Robert M. Cothren, PhDCalifornia Health eQuality Program

IPHI / UC Davis Health System

Update on the Western States Consortium

January 28, 20133:00PM

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Who is the WSC?

What are we doing?

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Investigating the policies, procedures, and technologies that allow and promote interstate exchange of health information.

What is the issue?

Use case…Using Direct to exchange clinical information between providers across state lines for treatment purposes.

A simple use case that allows us to concentrate on

interstate exchange.

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Who is participating… as proposed?

• One data sharing agreement• One exchange of digital certificates• One exchange of user addresses

Focus on the issues of interstate exchange.

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OregonCalifornia

Who will be participating… soon?

• Six data sharing agreements• Six exchanges of digital certificates• Six (ongoing) exchanges of user addresses

Focus on the issues of scalable trust.

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Oregon

California

Alaska

Again… What is the issue?

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Use case…Using Direct to exchange clinical information between providers across state lines for treatment purposes.

Really about scalable trust.

Two important components…1. Establishing inter-organizational trust.2. Discovering how to communicate with others.

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How is trusted exchange established?

The Western States Consortium Trust Community

Developed “umbrella governance organization”: signatories to an MOU establishing the Governance Body.– Currently includes

California, Oregon,and Alaska.–Other core states

evaluating whenthey can join.

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How is trusted exchange established?

The Western States Consortium Trust Community

Developed “umbrella governance organization”: signatories to an MOU establishing the Governance Body.

Developed a set of Eligibility Criteria for Qualified Entities joining the WSC Trust Community.– Based on…

…Direct Applicability Statement, and technical standards

…ONC guidance on directed exchange. policies and procedures

– Memorialized in policies and procedures.

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How is trusted exchange established?

The Western States Consortium Trust Community

Developed “umbrella governance organization”: signatories to an MOU establishing the Governance Body.

Developed a set of Eligibility Criteria for Qualified Entities joining the WSC Trust Community.

Developed procedures for collecting, managing, and distributing a Trust Bundle that identifies Qualified Entities.–Manual process now.–Move to a standardized process under development.

Office of the National Coordinator for Health Information Technology

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How is trusted exchange established?

The Western States Consortium Trust Community

Developed “umbrella governance organization”: signatories to an MOU establishing the Governance Body.

Developed a set of Eligibility Criteria for Qualified Entities joining the WSC Trust Community.

Developed procedures for collecting, managing, and distributing a Trust Bundle that identifies Qualified Entities.

Testing in a pilot.– Adding states to the Governance Body.– Adding Qualified Entities to the Trust Community.–Updating Trust Bundle distribution procedures.

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What is this “Trust Bundle”?

• Collection of public digital certificates or “trust anchors”.– Establishes the electronic identity

of members of the Trust Community.–Managed and published by the

Governance Body.–Memorialized in policies,

procedures, and technology.

Add New Qualified Entity to Trust Community

Party StateGovernance Body Trust Bundle Coordinator

New Qualified Entity POC

Existing Qualified Entity POCs

Requests that Qualified Entity be

added to Trust Community.

Requests Trust Anchor.

Returns Trust Anchor (via email).

Inspects Trust Anchor to verify it

meets Eligibility Criteria.

Places Trust Anchor in test HISP.

Sends trust anchor for test HISP (via

email).

Places trust anchor for test HISP in HISP.

Conducts test of Trust Anchor

Conducts test of Trust Anchor.

Adds Trust Anchor to Trust Bundle.

Sends notice that Trust Bundle has been updated.

Corrects issues.

Notes update to Trust Bundle.

Retrieves Trust Bundle (via FTP) and

places in HISP.

Retrieves Trust Bundle (via FTP) and

places in HISP.

Corrects issues.

Sends notice of addition to Trust

Community.

Notes successful addition to Trust

Community.

Issues? yes

no

Issues?

no

yes

From “Eval of Qualified

Entity”

What about standards?

• The WSC Trust Bundle is a low-tech solution examining policies and procedures for managing trust anchors.–Distribution: SFTP– Content: trust anchors in an SFTP directory– Change management: out-of-band email alerts

• The developing standard…–Distribution: HTTP or HTTPS– Content: (optionally) signed PKCS7 container

See the Direct Project Trust Bundle Sub Work Group at http://wiki.directproject.org/Trust+Bundle+Sub+Work+Group.

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Once more… What is the issue?

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Use case…Using Direct to exchange clinical information between providers across state lines for treatment purposes.

Really about scalable trust.

Two important components…1. Establishing inter-organizational trust.2. Discovering how to communicate with others.

How are addresses discovered?

Directory Services

Developed architecture for distributed management of individual (and organizational) addresses.– States query each other.– The architecture within each state

is up to the state.– California is also federating directories.

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How are addresses discovered?

Directory Services

Developed architecture for distributed management of individual (and organizational) addresses.

Developing functional requirements and expected behavior for state-level directories.– To be memorialized in policies and procedures.–May include eligibility criteria for participating in Directory

Services.

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How are addresses discovered?

Directory Services

Developed architecture for distributed management of individual (and organizational) addresses.

Developing functional requirements and expected behavior for state-level directories.

Developing standardized query for state-level directories.– Based on previous work.– In California, also being used for internal federation.

Please let us know if you would like to participate!

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How are addresses discovered?

Directory Services

Developed architecture for distributed management of individual (and organizational) addresses.

Developing functional requirements and expected behavior for state-level directories.

Developing standardized query for state-level directories. Testing in a pilot.– Adding states to the architecture.– Adding local directories in California.– Learning how it all might work.

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What about standards?

• Based on the work of other “standards” organizations.– IHE Healthcare Provider Directory (HPD)– S&I Framework guidance for queries– EHR|HIE Interoperability Workgroup (HPDPlus)

• Developing standards…–HTTP and TLS– SOAP web services–HPD / HPDPlus data model–DSML query and response

See the December HITRC PD CoP meeting for more…http://hitrc-collaborative.org/confluence/download/attachments/12419271/Provider+Directory+CoP+Membership+Mtg+2012+12+19+FINAL.pptx

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When can I see it?

Overlapping Trust Communities

WSC Trust Community

CA Trust Community

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When can I see it?

Distributed Directory Services

OR State Directory ServiceCA State Directory Service

RWMN Local Directory Service NCHIN Local Directory Service

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Questions?