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Direct Transport for QH 10/18-19 F2F Notes (SPN)

Direct Transport for QH 10/18-19 F2F Notes (SPN). NwHIN Direct = Email for Healthcare . Add “just enough” technology to email to create a safe and usable environment Include providers and patients Provide an incremental path to evolve from…. unstructured to structured data (attachments)

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Direct Transport for QH 10/18-19 F2F Notes (SPN)

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  1. Direct Transport for QH10/18-19 F2F Notes (SPN)

  2. NwHIN Direct = Email for Healthcare • Add “just enough” technology to email to create a safe and usable environment • Include providers and patients • Provide an incremental path to evolve from…. • unstructured to structured data (attachments) • simple mail to integrated EHRs (inbox -> clinical task list) • manual to automated workflows (referrals@mypractice.com) • And integrate seamlessly with the existing NwHIN/IHE constructs

  3. MIME support for QH envelope • Request • Body text: human-readable notes • Attachment: text/xml+queryhealth-query • Attachment: query payload • Response • Body text: human-readable notes • Attachment: text/xml+queryhealth-response • Attachment: response data (text/csv?) Encrypted & Signed

  4. Direct “Trust Circles” = “Query Networks” • Need to be able to take advantage of “trust where we can find it” … individual, regional, organizational, someday national • But demand convenience of a single email address / infrastructure • Solution = enable participation in multiple “trust circles” as demonstrated by possession of certificates from multiple CAs • HITPC still working on global trust Ohio HIE Trust Circle CCF Toronto CCF Abu Dhabi University Hospital CCF Cleveland CCF Trust Circle

  5. Query Lifecycle 1a Query Builder UX Authorized Requestor 1b 7 • Requestor optionally uses a query builder user interface to create a query and submits it to their dedicated orchestrator. • The orchestrator determines at what time and frequency the query should run (one time, monthly, etc.) and submits the query when appropriate to its requestoragent. • Requestor agent submits the query over the Internet to each participating organization’s responder agent and awaits responses. Responder agents may provide a number of services: additional authorization, manual review, etc. • The responder agent calculates site resultsusing the appropriate data sources. • The responder agent returns site results to the appropriate requestor agent. • The requestor agent returns site results to the aggregator that combines site results into combined results • The aggregator makes interim and final results available to the requestor. 6 2 Aggregator Orchestrator Requestor Agent 3 5 Responder Agent Responder Agent 4 Source Data Source Data Responder “1” Responder “N” … Note: All communication between Requestors and Responders are asynchronous.

  6. .NET Reference Implementation Components Email Clients Windows SMTP Service (Gateway) “Real” SMTP Server SMTP Inbound, Outbound SMTP Msgs SMTP Event Sinks Security Agent File Drop Pickup XDD Gateway Inbound, Outbound XDD Msgs DNS Responder XDD Clients MX, CERT Requests Human Admin Configuration Web/Console UI Query Health Agents and Computation engines Configuration Web Service SQL Automated Admin

  7. Direct-based QH Data Flow 1 2 • Requestor uses a standard email client or research software to send a Direct query to a known address, e.g., queries@cdc.gov • Using standard COTS email list software, the distributor forwards the request to nodes that have agreed to respond. Certificates enforce “query network” security. • Each response node replies with a Direct message containing query results • Requestor aggregates responses as needed, either automatically or manually Direct HISP Direct HISP Direct HISP … Direct HISP Email Client or other research software COTS / open source mailing list software EHR or other data source EHR or other data source Responder 1 Responder N Requestor Distributor 4 3

  8. Advantages of NwHIN/Direct for QH Transport • Asynchronous by design (with built-in acknowledgement) • Secure / Proofable • Supportive of multiple “query networks” by config • Native support for multiple “query types” • Reference implementations already have extensibility hooks to call into computation engines • Infrastructure used to support basic messaging scenarios is 100% reusable for Query Health. No capital investment required, no new firewall rules, no new technology for IT. • Bonus: supports “plain old email client” submission and receipt of QH queries if desired.

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