Business Case for Adoption: Vendor Community June 29, 2009 Copyright 2009. All Rights Reserved.

Business Case for Adoption: Vendor Community

June 29, 2009

Copyright 2009. All Rights Reserved.

Google Open Source Programs Office

Daniel BerlinSenior Engilawyer


“”

The Goals of NHIN and Google are Complementary

The NHIN will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health.

Google’s mission is to organize the world's information and make it universally accessible and useful.

We now live in a world where you can get information at your fingertips on

virtually every topic known to mankind, yet the most important area of all —

our health — we can’t easily get the information when we need it. It’s time

to change this once and for all.

Vish Sankaran, FHA program director

Copyright 2009. All Rights Reserved.3Copyright 2009. All Rights Reserved.3

Google Health Embraces These “Rules of the Road”

Data Portability

Interoperability

Data Liquidity

Consumers control their data regardless of employers, health plans, or care providers.

Data owners should be able to securely exchange data with different systems in a consistent manner.

Data from different sources should move over networks with minimal costs, ‘friction’, and hassle.

Copyright 2009. All Rights Reserved.4

Google Fully Supports Free and Open Source – CONNECT is a Natural Fit

Google USES millions of lines of open source code

– More effective than writing it all ourselves

– Shares support costs for software

– Gain the improvements of everyone instead of just your own

Google RELEASES millions of lines of open source code

– Builds communities around software

– Faster and more effective development

– Give back something to the world


Google Health Plans to Connect to NHIN

The health ecosystem requires an open, interoperable network

The value of the network is dependent upon the number of data providers and users in the network — the more providers and users, the more value (exponentially!).


Google Health Plans to Connect to NHIN

The value of the network is dependent upon the number of data providers and users in the network — the more providers and users, the more value (exponentially!).

The health ecosystem requires an open, interoperable network

7Copyright 2009. All Rights Reserved.

Initiate Systems

Deanna Cagney

Director of Product Marketing


Initiate Systems, Inc.

Enabling healthcare providers and state/regional exchanges to connect, share, and securely use patient data within and across boundaries

•Industry standard for patient registry & health information exchange (HIE) solutions

•Proven experience in HIE and patient data management

– 76 Providers / IDNs and 40 health information exchanges

– Eight Canadian provinces, supporting the pan ‐Canadian electronic health record.

– Patient registry in Nationwide Health Information Network (NHIN II) and all four of the NHIN I demonstrations

•192 customers across 10 market segments

•Cited as ‘leader’ by Forrester & Gartner

“2009 KLAS Category Leader for EMPI”

“Leader at IHE Connectathon”


The Challenges of Interoperability

Data ownership – how to stay up to date?

Need to manage and audit patient

privacy preferences

Availability and quality of data varies

Processes for data sharing inconsistent

FamilyHistory

PrescriptionHistory

ApprovedPhysicians

Unclear funding models for sharing

Patient Symptoms

TreatmentRecords

AdmissionHistory

ExamRecords

HealthData


CONNECT: Addressing the Challenge

• Federated data model

• Common message choreography and data sets

• Patient privacy protection

• Open and interoperable

• EMPI at the foundation

ExchangeExchangeExchangeExchange

HospitalsHospitals

Hospital1

Hospital1

Hospital2

Hospital2

Hospital3

Hospital3

PharmaciesPharmaciesFamily

ServicesFamily

Services

Public HealthPublic Health

Social Programs

Social Programs

NHINNHIN

PayersPayers


EMPI:What You Need To Support HIE

NHIN

Subject Discovery

Doc Retrieve / Query

Document Subscription / Notifications

UDDI

Agency Adapter

NHINC Gateway

MPI Document Policy Subscription / Notifications

Standards and/or NHIE based messages

(hl7v3, xds, etc)

