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Showing posts from July, 2012

Using SOA to create Interoperablity between Providers

In the State of New York we have found the key to interoperability for Healthcare Information Exchange (HIE) is in building on a services oriented architecture (SOA). The preferred SHIN-NY 1.0 architecture was based on SOA in order to get the benefits of its characteristics, which are having business focused services based on open standards that provide reusability, flexibility, agility, and loose coupling (abstraction). Abstraction is also one of the foundational concepts of computer science. In HIE, we want abstraction between providers and consumers of information; such that the provider does not have to know how the consumer wants the information and the consumer does not have to know how the provider sends the information.
One of our business goals is to make HIE a value-adding process for users in that it transforms between standards without losing the meaning of the content being shared. For example, what if a primary care provider (PCP) wants to send a referral patient summar…

Exchanging Care Plans, Discharge Summaries, and other Unstructured Narrative Content

In an ongoing debate about the readiness of HIE for Medicaid Health Homes and other ACOs, one of the issues has been the need to exchange care plans. Unfortunately, I think people are hung-up on the concept of structured XML documents and structured data. Just because the document is structured and contains many areas of coded, structured data; should not be interpreted as though there cannot be sections of data that are unstructured narratives with limited structured elements describing the content such as date/time, author, and type of report. Recently, we have gone so far as to add narrative data in several areas of the CCD where it can be supported. These include pathology reports, image studies, discharge summaries, and care plans. Part of the problem with exchanging this type of data is that the default stylesheet (XSLT) from HL7 for viewing a CDA R2 document, such as a CCD/C32, as an HTML document, does not display narrative data properly. Basically, it just needs to respect the…

The Well Architected HIE and Direct Push

In "The Dangers of Too Much Ambition in Health Information Exchange" published in ihealthbeat, Micky Tripathi recently wrote about "over-architecting" HIEs. Mickey is correct that HIEs should not try to boil the ocean. However, the final point of Mickey’s article seems to be “Start with PUSH” because it is high value to physicians and low risk. It is true that PUSH is high value to physicians and that it is the primary thing they are willing to pay for. But, this alone will not make an HIE sustainable because physicians and hospitals won’t pay enough for it. On the other hand, Governments and Health Plans have been willing to make longer term investments into the data warehouse that supports PULL of a patient centric record. So to some degree, HIEs have to follow the money. This isn’t such a bad thing as for example the money for New York HEAL grants was to establish a strong foundational architecture for HIE. If regions followed the State architecture, they imple…