Sun HealthCare Business Solutions for Health Information Exchange and Interoperable Connectivity
Built on a foundation of integration with unified capabilities for Single Patient View”…
…combining all integration technologies in one easy-to-use environment.
Sun Confidential: Internal Only Health Information Exchange
Sun Confidential: Internal Only 2 What is an Health Information Exchange (HIE)? • Electronic Exchange of Healthcare Information between parties, across institutional boundaries • Similar to a Regional Health Information Organization (RHIO), but without a Regional Restriction • Precursor to a NHIN – National Health Information Network • Facilitates access to and retrieval of clinical data to provide patient centric care
Sun Confidential: Internal Only 3 Why an HIE?
• Goal is to provide more accurate information to Health Providers for the Patients Benefit • Reduce Costs
> Reduce duplicate clinical tests
• Provide Patient Centric Clinical Care
> All inclusive view of patients health
> More information should lead to better diagnosis • Better delivery of clinical results
• Research Capabilities > De-personalize clinical data
Sun Confidential: Internal Only 4 Health Information Exchange
Interoperability
National Health Information Network (NHIN) Regional Health Information Organizations Electronic Health Records Electronic Medical Records Personal Health Records Public Health Participation Physician Portals Patient Portals Payer Portals Sun Confidential: Internal Only 5 Digitization of HealthCare Patients The Underlying Problem - Finding the information
`
Composite Applications:
EHR System EHR System
Sun Confidential: Internal Only 6 RHIOs: “Wiring” Healthcare HIE
Current system fragments patient information Future system will consolidate information and and creates redundant, inefficient efforts provide a foundation for unifying efforts
Hospitals Public Hospitals Public health health
Primary care Primary care Laboratory physician Laboratory physician
Health Pharmacy Pharmacy Information Exchange
Specialty Specialty physician physician
Payors Payors
Ambulatory Ambulatory center (e.g. center (e.g. imaging imaging centers) centers)
Source: Indiana Health Information Exchange Sun Confidential: Internal Only 7 Realizing the Goals Need Solution
• Consumer-directed Healthcare • Personal Health Records – Health records Clinicians • Long Term Care Management For Higher for care and cost management (Patient-centric) Quality And Lower Cost • Disease Management Platforms - Best • Single Entity View practice guidelines, treatment plans
• Electronic Medical Records – patient • Reduce Costs centric for cost-effective, specific and real- Payers • Genomic Profiling And Pharma Data time guidance • Guidance Based On Best Practices • Identity Management & Security – • Data Privacy Regulate, track and audit access
• Health Information Networks – Infrastructure • Digital Information Flow for secure data exchange and access • Administration Management Of Escalating Data • • Regulatory Privacy& Access Control Federated IdM and Compliance for data access and audit trails
• Vendor Mergers & Acquisitions • Business Integration & Composite • SOA-based Architectures Leverage Legacy Applications– Enable new business IT Management Systems processes without rip and replace • Image Archiving
Sun Confidential: Internal Only 8 Health Care Solutions
• Single Entity View > Provides a secure, real-time & high quality single entity (patient / provider) view across disparate systems, networks & health services with no common identifier. Delivers matching, duplicate eliminating, and unifying across all records in an Enterprise. Uses all the information available to cleanse & probabilistically evaluate all records in real time and link related records. Leverages eIndex, EMPI & Java CAPS. Success: McKesson, HealthNow, Excellus BCBS • Health Information Exchange > Connects Applications, Businesses & Caregivers delivering a 360° view of Patients and Procedures. Enables providers and payers to share more information thereby improving efficiency and quality of care, at the same reducing costs. Leverages eIndex, EMPI, iProvider & Record Locater System. Success: Colorado RHIO, British Columbia PLIS, UK NHS
Sun Confidential: Internal Only 9 Without Consistent Master Data
The Problems of Piecemeal Knowledge...
