• Today’s Objectives Arlo Jennings, Datalink• Review of HIT Collaborative Decision Points Vandana Shah, HWTF• Work Group Deliverables Arlo Jennings, Datalink• Deliverable Dependencies Melanie Allison, HWTF • NC HIE Challenges Melanie Allison, HWTF• NC HIE Strategy Submitted to ONC Arlo Jennings, Datalink &

Melanie Allison, HWTF• Role of Technical Infrastructure Work Group Arlo Jennings, Datalink &

Melanie Allison, HWTF

NC HIE StrategyTechnical Infrastructure Work Group

agenda

Thursday, December 03, 200910:00 am -12:00 PM1100 Navaho Drive

Raleigh1-866-427-0083

Room #: *8041709* (don’t forget the asterisks before and after the room #)

Today’s Objectives

• Discuss dependencies of Technical Workgroup Deliverables on Community HIE Deliverables

– Functional requirements

• Review architecture design proposed in Strategic Plan submitted to ONC on October 16th

– Shared Services Environment

– Service Oriented Architecture

• Discuss role of Technical Infrastructure Work Group– Working from the same “playbook”

– Service Design Process

StructureRole DefinitionProcess

Decision Point #1

Decision Point #4

Decision Point #3Decision Point #2

NEAR TERM DECISION POINTS

GovernanceCommunityDefinition

Functional Requirements

CHIE Geographic DefinitionDomain CHIEs Prioritization of MU Criteria by

statewide stakeholders

DeploymentRoadmap

“Where & When” Selection Criteria for Target Communities

Decision Point #5

Consent ModelDevelopment ProcessLeverage existing work?Time Constraints

Decision Point #6

Business Model

Core HIE ServicesStatewide Directories/RepositoriesOther Data or Functional Assets?

ROI ModelingRevenue Stream Projection

MUPrioritization

Community HIE Workgroup

Technical Infrastructure Workgroup

Business Model/Sustainability Workgroup

Legal/P & S Sub-workgroup

Goveranance Workgroup

Review: Technical Infrastructure Work Group Deliverables

Deliverable One:

– Define HIE Services & functional requirements• Core services

• Additional services

Deliverable Two:

– Deployment Roadmap• What is being developed for whom?

• How and when will it be deployed?

Deliverable Dependency on Community HIE Work Group Deliverables

Community HIE Work Group Status:2)Consensus on RHIO vs. CHIO3)Consensus on Defining a region based-HIE (RHIO) & Domain-based HIE4)Consensus on recognition of 3 RHIOs in NC & leveraging CCNC for organizing/convening other potential RHIO initiatives

Community HIE Work Group Status:2)In process of defining NC HIE services at high level of abstraction3)Exploring “tiered approach”: functional requirements of existing RHIO vs. new RHIO

NC HIE Challenges

• Limited Funding: $12.9M

• HIE Capacity Needs: CMS/Supporting MU Requirements & building capacity in other sectors

• Currently working in vacuum: MU final ruling due in December 2009 & could be delayed until Q1 2010

• Varying technical and resource capabilities across healthcare organizations

• Variability in HIE value propositions across stakeholders

• Privacy Issues: Delicate balance of protecting a patient’s privacy & allowing access to needed clinical information

• Non-defined consent management strategy

• Sustaining HIE over time post ONC funding

NC HIE Strategy Submitted to ONC

North Carolina Harmonization:Shared HIE Services

NC

HIE

TE

CH

NIC

AL

INFR

AS

TR

UC

TU

RE

PHIN

Commercial Labs

RXHubGateway Service

CHIO

Hospital EHR Primary Care

Providers:EHRDiagnostic Imaging

Service Providers ConsultingClinicians

COMMUNITY DATA PROVIDERS& USERS (Consumer)

