1. 1 Providing a new HITSP standard XML input to BioSense RT – The Beth Israel Deaconess Project W. Lane Chambers Healthcare Systems Consultant – SAIC and Robert F. Beckley, III Consultant - Beth Israel Deaconess

2. 2 Beth Israel Deaconess Medical Center Founded in 1896 A teaching hospital of Harvard 601 Licensed Beds Level 1 Trauma Center Known for it’s excellence in surgery, cardiac conditions, cancer, pulmonary and thoracic disorders US News – America’s Best Hospitals List – 2007 Developed their own in-house CIS/HIS system

3. 3 CDC’s BioSense BioSense is a national program intended to improve the nation’s capabilities for conducting real-time biosurveillance, and enabling health situational awareness through access to existing data from healthcare organizations across the country. The BioSense system collects over 1 million de-identified admission, census, emergency department, laboratory, radiology and pharmacy messages a day from healthcare providers across the US. Data sources include: –State/regional surveillance systems –Local and regional hospitals and health care systems –National laboratories –Department of Defense (DoD) –Department of Veterans Affairs (VA) Beth Israel Deaconess (BIDMC) was one of the original 10 “vanguard” sites that began transmitting data real time to BioSense in Dec. 2005

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5. 5 The Genesis of the XML Project BIDMC was sending only ED data initially in a pipe-delimited flat file format This data was being extracted from BIDMC’s integrated CIS/HIS system – no existing HL7 API’s were needed or available BioSense and BIDMC wanted to increase the number of data types being transmitted to include ADT, Census, Lab, Radiology and Pharmacy A new extract/API would need to be developed by BIDMC. John Halamka, CIO of Beth Israel Deaconess and Chair of the Healthcare Information Technology Standards Panel (HITSP) proposed that the development be a BioSense proof of concept utilizing the emerging HITSP XML standards. As a pilot for this new BioSense input option, BIDMC committed to deliver the full set of BioSense data types of interest in the new XM.

6. 6 BioSense Standard Queue BioSense Application CDC PHIN MS Receivers Data Messaging Broker (transfers from PHINMS, edits and parses messages, and reformats in XML for load) BioSense Data Warehouse and Application BioSense HL7 2.5 and vocabulary Local vocabulary and message formats BioSense Integrator with LINKER and PHIN MS Sender Common BioSense Message Flows HIS/CIS Systems Interface Engine Data SourceCDC

7. 7 Highlights of Required Changes BIDMC –Develop extract routines for all new data types –Utilize LINKER (de-identification) functionality from original BioSense API –Format output in BioSense XML format CDC –Create new BioSense XML PHIN MS queue –Create new DMB route for XML which bypasses standard edits and reformatting functionality

8. 8 New BIDMC Message Architecture New BioSense XML Queue “Sugarloaf” PHIN MS Sender “Mycroft” Red Hat Enterprise 4 cluster (New API extracts, de-identifies, standardizes vocabulary, and formats) BioSense Application CDC PHIN MS Receivers New Data Messaging Broker XML Route (edits messages and transfers XML directly to DW for loading) BioSense Data Warehouse and Application BioSense XML messages and standard vocabulary BioSense XML messages and standard vocabulary BIDMCCDC

9. 9 Recap of the Project Initial (ED only) Activation – December 31, 2005 Original plan was to activate new data types (ADT/Census, Lab, Radiology, and Pharmacy) in stages Due to delays on the receiving side, the project opted to activate the new XML feed all at one time (big bang!) BIDMC development and system testing were complete in late November 2007. Integrated Testing (end to end) began on March 27, 2008 Activation of the new feed occurred on May 2, 2008. BIDMC is now one of the most comprehensive feeds of any BioSense data source and sends ~ 5000 messages per day every 15 minutes, 24/7.

10. 10 Benefits of the Project BioSense has a second proven format for accepting data that other data sources might prefer to use in the future BIDMC’s CIS/HIS now has a standard XML output for a wide variety of data/message types that can be leveraged for other external interoperability requirements in the future The successful BIDMC/BioSense link demonstrates the practicality and benefit of implementing HITSP standards to streamline the exchange of healthcare data

11. 11 BioSense Future Vision Facility System Data Integrator Facility Syndromic Data Case Data Federated Data Grid National Health Surveillance Portal CDC Local/ State Data Local/State Health Dept Syndromic Surveillance Existing Capacity Disease Surveillance RHIO/HIE Data Integrator BioPhusion Portal NBIS Portal CDC Data Local/State Health Dept Local/ State Data DHS