Patient Perspective IT Perspective Business Perspective
• Medical errors and other • Fragmented information non-optimum results and poor data quality • Physician retention leads to inefficient issues • Patients feel business operations. disenfranchised from • Billing and AR Issues their care givers • More complex process to blend data sets • Tarnished reputation for customer service • Loyalty diminishes • Larger systems footprint through duplication • Poor Care • News of poor customer experiences spreads • Higher operational costs • Lost Patients fast on the Internet and lower efficiency
“Through 2011, 70% of SOA projects in complex, heterogeneous environments will fail to yield expected business benefits unless MDM is included.” - Gartner, Inc. “Predicts 2008: Master Data Management” by Andrew White, John Radcliffe - 25 February 2008
10 Sun Confidential: Internal Only 10 How do you link Related Information across Disparate Systems without a Common Identifier? System A System B
Clare Smith Claire Smith Same Person, Different ID ID: 667788 ID: 4444444 Medicare: 123-45-6789 Medicare: 123-45-6788 DOB: 10/07/1954 DOB: 10/07/1954
• No unique identifier exists between the systems
Historically healthcare facilities have identified their patients uniquely per facility eg. MRN on Patient Master Index, DVA, etc
With increasing complexity and the need to provide cross-facility and interdisciplinary services the facility based MRN no longer provides satisfactory identification ie UPI is required to form the basis of the EHR, CMR, etc Sun Confidential: Internal Only 11 The Root of the Problem
Multiple Entity Views Dispersed, un-integrated data
Test Results Procedure Orders Enterprise Patient View
Monolithic, Master Patient Index Master Patient Index Master Patient Index Independent Applications Registration Registration Registration Radiology Pharmacy Laboratory
Data Data External Repositories Payers Providers Hospitals Finance Warehouse Providers
Sun Confidential: Internal Only 12 Single Entity View • Link related patient / provider information across Challenge disparate systems with a common identifier ● Provide comprehensive management tools to ensure data quality in real-time Solution/Benefits ● Cross-indexing solution that delivers single customer (patient / provider) view ● Provides real-time automated person matching system
Products • Sun Master Index • Java CAPS • Open SSO • Service Registry Partners • McKesson
• Excellus Blue Cross Blue Shield Success • McKesson • HealthNow
Sun Confidential: Internal Only 13 A Smarter Approach
Single Entity View
Test Results Procedure Orders Enterprise Patient View Other Composite Composite Applications Applications
Master Reusable Registration Laboratory Radiology Pharmacy Services Patient Index
Data Payers Providers Hospitals Finance Data External Repositories Warehouse Providers
Sun Confidential: Internal Only 14 Health Information Exchange • Enable clinicians, public/private health caregivers, Challenge payers & providers to share & access vital health information when & where needed
● Using Sun’s Single Entity View and HIE Framework, Solution/Benefits caregivers can consolidate and aggregate clinical results from the hospitals and clinics enhancing patient safety & care
Products • Sun Master Index • Sun Business Process Manager • Java CAPS
Success • Colorado, USA RHIO • British Columbia, Canada PLIS • United Kingdom NHS
Sun Confidential: Internal Only 15 Sun’s 360° Health Information Exchange Network
Specialty Finance Research Academic Clinic and Education Medical Center Home Health
Long-Term Payers Care
Public Health
Hospital Diagnostic Pharmacy Imaging Center Pharmacy Benefit Management Medical Supplier
Clinical Physicians Documents Employer Single-Patient View
Private Ambulatory Insurance Centers Screening Government Registers Emergency Reference Insurance Services Laboratory
Sun Confidential: Internal Only 16 Health Information Exchange
Portal and Presentation Layer
District Nurses, Hospice Framework for Security and GPs, Practice Nurses, Hospital Clinicians, Staff, Community Identity Management Health Visitors Regional Specialists Practitioners Enterprise Patient/Provider Views Transaction Processes Electronic Health Records A Single Enterprise Master Patient Single Entity View Record
Patient Record Matching, Enterprise Master Patient Index Cleansing, Merging and Linking
Connectivity and Integration Services
Reliable, Scalable Storage Solutions Primary Hospital Outpatient Care Other Care Proven, Sustainable Hardware Sun Confidential: Internal Only 17 Claims Lifecycle Manager • Single entry point to search transactions Challenge • Single entity reporting “receipt to completion” transaction activity
● Solution/Benefits A transaction monitoring system ● Central entity for reporting process errors ● Collects data for Search & Reporting ● Supports standards based HIPAA transactions Products ` • Sun Patient Master Index • Sun Master Index • Java CAPS
Partners • ServiceSpan
• Caremark Success • Blue Cross Blue Shields Massachusetts • eMDeon (formerly known as WebMD)
Sun Confidential: Internal Only 18 Claims Lifecycle Manager
HIPAA Transactions
