1. OpenHIE’s Architecture and its Components
A whirlwind tour of the inner workings of OpenHIE’s standards-based health information exchange.
Derek Ritz, P.Eng., CPHIMS-CA
AeHIN Conference (Manila), August 2015

2. Agenda Introductions What is OpenHIE?
Who is OpenHIE? (the “community”)
What does it do? (the “black box”)
How does it work? (the “clear box”)
Where is it going next?
Q&A

3. Introductions

4. What is OpenHIE?

5. This mission statement stuff is copied directly from the OpenHIE website. The key take-away is that this is an international community working in low resource settings. The countries on the left are all ones where OpenHIE is active: Rwanda, South Africa, Philippines, Tanzania, Bangladesh, Liberia, Zimbabwe, Nigeria – and indirectly (or directly) in the 50+ countries where the US PEPFAR (President’s Emergency Plan for AIDS Relief) is active.

6. Ok… but what does it do?

7. Ready?
Set?
What OpenHIE is for… explained in 60 seconds or less!

8. Communicable Diseases
Services are provided within a care programme (e.g. Communicable Diseases) at a point of care…
Communicable
Diseases

9. CD database Communicable Diseases
…and information about these person-centric care services may be saved to a database…
Communicable
Diseases

10. CD databases Communicable Diseases
There may be multiple systems saving person-centric care information to multiple databases.
Communicable
Diseases

11. CD databases Communicable Diseases NCDs
There may be other care programmes (e.g. NCDs)…
Communicable
Diseases
NCDs

12. CD databases NCD databases Communicable Diseases NCDs
…with multiple points of service writing person-centric information to multiple databases…
Communicable
Diseases
NCDs

13. CD databases NCD databases MCH databases Communicable MCH Diseases
As these databases proliferate…
Communicable
Diseases
MCH
NCDs

14. Communicable Diseases MCH NCDs
…we need a way to tell that this information is all pertaining to the same individual. We need to be able to tell that these episodes are all chapters in Mosa’s health story.
Communicable
Diseases
MCH
NCDs

15. CD databases NCD databases MCH databases Communicable MCH Diseases
NCDs

16. CD databases NCD databases MCH databases Communicable MCH Diseases
This is what OpenHIE does. It connects the data silos.
Communicable
Diseases
MCH
NCDs

17. Communicable Diseases MCH NCDs
OpenHIE is a cloud-based health information sharing service that follows the golden thread of Mosa’s care over time and across different care sites.
Communicable
Diseases
MCH
NCDs

18. Communicable Diseases MCH NCDs
OpenHIE gives care providers a way to communicate with each other as members of a care team.
Communicable
Diseases
MCH
NCDs

19. Automatic generation of population indicators and metrics
Continuity of guideline-based care, over time and across multiple sites
Automatic generation of population indicators and metrics
Support transaction processing for UHC and CRVS
OpenHIE supports: [3 bullet points]

20. OpenHIE helps make health systems stronger!

21. …and 60 seconds are up!

22. How does OpenHIE work?

23. This diagram is often used to describe OpenHIE’s “inner workings”.

24. The “Einstein Principle” states that a favoured solution should be as simple as possible, but no simpler. This diagram is too simple.

25. HWD FD CR ILR SHR HMIS IL TS POS
There is an architectural element, the Interlinked Registry (ILR), that is not on the previous diagram. The ILR plays an important role. We also will talk about the TS and the role it plays as a definitive library that POS systems can access to seed their code sets. This diagram is the one we’ll use for today’s description of OpenHIE and how it works.
POS

26. HWD FD CR ILR SHR HMIS IL TS POS
Point of Service (POS) – the applications that communicate with the HIE including mHealth apps, EMRs, hospital EPRs, lab and pharmacy, etc.
HWD FD CR
ILR
SHR
HMIS IL TS
POS

27. HWD FD CR ILR SHR HMIS IL TS POS
Interoperability Layer (IL) – manages all inbound communication from POS applications and orchestrates how OpenHIE will do its work to satisfy them. The IL also provides centralized authentication, authorization and audit logging services.
HWD FD CR
ILR
SHR
HMIS IL TS
POS

28. HWD FD CR ILR SHR HMIS IL TS POS
Terminology Service (TS) – provides the canonical database of code sets and clinical ontologies and, where applicable, can map between them. CR
ILR
SHR
HMIS IL TS
POS

29. HWD FD CR ILR SHR HMIS IL TS POS
Client Registry (CR) – provides the definitive demographic data regarding subjects of care and cross-references local client ID codes to the enterprise client ID (ECID). TS
POS

30. HWD FD CR ILR SHR HMIS IL TS POS
Health Worker Directory (HWD) - provides definitive demographic data and competency data regarding providers of care and cross-references local provider ID codes to the enterprise provider ID (EPID).
POS

31. HWD FD CR ILR SHR HMIS IL TS POS
Facility Directory (FD) - provides definitive data about sites of care and the services provided at them; cross-references local facility ID codes to the enterprise facility ID (EFID).
POS

32. HWD FD CR ILR SHR HMIS IL TS POS
Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of a Health Worker Registry (HWR) and Facility Registry (FR).
POS