Transformation

Terminology

SDK Services

Other services

NHINC Service Components

Do

c Re

po

sitory

Do

c Re

gistry

MP

I

Po

licy En

gin

e

CP

P R

ep

osito

ry

Su

bscrip

tion

M

ana

ge

r

Target Architecture (message from NHIN)

NHIN Message Orchestration Components

LegendNHINC

ComponentsCustomizable Components

Message

Replaceable Components

Authroization/Messaging Framework

Patient Correlation Repository

Audit Repository

UDDI Document Cache

Subject Discovery

xx

xx xx

xx

Document Query

xx

xx xx

xx

Document Retrieve

xx

xx xx

xx

Sub. Management

xx

xx xx

xx

Notification Processing

xx

xx xx

xx

Audit Reporting

xx

xx xx

xx

UDDI Sharing

xx

xx xx

xx

Agency Integration Software

PerformancePerformancePerformancePerformance

Enterprise Master Enterprise Master Patient IndexPatient IndexEnterprise Master Enterprise Master Patient IndexPatient Index

Integration Integration Integration Integration

AccuracyAccuracyAccuracyAccuracy

SecuritySecuritySecuritySecurity

Stewardship/QualityStewardship/QualityStewardship/QualityStewardship/Quality


Data Quality & ReportingData Quality & Reporting

Data StewardshipData Stewardship

Patient-Provider RelationshipsPatient-Provider Relationships

Enterprise Master Person IndexEnterprise Master Person Index

SecuritySecurity

IntegrationIntegration

Initiate CONNECT Initiate CONNECT Gateway AdapterGateway AdapterInitiate CONNECT Initiate CONNECT Gateway AdapterGateway Adapter

Initiate’s Contribution- Community & Technology

Initiate CONNECT Gateway Adapter

CONNECT Community Forum for Initiate Customers

CONNECT: Selecting the Right Solution


A Connected Community Vision

Athens Regional

Baylor

CarolinasHealthCare

CatholicHealthcareWest

Cedars-Sinai

Children’sHospital

HealthServe

IowaHealth

PresbyterianHealth

LehighValley

LutherMidelfort

NorthwestComm. Hosp.

Ochsner

PeaceHealth

ProHealth

Providence

St. Josephof Orange

Sutter Health

Trinity Health

UC, Davis

UPH

UPMC

Anthem

BS of CA

BCBS ofKansas

Humana

Optum

UnitedHealth

WellPoint

Ingenix

Availity

LIPIXSpectra/Lab

Carespark

DCIPA

Long BeachNetwork

State of ND

Louisiana Rural

PAML

Sutter Health

UPH

LovelaceFoundation

VeteransAffairs (VA)Albertsons

Wal-Mart

Walgreens

CVS/Caremark

Kroger’s

Long’s Surescripts/RxHub

Surescripts/RxHub

Banner Health

CatholicHealthcare West

St. Alphonsus

Advocate

RockfordHospital

Ohio Health

UniversityCommunity

Sentara

NGHS

BJCMoses Cone

NCHICA

Riverside

DeaconessMaine General

Province of BC

CapitalHealthAuthority

CalgaryHealthRegion

Province ofNewfoundland

Province ofNew Brunswick

Province ofNova ScotiaEHealth

Ontario

Province ofSaskatchewan

Provinceof Manitoba

NORRad

Provinceof Alberta

LEGEND:

Providers & IDNs

Payers

Health Exchanges

Pharmacy & PBMs

Brooklyn RHIO

NYCLIX

IndependentHealthAssociation

Carefirst BCBS

Active Health

HACCNY

HIXNY

Bronx RHIO

UMass

Delta HealthAlliance

Intermountain

H Lee Moffitt

BCBS of MN

MN E-Health

Sandlot

OK HealthAuthority

WestPenn

ConemaughMemorial


CONNECT: Business Value

Improve quality of care and patient

safety

Information at the right place at the

right time

Enable connected communities

to leverage existing investments

Maintain data ownership

Ensure trust and data integrity across

all participants

Increase adoption

Eliminate redundant actions

Break down data silos between federal

agencies and providers

Expand to citizen services

Improve Care& Safety

Share Information Across Silos

Achieve a Virtual Nationwide View

Reduce Costof Care


Science Applications International Corporation

David Dobbs

Program Manager


SAIC Business Overview

Business Areas– Health– Energy– Environment– National Security – Critical Infrastructure

