1. 3/5/2016 3:33 PM Services and the Global View May 2006 Ken Rubin EDS Co-Chair, OMG Healthcare Domain Task Force Co-Chair, HL7 Services-oriented Architecture SIG ken.rubin@eds.com Ken Rubin EDS Co-Chair, OMG Healthcare Domain Task Force Co-Chair, HL7 Services-oriented Architecture SIG ken.rubin@eds.com

2. Page 2 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Overview Background / Rationale behind HSSP HSSP Objectives The Impetus for Collaboration OMG, HL7, and Operational Concerns Project Artifacts Dialog: The Value of Participating Current Status/Update

3. Page 3 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted “How do you know that the [web-] services you’re building are not just the next generation of stovepipes?” Janet Martino, LTC, USAF (Retired) to a panel of Healthcare IT Leaders “How do you know that the [web-] services you’re building are not just the next generation of stovepipes?” Janet Martino, LTC, USAF (Retired) to a panel of Healthcare IT Leaders

4. Page 4 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Why HSSP Was Created Several large provider organizations were each facing challenges in integrating current and emerging systems –Veterans Health Administration –Kaiser-Permanente –SerAPI Project (Finland) There were a number of shared beliefs among the founding partners…

5. Page 5 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted In each case… There was active integration and development work There was a shared belief that messaging alone was not the optimal solution A services-oriented architecture was the target environment There was strong commitment to standards There was recognition standard services would further interoperability with partners and products It was recognized that developing “stovepipe” services would not address business challenges

6. Page 6 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted So, what is HSSP? The “Healthcare Services Specification Project” Effort to create practical interface specifications for services important to health IT A joint sponsored activity by HL7 and OMG Current focus activities –Define a “Roadmap” for Services in Healthcare –Entity Identification Service (EIS) –Retreive, Locate, and Update Service (RLUS) –Common Terminology Service (CTS) –Decision Support Service (DSS) –Migration guidance for Web Services in HL7 (SOA4HL7) –Produce a methodology

7. Page 7 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Why “services” and not “messages”?* Accepted industry best practice –A common practice in healthcare but not yet healthcare IT –Commonplace usage across “IT” outside of healthcare –Many key products use them but do not expose interfaces Services define behavior explicitly and data transport implicitly –Ensures functional consistency across applications –Furthers authoritative sources of data –Minimizes duplication across applications, reuse Services do not preclude the use of messages –Services rely upon underlying transport protocols –Messages can be used as payloads for service calls –Messaging infrastructure may be used as underlying transport *slide adapted from a Veterans Health Administration Presentation, used with permission

8. Page 8 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted So, what about web services? Web services alone (e.g., SOAP/WSDL, etc) do not solve the problem: –What behaviours do we expect of an MPI? –What behaviours are not expected or should remain unspecified? –What confidence do we have that two MPIs can interoperate in an SOA intra- or inter-organization? –What about information semantics? –How will business exceptions be managed across instances? These issues are not addressed via selection of SOAP/WSDL as a platform These issues are not entirely addressed via Web Services as an ITS

9. Page 9 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted HSSP Builds Upon Existing Work Ability to Interoperate High Low

10. Page 10 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Overview of Key HSSP Artefacts Service Development Framework (SDF) –Methodology describing the services specification process –Integrates life cycle across HL7 and OMG with callouts to existing processes (such as ballots) –Version 1.0 Baselined in January 2006 (HL7 Phoenix) Service Functional Model (SFM) –Describes in business terms the behaviour of the service –Identifies relevant information content (e.g., RIM-derived artefacts, terminologies, etc.) –Technology independent –Includes conformance profiles RFPs Submissions

11. Page 11 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Current HSSP Priority Areas AreaScope and Rationale for Priority Terminology ServicesTo develop a comprehensive terminology specification (versioning, maintenance, query, etc.) built upon the current CTS specification. Selected based upon past precedence, ongoing work interest, and ability to validate the emerging methodology. Entity IdentificationTo manage and maintain identities within and across domains, localities, or products. Anticipated to be critical path dependency for other services; foundational work was available from HL7 and OMG. Record Location and Retrieval To discover, retrieve, and update records in distributed environments. Seen as core foundational service to support EHR and healthcare delivery with interest from many national and regional programmes. Location & Retrieval merged upon recognition that location was effective retrieval of metadata. Decision SupportTo assess data (such as patient data) and returns specific conclusions as the output. Seen as a way to significantly reduce effort required and to promote wider adoption of CDSS implementations. Selected based upon strong business need and interests and additional volunteer community.

