Expanded SOA White Paper

Detailed Profile Proposal for 2008/09presented to the

IT Infrastructure Planning Committee

Alean KirnakJoe Natoli

Et alNovember 18, 2008

IT Infrastructure Planning Committee

• In 2007-2009, Public Health Data Standards Consortium (PHDSC), the American Immunization Registry Association (AIRA), and Software Partners developed the Immunization Content (PCC) Profile and the Pediatric Demographics supplement

• This work suggests new public health models

• PHDSC white paper*: silos repeat functionality and don’t talk to each other

• New standards offer new workflow possibilities and related cost savings

* Building the roadmap for health information systems interoperability for public health

Public Health Use Case

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How can IHE profiles plus SOA reduce public health costs?• Decentralized, user-centric workflow• Reduction in connectivity costs by transforming order(N2)

costs to order (N)

IHE, SOA and Economics

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• Cancer Registries• Chronic Disease Management Solutions• Quality Reporting• Biosurveillance• Adverse Event Reporting• Organ Donor Registries• Immunization Information Systems

Numerous Use Cases within Public Health

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Common Workflow

  Public Health Scenario

  Scenario Immunization Registries (IIS) Cancer Registries (CCR)

A process of contributing data to registry    

A.1 take some clinical action administer vaccines diagnose cancer (xray, path report, etc.)A.2 data enter the clinical action into EHR-S    

A.3 run decision support

validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.) determine if this is a reportable cancer

A.4 populate formformat "official immunization record -e.g. yellow card" populate standard form for reporting incident

A.5 physician data entry of additional info into form signature of provider enter treatment plan

A.6 update the local EHR-S save immunization data in XDS registry save treatment plan

A.7 populate the registry Send HL7 message to IIS HL7 message sent to CCR from EHR-S

A.8 notify additional interested parties

local IIS updates state IIS, IIS updates other providers with this patient in common

local CCR updates state CCR, CCR updates other providers with this patient in common

B use of registry at point of care    

B.1identify patient (retrieve identifiers from demographic data)    

B.2 retrieve registry dataretrieve immunization history and other clinical data retrieve cancer case summary

B.3 execute decision support

validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.) suggest lab tests, further treatment options

B.4 take clinical action (i.e. return to step A.1)    

C additional use of decision support output    

C.1 case managementfind children not up to date and try to get them in for their vaccines

contact patient for follow-up information on cancer status

C.2 reminder/recall send appointment reminders notify for clinical trialsC.3 reporting coverage rate reporting, etc. incidence rates, etc.

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• retrieve immunization and other clinical data• validate immunization history • determine patient status (vaccines due, etc.)• Administer and record vaccines• forecast next due date• provide an official record - “yellow card“• save data in IIS• (IIS may forward to other interested provider)

IIS Workflow: Directly Connected User

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Retrieve patient data

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Validate, recommend, record

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Web-based Architecture

Web-based Application

Immunization Information System (IIS) Data Store

Data Stores

Identity Resolution (PIX/PDQ)

Retrieval/Update of Data (XDS, Immunization

Content)

Decision Support (Current PCC

proposal)

(Pub/Sub)

Hospital #2

Clinic #2

Hospital #1 user

Clinic #1

user

Other user

Stakeholders

Other provider user

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• retrieve immunization and other clinical data• validate immunization history • determine patient status (vaccines due, etc.)• administer and record vaccines• forecast next due date• provide an official record - “yellow card“• save data in electronic health records (EHR) system• send the data to the IIS• (forward to other interested providers)

IIS Workflow: Provider with EHR

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Retrieve Medical Summary

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Validate, recommend, record

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Send Immunization Content to IIS

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IIS Receives Immunization Content

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Document Repository Receives Immunization Content

…<administerableMaterial classCode="MMAT" determinerCode="INSTANCE"> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2" /> <templateId root="2.16.840.1.113883.10.20.1.53" /> <code code="20" codeSystem="2.16.840.1.113883.6.59" displayName="DTap" />…

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Public Health Nurse or Patient PHR

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Public Health Nurse or Patient PHR

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Public Health Nurse or Patient PHR

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Public Health Nurse or Patient PHR

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IIS Service-Oriented Architecture

Service Bus

Secu

rity

Other Service (yellow card?)

Decision Support Service (PCC -

proposed)

Locate, Retrieve and Update Service (XDS, IC, content)

Patient Identification

Service (PIX/PDQ)

Tran

sfor

mati

on

Hospital #2

Clinic #2

Hospital #1 EMR

Clinic #1

EMR

Other patient or provider Interface

Stakeholders

Web-based EMR interface for small

providers

Other Data Store

Master Person Index

XDS Document Repository

Data Stores

SDIR (MPI, immunization data)

XDS Document Registry

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Reduced Costs

Mathematics of connectionsN2 -> N

User-centric workflowNo double data entry

Many more benefits

Status quo

suggested

SOA

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• Multiple versions (i.e. PIX/PDQ)• Scattered documentation• Lack of uniformity among services• More semantic specification including possible formalisms

What IHE issues need to be explored?

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Experience of some of the authors to date:• Mechanism for payload specification• Harmonization of multiple HL7 artifacts (as in

harmonization of HL7 Immunization and Care Provision standards in creating the PCC Immunization Content profile)

• Common approaches taken in multiple service specifications

• How to build upon existing IHE profiles• Methods for specifying operations semantics

Open Issues

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What Standards and SDO Activities to Consider

• Existing Web Services Glossy• HL7 Service-Aware Enterprise Architecture Framework

(SAEAF)• HL7 HSSP Service Functional Models• HL7 SOA Practical Guide• HSSP service specifications in OMG

– Entity Identification Service (EIS)– Retrieve, Locate and Update Service (RLUS)– Decision Support Service (DSS)

• ?DICOM activities• ?HITSP Framework group• Existing IHE profiles

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Authors

• Alean Kirnak, Software Partners LLC (Dave Shields)• Joseph Natoli, Intel (Josh Painter)• Anna Orlova, Public Health Data Standards Consortium

(PHDSC)• Charles Parisot, GE Medical• Karen Witting, IBM• Michael Nusbaum (for Canadian Health Infoway)• Ana Estelrich (for QRPH)• ?Author from Epic (Vassil Peytchev)• ?Author from PCC (Keith Boone)

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Effort

• Medium but flexible