Our Successes– 40 years of continuous growth

» $10.1 billion in annual revenues for fiscal year 2009» FORTUNE 500® company - #266

– Highly skilled staff of professionals» Nearly 45,000 personnel worldwide» 10,000 employees with advanced degrees» 19,000 with security clearances


74% With MoreThan 10 Years

14% With5–10 Years

12% With LessThan 5 Years

Higher Education

Experienced Staff

82% Technical Professionals

10% Managerial

8% Administrative

6% Ph.D.s

36% Master’sDegrees

58% Bachelor’s Degrees

53% Sciences

16% Humanities,Social Sciences

15% Engineering

16% Business,Economics/Law

Fortune 500 is a registered trademark of Time, Inc. in the U.S. and/or other countries.

Domain ExpertiseDomain Expertise

TechnologyTechnology

SolutionsSolutions

Health Solutions

• More than 1,900 employees

• Health domain expertise includes:

– MDs, PhDs, MPHs, RNs, DDSs, epidemiologists,

biostatisticians, psychologists, pharmacists,

radiologists, labratorians, informatics specialists,

biochemists, toxicologists, microbiologists

• Health IT specialists include:

– Enterprise architects, network, systems,

and security engineers, software

engineers/developers, web developers, network

administrators, database engineers,

software test engineers, configuration

and data management specialists


U.S. Health IT Context

• National imperative for Health IT adoption

– Controlling costs

– Improving quality and patient outcomes

• Critical policy challenges1

– Driving the adoption of electronic health records (EHR)

– Making EHRs interoperable

– Ensuring EHRs help improve health care quality and efficiency

• Health information exchanges (HIEs) are connecting hospitals, clinics, and laboratories to share interoperable health information


1- Summarized from D. Blumenthal, The Federal Role in Promoting Health Information Technology, The Commonwealth Fund, January 2009

Selected SAIC Health Information Exchange Projects

Project Stakeholders

BioSense

Public Health Situational Awareness through Health Information Exchanges

Military Health System’s (MHS) Composite Health Care System (CHCS)

VA/DoD Data Sharing Research & Development Departments of Veterans Affairs and Department of Defense

CDCCenters for

Disease Control

BioSense

MHSMilitary Health System

INHSInland

Northwest Health Services

WA DOHWashington

State Department of Health

VADepartment

of Veterans Affairs

DoDDepartment

of Defense

CDCCenters for

Disease Control


CONNECT Business Drivers

• Sharing interoperable health information

– Enabled by a standards-based, agreed-upon architecture

– Extensible because it’s open source

• Adoption by health information exchanges (HIEs) and federal / state agencies for clinical data sharing

– Between HIEs to improve patient care

– Between HIEs and federal agency for reporting, quality and research

– Some states are beginning to adopt (such as Washington, Indiana, and New York)

• CONNECT adoption drives

exponential value– Increased access to distributed

health care information– Accelerated ability to improve patient

outcomes, public health and quality


Time

Adoption / V

alue

CONNECT – Linking Health Care


Clinics Pharmacies

Laboratories

Hospitals

SOA = service-oriented architecture

Radiology

State & LocalPublic Health

NHIN CONNECTSOA Platform

IHSIndian Health Service

SSASocial Security Administration

FDAFood and Drug Administration

CMSCenters for

Medicare and Medicaid Services

NIHNational

Institutes of Health

Health CareDelivery

Health CareData Users

CONNECT

MHSMilitary Health System

VADepartment

of Veterans Affairs

CDCCenters for

Disease Control

• Make electronic health records (EHRs) interoperable– Terminology Services to create semantically interoperable health care data

