OpenHIE’s Architecture and its Components A whirlwind tour of the inner workings of OpenHIE’s standards-based health information exchange. Derek Ritz, P.Eng., CPHIMS-CA AeHIN Conference (Manila), August 2015

Agenda Introductions What is OpenHIE? Who is OpenHIE? (the “community”) What does it do? (the “black box”) How does it work? (the “clear box”) Where is it going next? Q&A

Introductions

What is OpenHIE?

This mission statement stuff is copied directly from the OpenHIE website. The key take-away is that this is an international community working in low resource settings. The countries on the left are all ones where OpenHIE is active: Rwanda, South Africa, Philippines, Tanzania, Bangladesh, Liberia, Zimbabwe, Nigeria – and indirectly (or directly) in the 50+ countries where the US PEPFAR (President’s Emergency Plan for AIDS Relief) is active. www.ohie.org

Ok… but what does it do?

Ready? Set? What OpenHIE is for… explained in 60 seconds or less!

Communicable Diseases Services are provided within a care programme (e.g. Communicable Diseases) at a point of care… Communicable Diseases

CD database Communicable Diseases …and information about these person-centric care services may be saved to a database… Communicable Diseases

CD databases Communicable Diseases There may be multiple systems saving person-centric care information to multiple databases. Communicable Diseases

CD databases Communicable Diseases NCDs There may be other care programmes (e.g. NCDs)… Communicable Diseases NCDs

CD databases NCD databases Communicable Diseases NCDs …with multiple points of service writing person-centric information to multiple databases… Communicable Diseases NCDs

CD databases NCD databases MCH databases Communicable MCH Diseases As these databases proliferate… Communicable Diseases MCH NCDs

Communicable Diseases MCH NCDs …we need a way to tell that this information is all pertaining to the same individual. We need to be able to tell that these episodes are all chapters in Mosa’s health story. Communicable Diseases MCH NCDs

CD databases NCD databases MCH databases Communicable MCH Diseases NCDs

CD databases NCD databases MCH databases Communicable MCH Diseases This is what OpenHIE does. It connects the data silos. Communicable Diseases MCH NCDs

Communicable Diseases MCH NCDs OpenHIE is a cloud-based health information sharing service that follows the golden thread of Mosa’s care over time and across different care sites. Communicable Diseases MCH NCDs

Communicable Diseases MCH NCDs OpenHIE gives care providers a way to communicate with each other as members of a care team. Communicable Diseases MCH NCDs

Automatic generation of population indicators and metrics Continuity of guideline-based care, over time and across multiple sites Automatic generation of population indicators and metrics Support transaction processing for UHC and CRVS OpenHIE supports: [3 bullet points]

OpenHIE helps make health systems stronger!

…and 60 seconds are up!

How does OpenHIE work?

This diagram is often used to describe OpenHIE’s “inner workings”.

The “Einstein Principle” states that a favoured solution should be as simple as possible, but no simpler. This diagram is too simple.

HWD FD CR ILR SHR HMIS IL TS POS There is an architectural element, the Interlinked Registry (ILR), that is not on the previous diagram. The ILR plays an important role. We also will talk about the TS and the role it plays as a definitive library that POS systems can access to seed their code sets. This diagram is the one we’ll use for today’s description of OpenHIE and how it works. POS

HWD FD CR ILR SHR HMIS IL TS POS Point of Service (POS) – the applications that communicate with the HIE including mHealth apps, EMRs, hospital EPRs, lab and pharmacy, etc. HWD FD CR ILR SHR HMIS IL TS POS

HWD FD CR ILR SHR HMIS IL TS POS Interoperability Layer (IL) – manages all inbound communication from POS applications and orchestrates how OpenHIE will do its work to satisfy them. The IL also provides centralized authentication, authorization and audit logging services. HWD FD CR ILR SHR HMIS IL TS POS

HWD FD CR ILR SHR HMIS IL TS POS Terminology Service (TS) – provides the canonical database of code sets and clinical ontologies and, where applicable, can map between them. CR ILR SHR HMIS IL TS POS

HWD FD CR ILR SHR HMIS IL TS POS Client Registry (CR) – provides the definitive demographic data regarding subjects of care and cross-references local client ID codes to the enterprise client ID (ECID). TS POS

HWD FD CR ILR SHR HMIS IL TS POS Health Worker Directory (HWD) - provides definitive demographic data and competency data regarding providers of care and cross-references local provider ID codes to the enterprise provider ID (EPID). POS

HWD FD CR ILR SHR HMIS IL TS POS Facility Directory (FD) - provides definitive data about sites of care and the services provided at them; cross-references local facility ID codes to the enterprise facility ID (EFID). POS

