Learn HIE Concepts

Provider / Network Participant Identity Management

Our node level identity management is done in observance of the Audit Trail and Node Authentication profile from IHE. This system is built around a local certificate authority service (which is included in our solution) thereby reducing costs for the HIE Operator. Each node has a client and server certificate which it uses for communication using PKCS (Public Key Cryptographic Services). Network user identities are maintained in a standards-based LDAP directory. This allows any user to discover other users and end points (nodes) on the HIE for easy communication.

Document Registry

An important component of our solution is an XDS.b registry. This has been tested with the pre-Connectathon 2010 MESA test suite and has passed all tests in November 2009. Furthermore, we successfully completed interoperability testing with 11 other IHE-standards-based vendors at the recently concluded RSNA Annual Conference in Chicago. This testing involved XDS.b and XDS.I profiles.

Our solution does include a centralized service for Document Registry. We also support use cases where the registry will not play a role, in support of the constraints placed by those services (e.g. retrieving medication history from RxHub/Surescripts; accessing NHIN gateway of external HIEs). IHE has established XDS.b testing requirements. Their latest pre-Connectathon 2010 MESA test suite covers 35 mandatory test cases. Supported transactions include:

Transactions:

• Provide and Register Document Set - b
• Register Document Set - b
• Stored Query
• Retrieve Document Set - b

Document Repository

Each edge device hosts a document repository. This repository has passed all MESA tests intended for XDS.b support. We believe that we have one of the most advanced implementations of the repository. Features that make us unique include full support for ingesting HL7 documents to the repository (HL7 being the most widely used EHR integration standard), cleansing and standardization tools to most efficiently load the repository, and intelligent configuration tools to send notifications and summarizations by utilizing the workflow engine built into the repository.

Our solution does include a distributed Document Repository component. This service is a key feature of our edge servers. IHE has established XDS.b testing requirements and we remain compliant. Their latest pre-Connectathon 2010 MESA test suite covers 13 mandatory test cases. The transactions supported are:

Transactions:

• Provide and Register Document Set - b
• Retrieve Document Set - b

Edge devices

Our edge devices are proven in live deployments across some of the biggest hospitals in the nation. For security and efficiency we generally recommend that they be embedded and hosted in a central location. The typical edge device includes a database server (SQL Server) and a full featured interface engine (BizTalk Server). We have sophisticated set of services that can handle large volume of messages coming to the Edge Servers. The Edge Server is also resilient to out of order messages and de-duplication of resent messages, and includes advanced diagnostics and multi tenant support. If a customer chooses their own edge device, we will provide technical details to describe how to integrate into the the HIE Operator HIE.

Integration and Adapter Framework

Our integration and adapter framework deploys a multi stage document management and processing service. The first stage receives the documents and files them rapidly in a set of file folders. The documents are then processed through our integration engine. We support data cleansing, data transformation, validation, code mapping and call out to other services during both inbound and outbound processes to provide immense flexibility and adaptability to change.

Authentication and Authorization

All users are authenticated before they can access the system. We provide SQL Server based identity management or other external ID management mechanisms such as active directory, single sign on solutions, and context management. For authorization, we also support role-based security for most actions on the HIE. For example, the break the glass facility can be restricted to a small set of trusted users.

Consent Management

We have a patent pending model for managing consents through a HealthVault application. The system is flexible enough to handle a wide variety of consent processes, including the opt-in and opt-out processes typically desired for HIE applications. If desired we can also support digital signature pads to record patient consents as administered at the time of the encounter.

Subscription Management

We support various types of subscription management facilities. Here are some examples:

1. Service Subscription: Every HIE Operator Service can be individually enabled for particular nodes. E.g. some providers subscribe to lab results delivery and HRB while others may subscribe to secure messaging and clinical summary. the HIE Operator will have the flexibility to decide to offer some services for a base price while charging extra for additional services if it makes business sense to do so.
2. Enrolling in specific service like lab results: Physicians may want to receive lab results in more than one practice location. They can subscribe to the applicable facilities.

Logging and Audit

We provide full audit and logging support. We provide advanced tools for viewing the audit log. We also provide facilities to export the audit log for further processing in a different application.

Network Monitoring

Our entire network is capable of being monitored from a central console called the HU Manager. This allows the HIE Operator to minimize operating costs by efficiently deploying central staff to maintain the distributed network.

Nomenclature Normalization

We support nomenclature normalization by keeping a copy of the source data as received, mapping to well-accepted standards as an inbound process when appropriate, but also allowing for transforms as an outbound process when an application or receiver requires it for a particular coding scheme. This late binding approach is very efficient and provides flexibility to map to new schemas that may emerge in the future.

Reporting/Analytics

The unique Amalga architecture allows users to explore real time data in ways that previously required report requests and custom queries by information technology professionals. This decreases costs of personnel devoted to responding to routine report requests as users provide for themselves. Depending on the desires of the HIE Operator and HIE governance entities, reports and analytics can be constrained to specific users or specific types of reports. For example in many instances only de-identified data will be made available. This feature is well proven and has been instantiated at both local and state based levels in our previous deployments.

HRB (Heath Record Bank – HealthVault)

We provide an integrated HRB data store (HealthVault) that supports a wide variety of PHR applications. The PHR then provides the patient presentation layer and all of the features that are typical for the HRB model.

Network Management

The HIE Operator’s entire network can be modeled using a very friendly and intuitive tool called the GHIN Network Manager. After the design is complete, the model is pushed to each of the Edge Servers for configuration. Again this set of tools was created to allow maintenance to be extremely efficient.