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Universal Public Health Node (UPHN)

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Universal Public Health Node (UPHN)
Universal Public Health Node (UPHN):
An Evolution of Health Information Exchange in New York
Linh H. Le, MD, MPH; Ivan J. Gotham, PhD; Lori Evans, MPH, MPP; Dale Morse, MD,
MS; John Fuhrman; John Brady (New York State Department of Health); Farzad
Mostashari, MD, MPH; Nicholas Soulakis, MS (NYC Department of Health and Mental
Hygiene); LeRoy Jones (GSI Health); Mark Ciampa, MS, PMP (Booz Allen Hamilton)
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
Why a new architecture for Health Information
Exchange (HIE) for Public Health in New York
1
Unprecedented investment in HIE from New York State with
HIE for Public Health as one of clinical investment priorities
Support from CDC new initiative for Enhancing Public Health
Capabilities Through Health Information Exchanges
Need to move from uncoordinated, point to point
communications to a common, bi-directional health information
exchange for public health
Need to take advantage of and comply with the Statewide
Health Information Network - New York (SHIN-NY) architecture
and national standards for healthcare interoperability
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
2
Evolution of Health Information Exchange
(HIE) for Public Health In New York
text
text
Hospitals
Patients
HL 7 2.4
Hospitals
Patients
Pharmacies
text
CDA
Pharmacies
text
$
HL 7 2.3
X12
Physicians
text
HL 7 2.5
Physicians
RHIOs
Public
Health
Payers
$
cvs
Payers
Labs
Labs
Clinics
U
P
H
N
Clinics
Public
Health
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
3
Critical Challenges
How can information from different HIEs be integrated?
How can we move from a one-way to bilateral exchange of
information from clinical systems to public health?
How can we exchange data in a timely, secure and
standardized manner?
How can we achieve our above goals while protecting
patient privacy to the greatest extent possible?
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
4
What is the Universal Public Health Node
A collection of services and operational policies designed to fulfill
designated biosurveillance and public health reporting objectives by
exchange of data, bi-directionally between RHIOs and public health
agencies
A subset of the architecture for the Statewide Health Information
Network of New York (SHIN-NY), and complies with its architectural
parameters for full compatibility with other SHIN-NY domains beyond
public health
Based on a service-oriented architectural paradigm (SOA), implemented
through web services operating through an enterprise service bus (ESB)
Developed as part of a statewide collaboration process with active
participation across public and private sectors under leadership from
NYSDOH
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
5
Overarching Architecture Principles
Integration of Public Health Reporting Across Multiple HIEs
– Exchange of data for public health in a standard manner
– Collaborative Development of Consensus Implementation Guide
Enabling Bidirectional Flow of Information and Intelligence
– Public Health Participation in RHIO data exchange as equal partners,
providing and receiving information as needed
– Dynamic Querying Capabilities
Ensuring Patient Privacy
– Implement and Enforce of Privacy & Security Standards
– Minimum Data Necessary - Filtering, Anonymizing, Aggregating
Compliant with not only the SHIN-NY architecture, but also the national
standards for healthcare interoperability
– UPHN is a HITSP-compliant and HITSP-consistent architecture
– UPHN also leverages the work of the NHIN effort in its architectural framework
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
6
UPHN Primary Functionalities
Patient Query: allow public health to query and receive
responses for data about and individual patient based on
query parameters
Line List Query: enable public health to request and
receive patient-level data for specific disease conditions
Anonymize/Re-identify Query: enable the linkable deidentification and re-identification back to identified data as
needed for public health investigation
Analytic Query: enable public health to receive data based
on predefined queries for counts of specific disease
conditions
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
7
Public Health Scenarios
Public Health Investigation
311 Patient Locator
Tuberculosis (TB) All Points Bulletin (APB)
Influenza Surveillance
Syndromic Surveillance
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
8
Public Health Investigation
In response to a suspect or confirmed case report of public
health significance, public health authorities can query
multiple RHIOs using a standard interface and receive
additional clinical information regarding past medical history,
treatment, etc
Send request for data about certain patients
Get available data for requested patients
Return data for requested patients
Public
Health
RHIOs
Data Sources
Patient Query
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
9
311 Patient Locator
In case of emergency, public authorities can query multiple
RHIOs using a standard interface and receive information
regarding recent encounters/ admissions, which could help
in locating and tracking missing persons.
