1. January 19,2010 SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT Healthcare Provider Directory (HPD) Standards and Transaction Discussion IHE TCON -2 January 19, 2010 Presenter: Nitin Jain (IBM/SSA) SSA Representative: Shanks Kande

2. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 2 January 19, 2010 Topics Overview of recommended standards Analyze in detail the recommended standards Identify any commonality and/or gaps between standards and HPD Transaction Services Metadata Next Steps

3. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 3 January 19, 2010 Recommended Standards Overview StandardSDO Description ISO TC 215 : ISO/TS 21091 Health Informatics ISODirectory services for health care providers, subjects of care, and other entities HL7 V3HL7Covers message standards, interactions and the XML data model for provider registry Lightweight Directory Access Protocol (LDAP) OASIS Defines the messaging protocol, operations and data schema for directory services. OASIS DSML v2 as a means to cover this with SOAP messages Personnel White Pages (PWP)IHEThe Personnel White Pages Consumer may make a wide variety of queries and cascaded queries using LDAP. Intended for inside of an organization; Universal Description Discovery and Interaction OASISDefines a way to publish and discover information about Web services.

4. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 4 January 19, 2010 ISO/TS 21091 Overview Directory services for health care providers, subjects of care, and other entities Supports the communication through X.500 framework Provides common directory information model of healthcare professionals extending the X.500 object model Extended Attributes (e.g. HcIdentifier, HcOrganization, HcSpecialisation) HL7 defined attributes (e.g. HL7 Sex, HL7 County Code etc) Supports LDAP query and syntax for representing attributes Inherits security requirements for authentication and non-repudiation from ISO 17799 and ISO TR 13335

5. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 5 January 19, 2010 ISO/TS 21091: Directory Information Tree

6. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 6 January 19, 2010 Commonality between ISO/TS 21091 and HPD Requirements Supports Transactions for Lookup Provider (how it is extensible for other lookup attributes) Store Provider Contact Information, Credentials Schema for Healthcare Organizations, different organization types Individual Professionals, Credentials Health care-specific contact information, Health care identifiers, roles (standard and local), Multiple Affiliations: Persons to Multiple Organizations affiliations Supporting Organizations (can be used for HIE/HIO information) Vocabulary Sets: HL7 domain, ISO 21298

7. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 7 January 19, 2010 Gaps between ISO/TS 21091 and HPD Business Relationship definitions between Individual and Organization (how to provide a definition for a relationship entity in the X.500 object model) Electronic end point information of Provider, HIE/HIO: (could explore usage of UDDI standard to define a service and its end points; attribute to query UDDI) Support for SOAP/XML communication protocol? May consider applying DSMLv2 to express LDAP requests and responses in SOAP 1.1 bindings. DSMLv2 is a systematic translation of LDAPs ASN.1 grammar (defined by RFC 2251) into XML-Schema. How easy is it to implement DSML v2? Would it cause any unreasonable burden on the implementers and adopters?

8. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 8 January 19, 2010 HL7 v3: Personnel Management; Provider Registry Uses Messaging protocol of HL7 v3.0 Vocabulary Code set: Provider Role Type, HL7 Domain tables Schema Organization (Organization), Principal Person (Individual) Licensed Entity (Credentials), Healthcare Provider (Specialty), LicensedEntity (Qualifications), AssignedEntity (Functional Role) AlsoKnownAs (Aliases), Place (Location) OrganizationPartOf, OrganizationContains (Organization Hierarchy) Employee, Affiliate (Business relationships between Individual and Organization)

9. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 9 January 19, 2010 HL7 v3: Personnel Management; Provider Registry

10. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 10 January 19, 2010 Commonality between HL7 v3 and HPD Supports Transactions Add Provider Update Provider Add Provider Notification (Broadcast) Update Provider Notification (Broadcast) Query Provider Details Find Associated Providers Identifiers Query Supports SOAP/XML Communications

11. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 11 January 19, 2010 HL 7 v3 - Gaps/Open Questions Electronic end point information of Provider, HIE/HIO: (could we support this in current schema?: use of device) If there is an extension needed on HL7 v3, how could IHE support on getting it incorporate What is the adoption of this standard in industry for directory services Any Interoperability issues?

12. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 12 January 19, 2010 LDAP V3 Basis for ISO/TC 21091 Lightweight exchange protocol of X.500 schema Exchange protocol TCP/IP with LDAP specific syntax Operations: StartTLS, Bind, Search, Compare, Update, Abandon, Unbind

13. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 13 January 19, 2010 LDAP v3 - Advantages LDAP a very commonly implemented protocol, many implementations including opensource LDAP well understood and adopted across many industries LDAP schema supports most requirements of HPD and can be extended ISO and IHE have already adapted generic LDAP to the healthcare provider space – providing a platform for our work

14. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 14 January 19, 2010 LDAP v3 - Disadvantages No support for SOAP/XML communication protocol in native LDAP communication protocol. May consider applying DSMLv2 to express LDAP requests and responses in SOAP bindings. DSMLv2 is a systematic translation of LDAPs ASN.1 grammar (defined by RFC 2251) into XML- Schema. How easy is it to implement? Would it cause any unreasonable burden on the implementers and adopters? No automatic support for Notification

15. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 15 January 19, 2010 PWP – Personnel White Pages

16. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 16 January 19, 2010 PWP – Query Personnel White Pages Transaction Standard: Lightweight Directory Access Protocol (v3) Commonly used schema found in X.500 Schema for LDAP and inetOrgPerson Schema includes required elements for: Names phone #s Email Organization Address Language Title Optional elements: Alias Vehicle license Department employee # employee type home address/phone Photo Locality URI Manager preferred delivery method registered address Secretary Uid User S/MIME Certificate X.500 ID

17. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 17 January 19, 2010 PWP – Disadvantages Intended for inside of an organization. Not Designed for Broader scale to allow cross-enterprise queries. Need to accommodate Health care specifics attributes

18. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 18 January 19, 2010 Secure IT Infrastructure Healthcare Provider Directory HPD Actors and Transactions Provider Directory Source Provider Directory Consumer Add/Update Provider Notify of Change Subscribe Lookup Provider AuthenticationAuditing Transaction Actor

19. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 19 January 19, 2010 Transaction Metadata Add/Update Provider Request Organization/Individual Provider Name, Demographics, Aliases Individual Provider Identifiers Individual Provider Specialty Individual provider association to the provider organization Organization structure including Facilities Organization/Individual Provider Association to HIE/HIO Provider Status Add/Update Provider Response HPD Provider ID Acknowledgement

20. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 20 January 19, 2010 Transaction Metadata Lookup Provider Request Provider Name, Alias Provider Address Provider global and directory Identifier (NPI, HPD Provider Id) Provider other traits such as DOB, Gender Provider Specialty Zip code (geographic searches) Lookup Provider Response Provider Name, Demographics Provider Identifiers Provider Specialty Individual provider association to the provider organization Provider Association to HIE Associated HIE URLs Provider and relationship Status Exact Match Indicator Ambiguous Match indicator Provider Type (Department, organization, Individual)

21. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 21 January 19, 2010 Transaction Metadata Subscribe Request Event definition code Provider Identifier such as HPD ID Provider Name Subscriber Name Subscriber Identifier Subscribe Response Subscription Id Confirmation message

22. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 22 January 19, 2010 Transaction Metadata Notification Request N/A Notification Response (Same as Lookup Provider Response) Provider Name, Demographics Provider Identifiers Provider Specialty Individual provider association to the provider organization Provider Association to HIE Associated HIE service endpoints (URLs) Provider and relationship Status Provider Type (organization, Individual)

23. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 23 January 19, 2010 Next Steps (to be completed by Face to Face) Decide on Content Model Standards Decide on Communication standards Confirm metadata for the Transactions Confirm Data modeling tool

24. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 24 January 19, 2010 Backup Slides

25. SOCIAL SECURITY ADMINISTRATION-HIT SUPPORT 25 January 19, 2010 HL7 v3: Personnel Management; Provider Registry