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Direct Implementation Perspective. Mark Bamberg, Vice President Research & Development MEDfx. Overview. Introduction Secure Content Delivery with DIRECT HIE Architecture Lab result delivery Heterogeneous Labs Multiplexed thru HIE Recommendations. Introduction - MEDfx.
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Direct Implementation Perspective Mark Bamberg, Vice President Research & DevelopmentMEDfx
Overview • Introduction • Secure Content Delivery with DIRECT • HIE Architecture • Lab result delivery • Heterogeneous Labs Multiplexed thru HIE • Recommendations
Introduction - MEDfx • Committed member of ONC Standards and Interoperability Framework. • Participating member of Transitions of Care Architecture Workgroup. • Participating as Workgroup Lead for S&I Framework Transitions of Care Reference Implementation and Pilots Workgroup. • Participating member of Direct Reference Implementation and Direct Implementation Geographies Workgroups. • Completed Direct Project Pilot unveiled at the HIMSS 2011 ONC Interoperability Showcase with a live demonstration of NwHIN and Direct interoperability.
Introduction – MEDfx • Developed 1st integration of an HIO to a government agency to provide CCD documents to SSA automating the disability determination process. • Integrated the 2nd Virtual Lifetime Electronic Record (VLER) community using the NwHIN to connect an HIO to the Veterans Administration (VA) and Department of Defense (DoD). • ‘First to CMS via the NHIN’ as a participant in the C-HIEP project enhancing communication and coordination of care across multiple settings. • Invited to demonstrate NwHIN integration to members of Congress as part of Health IT Week in Washington, D.C., September 2009.
Secure Content Delivery with DirectLab Order Example SMTP 2 • EHR Portal/Client sends lab result query to EHR Backend or HIE via EDGE over secure channel • EHR Backend or HIE sends message to HISP using SMTPS on port 465 • HISP verifies Lab is trusted by verifying the Lab’s certificate can be located and has been digitally signed by a trusted authority (Root Anchor) • HISP uses Provider’s Private Key (to sign) and Lab’s Public key (encipher) to create a secure payload encode using S/MIME • HISP routes message via SMTP on port 25 to Lab’s HISP • Lab HISP verifies Provider is trusted by verifying the Provider’s certificate can be located and has been digitally signed by a trusted authority (Root Anchor) • Lab uses its Private key to decipher and Providers public key to verify message signature • HISP sends deciphered message to Lab backend • HISP sends receipt to Provider SMTP 1 SMTP 3 HIE/EHR HISP LAB HISP HIE / EHR Backend HIE / EHR Portal/Client Lab
Secure Content Delivery with DirectLab Result Example SMTP 2 • Lab sends lab result sends message to Lab HISP using SMTPS on port 465 • HISP verifies Provider is trusted by verifying the Provider’s certificate can be located and has been digitally signed by a trusted authority (Root Anchor) • HISP uses Lab’s Private Key (to sign) and Provider’s Public key (to encipher) to make a secure payload encoded using S/MIME • HISP routes message via SMTP on port 25 to Provider’s HISP • Provider’s HISP verifies Lab is trusted by verifying the Lab’s certificate can be located and has been digitally signed by a trusted authority (Root Anchor) • Provider uses its Private key to decipher and Lab’s public key to verify message signature • HISP sends deciphered message to HIE /EHR backend • HISP sends receipt to the Lab SMTP 1 SMTP 3 HIE/EHR HISP LAB HISP HIE / EHR Backend HIE / EHR Portal/Client LAB
HIE Architecture Components Clinical UI HIE Service Framework MPI EDGE Identity Provider NwHIN Provider Registry DIRECT Audit Repository Other Authorization Store RIM-based CDR Consent Subscription Management Administration HIE Framework
HIE Lab Feeds Clinical UI HIE Service Framework SSA VA NwHIN EDGE DIRECT EDGE DOD HISP EHR Backend Lab Feeds EHR Portal/Client
Lab Provider with No DIRECT Capability • Traditional Approach • Transport • VPN • MLLP • FTP • SFTP • Content • HL7V2 EDGE Lab Feeds
Lab Provider with DIRECT Capability • SMTP • Patient Context • Message • CDA based document container • HL7V2 • IHE XDS.b profile • Metadata used to construct patient context HISP Lab Feeds
EHR with no DIRECT Interface • DIRECT to HISP • SMTP • IHE XDS.b profile • Conversion to traditional feed • CDA contained messages can be converted to HL7V2 HIE Service Framework EDGE DIRECT HISP EHR Backend Lab Feeds
DIRECT Enabled EHR • DIRECT to HISP • SMTP • IHE XDS.b profile HISP EHR Backend Lab Feeds EHR Portal/Client
Heterogeneous Labs Multiplexed thru HIE HIE Portal EHR Portal EHR Portal HIE Portal HIE EDGE HISP HISP EHR Portal Traditional Lab Feeds Traditional Lab Feeds EHR Portal EHR Portal Traditional Lab Feeds Traditional Lab Feeds EHR Portal EHR Portal Traditional Lab Feeds Direct enabled Lab Feeds EHR Portal
HIE Simplifies Complexity Lab 1 Lab 2 Lab 3 Lab 1 Lab 2 Lab 3 HIE EHR 1 EHR 2 EHR 3 EHR 1 EHR 2 EHR 3 O(n2) O(n)
Recommendations • Multiplex Lab Feeds thru HIE • Reduces complexity and cost of developing interfaces • Handles message routing • Automatic transport and content conversion • Ensures lab orders and results delivery • Message failures are routed to remediation • Utilize EHR Hub Solutions • When an EHR has a Hub solution, the EDGE appliance can connect to the EHR Hub for message routing
Contact Mark Bamberg Vice President of Research and Development mark.bamberg@medfx.com (401) 965-6626
