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Transforming Public Health through Service-Oriented Architecture and Interoperability

This white paper presents an extensive proposal for enhancing public health information systems through the integration of Service-Oriented Architecture (SOA) and new interoperability standards. It underscores the findings of the Public Health Data Standards Consortium and collaborating organizations on developing the Immunization Content Profile and Pediatric Demographics supplement. The paper discusses how decentralized, user-centric workflows can reduce costs and improve efficiencies in public health applications, such as cancer registries, chronic disease management, and immunization information systems.

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Transforming Public Health through Service-Oriented Architecture and Interoperability

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

  3. IHE, SOA and Economics How can IHE profiles plus SOA reduce public health costs? • Decentralized, user-centric workflow • Reduction in connectivity costs by transforming order(N2) costs to order (N)

  4. Numerous Use Cases within Public Health • Cancer Registries • Chronic Disease Management Solutions • Quality Reporting • Biosurveillance • Adverse Event Reporting • Organ Donor Registries • Immunization Information Systems

  5. Common Workflow

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

  7. Retrieve patient data

  8. Validate, recommend, record

  9. Web-based Architecture Stakeholders Web-based Application Data Stores Identity Resolution (PIX/PDQ) Retrieval/Update of Data (XDS, Immunization Content) Decision Support (Current PCC proposal) (Pub/Sub) Immunization Information System (IIS)Data Store Hospital #2 Clinic #2 Hospital #1 user Clinic #1 user Other provider user Other user

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

  11. Retrieve Medical Summary

  12. Validate, recommend, record

  13. Send Immunization Content to IIS

  14. IIS Receives Immunization Content

  15. Document Repository Receives Immunization Content … <administerableMaterialclassCode="MMAT" determinerCode="INSTANCE"> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2" /> <templateId root="2.16.840.1.113883.10.20.1.53" /> <code code="20" codeSystem="2.16.840.1.113883.6.59" displayName="DTap" /> …

  16. Public Health Nurse or Patient PHR

  17. Public Health Nurse or Patient PHR

  18. Public Health Nurse or Patient PHR

  19. Public Health Nurse or Patient PHR

  20. IIS Service-Oriented Architecture Service Bus Data Stores Stakeholders XDS Document Registry Hospital #1 EMR Decision Support Service (PCC - proposed) Other Data Store Master Person Index SDIR (MPI, immunization data) Clinic #2 Hospital #2 Other Service (yellow card?) Security Transformation Patient Identification Service (PIX/PDQ) Locate, Retrieve and Update Service (XDS, IC, content) Clinic #1 EMR XDS Document Repository Web-based EMR interface for small providers Other patient or provider Interface

  21. Reduced Costs • Mathematics of connections • N2 -> N • User-centric workflow • No double data entry • Many more benefits Status quo suggested SOA

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

  23. Open Issues Experience of some of the authors to date: • Mechanism 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) • Common approaches taken in multiple service specifications • How to build upon existing IHE profiles • Methods for specifying operations semantics

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

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

  26. Effort • Medium but flexible

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