Shared Services in Health IT (based on SOA principles). What are some of common business services that most Health IT appliocations need? How do we change the paradigm from developing seperate silo applications to the one based on shared services? Presentation by Paul Aneja.

1. Shared Services Strategy
(based on SOA for Health IT Applications)
Paul Aneja
Co-Chair Enterprise Architecture CoP
Nov 2009
Draft Work in Progress
Paul.aneja@state.or.us

2. Motivation: Shared Services in Health IT
Informatics EA WG initiated a focus on Shared Services
Action Item: Paul Aneja working with Informatics EA WG and Industry experts
to lead development of a Shared Services Strategy for Health IT
How can Shared Services improve Health IT?
Why do we have so many separate or disparate systems?
How do we change the paradigm of building separate health systems to
reusing shared services?
What can we do get started?
This presentation builds upon “Strategies for Improving Health IT Architecture Interoperability” and “SOA
Foundation” presentations.
Health IT Shared Services Strategy 2

3. Current State
Future State

4. Current State: Vertical Applications
(Separate, Disconnected, Different Architectures, Technologies, Integration is a challenge…)
Division “A” Division “B” Division “C” Division “D” Division “E”
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5. “Shared Services” in a Future
There are common functions across applications
Citizens
Programs
Shared
Services
Health
Partners
Federal/CDC
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6. Current State vs. Future Shared Services Impact
Current State Shared Services
Vertical Applications
Vertical Applications Improve Interoperability
Improve Interoperability
Difficult to share applications Increase sharing
Increase sharing
Difficult to share applications
Functional Duplication Common Functional Services
Common Functional Services
Functional Duplication
Services Oriented Architecture with
Services Oriented Architecture with
“Point to Point”
“Point to Point” Services Bus
Services Bus
Inconsistent business logic for
Inconsistent business logic for Shared services provide consistency
Shared services provide consistency
same purpose
same purpose
Minimum Sharing of Applications/Technology
Minimum Sharing of Applications/Technology Shared Services
Shared Services
Investments
Investments
Different Architectures SOA acts as a Unifying/Overall Architecture
SOA acts as a Unifying/Overall Architecture
Different Architectures
Inefficient – Increases Costs Lower cost over time
Lower cost over time
Inefficient – Increases Costs
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7. Shared Services
Starter List for Health IT

8. Shared Services in Health IT
(Here is a starting list of potential HIE shared services…)
PH Case Reportable Lab
Enrollment
Health Reporting Surveillance Data Result
Shared Get Vital Stats
GIS Eligibility
Services Immunization Record
Service Get Immunization Check
Validation Vocabulary
Records
Service
Update Client
Authentication Address Demographics
HIE Record Matching
Foundational Service Provider Validation Service
Shared Identification Secure Get Synchronize
Security
Services Get/Update Messaging HIE Record State HIE
Service
Exchange PHR
Consent
EMR Data De-Identify
Management
Service
Subject Health Information
Retrieve
Discovery Authorized Event Log
NHIN Case Follow-up
Documents
Shared
Query for NHIE Service Query
Services
Documents Registry Audit Log
What other Shared Services are needed?
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9. Shared Services Strategy
Shared Services Strategy
Identify Shared Services that can be leveraged
Have one National Health Shared Services repository
Increase the number of Shared Services over next 2-3 years
Actively manage the Shared Services Portfolio
Focus on a prioritized set of initial services
Adopt, extend and leverage industry SOA and Services standards
EA to coordinate shared services across enterprise
Work with Federal/industry infrastructure orgs on pilot
Training for SOA and services
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10. Industry Initiatives
(a select list)

11. Nationwide Health Information Network Standards and Services
Profiles describe how to
NHIN Profiles implement services for a
specific domain like
Consumer Preferences Profile consumer preferences for
• Store and exchange consumer Other Profiles in Development
• GIPSE (Biosurveillance) information sharing or
preferences for sharing of personal health biosurveillance
information
NHIN Services Services describe specific
interfaces (web services)
Discovery Services used between HIEs to
Information Exchange Services discover and exchange
• Subject Discovery
• Retrieve Documents health-related information
• Authorized Case Follow-up
• Query Audit Log
• Query for Documents
• Health Information Event Messaging
•NHIE Service Registry
Messaging, Security and
Privacy Foundation
describes the underlying
protocols and capabilities
Messaging, Security and Privacy Foundation necessary to send and
secure messages between
NHIE
Security
Messaging Authorization Framework
• Public Key Infrastructure
• Message Transport • Requestor Authentication
• Encryption
• Services Definition • Requestor Authorization
• Digital Signature
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Copyright 2009. Shared Services Strategy
Health IT All Rights Reserved. 11