• Terminology subscriptions

• Standards-based encoding of health care data

• Encoding translation services

– Reliable Messaging for secure information delivery• Security – authentication, encryption, non-repudiation, HIPAA-compliant

• Reliability – guaranteed delivery, non-repudiation, audit logs, automated retries

• Use EHRs to improve health care quality and efficiency– Health Care Knowledge Base for analyzing EHR data

• Public health reportable conditions and outbreak alerts

• Centers for Medicare and Medicaid Services quality guidelines

• Clinical research support

• Adverse event identification

SAIC CONNECT Services


SUN Microsystems, Inc.

Catharine Evans

Director, SunFederal


Significant Drivers for Health Information Exchange

77%

60%

44%

37%

29%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Pr ovide rine fficie ncie sd ue to lack o f

data to s upp or tpatie n t car e

Ris inghe althcar e

cos ts

Availab ility ofg r an t fu ndi n g

Incr e as e dnational

atte n tion on HITand HIE

Pub lic h e alths ur ve illance

ne e ds

De m and fo rpe r fo r m ancein for m ation

History in Healthcare with Thousands of Clients Worldwide

Prominent Healthcare Clients

Innovation Experience Knowledge

Sun's Strength in Healthcare


Sun's Open Source in CONNECT


Caregiver Mobility with

Security

NHIN

Health Information Exchange

ComplianceSecure

DataManagement

PayerEfficiency

Integration with infrastructure,

SOA and composite

applications

CONNECT

Privacy, identity management,

access control, fraud detection

and activity monitoring

Information lifecycle

management & identity

management

Business and clinical

transformation through secure, instant access

to patient information

Consumer-centric

approach to healthcare

delivery, care management and business

workflow

Sun in Healthcare

GlassfishHealth– HL7 Binding Components

– Master Patient Index

– OpenSSO integration with HTTP BC

– PIX/PDQ support

– XDS/XCA

– Advanced Graphical Mapper (HL7, etc)

– NC PDP

– XACML Support

– Open SSO - graphical support of XSPA policies

Sun's Healthcare Pack:Supported Architecture for CONNECT


• Sun's Product Support – 7x24 Support

• Indemnified

• Sun Professional Service Offerings – CONNECT– Setting up the CONNECT

Environment

– Assisting the MPI configuration

– Integration Support

Sun's Healthcare Pack:Supported Architecture for CONNECT


Vangent, Inc.

Jeanne O’Kelley

Senior Vice President

Technology Excellence Center


Business Case for Adoption

• CONNECT– Instantiation of Health Standards

• Open Source– Government/Industry Collaboration

• Customer Support– Federal Agencies

– State and Local

– Commercial


XDS.b – An Essential Part of CONNECT Gateway Capability


Supports federated document repositories anda document registry that create a longitudinal record of

patient information within a healthcare community

Diagram Source: FHA CONNECT Software Architecture Document, 31 March 2009Diagram Source: FHA CONNECT Software Architecture Document, 31 March 2009

Authorized CaseFollow-up

Health InformationEvent Messaging

Retrieve DocumentsSubject

DiscoveryQuery for

Documents

Query Audit LogQuery Audit LogConsumer Preferences ProfileConsumer Preferences Profile

Authorization FrameworkAuthorization FrameworkNHIE Services RegistryNHIE Services Registry

Messaging PlatformMessaging Platform

XDS.b “Plug and Play” CONNECT Gateway Integration


AGENCY AAGENCY A

CONNECTCONNECTSolutionSolution




XDS.bXDS.bRegistryRegistryXDS.bXDS.b

RegistryRegistry

XDS.bXDS.bRepositoryRepository

XDS.bXDS.bRepositoryRepository

ExistingAgency

System(s)

ExistingAgency

System(s)