Send request for data about certain patients
Get available data for requested patients
Return data for requested patients
Public
Health
RHIOs
Data Sources
Patient Query
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
10
Tuberculosis (TB) All Points Bulletin (APB
In case of an imminent public health threat posed by an
individual with contagious condition who has been lost to
public health follow-up (e.g., XDR TB, SARS case)
Send request for data about certain patients
Get available data for requested patients
Return data for requested patients
Public
Health
RHIOs
Data Sources
Patient Query
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
11
Influenza Surveillance
For regular surveillance and in response to an influenza
outbreak, RHIOs would send patient care and hospital
resource data to the public health authority.
Re-identify record using pseudomized linker
Send anonimized data with pseudomized linker
Get identified record
Send request for identified data with pseudomized linker
RHIOs
Return identified data
Public
Health
Data Sources
Anonymize/Re-identify Query
Send request for data with certain case defintion
Get available data for requested case definition
Return data for requested case definition
Public
Health
Data Sources
RHIOs
Line List Query
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
12
Syndromic Surveillance
To monitor the rate of outpatient, ED and inpatient
encounters for respiratory and gastrointestinal illnesses. As
more specific information regarding the illness is obtained,
public health can distribute an updated query to partner
RHIOs specifying case definition and other parameters
relevant to this outbreak. The RHIOs modify their
aggregation and reporting system to incorporate this new
query.
Send aggregated data based on pre-defined criteria
Get data based on pre-defined query definition
Send updated query definition
Return aggregated data with updated criteria
Public
Health
Get data with updated query definition
Data Sources
RHIOs
Analytic Query
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
13
Key System Components
Enterprise Service Bus (ESB)
Service Registry and Discovery
Common communication and transport protocols
Standardized messaging format and vocabulary
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
14
Enterprise Service Bus (ESB)
The SHIN-NY ESB is a federated (or “distributed”) ESB,
allowing multiple physical ESB instantiations to be exposed
as one logical instantiation
An integrated physical instantiation of the SHIN-NY ESB is
referred to as a SHIN-NY ESB node
UPHN ESB is a domain-specific ESB node, exclusively
handling public health services and transactions
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
15
Service Registry and Discovery
UPHN ESB will maintain a restricted service registry using
UDDI v2.0.4 as documented in the NHIN Messaging
Platform Specification
The service registry will keep both endpoint servers
addresses and Web Services Description Language (WSDL)
service definitions
Copies of the registry that are kept in synch via replication
or another appropriate means with other ESBs within the
SHIN-NY
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
16
Common communication
and transport protocols
UPHN supports the communication and transport protocols
specified in the NHIN Interface Specification – Messaging
Platform v1.9
– Common transport layer for all messages using SOAP 1.2 over HTTP
– Messages between UPHNs will be secure from end to end by the use
of encryption as well as addressing within messages
– Message envelope will support assertions about security and trust
between UPHNs
– Authentication will use X.509 certificates issued by a common trusted
certificate authority
– All messages will be digitally signed for purposes of authentication and
non-repudiation
– Use WS-ReliableMessaging as a baseline message exchange pattern
to ensure acknowledgement of all communications (uni- or bidirectional)
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
Standardized messaging format
and vocabulary
17
Fully comply with HITSP Interoperability Specification for
Biosurveillance
HL7 2.5 is implemented initially
HL7 3.0 will be used when become more broadly used
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
18
Contact Information
Linh Le, M.D., MPH
Research Scientist
New York State Department of Health
Bureau of Healthcom Network Systems Management
800 North Pearl, Albany, NY 12204
Phone: 518-473-1809
Email: [email protected]
Accelerating State-Wide Public Health Situational Awareness
in New York Through Health Information Exchange
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