CommonServices

NC SHARED HIESERVICES

NHIN

MPI,Data &Query Services

Hospital HISSource System

Hospital RXSource System

Hospital LisSource System

HO

SP

ITAL D

ATA

PR

OV

IDE

RS

& C

ON

SU

ME

RS

MPI,Data &Query Services

LIS Source System

MPI,Data &Query Services

CHIO

MMIS

COMMUNITY HOSPITALS

MPI,Data &Query Services

Co

mm

erc

ial L

abs

IDN

sH

ealth

Pla

ns

IMMUNIZATIONREGISTRY

DISEASERGISTRY

PROVIDERDIRECTORIES

DHIO( Domain Community)

MPI,Data &Query Services

CLINICS

Table 3: Service Implementation Estimate

2010

2011

2012

2013

RHIO 1

CHIO 2

UTILITY SERVICES

Patient Id Resolution Svc: MPI & RLS 2010Access Conrol/Security ServicesIntegration ServicesEMR Data Service 2011Healthcare Vocabulary Service 2011Provider Registry 2013 2013Immunization Registry 2013 2013NHIN Gateway 2013 2013

TASK SERVICESElectronic Eligibility and Claims 2013 2013Electronic Prescribing and Refills 2011Electronic Clinical Lab ordering and Results 2012Electronic Public Health Reporting 2013 2013Quality Reporting 2013 2013RX Fill Status and/Med Fill History 2011Clinical Summary Exchange (CCD) 2013 2013

GOVERNANCEMaster Consent/Participation Agreement 2010Master Data Sharing Agreement (DURSA) 2010

Co

re S

erv

ice

s

BUILDING HIE SERVICE AND E.H.R. CAPABILITIES SIMULTANEOUSLY TO RAPIDLY EXPAND CAPACITY

COMMUNITY HIE ONE

HIE SERVICE BUILD-OUT

CORE HIE SERVICES & ACCESS TO CLINICAL DATA VIA WEB APPLICATION

ADDITIONAL CLINICAL DATA SOURCES

REAL TIME CLINICAL ORDERS/ RESULTS

EXCHANGE OF PATIENT DATA ACROSS PROVIDERS

E.H.R. CAPABILITY DEVELOPMENT LIFECYCLE

E.H.R.IMPLEMENTATION

CAPABILITIES EXPAND:E.H.R CAN GENERATE CLINICAL ORDER & RECEIVE RESULT

CAPABILITIES EXPAND: HISTORICAL LAB RESULTS & MEDICATION HISTORY POPULATE E.H.R

CAPABILITIES EXPAND: E.H.RCAN GENERATE A CCD/PATIENTSUMMARY

CAPABILITIES EXPAND: E.H.REXCHANGING PATIENT DATAACROSS PROVIDERS

NHIN-COMPLIANT HIE SERVICE

E.H.R.IMPLEMENTATION

CAPABILITIES EXPAND: HISTORICAL LAB RESULTS & MEDICATION HISTORY POPULATE E.H.R

CAPABILITIES EXPAND:E.H.R CAN GENERATE CLINICAL ORDER & RECEIVE RESULT

CAPABILITIES EXPAND: E.H.RCAN GENERATE A CCD/PATIENTSUMMARY

COMMUNITY HIE TWOITERATIVE IMPLEMENTATIONPROCESS

NCSHS

E.H.R.

NC SHARED HIE SERVICES CAPABILITY DEVELOPMENT LIFECYCLE

Role of Technical Infrastructure Workgroup• Tight alignment with Community HIE Work

• NC HIE adoption of HIE terms/concepts

• Working from the same “playbook”– Fundamentals of SOA

• Basic Terms & Concepts/Architecture Fundamentals

• Architecture of Service-Orientation

• SOA Design Pattern– Fundamentals

– Pattern Notation & Profiles

• Service Inventory Design Patterns

• Service Design Patterns

• Service Implementation Patterns

• Service Composition Design Patterns

– Service Design Process

• Creation of Service Design Team: Developing service inventory functional requirements