Locate Patient

Records

Locate Patient

RecordsLocate Patient

RecordsLocate Patient

Records

Locate Patient Records

Locate Patient Records

Retrieve Patient Records



Retrieve Patient Records Retrieve

Patient Records

Retrieve Patient

Records

Store Patient

Records

Store Patient

Records

AGENCY BAGENCY B

Register Patient Records

Register Patient Records

IHE/HITSP compliant solution that unleashes EHR data from agency systems and makes data available for use over the NHIN

IHE/HITSP compliant solution that unleashes EHR data from agency systems and makes data available for use over the NHIN

Health Information ExchangeOpen Source (HIEOS)Released in “Open Source”

Vangent’s XDS.b implementation is available in “open source”– Is scheduled to be part of CONNECT’s September release

– Part of Vangent’s Health Information Exchange Open Source (HIEOS) project available at the following URL: http://kenai.com/projects/hieos

– Includes:

• Wiki Site

– Architecture Description

– Setup and Configuration Guide

• Discussion Forums

• Mailing Lists

• Issue Tracker

• Software Source Code


Harris CorporationDr. Bart J. Harmon

Chief Medical Officer


CONNECT: Addressing Integrator Motivation and Challenges

• A part of the new Health Ecosystem

• Current work is developing the freely available CONNECT services, providing Help Desk Support and Engineering Services

• Supported government agency participation in the December, 2008 NHIN Forum

• Culture, tool sets and partners vary widely across various institutions and Health Information Exchanges, creating slightly different challenges when supporting each entity


Why does an integrator want to work in this space?

Reasons for supporting CONNECT:• Helping establish part of a new health ecosystem where entities

compete on value and customer service rather than controlling information

• Based on national standards

• Enabling providers

• Empowering patients

• Streamlining payors

• Supporting the protectors

• Opportunity to work in a space where we will have a chance to be useful as long as we are helpful


CONNECT’s Value for an Integrator

Converting waste into value via information availability –Supporting fundamental transformation in

– Clinical processes

– Health business processes

– Surveillance processes

– Lighten the burden of run-away health costs on the economy

– Provide quality care to more people

– Put individual people more in control of their health information and health experience

Many entities will want help with these services, to include integration support

Platform on which to re-purpose technologies from other areas of expertise into the health space


RelayHealth, SpartanburgRegional Health System, NXT Health

Partnership to Provide Continuityof Care for Wounded Warriors

Chris Ingersoll

Director, Interoperability Product Management


CONNECT: Addressing RelayHealth’s Goals

• RelayHealth’s Business Drivers– Maximize the breadth of longitudinal information that can be provided to

health systems, physicians and patients

– Prepare health system customers for transformation caused by ARRA and health reform – The need to share and exchange clinical information

– Provide improved access, support and continuity of care for military personnel receiving private sector health care

• RelayHeath’s Current HIE Offerings– Clinical health record viewer

– Integrated patient PHR with secure messaging

– Referrals and patient health record sharing

– Results and clinical documentation distribution

– Clinician messaging amongst physicians and members of a Care Team


RelayHealth-Spartanburg Partnership

Spartanburg Regional Health System• Network of hospitals and physician offices across five

counties in SC• “Hospital of the Future”: recipient of Congressional

Special Interests projects

NXT Health• Non-profit research and design organization affiliated

with SRHS• Undergoing study of health record sharing between

military and private health systems through Spartanburg’s grant

Partnered with RelayHealth • Demonstrate Spartanburg physician and patient access

to medication history, allergies, and diagnoses data from DoD

• Project funded by Spartanburg and McKesson managed through TATRC

• Three developers for two months


Demonstration Use Case


EHR

RelayHealthHealth Summary Manager

webVisit Personal Health Record

DoD Test Server(Harris)

DoD Test Server(Harris)

CONNECT

1. Sgt Sonja, recently returned home, develops an infected rash from lingering burn wound. She fills out online consultation to Dr. Smith, her private sector PCP