12. Page 12 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted How the priorities were determined… Based on an open selection process Brainstorming gave way to successive refinement and downselect Priorities determined by business need and resources Initial list included Terminology, Entity ID, Record Location, Record Retrieval Record Location and Retrieval activities subsequently merged Decision Support added later based upon community interest and resources

13. Page 13 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted HL7, OMG, and the Collaboration

14. Page 14 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted What is HL7? * Slide content courtesy of HL7, used with permission Health Level Seven (HL7) is an ANSI accredited standards organization (ASO), working in areas of: Electronic Data Exchange Healthcare Messaging Arden Syntax Visual / Context Integration (CCOW) Clinical Document Architecture (CDA) Electronic Health Record System (EHRS) Functional Model Service-oriented Architecture Members include providers, vendors and consultants, government & others. There are also now 30+ international affiliates. ISO’s Open Systems Interconnect (OSI) model: Application Level” – level 7 ISO’s Open Systems Interconnect (OSI) model: Application Level” – level 7

15. Page 15 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted What is OMG?* The Object Management Group--a 15-year-old not-for-profit Computer Industry Standards Consortium Home of UML, the Industry’s Modeling Standard and the Model Driven Architecture (MDA) Open Membership and Adoption Process –One-member, One-vote Specifications Available Free on our Website Vendors using OMG specifications may or may not be OMG members Over 500 members including Companies, Government Agencies, Universities * Slide content courtesy of OMG, used with permission

16. Page 16 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Collaboration Rationale – Initial Thoughts… HL7 has a world-class functional community …but HL7’s strength is not service architecture HSSP project needed to leverage talent of a strong architectural community OMG has history and demonstrated leadership in service definition and SOA OMG provided the ability to interact with multiple vertical domains (pharma, manufacturing, etc.)

17. Page 17 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted The Result… HL7 brings… –Healthcare semantic interoperability expertise and credibility –Rich, extensive international community perspective –Diverse membership base OMG brings –distributed systems architecture and modeling excellence –Effective, efficient, rapid process –Premise that standards must be implemented Resulting in… –Services will be identified by the community needing them –Improved methodology resultant from functional and architectural merging of the two groups –Facilitation of multi-platform implementation and broader implementation community

18. Page 18 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted The Opportunity Created... HSSP is open to any type of participant: –National, Federal, State, Local Governments –Payers, Providers, Consultants –Individual stakeholders The process facilitates each party participating to their maximum advantage –Discussions are “community of interest” focused Healthcare discussions in healthcare venue Technical discussions in technical venues Processes and results are open and available –All proceedings are published on web and listserv –Consistent multinational/multicultural participation “Guiding Principles” ensure we don’t lose sight of our objectives

19. Page 19 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Project Operational Concerns

20. Page 20 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted The Approach HL7 is leading in service selection, functional elaboration, and conformance criteria OMG is leading the technical specification Both organizations jointly participating in all activities Work products are “owned” by only one organization but used collaboratively (e.g., any product is “hosted” by HL7 or OMG) “Operate as one project” is a core principle Actively seeking vendor participation Eclipse has committed to providing open source implementations IHE discussions are underway to profile and demonstrate viability of the implemented solutions

21. Page 21 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Project Organisation One overarching project with five subproject efforts Overall project –Meets at HL7 and OMG meetings –Status teleconferences biweekly –Owns responsibility for planning, marketing, etc. “Infrastructure” Subgroup –Developed and maintains methodology Subprojects –Determine their own deadlines, meeting schedules, etc. –May be hosted by other committees –Leverage project infrastructure and methodology