33. HWD HWD HWD FD FD FD CR ILR SHR HMIS TS
Inter-linked Registry (ILR) – cross-references organizations, facilities, health workers and services and provides cross-indices between the local provider and facility IDs and the enterprise ID for each (EPID, EFID). Importantly, the ILR supports federation of multiple HWDs and FDs and, in doing so, can play the role of a Health Worker Registry (HWR) and Facility Registry (FR).
POS

34. HWD FD CR ILR SHR HMIS IL TS POS
Shared Health Record (SHR) – is a repository of person-centric health transactions indexed by ECID, EPID, EFID and timestamp. The SHR provides a longitudinal health record; it may be used to generate an on-demand health summary (care continuity) document. TS
POS

35. HWD FD CR ILR SHR HMIS IL TS POS
Health Management Information System (HMIS) – the database of (aggregated) data elements and indicators that support big data analytics, public health planning and decision making. TS
POS

36. HWD FD CR ILR SHR HMIS IL TS POS
So… these are the puzzle pieces. How do they work? What do they do?
POS

37. OpenHIE’s transactions…
Save a new demographic record
Query for a demographic record
Query by ID
Query by fuzzy match
Update an existing demographic record
Update inter-linked records
Query for inter-linked records (Providers, Facilities, Organizations, Services)
Save client encounter document
Query for client encounter documents
These are the transactions OpenHIE supports.

38. OpenHIE’s transactions…
Save a new demographic record PIX ITI-8
Query for a demographic record
Query by ID PDQ ITI-21
Query by fuzzy match PDQ ITI-21
Update an existing demographic record PIX ITI-8
Update inter-linked records CSD ITI-74
Query for inter-linked records (Providers, Facilities, Organizations, Services) CSD ITI-73
Save client encounter document XDS.b ITI-41
Query for client encounter documents XDS.b ITI-18
OpenHIE is standards-based, conformance-tested digital health infrastructure. These are the globally balloted IHE transactions that OpenHIE leverages to execute its transactions.
XDS.b ITI-43

39. Save/Update demographic record
This is the pattern of communication for saving/updating demographic information about a subject of care. [NOTE: taken from OpenHIE wiki. Error in showing HWR and FR and not showing ILR.]

40. HWD FD CR
ILR
SHR
HMIS
ITI-8 IL TS
ITI-8
POS

41. Query demographic record(s)
This is the workflow pattern for querying for demographic records.

42. HWD FD CR
ILR
SHR
HMIS
ITI-21 IL TS
ITI-21
POS

43. Update/Query inter-linked record(s)
ITI-74
This workflow pattern illustrates how the ILR is refreshed from its underlying health worker and facility directories and how a POS can make queries against the ILR.
ITI-73

44. On a regular refresh cycle…
HWD FD
ITI-74
On a regular refresh cycle… CR
ILR
SHR
HMIS IL TS
POS

45. HWD FD CR
ILR
SHR
HMIS
ITI-73 IL TS
ITI-73
POS

46. Save client encounter document
ITI-41
ITI-9
ITI-73
ITI-73
This workflow illustrates how person-centric information is saved. First, the IL cross-indexes the inbound information to the ECID, EPID and ELID, and then the newly cross-indexed health record is saved to the SHR.

47. HWD FD CR
ILR
SHR
HMIS
ITI-9
ITI-73(2)
ITI-41 IL TS
ITI-41
POS

48. Query client encounter document
ITI-18
ITI-9
ITI-18
To fetch a particular health record (clinical document), the POS first asks for the document’s ID (or a list of documents IDs matched to the client’s ECID) and then fetches the specific document(s), by ID, from the SHR.
ITI-43
ITI-43

49. If document ID is unknown
HWD FD CR
ILR
SHR
HMIS
ITI-9
ITI-18 IL TS
ITI-18
If document ID is unknown
POS

50. ITI-43 ITI-43 For each document ID HWD FD CR ILR SHR HMIS IL TS POS
Instead of a particular clinical document, the POS may be looking for a health summary. To return this, the POS asks for an on-demand document to be generated by the SHR that collects and collates all of the available information about the client.
ITI-43
For each document ID
POS

51. Which documents?

52. Supported HL7 CDA Document Sections
Clinical documents are broken down into sections. Each section contains health information about the client that is formatted based on a standardized template.

53. Supported CDA documents…
Many clinical documents contain the same underlying sections. This is a list of the clinical documents OpenHIE presently supports (and more are being added all the time).

54. What’s next for OpenHIE?
Aggregate Data Exchange (ADX) – IHE profile for submitting data element & indicator content to the HMIS
Mobile Alert Communication Management (mACM) – IHE profile for sending unstructured messages to human recipients
On-demand Document (ODD) – XDS.b option to create a CDA on-the-fly… implemented by OpenSHR but not yet tested at CAT
Basic consent management (opt-out, no BTG)
Other features based on Architecture Meetings…
Presently (August, 2015), OpenHIE has plans to extend its transaction support by adding new capabilities. [points listed]

56. Thank you.