1. Meeting Etiquette Please announce your name each time prior to making comments or suggestions during the call Remember: If you are not speaking keep your phone on mute Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call –Hold = Elevator Music = very frustrated speakers and participants This meeting, like all of our meetings, is being recorded –Another reason to keep your phone on mute when not speaking! Feel free to use the “Chat” or “Q&A” feature for questions or comments, especially if you have a bad phone connection or background noise in your environment NOTE: This meeting is being recorded and will be posted on the Wiki page after the meeting From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute

2. RESTful Health Exchange (RHEx) Content Approach WebEx #5 August 23, 2012 Powering Secure, Web-Based Health Data Exchange wiki.siframework.org/RHEx

3. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 2

4. What is RESTful Health Exchange (RHEx)? An open source, exploratory project to apply proven Web technologies to demonstrate a simple, secure, and standards-based health information exchange Sponsored by the Federal Health Architecture (FHA) program in FY12 –Helps to address Nationwide Health Information Network (NwHIN) Power Team recommendation to develop a specification for RESTful exchange of health data –Informs a path forward for a RESTful health data exchange Demonstrates RESTful health information exchange in two phases –Phase 1: Security and Transport Approach (April-July 2012) –Phase 2: Content Approach (July-September 2012) 3 wiki.siframework.org/RHEx

5. RHEx Architecture Stack 4 Phase 1 Phase 2

6. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 5

7. Components of the RHEx Content Layer 6 Content Organization Content Payload What data will be exposed? How should data be organized and managed?

8. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 7

9. Content Organization Goals 8 Establish traversable hierarchical organization of data Provide common structured interaction using standard HTTP methods and RESTful Principles Support representation of data at appropriate levels of granularity aligned with Use Case –TATRC Pilot Use Case (discussed later in briefing)

10. Content Organization Options Atom Publishing Protocol (AtomPub)Atom Publishing Protocol (AtomPub –Original Web 2.0 protocol for publications and posting on Web resources Open Data Protocol (OData) –Extends AtomPub –Data represented by Entity Data Model –Provides specificity at the field and data type levels –Not healthcare specific hData –Similar to AtomPub, but more constrained –Data can be represented using multiple standards –Provides specificity at the granular document levels –Developed with healthcare domain in mind Hierarchical structure supporting linked documents Provides a means for discoverability of changed content –Can interoperate with other protocols OData can be integrated in the hData hierarchy Fast Healthcare Interoperability Resources (FHIR) Content Profile can be developed 9

11. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 10

12. Content Payload Goals Establish Common Data Model for Exchange –Semantic and Syntactic Interoperability Use existing standards Provide extensible solution to manage multiple data standards Align content with use case –TATRC Pilot Use Case (discussed later in briefing) 11

13. Content Payload Options Healthcare Standards –HL7 CDA HITSP C83/C80/C154/C32 greenCDA for C32 –HL7 2.6 REF_I12 –HL7 V3 REPC_MT210001UV –Consolidated Clinical Document Architecture (CDA) –DICOM 12

14. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 13

15. TATRC Pilot Motivation Pilot is designed to develop proof of concept for a World Wide Web model for health data exchange –Test the application of REST to health data exchange –Help to address the NwHIN Power Team recommendation Worked with selected federal partners to identify critical capability gap and select a prototype use case –Consult results are not consistently sent to PCP today, impacting healthcare for Veterans and Service Members Phase 2 pilot designed to evaluate Content Organization and Payload concepts 14 TATRC = Telemedicine & Advanced Technology Research Center

16. consult results TATRC Pilot Use Case – Consult/Referral 15 PCP Consulting Physician consult request PCP = Primary Care PhysicianURL-1 = Consult Requests Details URL URL-2 = Consult Results Details URL URL-1 URL-2

17. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 16

18. RHEx Content Approach in TATRC Pilot 17 Context –Designed to summarize a patient’s electronic health record for the purpose of clinical consultation and referral –Components were modeled to support pilot use case: specialist consultation for knee replacement Content Organization choice: –Hybrid approach Patient data is organized into an hData Record on the Consulting Provider’s EHR –Each section has zero or more entries –Unique Uniform Resource Identifier (URI) links are used for authorized patient record data access Patient data is exposed as links to greenC32 representations on PCP EHR Content Payload choice: –greenC32 schemas used as content payload

19. Approach to Content Organization, 1 of 2 18 hData Abstract Content Model Diagram Supports coarse documents OData could be implemented as a Section Feed Supports hierarchy of patient data Describes content available and resource URIs URIs can point to DICOM images or granular patient data, such as allergy or medication

20. Approach to Content Organization, 2 of 2 19 Course Grained Link Example Granular Content Link Example

21. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 20

22. RHEx TATRC Pilot Phase 2 Model Vision 21 greenC32 Patient Procedures Allergies Medications Lab Results Vital Signs PCP EHR Consulting Provider EHR

23. RHEx Content Payload for TATRC Pilot 22 Existing data standards Resource Directory Description Language

24. Overview Orientation –What is RESTful Health Exchange? –RHEx Architecture Stack The RHEx Content Layer –Content Organization –Content Payload RHEx Content Approach in TATRC Pilot –Content Organization –Content Payload Questions and Wrap-up 23

25. Summary RHEx Content Layer includes Content Organization and Payload –Options exist for each Concepts for Content Organization and Payload are being evaluated in the TATRC Pilot –Hybrid approach to Content Organization hData is used as the Content Organization for RHEx at Consulting Provider –Supports multiple data standards –Developed with healthcare domain in mind greenC32 sections represented at Primary Care Provider –greenC32 used for Content Payload Builds on existing standards Provides a format that is easier for developers to use 24

26. Questions & Wrap-up Questions? For more information: –http://wiki.siframework.org/RHExhttp://wiki.siframework.org/RHEx Discussion on the Google Groups forums:Google Groups –https://groups.google.com/forum/?fromgroups#!forum/restfulhealthexchangehttps://groups.google.com/forum/?fromgroups#!forum/restfulhealthexchange 25

27. BACKUPS 26

28. Green Process 27