1. CONNECT 4.0 Enhancing Health Information Exchange for Interoperability Success February 12, 2013

2. Introduction Greg Turner CONNECT Product Manager Brian Humphrey CONNECT Architect 2

3. Webinar Technical Details 3 Type questions in advance; click sendQuestions + answers appear in chat window During discussion time, “raise hand” to speak What is the largest file size I can stream using CONNECT 4.0?

4. What is CONNECT ? 4

5. CONNECT is a software platform that supports health information exchange CONNECT uses Nationwide Health Information Network standards and governance to ensure HIEs interoperate with other current and future exchanges CONNECT is a low cost open source solution that is designed to be flexible to support an evolving health data exchange environment 5

6. Why CONNECT? CONNECT can be used to: Set up a health information exchange within an organization Set up a Direct health information service provider (HISP) Tie a health information exchange into other HIEs including the eHealth Exchange, CMS esMD or Direct Support patients by providing the technology that allows them to electronically “carry” their health record as they traverse the healthcare system. Support providers by enabling a more complete picture of a patient’s medical record increasing quality of care 6

7. CONNECT Building Blocks CONNECT sits between the HIE implementation system, or EMR, and “exchange partners” CONNECT sends and receives NwHIN Exchange and NwHIN Direct messages to other practices, hospitals, and HIEs A CONNECT adopter is required to create or implement services called adapter services that allow for processing the messages to and from CONNECT CONNECT provides reference adapters that include sample code on how to connect back-end systems to CONNECT using adapter services 7

8. Master Patient Index (MPI) System EMR or HIE System EMR or HIE Adapter Service Creates/sends messages to CONNECT and receives/processes and responds to messages from CONNECT Document Registry System Document Repository Policy Engine Regional Health Information Organization Government Agency Health Information Exchange Hospitals, physicians, practices Disease Oriented Care Network NwHIN Exchange

9. Any mail server EMR or HIE System EMR or HIE Adapter Service Creates/sends messages to CONNECT and receives/processes and responds to messages from CONNECT Regional Health Information Organization Government Agency Health Information Exchange Hospitals, physicians, practices Disease Oriented Care Network NwHIN Direct CONNECT 4.0 Direct Overview

10. CONNECT is Open Source Software Open source license Open release planning, sprint review and planning sessions Community contributions welcomed –Bug reports + fixes –Features requests + implementations –Testing and requirements FHA-sponsored Product Management, Curation, Development 10

11. CONNECT 4.0 Release Overview 11

12. CONNECT 4.0 Release Features ① Increased throughput targeting increased numbers of PD, QD, RD, AD, and DS transactions ② Exchange and process large payload sizes of up to 1 GB ③ Run CONNECT on additional application servers such as IBM WebSphere and Oracle WebLogic to meet their environment needs ④ More comprehensive event logging and metric data ⑤ Ability to determine the state of a transaction across messages in order to better review and analyze the operation of CONNECT and adopters’ trading partners ⑥ Minimize deployment load by supporting a lightweight gateway which allows smaller server footprint and use of system resources ⑦ Support Direct messages to allow for greater adoption and exchange 12

13. #1 – Increase Throughput for CONNECT FEATURE Increase throughput, targeting increased numbers of PD, QD, RD, AD and DS transactions BENEFITS More efficiency of gateway at higher volumes Support more widespread or national rollout plans for health data exchange Better utilization of adopter infrastructure 1600 messages/minute 13 Test Plan and Test Report https://developer.connectopensource.org/display/CONNECT40/Performan ce+Testing

14. #1 – Increased Throughput for CONNECT Increasing CONNECT’s throughput and efficiency 14 *These numbers are based on the same testing methodology performed during the CONNECT benchmark testing for release 3.3. Achieving Gains Reduction in memory usage ApacheCXF & OpenSAML Reduced number of static classes Fewer number of Webservices running Removed redundant and duplicative code flows

15. #2 – Large Payload Support Provide the ability to exchange and process large payload sizes of up to 1 GB BENEFITS Increased ability to support the data exchange needs of more adopters Enable additional use cases that require the exchange of larger file sizes Positive impact on performance of gateway when handling larger payloads 15 FEATURE

16. #2 – Large Payload Support Large Payload (Combinations of Messages with payloads totaling 1 Gigabyte) 16 Document Submission Document Submission Deferred Req Document Retrieve 1 - GB Message 119 s* 143 s 63 s 2 - 500 MB Messages 84 s 87 s 29 s 10 - 100 MB Messages 48 s 45 s 25 s 20 - 50 MB Messages 45 s 48 s 24 s 50 - 20 MB Messages 50 s 25 s 100 - 10 MB Messages 54 s 55 s 30 s *Seconds

