INTEROPERABILITY

ABOUT ME Jarod Ferguson CEO of Royal Jay, Chief Architect of Kno2

15 employees 80% of revenue is Health Technology Kno2, Aprima EHR, IHDE, St Luke's Health Partners

Technical Career path 3x Microsoft Data Platform MVP, AspInsider

“The extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.” - HIMSS

What is interoperability?

“What if you had a cell phone plan that only allowed you to call other customers of your carrier? That’s the situation for most healthcare providers today, when they join a data sharing network.” – Sequoia Project

What is Interoperability?

How many mg do I take?

When was that surgery?

HOW DID WE GET HERE?

THE PAST

Why is patient data sharing so complicated?

Mary Smith, TX ???

But data sharing isn’t new? Why is healthcare so far

behind?

Let’s take a look…

ASTM

American Society for Testing and Materials

Formed in 1898 First Standard on steel rails issued Henry Ford Emerging standard during WWII

COMMITTEE F04

Formed in 1962 Global Agenda for Medical Device Medical and surgical instruments,

orthopedic devices, implant systems MRI to Manufacturing

HL7 Formed in 1979 Reached maturity 1992 Defines the “What”

I think you missed a pipe on line 4…

IHE Formed in 1998 “improve the way computer systems

share information” Defines the “How”

[XDR] Cross-Enterprise Document Reliable Interchange[XDS-SD] Cross-Enterprise Sharing of Scanned Documents [MPQ] Multi-Patient Queries [PAM] Patient Administration Management[PIX] Patient Identifier Cross-Referencing (PIX)

IHE Profiles

HL7 V3 2005 Based on XML and Object Oriented Principles Far more rich and flexible

RIM 1.0 (first non-draft) – Jan 2001 ANSI/HL7 RIM Release 1 – Approved July 2003 ISO 21731 (RIM Release 1) - Approved 2006

IHE CCD =

HL7 RIM CDA + ASTM CCR

Connecting with the right format is not enough

We can help!

DIRECT TRUST 2010 A “Network” of HISP’s (no more peer to peer) Provides addressing similar to email Establishes security standards Uses IHE XDR as the protocol Can transport many document types (CCD, CDA, DICOM, PDF) Based on web technologies (HTTP, DNS) Private non-profit ultimately governed by HITPC & NwHIN

Sending……

WHERE ARE WE GOING?

THE FUTURE

I don’t see any patients?

THE SEQUOIA PROJECT 2012 Non-profit “advance the implementation of secure, interoperable

nationwide health information exchange” Teamed with Care Connectivity Consortium ONC transitioned management of eHealth Exchange for

maintenance to Sequoia Supports Carequality initiative

COMMONWELL ALLIANCE❮ 2013❮ Interoperability group❮ Cerner, McKesson, Athena, Allscripts❮ Epic NOT a member❮ IHE XCA or FHIR❮ Roles

❮ Enrollment❮ Record Locator❮ Patient Identification & Linking❮ Data Query & Retrieval

CAREQUALITY 2014 Common Framework “dedicated to accelerating progress

in health data exchange among networks, providers, payers, EHR and HIE vendors.”

EPIC, ORION, eClinicalWorks, Nextgen, Surescripts, Kno2 Record Locator Services, EHR Vendors Existing private/public networks and platforms Uses IHE profiles

CAREQUALITY Uses IHE Profiles Roles

Initiator Responder Record Locator Service

XCPD Flow

THE ARGONAUT PROJECT 2015 Private Sector Open internet standards Promotes FHIR to replace CCDA, FHIR APIs to replace

DIRECT “replace healthcare-specific document and messaging

standards with the more universal and essentially free equivalents taken from the Internet.” - John Halamka

ARGONAUT SPONSORS Accenture athenahealth Beth Israel Deaconess

Medical Center Cerner Epic Intermountain Healthcare Mayo Clinic

MEDITECH McKesson Partners HealthCare System SMART at the Boston Children’s

Hospital Computational Health Informatics Program

The Advisory Board Company Surescripts

FHIR Fast Healthcare Interoperability Resources Lightweight, no overhead Uses “Modern” web stacks. HTTP, REST Developers love it, integrates the same as other apps Pronounced “fire”

Just stay to the right….

INTEROPERABLE?Can your HIE receive an HL7 CDA via DIRECT IHE XDR over the Surescripts HISP?

Then, Yes.

THANK YOUjarod@royaljay.com@jarodf