1. Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Linh H. Le, MD, MPH; Ivan J. Gotham, PhD; Lori Evans, MPH, MPP; Dale Morse, MD, MS; John Fuhrman; John Brady (New York State Department of Health); Farzad Mostashari, MD, MPH; Nicholas Soulakis, MS (NYC Department of Health and Mental Hygiene); LeRoy Jones (GSI Health); Mark Ciampa, MS, PMP (Booz Allen Hamilton) Universal Public Health Node (UPHN): An Evolution of Health Information Exchange in New York

2. 1 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Why a new architecture for Health Information Exchange (HIE) for Public Health in New York Unprecedented investment in HIE from New York State with HIE for Public Health as one of clinical investment priorities Support from CDC new initiative for Enhancing Public Health Capabilities Through Health Information Exchanges Need to move from uncoordinated, point to point communications to a common, bi-directional health information exchange for public health Need to take advantage of and comply with the Statewide Health Information Network - New York (SHIN-NY) architecture and national standards for healthcare interoperability

3. 2 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Evolution of Health Information Exchange (HIE) for Public Health In New York text CDA HL 7 2.4 HL 7 2.3 HL 7 2.5 text X12 cvs text

4. 3 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Critical Challenges How can information from different HIEs be integrated? How can we move from a one-way to bilateral exchange of information from clinical systems to public health? How can we exchange data in a timely, secure and standardized manner? How can we achieve our above goals while protecting patient privacy to the greatest extent possible?

5. 4 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange What is the Universal Public Health Node A collection of services and operational policies designed to fulfill designated biosurveillance and public health reporting objectives by exchange of data, bi-directionally between RHIOs and public health agencies A subset of the architecture for the Statewide Health Information Network of New York (SHIN-NY), and complies with its architectural parameters for full compatibility with other SHIN-NY domains beyond public health Based on a service-oriented architectural paradigm (SOA), implemented through web services operating through an enterprise service bus (ESB) Developed as part of a statewide collaboration process with active participation across public and private sectors under leadership from NYSDOH

6. 5 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Overarching Architecture Principles Integration of Public Health Reporting Across Multiple HIEs –Exchange of data for public health in a standard manner –Collaborative Development of Consensus Implementation Guide Enabling Bidirectional Flow of Information and Intelligence –Public Health Participation in RHIO data exchange as equal partners, providing and receiving information as needed –Dynamic Querying Capabilities Ensuring Patient Privacy –Implement and Enforce of Privacy & Security Standards –Minimum Data Necessary - Filtering, Anonymizing, Aggregating Compliant with not only the SHIN-NY architecture, but also the national standards for healthcare interoperability –UPHN is a HITSP-compliant and HITSP-consistent architecture –UPHN also leverages the work of the NHIN effort in its architectural framework

7. 6 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange UPHN Primary Functionalities Patient Query: allow public health to query and receive responses for data about and individual patient based on query parameters Line List Query: enable public health to request and receive patient-level data for specific disease conditions Anonymize/Re-identify Query: enable the linkable de- identification and re-identification back to identified data as needed for public health investigation Analytic Query: enable public health to receive data based on predefined queries for counts of specific disease conditions

8. 7 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Public Health Scenarios Public Health Investigation 311 Patient Locator Tuberculosis (TB) All Points Bulletin (APB) Influenza Surveillance Syndromic Surveillance

9. 8 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Public Health Investigation In response to a suspect or confirmed case report of public health significance, public health authorities can query multiple RHIOs using a standard interface and receive additional clinical information regarding past medical history, treatment, etc Patient Query

10. 9 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange 311 Patient Locator In case of emergency, public authorities can query multiple RHIOs using a standard interface and receive information regarding recent encounters/ admissions, which could help in locating and tracking missing persons. Patient Query

11. 10 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Tuberculosis (TB) All Points Bulletin (APB In case of an imminent public health threat posed by an individual with contagious condition who has been lost to public health follow-up (e.g., XDR TB, SARS case) Patient Query

12. 11 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Influenza Surveillance For regular surveillance and in response to an influenza outbreak, RHIOs would send patient care and hospital resource data to the public health authority. Line List Query Anonymize/Re-identify Query

13. 12 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Syndromic Surveillance To monitor the rate of outpatient, ED and inpatient encounters for respiratory and gastrointestinal illnesses. As more specific information regarding the illness is obtained, public health can distribute an updated query to partner RHIOs specifying case definition and other parameters relevant to this outbreak. The RHIOs modify their aggregation and reporting system to incorporate this new query. Analytic Query

14. 13 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Key System Components Enterprise Service Bus (ESB) Service Registry and Discovery Common communication and transport protocols Standardized messaging format and vocabulary

15. 14 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Enterprise Service Bus (ESB) The SHIN-NY ESB is a federated (or distributed) ESB, allowing multiple physical ESB instantiations to be exposed as one logical instantiation An integrated physical instantiation of the SHIN-NY ESB is referred to as a SHIN-NY ESB node UPHN ESB is a domain-specific ESB node, exclusively handling public health services and transactions

16. 15 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Service Registry and Discovery UPHN ESB will maintain a restricted service registry using UDDI v2.0.4 as documented in the NHIN Messaging Platform Specification The service registry will keep both endpoint servers addresses and Web Services Description Language (WSDL) service definitions Copies of the registry that are kept in synch via replication or another appropriate means with other ESBs within the SHIN-NY

17. 16 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Common communication and transport protocols UPHN supports the communication and transport protocols specified in the NHIN Interface Specification – Messaging Platform v1.9 –Common transport layer for all messages using SOAP 1.2 over HTTP –Messages between UPHNs will be secure from end to end by the use of encryption as well as addressing within messages –Message envelope will support assertions about security and trust between UPHNs –Authentication will use X.509 certificates issued by a common trusted certificate authority –All messages will be digitally signed for purposes of authentication and non-repudiation –Use WS-ReliableMessaging as a baseline message exchange pattern to ensure acknowledgement of all communications (uni- or bi- directional)

18. 17 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Standardized messaging format and vocabulary Fully comply with HITSP Interoperability Specification for Biosurveillance HL7 2.5 is implemented initially HL7 3.0 will be used when become more broadly used

19. 18 Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Contact Information Linh Le, M.D., MPH Research Scientist New York State Department of Health Bureau of Healthcom Network Systems Management 800 North Pearl, Albany, NY 12204 Phone: 518-473-1809 Email: lhl02@health.state.ny.us