Diagnosis Codes District Nurses, Hospice GPs, Practice Nurses, Hospital Clinicians, Staff, Community Health Visitors Regional Specialists Practitioners Enterprise Patient/Provider Views Remittance Electronic Health Records Eligibility Single Entity View
Claims Enterprise Master Patient Index
Single Transactions View
Primary Hospital Outpatient Care Other Care Sun Confidential: Internal Only 19 Nationwide Health Information Network
Sun Confidential: Internal Only 20 Current Challenges in the Federal Healthcare. The secure exchange of interoperable health information within the federal government, and with the public and private sectors, can support agency priorities such as: • Military: Supporting Wounded Warrior, to enable the continuum of care between public and private healthcare systems for the 30,000 service personnel wounded in Iraq and Afghanistan • Social Security: Creating electronic records and authorization to ease the backlog in SSA processing of disability and claims applications, now at 755,000 which is up from 311,000 in 2000 • FDA: Ensuring pharmaceutical product safety and efficacy using outcomes data in the real world, a benefit of Post-Market Surveillance of drugs and durable medical goods • CDC: Federal, state, and local Bio-surveillance efforts to spot disease outbreaks or bioterrorism incidents and to track cases of contagious diseases • Health IT for Emergency response to Pandemics/Disasters to assist in managing triage systems, evacuation efforts and the health of displaced citizens
Sun Confidential: Internal Only 21 Nationwide Health Information Network (NHIN)
Office of the National Coordinator for HealthIT (ONCHIT) ● created by executive order in 2004 ● goal to create a national health IT infrastructure ● they initially created Federal Health Architecture
FHA envisions electronic health information to: ● improve the quality / efficiency of health care ● empower the individual patient ● support public health, emergency preparedness, and research
Sun Confidential: Internal Only 22 Nationwide Health Information Network (NHIN)
● Part of the ONC is effort is to not only increase the Electronic Health ● Record adoption, but also to ensure connectivity between E.H.R. Systems. ● NHIN is based on a set of standards and use cases ● NHIN has 16 + participating grantees ● NHIN CONNECT is the Federal Government version of this initiative Requires common elements: ● minimum set of detailed standards - a shared network “dial tone” ● support for consumer / inter-organizational trust ● value of exchanging data exceeds the cost
Sun Confidential: Internal Only 23 NHIN Benefits In describing the importance of Healthcare IT, Secretary Michael Leavitt identified these benefits, most of which rely in some way on the NHIN: • To the healthcare consumer: > Higher-quality care > Reduction in medical errors > Fewer duplicate treatments and tests > Decrease in paperwork > Lower health-care costs > Constant access to health information > Expansion of access to affordable care • To public health: > Early detection of infectious disease outbreaks around the country > Improved tracking of chronic disease management > Ability to gather de-identified data for research purposes > Evaluation of healthcare based on value, enabled by the collection of price and quality information that can be compared Sun Confidential: Internal Only 24 What is the NHIN-CONNECT Gateway?
• Software for all federal healthcare agencies to “connect” to the National Healthcare Information Network (NHIN) • Developed in Open Source, Contributed back to Open Source • Software – Sun Open Source NetBeans Project Mural Glassfish Project Metro/Tango/WSIT OpenESB Open SSO Open DS mySQL
Sun Confidential: Internal Only 25 Nationwide Health Information Exchange
Health Bank or PHR Support Organization Community Health Centers
CDC VA Community #1 Common “Dial Tone” & “Chain of trust” SSA
CMS FDA Integrated Delivery System
Community #2 The Internet Standards, Specifications and Agreements 26 for Secure ConnectionsSun Confidential: Internal Only 26 Sun Open Source SOA Case Study Nationwide Health Information Network - Connect (NHIN- Connect) • Challenge > Lacking ability to easily share electronic health information between multiple healthcare entities – Social Security, Military Health,Veterans Admin... • Solution > Using Sun open source OpenESB, ● The Gateway utilizes an Enterprise GlassFish, Sun identity mgmt. Service Bus (JBI/JSR208) > Secure exchange of interoperable ● Developed as open source using open health information standards > ESB/SOA framework Source: Office of the National Coordinator for IT U.S. Dept. of Health & Human Services April 2008
http://events.fcw.com/events/2008/ea/downloads/EA08_2-
4_Sankaran.pdf Sun Confidential: Internal Only 27 Sun Open Source SOA for NHIN
• Nationwide Health Information Network-Connect > “We wanted to make sure that the vendor was a reputable company that we could rely on for help and support. We were able to use Sun's entire open source SOA and Identity software infrastructure technology for NHIN.” > “And last, but not least, we wanted to work with a technology provider that would be a partner as opposed to just a vendor and I am happy to report that Sun has definitely been a partner in helping us to achieve the tremendous success of NHIN."