12. IHE Integration Profiles (select)
Clinical and PHR Content Security & Privacy
Basic Patients Privacy
Patient ID Mgmt
Emergency Referrals
PHR Extracts/Updates
Format of the Document Content
Consents
Establish Consents & Enable
ECG associated coded vocabulary
and Report Document
Format of the Document Content Access Control Patient
Lab ResultsDocumentvocabulary
and associated coded
Document Demographics Query
Format of the Content
Content vocabulary
Scanned Documents
and associated coded Cross-Enterprise User
Format of the Document Content Patient Identifier
Format of theInformation
Imaging Document Content
and associated coded vocabulary
Attestation
User Attributes fro Access Control Cross-referencing
Format of theSummary
Medical Document Content
Map patient identifiers across
and(associated coded vocabulary
Meds, Allergies, Pbs) independent identification
Format of the Document Content Document Digital
domains
and associated coded vocabulary Signature
Attesting “true-copy and origin
Health Data Exchange
Cross-Enterprise Audit Trail & Node
Other
Document Sharing Authentication Request Form
Registration, distribution and access
across health enterprises of clinical
Centralized privacy audit trail and for Data Capture
node to node authentication to create External form with custom
documents forming a longitudinal
a secured domain. import/export scripting
record
Cross-Enterprise Document
Pt-Pt Reliable Interchange Notification of
Cross-Enterprise Document Consistent Time Document
Media Interchange Coordinate time across networked Availability
Notification of a remote
Cross-Community Access systems provider/ health enterprise
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13. Health related Standards (select)
Others
Consistent Time (CT) T16 IETF NTP, SNTP 12367
Audit Trail and Node Authentication (ATNA) T15, T17 IETF RFC-3881, TLS
RFC- 12367
Cross Enterprise Document Sharing (XDS.b) TP13 ebRIM, ebRS, ISO 15000 12367
Patient Identifier Cross Referencing (PIX) V2.3.1 ADT TP22 12367
Patient Demographics Query (PDQ) V2.5.1 ADT TP23 12367
Request Form for Data Capture (RFD) TP50 W3C XHTML 2457
Medical Documents (XDS-MS)
(XDS- CDA R2, CCD C48 1
Sharing Lab Reports (XD-LAB)
(XD- CDA R2 C37 1
Infobutton T81 2
Query for Existing Data (QED) V3 Care Record TP21 3
Immunization Content (IC) CDA R2, CCD C78 3
V2.3.1 VXU C72 3
Cross Enterprise User Authentication (XUA) SAML TP20 35
Cancer Pathology V2 ORU 5
Drug Safety Content CCD C76 56
Digital Signatures (DSG) C26 X.509, W3C XADES 356
Basic Patient Privacy Consents CDA R2 TP30 356
Exchange of Personal Health Records (XPHR) CCD C32 6
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14. Informatics EA WG Session
Feedback on Shared Services
(Sept 2009)

15. Top Challenges: Shared Services
(from Informatics EA WG)
Service vs. System distinctions
How to incorporate all services + find commonality
Funding – how to creatively fund?
No group owns shared services
Shared infrastructure – where should it be?
Communicating value of Shared Services metrics for ROI
Stronger Architecture governance of Shared Services
How do we find Services? – Services Repository
Alignment across federal, state agencies
Some legal issues in sharing
Organizational culture and barriers
Funding mandates do not match needs
How do we share services from other groups, states, federal agencies?
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16. Key Interoperability Solutions for Shared Services
(from Informatics EA WG)
Define Shared Services (reusable)
Lifecycle model- bring PH into existing standards efforts
Funding models - “user fee model” or transaction–based (infrastructure tax
or tolls)
Executive ownership – need for tech support to promote sustainability
Stronger Architecture governance of Shared Services
Indentify common shared services for PH
Catalog of services i.e. open registry
PHIN/NHIN convergence ( alignment, integration)
Communicating value for reusability
Retraining to build in use of best practices
Open source, usable, technology neutral
PH (Public Health) + HC (healthcare) are on the same team
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17. Feedback - Questions & Answers
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