1. Expanded SOA White Paper Detailed Profile Proposal for 2008/09 presented to the IT Infrastructure Planning Committee Alean Kirnak Joe Natoli Et al November 18, 2008

2. 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 supplementIn 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 modelsThis work suggests new public health models PHDSC white paper*: silos repeat functionality and don’t talk to each otherPHDSC white paper*: silos repeat functionality and don’t talk to each other New standards offer new workflow possibilities and related cost savingsNew standards offer new workflow possibilities and related cost savings * Building the roadmap for health information systems interoperability for public health Public Health Use Case

3. IT Infrastructure Planning Committee How can IHE profiles plus SOA reduce public health costs? Decentralized, user-centric workflowDecentralized, user-centric workflow Reduction in connectivity costs by transforming order(N 2 ) costs to order (N)Reduction in connectivity costs by transforming order(N 2 ) costs to order (N) IHE, SOA and Economics

4. IT Infrastructure Planning Committee Cancer RegistriesCancer Registries Chronic Disease Management SolutionsChronic Disease Management Solutions Quality ReportingQuality Reporting BiosurveillanceBiosurveillance Adverse Event ReportingAdverse Event Reporting Organ Donor RegistriesOrgan Donor Registries Immunization Information SystemsImmunization Information Systems Numerous Use Cases within Public Health

5. IT Infrastructure Planning Committee Common Workflow Public Health Scenario ScenarioImmunization Registries (IIS)Cancer Registries (CCR) Aprocess of contributing data to registry A.1take some clinical actionadminister vaccinesdiagnose cancer (xray, path report, etc.) A.2data enter the clinical action into EHR-S A.3run decision support validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.)determine if this is a reportable cancer A.4populate form format "official immunization record -e.g. yellow card"populate standard form for reporting incident A.5physician data entry of additional info into formsignature of providerenter treatment plan A.6update the local EHR-Ssave immunization data in XDS registrysave treatment plan A.7populate the registrySend HL7 message to IISHL7 message sent to CCR from EHR-S A.8notify 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 Buse of registry at point of care B.1 identify patient (retrieve identifiers from demographic data) B.2retrieve registry data retrieve immunization history and other clinical dataretrieve cancer case summary B.3execute decision support validate existing immunization history and determine patient status (up-to-date, vaccines due, etc.)suggest lab tests, further treatment options B.4take clinical action (i.e. return to step A.1) Cadditional use of decision support output C.1case management find children not up to date and try to get them in for their vaccines contact patient for follow-up information on cancer status C.2reminder/recallsend appointment remindersnotify for clinical trials C.3reportingcoverage rate reporting, etc.incidence rates, etc.

6. IT Infrastructure Planning Committee retrieve immunization and other clinical dataretrieve immunization and other clinical data validate immunization historyvalidate immunization history determine patient status (vaccines due, etc.)determine patient status (vaccines due, etc.) Administer and record vaccinesAdminister and record vaccines forecast next due dateforecast next due date provide an official record - “yellow card“provide an official record - “yellow card“ save data in IISsave data in IIS (IIS may forward to other interested provider)(IIS may forward to other interested provider) IIS Workflow: Directly Connected User

7. IT Infrastructure Planning Committee Retrieve patient data

8. IT Infrastructure Planning Committee Validate, recommend, record

9. IT Infrastructure Planning Committee 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

10. IT Infrastructure Planning Committee retrieve immunization and other clinical dataretrieve immunization and other clinical data validate immunization historyvalidate immunization history determine patient status (vaccines due, etc.)determine patient status (vaccines due, etc.) administer and record vaccinesadminister and record vaccines forecast next due dateforecast next due date provide an official record - “yellow card“provide an official record - “yellow card“ save data in electronic health records (EHR) systemsave data in electronic health records (EHR) system send the data to the IISsend the data to the IIS (forward to other interested providers)(forward to other interested providers) IIS Workflow: Provider with EHR

11. IT Infrastructure Planning Committee Retrieve Medical Summary

12. IT Infrastructure Planning Committee Validate, recommend, record

13. IT Infrastructure Planning Committee Send Immunization Content to IIS

14. IT Infrastructure Planning Committee IIS Receives Immunization Content

15. IT Infrastructure Planning Committee Document Repository Receives Immunization Content … …

16. IT Infrastructure Planning Committee Public Health Nurse or Patient PHR

17. IT Infrastructure Planning Committee Public Health Nurse or Patient PHR

18. IT Infrastructure Planning Committee Public Health Nurse or Patient PHR

19. IT Infrastructure Planning Committee Public Health Nurse or Patient PHR

20. IT Infrastructure Planning Committee IIS Service-Oriented Architecture Service Bus Security Other Service (yellow card?) Decision Support Service (PCC - proposed) Locate, Retrieve and Update Service (XDS, IC, content) Patient Identification Service (PIX/PDQ) Transformation 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

21. IT Infrastructure Planning Committee Reduced Costs Mathematics of connections  N 2 -> N User-centric workflow  No double data entry Many more benefits Status quo suggested SOA

22. IT Infrastructure Planning Committee Multiple versions (i.e. PIX/PDQ)Multiple versions (i.e. PIX/PDQ) Scattered documentationScattered documentation Lack of uniformity among servicesLack of uniformity among services More semantic specification including possible formalismsMore semantic specification including possible formalisms What IHE issues need to be explored?

23. IT Infrastructure Planning Committee Experience of some of the authors to date: Mechanism for payload specificationMechanism 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)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 specificationsCommon approaches taken in multiple service specifications How to build upon existing IHE profilesHow to build upon existing IHE profiles Methods for specifying operations semanticsMethods for specifying operations semantics Open Issues

24. IT Infrastructure Planning Committee What Standards and SDO Activities to Consider Existing Web Services GlossyExisting Web Services Glossy HL7 Service-Aware Enterprise Architecture Framework (SAEAF)HL7 Service-Aware Enterprise Architecture Framework (SAEAF) HL7 HSSP Service Functional ModelsHL7 HSSP Service Functional Models HL7 SOA Practical GuideHL7 SOA Practical Guide HSSP service specifications in OMGHSSP service specifications in OMG –Entity Identification Service (EIS) –Retrieve, Locate and Update Service (RLUS) –Decision Support Service (DSS) ?DICOM activities?DICOM activities ?HITSP Framework group?HITSP Framework group Existing IHE profilesExisting IHE profiles

25. IT Infrastructure Planning Committee Authors Alean Kirnak, Software Partners LLC (Dave Shields)Alean Kirnak, Software Partners LLC (Dave Shields) Joseph Natoli, Intel (Josh Painter)Joseph Natoli, Intel (Josh Painter) Anna Orlova, Public Health Data Standards Consortium (PHDSC)Anna Orlova, Public Health Data Standards Consortium (PHDSC) Charles Parisot, GE MedicalCharles Parisot, GE Medical Karen Witting, IBMKaren Witting, IBM Michael Nusbaum (for Canadian Health Infoway)Michael Nusbaum (for Canadian Health Infoway) Ana Estelrich (for QRPH)Ana Estelrich (for QRPH) ?Author from Epic (Vassil Peytchev)?Author from Epic (Vassil Peytchev) ?Author from PCC (Keith Boone)?Author from PCC (Keith Boone)

26. IT Infrastructure Planning Committee Effort Medium but flexibleMedium but flexible