Craig Miller, Chief Architect, FHA, Vangent
Sun Confidential: Internal Only 28 Continuum of Care, integration support
Note: Longer term participation Shall include non-Federal Partners Sun Confidential: Internal Only 29 Sun Software Solutions
Sun Confidential: Internal Only 30 Sun's strength in HealthCare -
History in Healthcare with Thousands of Clients Worldwide
Prominent Healthcare Clients
Significant Drivers for Health Information Exchange
90%
77% 80%
70% 60% 60%
44% 50% 37% 40% 29% 30% 21% 20%
10%
0% Provider Rising Availability of Increased Public health Demand for inefficiencies healthcare grant funding national surveillance performance due to lack of costs attention on HIT needs information data to support and HIE patient care
Innovation Experience Knowledge
Sun Confidential: Internal Only 31 Clients: Sample of our Healthcare Clients
Pharmacy Benefits Managers Payer Organizations CVS / AdvancePCS / Caremark BlueCross BlueShield of LA First Health Services Corp. BlueCross BlueShield of MA BlueCross BlueShield of NE Hospital Systems and IDN’s BlueCross Blue Shield of NC New York Presbyterian Hospital Blue Shield of CA CareGroup, Inc. Group Health Children’s Hospital of Philadelphia Horizon BCBS Duke University Health System United Health Group Kaleida Health System Coventry New England Medical Center CMS Promina The Regence Group Cleveland Clinic Magellan Behavioral Health Sutter Health State of California Tenet Health System State of North Dakota Sisters of Charity State of Oregon State of South Dakota Long Term Care State of Washington Kindred Healthcare Genesis Health Ventures Healthcare Vendors Beverly Enterprises Cerner Quest Diagnostics / MedPlus Regional Health Exchanges GE Medical / IDX PLIS, BC Canada PointShare CORHIO Colorado Misys McKesson / Per-se PLIS-Canada
Sun Confidential: Internal Only 32 Analysts
• Leader in Back-End Application Integration, Gartner 2008
• Leader in Horizontal Portal Product, Gartner 2007
• Leader in Web Access Management, Gartner 2007
• Fastest Application Platform Server, SPECjAppServer, 2007
• Strong Performer in Customer Hubs, Forrester 2008
• Strong Performer in Application Server Platforms, Forrester 2007
• Visionary in Composite Applications, Gartner 2008
• Visionary in New Service-Oriented Business Applications, Gartner '08
• Visionary in Application Enterprise Servers, Gartner 2008
• Visionary in Data Integration Tools, Gartner 2008
Sun Confidential: Internal Only 33 The Market has Moved to Open
2/3 “Open source adoption of Clients Surveyed initially focused on the Using OSS in operating system and Web Mission-Critical server tiers of the Applications – June application platform stack, but early success widened 2008 the focus to include development tools, infrastructure components Gartner such as application servers and databases, and higher- Survey Finds Growing Use of Open- level components such as Source Software for Mission-Critical portal servers and content Applications - June 2008 management systems.” Open Source Adoption: Notes From The Field - July 2008 Sun Confidential: Internal Only 34 Open Source/Community Participation • Why it matters: > The only major vendor developing production SOA software as open source. Others only leverage open source components and maintain proprietary components • What: > Sun's open source Open ESB is not a scaled back version of Java CAPS...all future development takes place in this extended development community • Benefits: > Lowers customer risk through transparency into future releases > Allows customers to participate in the development
Sun Confidential: Internal Only 35 Sun's Unique Focus: Provide Value to Open Source IP and Communities
Added Value Features
Specialized Advanc Added Updates ed Added Value Backup Value Enablement Advanced Enterpri SunService Monitoring se Manage r Architecture 24x7 Consulting Support
Hot Performance Fixes Tuning Service Cumulat ive Patches Free Access
Sun Confidential: Internal Only 36 Sun Software Portfolio Multi-Platform and Open
Application Database Java/Client Infrastructure
Sun Open Storage Sun ZFS xVM
Storag Virtualization Datacente e r Developer Tools and Programs Professional Services (PS), Sun Learning Services (SLS), Support Sun Confidential: Internal Only 37 Sun's Unique Offering: Comprehensive, Pre-integrated & Open
•Application Containers •Master Data Management •Application Server •Single consistent view •Web Server •Vertical specific solutions •Message Queue •High performance data matching & •Mobility Services indexing
•Identity & Compliance •Application Integration & SOA •Automated Provisioning •Enterprise Service Bus •Access Management •Share/reuse services & processes •Single sign on •Workflow •Identity Auditing
•Directory Services • •Directory services User Interaction Platform •Virtual directory services •Portal, Widgets, Mashups •Security/failover services •Communities and Social Graph • •Data distribution services Wiki, blogs and Collaboration
2.2 million employees sold!