22. Page 22 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Timeline of Key Events 1996: First OMG Healthcare Service Spec Adopted (PIDS?) 2003: HL7 ServicesBOF formed 2004 September: HL7, OMG Collaboration MOU 2005 January: Joint Project Chartered 2005 April: Project Kickoff 2006 March: Issue Ballot for Functional Specs 2006 Q4: Technical Specs RFP (planned) 2005 September: Methodology and MetaSpecs Baselined (planned) 2005 October: Interoperability Services Workshop & Conference

23. Page 23 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted 2006 HSSP Project Schedule (major milestones) Jan: Charter HL7 SOA SIG HL7UK Information Day Jul: Issue 4 ballots (3 + 1) Feb: Announce intention to ballot RLUS Aug: Ballot review Mar: Issue RLUS Ballot Sep: HL7 Boca Raton (Reconciliation); RLUS DSTU Adopted! OMG Anaheim (Issue RFPs) Apr: OMG Meeting St. Louis (RLUS RFP prep) Oct: Intent to ballot DSS, EIS, CTS2 May: HL7 San Antonio (RLUS ballot reconciliation) Nov: HL7 Educational Summit Issue DSS, CTS2 Ballots Jun: Announce intention to ballot (3 committee, 1 membership) Dec: OMG Washington (Review Initial RFP Submissions)

24. Page 24 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted HSSP Project Differentiators Active participation from three continents and 15+ organizations Significant cross-cutting community involvement Providers (Kaiser, VHA, Intermountain Health, Mayo) Vendors (CSW Group, IBM, PatientKeeper, Universata) Value-added Providers (MedicAlert, Ocean Informatics, Eclipse Foundation, etc.) Payers (Blue Cross/Blue Shield, Kaiser) Integrators (IBM, EDS) Governments (Veterans Health Administration, Canada Health Infoway, HealthConnect (Australia), SerAPI (Finland)) Managing differences between SDOs in terms of membership, intellectual property, and cost models

25. Page 25 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted HSSP In the “Community” HSSP is actively seeking to collaborate with other groups HSSP specs have a section citing existing work and its relevance Working project relationships with: –HL7 Clinical Decision Support Technical Committee –HL7 Vocabulary Committee –Object Management Group Service-oriented Architecture SIG –Eclipse Open Healthcare Framework Initiative Emerging relationships with: –Integrating the Healthcare Enterprise (IHE) –Medical Banking Initiative

26. Page 26 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Where should I engage? Interest Area (including representative communities-of-interest) Venue Setting functional priorities; selecting priority services (Consumers, Providers, Vendors, Integrators) HL7 Defining behaviour; service capabilities (Consumers, Providers, Vendors) HL7 Defining functional conformance/compliance criteria (Consumers, Regulatory) HL7 Technical specification, interface specification, evaluation criteria (Consumers, Regulatory, Integrators) OMG Technical conformance/compliance criteria (Consumers, Regulatory, Integrators) OMG Architectural considerations; service interdependencies, SOA (Integrators, Vendors, Implementers) OMG Product development; technical standard creation; API definition (Vendors, Implementors) OMG

27. Page 27 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Dialogue: The Value of Participating

28. Page 28 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted For Product Consumers and Users… The Impacts and Rationale of HSSP Specifications ImpactsRationale Promotes deployment ease and flexibility Specifications will support multiple topologies Consistency at the interface level assures asset protection Standard interfaces means that conformant components are substitutable Multiple vendor product use/ interoperability Using compliant products means side-by-side interoperation of multiple product offerings Increased buyer/product offeringsConsumer demand will create increased marketplace competition Facilitates integrationUnity in purpose and consistency in interface eases integration burden Time to marketAvailability of an industry-accepted component interface eases product development burden Requirements definition – influence vendors in a direct way Participation by provider and payer community is direct expression of business need Lower cost = wider deployment = higher quality service

