1. Direct and the Nationwide Health Information Network Session 11 April 13, 2011

2. Agenda What is the Nationwide Health Information Network? –What health information exchange scenarios will the Nationwide Health Information Network help address? –What are the tools in the Nationwide Health Information Network toolkit? –How does Direct fit into the Nationwide Health Information Network toolkit? What are the clinical Use Cases for health information exchange? –How can Direct be used to enable a variety of use cases? –How can other tools address more complex use cases? How will Direct work at scale? MEDfx Presentation: Integrating Direct and CONNECT –Mark Bamberg, VP Research and Development, MEDfx Q&A Poll 2

3. What is the Nationwide Health Information Network? A set of policies, standards and services that enable the Internet to be used for secure and meaningful exchange of health information to improve health and health care. Enables a variety of health information exchange scenarios – from less complex to very robust 3

4. What scenarios will the Nationwide Health Information Network help address? Each health information exchange scenario requires a different “tool” from the Nationwide Health Information Network “toolkit”; e.g., Direct, Exchange, etc. Each tool must be used in conjunction with a coherent set of: –Standards –Services –Policies –Trust Fabric Directed Exchange Directed Exchange with Value-Added Intermediaries Longitudinal data access across settings of care within a community Cross-Community Access Scenarios Less Complex Very Robust 4

5. What are the tools in the Nationwide Health Information Network toolkit? Directed Exchange Directed Exchange with Value-Added Intermediaries Longitudinal data access across settings of care within a community Cross-Community Access Less Complex Very Robust ScenariosTools Direct Query for Documents Document Submission* Patient Discovery Retrieve Documents * Not currently in Nationwide Health Information Network toolkit 5

6. How does Direct fit into the Nationwide Health Information Network toolkit? The Direct Project provides HIEs with a low cost way to enable simple push messaging to their healthcare constituents The Direct Project doesn’t replace other ways information is exchanged electronically today, but it might augment them The Direct Project supports speedy adoption and simple use cases (e.g., provider referrals), but other methods of exchange might be better suited for other scenarios (e.g., real-time population health statistics) The Direct Project was designed to coexist gracefully with existing protocols for data exchange, e.g., web services, client-server, etc. The Direct Project seeks to replace slow, inconvenient, and expensive methods of exchange (e.g., paper and fax) and provide a future path to advanced interoperability. Though not technically incorporated yet, Direct Project specifications are expected to be incorporated into the NwHIN specifications Health information exchange: a puzzle with many pieces Cross-Community Access Directed Exchange Directed Exchange Longitudinal Data Access across a Community Directed Exchange with Valued-Added Intermediaries 6

7. How can Direct be used to enable a variety of use cases? Exchange Mechanism Use CaseSequence of Direct Messages One-way Directed Exchange Simple ReferralProvider  Provider: Clinical Summary Lab Results ReportLab  Provider: Lab Results Report Public Health Report from Labs Lab  ELR System: Reportable Lab Test Results Public Health Report from Providers Provider  IIS: Reportable Disease Diagnoses Two-way Directed Exchange Hospital Admit/Discharge Hospital  Primary Care: ADT Notification Primary Care  Hospital: Clinical Summary Immunization Request EHR  HISP/IIS: ADT Notification HISP/IIS  EHR: Updated Immunization Closed Loop ReferralPCP  Specialist: CCD/CCR Specialist  PCP: Updated CCD/CCR Medical Home Update Medical Home  EHR: Longitudinal Record Update HIE  Medical Home: Gap in Care, Updated Record 7

8. How can other tools address more complex use cases? ToolsSequence of Actions Patient DiscoveryInitiating Gateway  Responding Gateway: Request to indicate whether the community has knowledge of a patient matching a set of demographic criteria Responding Gateway  Initiating Gateway: patients with matching demographics known by the responding community Query for Documents Initiating Gateway  Responding Gateway: request for document communities associated with a particular patient Responding Gateway  Initiating Gateway: communities with documents associated with that patient Retrieve Documents Initiating Gateway  Responding Gateway: request to a community for documents associated with a particular patient Responding Gateway  Initiating Gateway: documents associated with that patient 8

9. How will Direct work at scale? Scalable Trust: –Standards-based certificates –Policies for issuance of certificates Scalable Directories: –DNS-based Directories at first –Interoperable statewide directories with certificate lookup next Upcoming S&I Framework initiatives targeted at both of these topics 9

10. MEDfx Presentation

11. Presentation Goals Involvement with Direct Involvement with CONNECT Evolution of the Direct / CONNECT integration How the integrated solution works 11

12. Involvement with Direct MEDfx involved from beginning in CONNECTathons Joined Direct in September 2011 –Implementation Group –Reference Implementation WG –Implementation Geographies WG Provided Install for Java Bare Metal Direct Reference Implementation Initiates Direct Project Pilot for Virginia Region –MEDfx, Verizon, MedVirginia, and Dominion –Supports Referral to Patient Centered Medical Home –Integrated support with Lifescape Portal Demonstrates Direct / CONNECT solution at HIMSS 2011 12

13. Involvement with CONNECT SSA Disability Claims Use Case –MedVirginia provides C32 to SSA via the NwHIN Proprietary NwHIN Gateway –July 2009 MEDfx integrates MedViriginia with CONNECT 2.0 –Supports SubjectDiscovery DocQuery DocRetreive CHIEP –MedVirginia submits C83 to CMS for Patient Discharge Events –Upgrades to CONNECT 2.4 –July 2010 MedVirgina goes into production –Supports Patient Discovery DocQuery DocRetrieve XDS.b –Provide and Register Document Set –Retrieve Document 13

14. Involvement with CONNECT cont. Virtual Lifetime Electronic Record (VLER) –MedVirginia provides full NwHIN support to VA and DoD –Supports SSA, VA and Dod with single CONNECT instance –Adds Centra as subordinate HIE through MedVirginia 14

15. CONNECT 2.0 Deployment MedVirginia Portal HTTPS Solution 1CONNECT SSA NwHIN Subject Discovery Document Query Document Retrieve 15

16. CONNECT 2.4 Deployment MedVirginia Portal HTTPS Solution 1CONNECT SSA NwHIN Patient Discovery Document Query Document Retrieve VA DoD CMS XDS.b Provide And Register Document Set Review Document 16

17. Legacy Integration SMTP MedVirginia HISP MedVirginia Portal SMTPS SSL HTTPS Dominion HISP Dominion Portal SMTPS SSL HTTPS Interchange Lifescape Solution 1 CONNECTfx Interchange Lifescape Solution 1 DOD VA SSA NwHIN 17

18. Target Architecture SMTP HISP 1 MedVirginia Solution 2 Portal SMTPS SSL HTTPS HISP 2 Verizon Lifescape Portal SMTPS SSL HTTPS Interchange Lifescape Oracle HTB Oracle OHMPI CONNECTfx Interchange Lifescape DOD VA SSA NwHIN 18

19. Capabilities RIM HL7v3 CDR Documents available via CONNECT Ability to shred Documents into CDR via Direct Ability to share Direct Sourced Documents Ability to share C32 with content from structured Direct Sourced Documents Low overhead installation Scalable 19

20. Q&A

21. Poll 21