Sun Confidential: Internal Only 38 Sun's Offerings: Application Integration & SOA
•Sun's SOA platform lowers TCO and introduces business flexibility for: •Sun ESB Suite •Enterprise Service Bus >1) Integrating customer data platform •Integration and process >2) Mergers & acquisitions management •Open source and >3) Application consolidation pluggable •Leverages legacy application functionality as re-usable services and combines with newly created services to rapidly address new business objectives •Java CAPS •Comprehensive composite •Transparency into future releases with open application platform suite source code base •Combines ESB with MDM Suite •Rated LEADER by Gartner and Forrester •Open source and pluggable
• “Sun's Java CAPS product is a rising star in the company's software portfolio”
Gartner: 23 April 2007 Paul McGuckin, Daryl Plummer, Jess
Sun Confidential: Internal Only Thompson 39 Java Composite Application Platform Suite Community Contribution Java CAPS
Portal Open Source
OPEN ESB OPEN SSO Business Activity Monitoring OPEN DS COMPLEX EVENT PROCESSING | BUSINESS DASHBOARDS MURAL NETBEANS Master Data Management Business to Business GLASSFISH PROJECT METRO SINGLE ENTITY VIEW MESSAGE EXCHANGE
Business Process Management ORCHESTRATION
Enterprise Service Bus
MEDIATION | ADAPTERS | ROUTING | TRANSFORMATION
Infrastructure MESSAGE APPLICATION DIRECTORY SINGLE SERVER | SERVER | SERVER | SIGN-ON
Sun Confidential: Internal Only 40 Sun's Offerings: Master Data Management
•Sun's MDM platform addresses the following critical business needs: >1) Multi-channel optimization >2) Increased customer satisfaction >3) Operational efficiency •Integrates disparate customer and other business data into a single comprehensive view to enable customer cross-sell across divisional or geographic boundaries •Improves customer support through automated •Sun MDM Suite matching of customer data across different •Customer data integration systems •Open source code base •SOA enabled •Community driven
Suns “integration of MDM is fairly unique, and is ahead of the market in recognizing the central importance of MDM in distributedebizQ, and June 12, federated 2008, Beth Gold-Bernstein, SOA architectures.” Sun CAPS 6 Has the Right Vision Sun Confidential: Internal Only 41 Mural - Open Source MDM Community
• Master Index Studio – Canvas for defining model, attributes and services for reference data
• Data Integrator – Provides extract-transform-load (ETL) and supports a wide variety of data sources
• Data Quality – Features matching, standardization, normalization, profiling, and cleansing capabilities
• Data Mashup – Provides server-side data composition and aggregation
• Data Migrator – Provides the ability to migrate database objects across database instances
Sun Confidential: Internal Only 42 Sun Solutions
● Sun has a Comprehensive Enterprise Solutions Offerings for: ● SOA == Sun Java System Java CAPS ● Security == Sun OpenSSO Enterprise ● Directory Server == Sun Java System Directory Server EE ● Identity Management == Sun Java System Identity Manager/Role Mgr ● Presentation == Glassfish Web Space Server ● Hosting Application Server == Glassfish Enterprise Server ● Hosting Web Container == Sun Java System Web Server
● Sun provides governance frameworks, services, developer tools including: ● Sun Center of Excellence (for SOA, Identity Management) ● Sun Reference Architectures ● SOA Governance == Sun Governance Framework ● Java IDE == NetBeans, Studio, Eclipse (Plug-ins) ● Training and Certification programs
