1. January 19,2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT Healthcare Provider Directory (HPD) Standards and Transaction Discussion IHE Face 2 Face February 1-3, 2010 Presenter: Nitin Jain (IBM/SSA), Toby Briks-Fader SSA Representative: Shanks Kande

2. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 2 February 2, 2010 Topics  Overview of recommended standards  Analyze in detail the recommended standards ► Identify any commonality and/or gaps between standards and HPD  Transaction Services Metadata  Next Steps

3. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 3 February 2, 2010 Recommended Standards Overview StandardSDO Description ISO TC 215 : ISO/TS 21091 Health Informatics ISODirectory services for health care providers, subjects of care, and other entities HL7 V3HL7Covers message standards, interactions and the XML data model for provider registry Lightweight Directory Access Protocol (LDAP) OASIS Defines the messaging protocol, operations and data schema for directory services. OASIS DSML v2 as a means to cover this with SOAP messages Personnel White Pages (PWP)IHEThe Personnel White Pages Consumer may make a wide variety of queries and cascaded queries using LDAP. Intended for inside of an organization; Universal Description Discovery and Interaction OASISDefines a way to publish and discover information about Web services.

4. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 4 February 2, 2010 Messaging Standard  We recommend adopting SOAP v1.2 as the messaging standard for the following reasons: ► Firewall friendly way to make remote procedures call and could be used over HTTP/TLS. ► Promotes Interoperability by providing a shared language for mapping structured data transmitted across different platforms and architectures. ► Allows full scale support to web services protocol standards with standard tooling, i.e. new requirements can be addressed without definition of new specification and implementations ► Encapsulates SAML assertions to carry user credentials for authorization and auditing purposes ► Extensive tooling support available for SOAP/XML

5. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 5 February 2, 2010 ISO/TS 21091 Overview  Directory services for health care providers, subjects of care, and other entities  Supports the communication through X.500 framework  Provides common directory information model of healthcare professionals extending the X.500 object model ► Extended Attributes (e.g. HcIdentifier, HcOrganization, HcSpecialisation) ► HL7 defined attributes (e.g. HL7 Sex, HL7 County Code etc)  Supports LDAP query and syntax for representing attributes  Inherits security requirements for authentication and non-repudiation from ISO 17799 and ISO TR 13335

6. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 6 February 2, 2010 ISO/TS 21091: Directory Information Tree

7. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 7 February 2, 2010 Commonality between ISO/TS 21091 and HPD Requirements  Supports Transactions for ► Lookup Provider (how it is extensible for other lookup attributes) ► Store Provider Contact Information, Credentials  Schema for ► Healthcare Organizations, different organization types ► Individual Professionals, Credentials ► Health care-specific contact information, ► Health care identifiers, roles (standard and local), ► Multiple Affiliations: Persons to Multiple Organizations affiliations ► Supporting Organizations (can be used for HIE/HIO information)  Vocabulary Sets: HL7 domain, ISO 21298

8. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 8 February 2, 2010 Gaps between ISO/TS 21091 and HPD  Business Relationship definitions between Individual and Organization  XML Based messaging

9. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 9 February 2, 2010 Enhancements on ISO/TS 21091  Encapsulating LDAP operations within XML for communication ► DSMLv2 to express LDAP requests and responses in SOAP bindings. ► DSMLv2 is a systematic translation of LDAP’s ASN.1 grammar (defined by RFC 2251) into XML-Schema. ► Allows HPD consumers to access HPD without having to write to the LDAP interface and offers a consistent way to interact with multiple dissimilar directories.  Open Issues ► Ease of DSMLv2 implementation? ► Would it cause any unreasonable burden on the implementers and adopters? ► Currently use of DSML v2 is primarily in identity management domain  Electronic end point information of Provider, HIE/HIO: ► labeledURIObject and labeledURI attribute [RFC2079] ► Mail attribute

10. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 10 February 2, 2010 HL7 v3: Personnel Management; Provider Registry  Uses Messaging protocol of HL7 v3.0  Vocabulary Code set: Provider Role Type, HL7 Domain tables  Schema ► Organization (Organization), Principal Person (Individual) ► Licensed Entity (Credentials), Healthcare Provider (Specialty), LicensedEntity (Qualifications), AssignedEntity (Functional Role) ► AlsoKnownAs (Aliases), Place (Location) ► OrganizationPartOf, OrganizationContains (Organization Hierarchy) ► Employee, Affiliate (Business relationships between Individual and Organization)

11. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 11 February 2, 2010 HL7 v3: Personnel Management; Provider Registry

12. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 12 February 2, 2010 Commonality between HL7 v3 and HPD Supports Transactions  Add Provider  Update Provider  Add Provider Notification (Broadcast)  Update Provider Notification (Broadcast)  Query Provider Details  Find Associated Providers Identifiers Query Supports SOAP/XML Communications

13. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 13 February 2, 2010 HL 7 v3 - Gaps/Open Questions  What is the adoption of this standard in industry for directory services  Any Interoperability issues?  Limited or no existence of HL7v3 provider directory in a production environment

14. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 14 February 2, 2010 Analysis of ISO vs HL7 V3  LDAP is much more extensively implemented than HL7 V3  Community and tooling know how easily available on LDAP standard  Tooling to support v3 schemas are incredibly complex and coded data and costly to implement HL7 interfaces  HL7v3 may pose significant barrier to adoption due to limited or no existence of HL7v3 provider directory in a production environment  HL7 v3 relies heavily on coded vocabulary; dependency on OIDs;

15. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 15 February 2, 2010 LDAP V3  Basis for ISO/TC 21091  Lightweight exchange protocol of X.500 schema  Exchange protocol TCP/IP with LDAP specific syntax  Operations: StartTLS, Bind, Search, Compare, Update, Abandon, Unbind

16. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 16 February 2, 2010 LDAP v3 - Advantages  LDAP a very commonly implemented protocol, many implementations including opensource  LDAP well understood and adopted across many industries  LDAP schema supports most requirements of HPD and can be extended  ISO and IHE have already adapted generic LDAP to the healthcare provider space – providing a platform for our work

17. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 17 February 2, 2010 LDAP v3 - Disadvantages  No support for SOAP/XML communication protocol in native LDAP communication protocol. ► May consider applying DSMLv2 to express LDAP requests and responses in SOAP bindings. DSMLv2 is a systematic translation of LDAP’s ASN.1 grammar (defined by RFC 2251) into XML- Schema. ► How easy is it to implement? ► Would it cause any unreasonable burden on the implementers and adopters?  No automatic support for Notification

18. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 18 February 2, 2010 PWP – Personnel White Pages

19. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 19 February 2, 2010 PWP – Query Personnel White Pages Transaction  Standard: Lightweight Directory Access Protocol (v3)  Commonly used schema found in X.500 Schema for LDAP and inetOrgPerson  Schema includes required elements for: ► Names ► phone #s ► Email ► Organization ► Address ► Language ► Title  Optional elements: ► Alias ► Vehicle license ► Department ► employee # ► employee type ► home address/phone ► Photo ► Locality ► URI ► Manager ► preferred delivery method ► registered address ► Secretary ► Uid ► User S/MIME Certificate ► X.500 ID

20. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 20 February 2, 2010 PWP – Disadvantages  Intended for inside of an organization. Not Designed for Broader scale to allow cross-enterprise queries.  Need to accommodate Health care specifics attributes

21. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 21 February 2, 2010 Secure IT Infrastructure Healthcare Provider Directory HPD Actors and Transactions Provider Directory Source Provider Directory Consumer Add/Update Provider Notify of Change Subscribe Lookup Provider AuthenticationAuditing Transaction Actor

22. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 22 February 2, 2010 Assumptions  Secured IT Infrastructure hosting HPD provides security services related to Authorization, Authentication and Auditing  Data validation for Add/Update transactions is out of scope  Access-based-control policy to view HPD data is out of the scope of HPD profile  HPD profile is agnostic of Search Algorithm and leave the business rules to determine exact/ambiguous rules to the HPD implementers

23. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 23 February 2, 2010 Transaction Metadata Add/Update Provider Request  Provider Name, Aliases  Provider Type (Organization/Individual)  Provider Address  Individual Provider Other Identifiers  Individual Provider other demographics (e.g. Gender, DOB, Race etc)  Provider Specialty  Provider Credential  Provider Status and Effective Dates  Individual provider association to the provider organization  Organization structure including Facilities?  Organization/Individual Provider Association to HIE Add/Update Provider Response  HPD Provider ID  Acknowledgement

24. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 24 February 2, 2010 Transaction Metadata Lookup Provider Request  Provider Name, Alias  Provider Address  Provider global and directory Identifier (e.g. NPI, HPD Provider Id etc)  Provider other traits such as DOB, Gender  Provider Specialty  Zip code (geographic searches)  Response parameters to return Lookup Provider Response  Provider Name, Alias  Demographics  Provider associated Address  Provider Other Identifiers  Provider Specialty  Provider Status and Effective dates  Provider Type (Organization, Individual)  Individual provider relationship to the provider organization and relationship status  Provider Relationship to HIE  Associated HIE Location, URLs

25. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 25 February 2, 2010 Next Steps (to be completed by Face to Face)  Decide on Content Model Standards  Decide on Communication standards  Confirm metadata for the Transactions  Confirm Data modeling tool

26. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 26 February 2, 2010 Backup Slides

27. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 27 February 2, 2010 HL7 v3: Personnel Management; Provider Registry

28. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 28 February 2, 2010 Transaction Metadata Subscribe Request (WS-Notif)  Event definition code  Provider Identifier such as HPD ID  Provider Name  Subscriber Name  Subscriber Identifier  SAML search request? Subscribe Response  Subscription Id  Confirmation message

29. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 29 February 2, 2010 Transaction Metadata Notification Request  N/A Notification Response (encoded search result?) (Same as Lookup Provider Response)  Provider Name,  Demographics  Provider Identifiers  Provider Specialty  Individual provider association to the provider organization  Provider Association to HIE  Associated HIE service endpoints (URLs)  Provider and relationship Status  Provider Type (organization, Individual)