NHIN Specifications Richard Kernan, NHIN Specification Lead (Contractor), Office of the National Coordinator for Health IT Karen Witting, Contractor to the North Carolina Healthcare Information and Communications Alliance (NCHICA), NHIN Specifications Factory WEDNESDAY, 3:30 – 3:50PM

NHIN Specification Framework Service Oriented Architecture (SOA) approach results in a framework of NHIN Specifications Modular design, based largely on IHE Technical Framework NHIN specifications instantiated in a NHIN Gateway Scope covers inter-gateway exchange only Implementations may vary to accommodate business needs HIMSS 20102

NHIN Specification Framework Transaction Profiles Utilize exchange patterns for specific transactions CMS CARE Doc Submission CDC GIPSE HIEM Discovery and Information Exchange Services Rely on foundations to enable exchange patterns Patient Discovery HIEM Doc Submission Services Registry Query & Retrieve Docs Messaging, Security, & Privacy Foundations Enable private, secure, and interoperable communication of health information Messaging Platform Authorization Framework MITA Eligibility Verification DiscoveryPull Push Pub/Sub Eligibility Verification Designates Pilot Use HIMSS 20103

Messaging, Security, and Privacy Foundations Messaging Platform defines how NHIN nodes must authenticate each other and encrypt the information exchanged between them Leverages widely-used standards for message transport and security WS-I Basic SOAP 1.2 over HTTP WSDL 1.1, WS-Addressing 1.0, WS-Policy 1.5 WS-I Security Public Key Infrastructure (PKI) to encrypt, creating secure channel using TLS; mutual authentication X.509 certificates as basis for node authentication AES-128 bit encryption Messages headers digitally signed HIMSS Messaging, Security, & Privacy Foundations Enable private, secure, and interoperable communication of health information Messaging Platform Authorization Framework

Messaging, Security, and Privacy Foundations Authorization Framework describes how nodes must provide each other with information needed to inform local authorization decisions Local Autonomy Decision to release information is that of the responding node; must be supplied with information characterizing request initiator Local Accountability Initiating node accountable for accuracy of info provided to responder SAML 2.0 Assertion Contained in SOAP Header security element Authentication Statement Attribute Statement Authorization Decision Statement (O) Digitally Signed HIMSS Messaging, Security, & Privacy Foundations Enable private, secure, and interoperable communication of health information Messaging Platform Authorization Framework

Discovery and Information Exchange Services Services Registry Interface – means for nodes to interact with UDDI Registry for node and endpoint discovery Patient Discovery – provides a means for a NHIN node to query another to determine if it is a source of information for a specific patient Query & Retrieve Docs – an exchange pattern that allows NHIN nodes to locate and retrieve patient-specific clinical documents held by other NHIN nodes Discovery and Information Exchange Services Rely on foundations to enable exchange patterns Patient Discovery HIEM Doc Submission Services Registry Query & Retrieve Docs DiscoveryPull Push Pub/Sub Eligibility Verification Designates Pilot Use HIMSS 20106

Discovery and Information Exchange Services Eligibility Verification – an exchange pattern that allows NHIN nodes to determine if a patient is eligible for health plan coverage Document Submission – a push mechanism that allows an initiating NHIN node to send one or more documents for a given patient to a receiving node Health Information Event Messaging (HIEM) – a publish/subscribe exchange pattern that allows a NHIN node to establish a subscription to information held by another node for periodic exchange HIMSS Discovery and Information Exchange Services Rely on foundations to enable exchange patterns Patient Discovery HIEM Doc Submission Services Registry Query & Retrieve Docs DiscoveryPull Push Pub/Sub Eligibility Verification Designates Pilot Use

Transaction Profiles Continuity Assessment Record and Evaluation (CARE) Describes how Document Submission service may be used to exchange CMS CARE data for transfer-of- care scenarios (C-HIEP) Geocoded Interoperable Population Summary Exchange (GIPSE) Exchange of CDC GIPSE data using the HIEM service for population health biosurveillance purposes (CDC Pilot) MITA Medicaid Eligibility Verification Defines how CAQH CORE may be used to perform administrative Medicaid eligibility verification transactions using the NHIN (HIMSS Demo) Transaction Profiles Utilize exchange patterns for specific transactions CMS CARE Doc Submission CDC GIPSE HIEM MITA Eligibility Verification Designates Pilot Use HIMSS 20108

NHIN Scenarios WEDNESDAY, 3:30 – 3:50PM

Scenario 1: New Patient Identify Target NHIN Nodes HIMSS New Patient Search for NHIN Nodes in local states List of local NHIN Nodes and electronic information exchange services available

Scenario 1: New Patient Discover Source of Patient Information Request each target NHIN Node identify a local matching patient Identify which target NHIN Nodes which have a matching patient New PatientSearch for NHIN Nodes in local states List of local NHIN Nodes and electronic information exchange services available HIMSS

Scenario 1: New Patient Search for Relevant Documents Identify which target NHIN Nodes which have a matching patient Each NHIN Node responds with queried documents for patient match List of documents available for the new patient HIMSS

Scenario 1: New Patient Retrieve Specific Documents List of documents available for the new patient Request documents of interest Clinical content needed to support the new patient is available to the provider HIMSS

Scenario 2: Submit Patient CARE Summary HIMSS Patient released Continuity Assessment Record and Evaluation (CARE) document generated Sent to CMS NHIN Node Document delivered to CMS Document verification returned to sender CMS

Thank You 15 The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal Health Architecture or the Department of Health and Human Services.