1. Global Business Services Nationwide Healthcare Information Network Design Decisions and Lessons Learned September 11, 2006 Dave Casey Webster IBM NHIN Chief Architect

2. IBM Global Business Services 2HL7 Plenary Session – Boca Raton – September 11, 2006 IBM NHIN Architecture Design Decisions Community-Centric –First build communities, then connect them –Communities determine where data is stored (centralized, locally, or both) –Lightweight, secure community hub provides basic services Drive and conform to standards –Instantiation of IHE interoperability framework using Java/J2EE (www.ihe.net) –Clinical events stored as HL7 CDA(r2)-compliant documents Provide security & privacy w/o sacrificing usability or research value –Anonymous/pseudonymous data that can be re-identified as needed/permitted –Support other data aggregates (registries, outcomes analysis, quality of care) Practical –Scalable and cost-effective at every level of practice –Point-of-care performance is critical to adoption

3. IBM Global Business Services 3HL7 Plenary Session – Boca Raton – September 11, 2006 Network Security IBM NHIN Architecture PIX (ID Xref) PDQ (Demog) Patient Identification Registry Services Document Locator URIs Community Hub Support Services ATNA (Audit) Logging CT (Clock) Authentication Authorization Access Control Patient Consent Community Services Biosurveillance PHR Portal XDS Community XDS Cross-Community: Search/Retrieval Policies/Security Admin/Maintenance NHIN Interface Hospital or Physician Practice Interface Integration Engine or Data Source Data Gateway Patient Lookup Data Services CDA Transform XDS Document Services Document Storage and Retrieval

4. IBM Global Business Services 4HL7 Plenary Session – Boca Raton – September 11, 2006 Security Services Find Document (intracommunity) Action Sequence PIX PDQ MPI Services Registry Services Document Locator URLs Community Hub XDS (CDA) Document Services Document Storage and Retrieval

5. IBM Global Business Services 5HL7 Plenary Session – Boca Raton – September 11, 2006 Lessons Learned Technology isnt a significant barrier –Consumer readiness, politics, lack of universal standards are much more problematic Politics can drive architecture –Substantial complexity and cost necessary to work around issues such as patient identification, provider authorization, state and local healthcare and privacy differences, etc. It is difficult to effectively separate policy from functionality

6. Global Business Services Thank you!