17. #3 – Support for Multiple App Servers Run CONNECT on additional application servers such as WebSphere and WebLogic to meet expanded environment needs BENEFITS More deployment options Remove any tech stack waivers Model for the community to add support for other app servers Adopters can use their preferred app servers and take advantage of internal sys admin expertise for things like security, scalability, etc. 17 FEATURE

18. CONNECT Deployment Diagram 18

19. #4 – Event Logging Provide more comprehensive event logging and metric data (counts and duration) using improved logging in CONNECT BENEFITS Allows adopters to better understand usage and performance Supports better planning and management of deployment Provides opportunity for automated monitoring Provides opportunity for dynamic scaling based on load 19 FEATURE

20. #4 – Event Logging Goals and Data Points 20 Two formal high level business goals: CONNECT provides the ability to count and produce durations for the following values: Number of a given transaction type (PD, QD, RD, etc.) Number of a given transaction group Number of transactions from a specific gateway Total duration for given transaction type Total duration for a given transaction group CONNECT can track and report on the following data points: Error Performance Transaction Type Payload Error Messages log (without PHI data)

21. #5 – Transaction Logging Provide the ability to determine the state of a transaction across messages in order to better analyze the operation of CONNECT and adopters’ trading partners BENEFITS Provides a more holistic view of a complete transaction with any given exchange partner Increased insight for troubleshooting and issue resolution More input for transaction management and planning 21 FEATURE

22. #5 – Transaction Logging Transaction Logging Example 22 Database and log output for a related transaction chain (Patient Discovery, Document Query, and Document Retrieve messages as a single transaction) Note that there are two transaction entries logged for each service The response Nhin message ID was logged based on its RelatesTo message ID

23. #6 – Lightweight Gateway Minimize deployment load by supporting a lightweight gateway which allows smaller server footprint and use of system resources and allows the adopters to maximize the use of custom-built adapters BENEFITS Adopters with capable back-end systems can have a more lightweight deployment footprint Allows for more economical allocation and use of infrastructure resources Paves ground for community- contributed adapter layers – to EMRs & etc. 23 FEATURE

24. #7 – Direct Integration with CONNECT Include ability to support Direct messages to allow for greater adoption and exchange BENEFITS Tool for Meaningful Use (Stage 2) Provides a means to support both NwHIN Exchange and Direct spec transactions through one deployment Offers a built-in growth or migration path for additional use cases Supports expanding federal, commercial, and state and regional HIE needs 24 FEATURE

25. Direct Deployment 25

26. Upcoming Events February 11, 2013 CONNECT Release 4.0 February 19, 2013 (2pm ET) CONNECT 4.0 Technical Deep-Dive webinar https://www1.gotomeeting.com/register/749358937 https://www1.gotomeeting.com/register/749358937 February 25, 2013 (10am ET) Next Sprint Review + Planning meeting March 4 -7, 2013 HIMSS Interoperability Showcase demo Spring 2013 (date to come, D.C. area) CONNECT User Group Meeting 26

27. Join Us for Sprint Review + Planning 27 Join us for sprint review and planning sessions, every other Monday, 10am-noon ET. The CONNECT product team will share the work of the last sprint for community review and feedback. We’ll then transition into a high-level planning session to set the themes for the coming sprint, in the context of the product roadmap. Community input and insights are welcome, so please join us! The meeting will start with a review of the work accomplished during the past sprint which leads into a planning discussion for the upcoming sprint, we flow from one topic to another based on content, questions and conversation. Sprint Review + Planning: Every other Monday 10am-12pm ET Tel: 646-216-4772 866-946-0485 Participant Code 922 914 63 Web: https://arkadin.webex.com/arkadin/j.php?J=703876882 (meeting id 703 876 882)

28. More Details on CONNECT https://developer.connectopensource.org/display/CON NECT40 https://developer.connectopensource.org/display/CON NECTWIKI/Requirements+Artifacts https://github.com/CONNECT-Solution/CONNECT http://issues.connectopensource.org http://www.connectopensource.org/developer- resources/forums/developer-forum 28 Release info: Requirements artifacts: GitHub: JIRA: Forums:

29. Useful Links Community Resources: www.connectopensource.org https://developer.connectopensource.org mailto:connect@hhs.gov Contributing code: https://developer.connectopensource.org/display/CONNECTWIKI/Contr ibuting+Code Sprint info: https://developer.connectopensource.org/display/NHINProgress/Progre ss+Summary+Page 29

30. Questions and Discussion 30

31. Webinar Technical Details 31 Type questions in advance; click sendQuestions + answers appear in chat window During discussion time, “raise hand” to speak What is the largest file size I can stream using CONNECT 4.0?

32. Thank you for watching! Please post questions to the community forums on connectopensource.org or email to connect@hhs.gov