1. Sgt Sonja, recently returned home, develops an infected rash from lingering burn wound. She fills out online consultation to Dr. Smith, her private sector PCP

Sgt. Sonja Dr. Smith Sgt. Sonja

2. Dr. Smith receives webVisit, indicates in RelayHealth that he has Sonja’s consent to view DoD data

2. Dr. Smith receives webVisit, indicates in RelayHealth that he has Sonja’s consent to view DoD data

3. Via CONNECT, DoD data is added to Sonja’s RelayRecord

3. Via CONNECT, DoD data is added to Sonja’s RelayRecord

5. Sonja receives message, sees that her PHR has been updated with DoD health data

5. Sonja receives message, sees that her PHR has been updated with DoD health data

4. Dr. Smith notes a possible medication allergy, prescribes new medication and schedules in-person appt

4. Dr. Smith notes a possible medication allergy, prescribes new medication and schedules in-person appt

Health Summary ViewerPhysician view


Patient consent designation

Medications from SureScripts, DoD, patient entered, and physician entered

Diagnosis from DoD

Allergies from DoD

Personal Health RecordPatient view

The data that the physician pulled from DoD can be viewed by the online patient.


Demonstration goals:

– Data integration: Automated load of health summary data into RelayHealth through CCD

– Connectivity: Ability to pull data from a federal facility

CONNECT Gateway provided connectivity

– Successful integration from .NET environment

– Took care of plumbing, allowed us to focus on data integration and presentation changes

– Good documentation and support

Long-term goal:

– Plug RelayHealth network into the NHIN

CONNECT’s potential as a complete network-network connectivity solution

– Comprehensive functional scope

– Open-source

– Federal adoption

Selecting the Right Technology for RelayHealth


Value of CONNECT for RelayHealth, Spartanburg and NXT Health

RelayHealth

– More connectivity means higher quality care and better patient outcomes

– SaaS model: low costs to provide this connectivity to all of our customers

– Step towards providing comprehensive care for our men and women in uniform accessing private sector health care

Spartanburg Regional Health System

– Recognition as the National test site for connectivity of patient record systems– Serves as a model for data sharing within the larger civilian community– Potential to expand RelayHealth personal health record capabilities to patient population

NXT Health

– Use this interoperability model and apply it to other research projects within the larger context of the patient room of the future

– Serves as a proof of concept phase to assist in recruiting potential partners for continuation of research efforts


Cisco’s ‘Medical Data Exchange’(MDES) Solution

Greg Pippin

Solution Architect


Market Drivers & Current Environment

Drivers

– Cost reductions and avoidance

– Lost productivity

– Interoperability of patient data

exchange

– Data is needed locally but

stored centrally

– Importation of unstructured

data into structured data

Current Environment

– Manual fax, copy

– Burn and transport CD ($10/CD)

– Multi-system log-ins

– Point to point proprietary

interfaces

– Proprietary health information

exchanges (HIE)


Medical Data Exchange – Enabling The Method Patient Centric Access


System A

DICOM

HL7 v 2

ISO 10781

EDI

SOAP

System B

HL7 v 2.5

HL7 v 3

IETF

XML

IHENetwork Broker Network Broker

Solution Benefits

Cost Reduction– Eliminate $10/CD & associated labor

– CD burner maintenance costs

Improve Productivity – Interoperability between systems reduces

efficient record access

– Reduce retests & rescans

Improve Quality of Care– Reduce delays in patient care

– Address incomplete information for treatment decisions

– Reduce delays in patient care


Medical Data Exchange Enables Patient Centric Integration & Access of Records

• Enables interoperability between disparate systems

• Enables the network as the platform for secure & standards based access & exchange

• Eliminates the need for manual transport of records & images

• Standards based (IHE) based PACS & EMR access

• Common patient identifier with network based IHE Cross Reference Manager & XDSi


Cisco and Tiani-Spirit offering a joint Medical Data Exchange Platform consisting of the ‘Spirit’ IHE SW stack based on the globally standardized IHE framework.