HWD FD CR ILR SHR HMIS IL TS POS Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of a Health Worker Registry (HWR) and Facility Registry (FR). POS

HWD HWD HWD FD FD FD CR ILR SHR HMIS TS Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of a Health Worker Registry (HWR) and Facility Registry (FR). POS

HWD FD CR ILR SHR HMIS IL TS POS Shared Health Record (SHR) – is a repository of person-centric health transactions indexed by ECID, EPID, EFID and timestamp. The SHR provides a longitudinal health record; it may be used to generate an on-demand health summary (care continuity) document. TS POS

HWD FD CR ILR SHR HMIS IL TS POS Health Management Information System (HMIS) – the database of (aggregated) data elements and indicators that support big data analytics, public health planning and decision making. TS POS

HWD FD CR ILR SHR HMIS IL TS POS So… these are the puzzle pieces. How do they work? What do they do? POS

OpenHIE’s transactions… Save a new demographic record Query for a demographic record Query by ID Query by fuzzy match Update an existing demographic record Update inter-linked records Query for inter-linked records (Providers, Facilities, Organizations, Services) Save client encounter document Query for client encounter documents These are the transactions OpenHIE supports.

OpenHIE’s transactions… Save a new demographic record PIX ITI-8 Query for a demographic record Query by ID PDQ ITI-21 Query by fuzzy match PDQ ITI-21 Update an existing demographic record PIX ITI-8 Update inter-linked records CSD ITI-74 Query for inter-linked records (Providers, Facilities, Organizations, Services) CSD ITI-73 Save client encounter document XDS.b ITI-41 Query for client encounter documents XDS.b ITI-18 OpenHIE is standards-based, conformance-tested digital health infrastructure. These are the globally balloted IHE transactions that OpenHIE leverages to execute its transactions. XDS.b ITI-43

Save/Update demographic record This is the pattern of communication for saving/updating demographic information about a subject of care. [NOTE: taken from OpenHIE wiki. Error in showing HWR and FR and not showing ILR.]

HWD FD CR ILR SHR HMIS ITI-8 IL TS ITI-8 POS

Query demographic record(s) This is the workflow pattern for querying for demographic records.

HWD FD CR ILR SHR HMIS ITI-21 IL TS ITI-21 POS

Update/Query inter-linked record(s) ITI-74 This workflow pattern illustrates how the ILR is refreshed from its underlying health worker and facility directories and how a POS can make queries against the ILR. ITI-73

On a regular refresh cycle… HWD FD ITI-74 On a regular refresh cycle… CR ILR SHR HMIS IL TS POS

HWD FD CR ILR SHR HMIS ITI-73 IL TS ITI-73 POS

Save client encounter document ITI-41 ITI-9 ITI-73 ITI-73 This workflow illustrates how person-centric information is saved. First, the IL cross-indexes the inbound information to the ECID, EPID and ELID, and then the newly cross-indexed health record is saved to the SHR.

HWD FD CR ILR SHR HMIS ITI-9 ITI-73(2) ITI-41 IL TS ITI-41 POS

Query client encounter document ITI-18 ITI-9 ITI-18 To fetch a particular health record (clinical document), the POS first asks for the document’s ID (or a list of documents IDs matched to the client’s ECID) and then fetches the specific document(s), by ID, from the SHR. ITI-43 ITI-43

If document ID is unknown HWD FD CR ILR SHR HMIS ITI-9 ITI-18 IL TS ITI-18 If document ID is unknown POS

ITI-43 ITI-43 For each document ID HWD FD CR ILR SHR HMIS IL TS POS Instead of a particular clinical document, the POS may be looking for a health summary. To return this, the POS asks for an on-demand document to be generated by the SHR that collects and collates all of the available information about the client. ITI-43 For each document ID POS

Which documents?

Supported HL7 CDA Document Sections Clinical documents are broken down into sections. Each section contains health information about the client that is formatted based on a standardized template.

Supported CDA documents… Many clinical documents contain the same underlying sections. This is a list of the clinical documents OpenHIE presently supports (and more are being added all the time).

What’s next for OpenHIE? Aggregate Data Exchange (ADX) – IHE profile for submitting data element & indicator content to the HMIS Mobile Alert Communication Management (mACM) – IHE profile for sending unstructured messages to human recipients On-demand Document (ODD) – XDS.b option to create a CDA on-the-fly… implemented by OpenSHR but not yet tested at CAT Basic consent management (opt-out, no BTG) Other features based on Architecture Meetings… Presently (August, 2015), OpenHIE has plans to extend its transaction support by adding new capabilities. [points listed]

Thank you.