for their patients.
FAST Supports Overarching ONC Goals
Supporting Documents;
• ONC's Cures Act Final Rule
• Strategy on Reducing Burden Relating to the Use of Health IT and EHRs
• 2020-2025 Federal Health IT Strategic Plan
(deadline for public comment extended to 4.3.20 at 11:59:59 PM ET!)
48SK
Putting the patient first in health technology enables the health care system to deliver:• Transparency into the cost and outcomes of their care
• Competitive options in getting medical care
• Modern smartphone apps to provide them convenient access to their records
• An app economy that provides patients, physicians, hospitals, payers, and employers with innovation and choice
ONC's 21st Century Cures Act Final Rule
49SK
Direct Links;• Fact Sheets• Webinars• Media/Press• Blog Post• Download Final Rule
Main Landing Page;https://www.healthit.gov/curesrule/
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FAST Initiative Output & Communication Strategy Update
All content is available on the https://tinyurl.com/ONC-FAST
FAST CONTENT FAST COMMUNICATION STRATEGY
FAST Initiative Use Cases, Version 2
FAST Initiative Core
Capabilities
FAST Regulatory and Policy Barriers,
Version 1
FAST Technical Barriers, Version 1
FAST Solutions (In Development/
Drafts)
FAST 101 and Keystone
Presentations
FAST 101 - Public Webinar
Technical Learning Community
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2019 FAST End of Year
Report
Industry Speaking Engagements
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Published Content and FAST Artifacts
All content is available on the https://tinyurl.com/ONC-FAST SK
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FAST 2019 End of Year Report
2019 End of Year Report
Summarizes progress made in 2019 and provides a sneak-peak of work in 2020
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Patient & Provider Identity Management
Directory Services
Version Identification
Scale
Exchange Process/Metadata
Testing, Conformance & Certification
Security
Pilots
FAST Focus
Join the Technical Learning Community to get updates and provide input on the technical and regulatory barriers, use
cases, and proposed solutions as they are developed.
SIGN UP!!
&JOIN THE LINKEDIN GROUP
400+ members & growing!
WANT TO GET INVOLVED??
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Questions?
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Thank You – Today's Presenters
Patrick MurtaFAST Chief Architect
Stephen KonyaONC – FAST [email protected]
For more information on the FAST Initiative, visit the FAST Project Page
Have any further questions/suggestions?
Please contact Stephen Konya at [email protected]& Diana Ciricean at [email protected]
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Upcoming Webinar: It’s a WIN: A New, Data-Driven Approach for Measuring Well-Being
April 24 | 12:00pm-1:30 pm ET
How might a loss of jobs in the transportation sector affect deaths of despair, such as those caused by alcohol, drugs or suicide? How might broadband access affect people’s movement from rural to urban areas? Insights into questions such as these are being provided for the first time by the Well-being in the Nation (WIN) measures, which examine how data across sectors might influence population and community health. This webinar/discussion will focus on the process of developing the measures, review the first multi-sector findings regarding community well-being, and share insights relating to their application.
hub.nic-us.org/events/it-s-a-win-a-new-data-driven-approach-for-measuring-well-being
Somava Saha
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Upcoming Webinar: From Indiana to the National Accelerators:
COVID-19 and Interoperability for a Better Path Forward
May 1st| 12:00pm-2:00 pm ET
hub.nic-us.org/events/from-indiana-to-the-national-accelerators-covid-19-and-interopera
58
Upcoming Webinar: Getting Evidence into Practice: Lessons from the Opioid Crisis
May 8 | 12:00pm-1:30 pm ET
Join experts from the Agency for Healthcare Research and Quality (AHRQ), to learn about resources for using evidence to combat the opioid crisis; about evidence syntheses on what works to manage pain and Opioid Use Disorder (OUD); and about tools to integrate the latest guidelines at the point of care.
hub.nic-us.org/events/getting-evidence-into-practice-lessons-from-the-opioid-crisis
59
Upcoming Webinars
04/24: It’s a WIN: A New Data-Driven Approach for Measuring Well-being –
Somava Saha
05/01: Interoperability Insights - State Health IT Connect Summit/SOC Institute
Collaboration (Gravity, DaVinci, Carin Alliance, Project Unify)
05/08: Getting Evidence into Practice: Lessons from the Opioid Crisis – Elisabeth
Kato, Roland Gamache, and Suchitra Iyer - Agency for Healthcare Research and Quality
(AHRQ)
60
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Special thanks to:
IRIS Healthcare Solutions
Alexandria Consulting
Interoperability Institute
…for their kind and in-kind support for Project Unify
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