Tiani Spirit-AXP runs on the Application eXtension Platform inside Cisco’s Integrated Services Router (ISR+AXP). It connects general practitioner’s systems, pharmacy software systems & hospital information systems with the eHealth infrastructure.

What is the Medical Data Exchange Solution?


+

Cisco AXP Network module

Cisco ISR Router

Globally leading SW solution forIHE based medical data exchange

Federated Data Distribution Enables Scaling

• Interoperability is based on a federated concept

• Avoids copying all data centrally (Cross Reference Manager)

• Retains data where it was produced originally.

• Data is kept as well on a regional level for redundancy purposes (orange level)

• IHE‚ Cross Reference Manager enables communications between the regions (red) or countries (white)


PIX/PDQXDS

(Repository,Registry)

Spirit Central Adapter (SCA)

Spirit Local Adapter (SLA)Spirit

Archive

DICOMClient

IHE Client, Legacy Client

SpiritArchive

PIX+Responding

Gateway

EnterpriseLevel

Community(Cross-Enterprise)Level

Cross-CommunityLevel(scalable to anyhierarchic level)

RespondingGateway

InitiatingGateway

MDES Reference in Wels Healthcare (Austria)

Prior Environment• 64 sub-systems in one hospital

• Organizational environment constantly changing

• Unscalable

• Difficult to integrate GP’s into the hospital environment

• 1500 proprietary data interfaces

• Multiple patient Indexes

Tiani Spirit software, based on Cisco and Intel technology has enabled us to substantially

raise the level of information where it is needed and when it is needed, to help our

doctors in their effort to provide the best care possible for our patients.

Dr. Walter Aichinger, Chief Physician of the Klinikum Wels-Grieskirchen


“”

MDES Value Proposition:Better & More Cost-effective Care

• Improve productivity

– Clinicians can access records from different institutions in a simple and straightforward manner

• Lower cost

– Avoid redundant clinical tests or procedures w/ access to this data

• Improve patient care

– Diagnosis & treatment plans w/ a more holistic view of a patient's record

• Avoid Costs

– Eliminate the need for production of CD's to transport images


CONNECT and Mirth Gateway –Streamlining NHIN Connectivity

Gary Teichrow

Vice President and Chief Architect

Mirth Corporation


Who is Mirth Corporation?

Mission:• Mirth Corporation delivers standards-based

open source infrastructure tools and services for healthcare

• We reduce the time, cost and technology barriers to information exchange in healthcare, leveling the HIT playing field for healthcare organizations of all sizes

Vital Stats:• Launched in 1993, focused since 1999 on Health IT

• Incubator of open source Mirth Project – 70,000 downloads worldwide

• Provide OSS, support, professional services, purpose-built appliances

• Technology partner to leading HIEs and HIE Vendors


CONNECT: Addressing Real World HIE Interconnect Challenges

• How to connect Orange County ConnectCare with Long Beach Network for Health?

– OC and LBNH HIEs wanted to share health information

– Each used different software with different capabilities

• Possible Opportunity using NHIN interface

– LBNH had NHIN gateway as an NHIN trial cooperative participant

– OC interested in using the NHIN interface, but needed software

• Challenges

– Not enough time to develop custom NHIN gateway for OC

– No apparent commercial NHIN gateway software available

– Limited budget to perform the work


Selecting the Right Solution for OC/LBNH

• Possible Solution with CONNECT

– CONNECT 2.0 released during analysis phase of project

– Provided OSS solution to OC NHIN gateway requirement

• Scope of Work

– Download and understand software

– Port to Linux and PostgreSQL

– Adaptor integration (ER Connect, MirthMatch, Mirth Connect)

• Solution

– Use Mirth Connect (integration engine) asglue between ER Connect (OC) and NHIN CONNECT adaptor layer

– Download to demo in less than a month


CONNECT in Action: One Success Leads to Another

California eHealth Collaborative Statewide NHIN DemoParticipants

• Kaiser Permanente (KP NHIN Gateway)

• Long Beach Network for Health (MedPlus/FirstGateways)

• Orange County ConnectCare (CONNECT)

• Redwood MedNet (CONNECT)

• Santa Cruz HIE(Axolotl)

Redwood MedNet connects to NHIN for demo• Mirth Corporation implemented CONNECT at

Redwood MedNet

• Integrated to Mirth Results

• Up and running in 3 days!