29. Page 29 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Product Vendor … The Impacts and Rationale of HSSP Specifications ImpactsRationale Market opportunity – ability to grow business / “Grow the pie” Standardization of interfaces eases cost-of-entry to markets Conformance adds legitimacy to product offering Consumers view conformance as a confidence metric Reduced time and cost to market Use of 3 rd party components Simplify / reuse of design Ability to reuse design ideas, incorporate off-the- shelf components into value-add offerings Participation provides the ability to influence the standard You can shape the standard to be supportive of your product architecture

30. Page 30 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Regulatory/Policy/Legislative … The Impacts and Rationale of HSSP Specifications ImpactsRationale Establishing objective assessment criteria: Measurement criteria for regulatory compliance Inclusion of rigorous conformance assertions benefits compliance and verification Allows for technology change within the regulation Concurrent support of multiple technologies allows for technology evolution Offering an easy/easier solution that is complete and actionable / ease the path to adoption: How do we “Pick the winning horse”? “Opportunity cost” of using the wrong standard has big implications HSSP integrates function/ behavior, data, and protocol promoting an integrated solution set Solution that complements existing standards HSSP is using HL7 semantics, OMG processes, IHE testing, and established technology protocols

31. Page 31 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Research … The Impacts and Rationale of HSSP Specifications ImpactsRationale Promotes accessibility to “raw” information Strong emphasis on semantically rigorous data and query/retrieval Enabler for collaborative studies, e.g. de-identification, retrieval, etc. Leveraged use of identity service enables de- identification Enlarges cell and sample sizes based on interoperability Facilitates responsiveness to bio- surveillance requirements Standard interfaces accommodate dynamic and emerging strategies and tools Enables construction of higher-order service stacks with less investment Composable nature of services promotes construction

32. Page 32 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Implementer/Integrator … The Impacts and Rationale of HSSP Specifications ImpactsRationale Reduced integration time and cost resulting from the use of standard tooling Use of standard in off-the-shelf tools facilitates their use Risk mitigation (skill portability/ training advantage, vendor independence, substitutability) By training staff in the standard, skills are portable across tools Creates a value offering opportunity based on the ability to deliver using these service standards Allows staff and solutions to build upon the use of the standard and not technologies Improved ability to deliver and support interfaces that have been implemented Using services speeds project design phases and promotes reuse

33. Page 33 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted SDOs … The Impacts and Rationale of HSSP Specifications ImpactsRationale Useable standardsEmphasis on practicality Market-focused standards based on commercial implementations Shortens time required to develop specifications and encourages collaboration Promotes harmonization, cooperation, cohesion among standards communities Integration of function, data, and technology promotes leveraged reuse More members/involvement = more revenue & better specs Practical, market-focus and iterative timeline promotes participation and results

34. Page 34 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted The Bottom Line…

35. Page 35 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Why participate in Standards? This is happening—the only way to influence the outcome is to engage Prime opportunity to directly engage with complementing stakeholder groups (provider-to- vendor, vendor-to-payer, SDO-to-SDO, etc) Benefit from “lessons learned” from others Reduce design burden Significant networking opportunities Establish/maintain market presence as thought-leader

36. Page 36 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Why HSSP? Relentless focus on added business value for healthcare and project participants –focused on and driven by business-need –not an “academic exercise” striving for perfection –“Standards must be used to be useful” –Emphasis on practical, achievable, & marketplace-relevant Without these standards, we’re building “service stovepipes” Aggressive timelines encourage progress Assembled community of top industry talent Project structure promotes targeted participation

37. Page 37 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted References HSSP Wiki http://hssp.wikispaces.com HL7 Website: http://www.hl7.org OMG Website: http://www.omg.org

38. Page 38 © 2006 HSSP Project, http://hssp.wikispaces.com Reuse with attribution permitted Thank you! Ken Rubin, EDS +1 703 845 3277 desk +1 301 335 0534 mobile ken.rubin@eds.com