Copyright 2009. All Rights Reserved.6060Copyright 2009. All Rights Reserved.

CONNECT in Action: …and Another

HealthBridge and Redwood MedNet Interstate DemoParticipants• HealthBridge

– 24 hospitals in KY, OH and IN– 5000+ physicians at 700+ practices– 25 million results delivered in 2008– 17 local health departments– National, hospital and physician office labs– 70+ EMR feeds to MD practices– Interfaces with 25+ EMR vendors– 70+ HIS/Data inbound connections

• Redwood MedNet HIE– Mendocino, Lake and Sonoma Counties– 4 rural hospitals– 3 independent laboratories– 2 local health departments– FQHCs, RHCs, and private practices– Long Term Care


NHIN


What’s Next: Mirth Gateway –How You Can Leverage CONNECT

Mirth Gateway ApplianceReady-to-run appliance based on OSS stack• CONNECT (OSS NHIN gateway)

• Mirth Match (OSS EMPI)

• Mirth Connect (OSS interface engine)

Accelerates NHIN Deployment• Simplified setup and configuration

• Simplified administration and monitoring

• Automated patch management

• Physical or virtual appliance

Mirth Connect simplifies “last mile”• Channel-based connectors ease integration

• Connect to NHIN via HL7, database, web services, FTP/SFTP/file system


NHIN


Jericho Systems Corporation

Brendon Unland

President and Founder


Historical Analogy:Transcontinental Railroad

• Engineering Marvel of 19th Century

• Began 1862: Finished 1869

• Shortened Trip of 5 monthsto 5 Days

• Extreme Technical Challenges

• Ingenius Collaboration Between Government and Business

• Necessity of Standards

• Bound the Nation Revolutionizing Population and Economy


Jericho Systems’ Current Business Model

• Founded in 2002

• Security Decisioning Software and Services

– Primary Clients are U.S. DoD, Intelligence Community, and Federal Agencies

– SOA-enabled Products Incorporate Open Standards: SAML, XACML,WS-Security

– Flagship Product: EnterSpace Decisioning Service (EsDS) Includes Policy Decision Point (PDP)


Jericho Systems’Current Business Model

Traditional Software Business ModelLicenses

Maintenance

Professional Services

Move into Health Care Market


Jericho Systems’Health Care Background

Participated in Cross-Enterprise Security and Privacy Authorization (XSPA) Demo at HIMSS 09

• Demonstrated OASIS Advanced

Privacy, Consent, Access Control--

Beyond Opt in/ Opt out

• Functionality Moving into Future

CONNECT Solution Release

Component of Flagship Product Utilized


• Policy Decision Point (PDP)

• XACML Compliance

• Logging

Jericho Systems’Health Care Business Model

• Embrace Open Source: Donate EnterSpace Health Care Community Edition for Inclusion into CONNECT Solution

• Potential Cloud Offering

• Provide Professional Services including:

– SOA-centric Identity and Access Management Consulting

– Standards Compliant Integration

– Policy Engineering for Security & Privacy


EnterSpace Continuum for Health Care

Cheyenne, Wyoming: 1882 and Now

Conclusion:CONNECT Community


Opportunity to Join

Community that: •Impacts and Improves the Future

•Profits Those that Labor for the

Community

CONNECT Seminar

Presentations are Available

for Download Online at http://www.connectopensource.org