Sun Confidential: Internal Only 43 The SoMI (mostly local) Sun Team • SLG now falls under SunFed • One Nationwide Team – No Regions • Sales, Systems Engineers, Specialists, Service Engrs: > Heidi Hoyles, Systems & Storage Sales > Andrew Springer, Prof Service Sales > Julie Elsenheimer, Software Sales > Christine Sluman, Services Sales > Danielle Weinberg, Systems SE > Ron Gregory, Software SE > Rhonda Kelly, Services Account Manager > Steve Malesko, Lead Services Engineer > Paul Wickstrom, SW Architect
Sun Confidential: Internal Only 44 The SoMI Sun Healthcare Team
• Sales, Systems Engineers, Specialists, Service Engrs: > John Barto, GEH HC Evangelist > Manish Chopra, Solution Architect – Delivery Mgr > Paul Cahill, HC Business Development > Nancy Abell, HC Clinical Solutions Manager > Jean Prater, Gov't Market SW Strategist > Catharine Evans, Civilian HC Business Development Director > Sean Keane, HC SW Architect > Anna Wehberg, HC Marketing Manager
Sun Confidential: Internal Only 45 What's Happening in MI - MiHIN • There are 9 HIE's or RHIOs (www.MIHIN.org): >Capital Area >Upper Peninsula >Southeastern MI >Genesee Area >West MI >Central MI >Northern Lower Peninsula >Southwest MI >South Central MI • There is a MiHIN Program Office >Consists of 9 State of MI Folks from DIT and DCH: – Ken Theis, CIO & Janet Olszewski, DCH are Executives – Scot Ellsworth, DIT & Beth Nagel are the Tech & Biz Leads
Sun Confidential: Internal Only 46 What's Happening in MI – MiHIN cont'd • Project Control Office RFP Issued and Awarded: >Dewpoint Prime Contractor >S2a Consulting Sub >Currently in Project Planning & Analysis Phase >Will release and RFI ~ a month >Will release an RFP for infrastructure at the end of the calendar year >Looking for grant funding from the ONC • State Goals: >Combination of a Consolidated and Federated System >Central Repository at the State level >Backbone at the State level >Connection hooks at the HIE/RHIO level >Provide the tools and means to connect the 80% small providers, considering they have little to no IT equipment, IT staff, or in many cases – internet connectivity >Works in conjunction with State's Broadband efforts
Sun Confidential: Internal Only 47 What's Happening in MI – HIT Commission
• The Health Information Technology (HIT) Commission: >Board Consisting of 13 members: 2 from The State: – Janet Olszewski, Director of DCH – Ken Theis, CIO >Others representation from non-profit HC corps, pharmacist, pharm mfgs, Dr's, consumers, purchasers and employers, schools of medicine and hospitals • The Big Picture Goals: > Utilize Technology to improve HC outcomes and clinical workflow > Empower Citizens with access to information • Framework for Successful Implementation in MI > Leverage the regional collaboration and successes > Refine statewide services that support a statewide HIE > Position MI for resources from the economic stimulus package - ARRA
Sun Confidential: Internal Only 48 HIE Implementation Proposed Technology
Sun Confidential: Internal Only 49 Software Services and Support
Professional Services Support Services Migration assistance, workshops Plans designed for individual and architecting identity management corporate developers, small, or SOA solutions, and medium-sized and enterprise implementation services. environments.
Learning Services Managed Services
Training and certification courses Reduce expensive downtime, to help you derive maximum minimize risk, conserve internal benefits from Sun software. resources and manage change
Sun Confidential: Internal Only 50 Thanks
Ron Gregory Software Technical Specialist Sun Microsystems Inc.
Sun Confidential: Internal Only Definitions
An Entity refers to functionally independent participants within the health care system, from a single doctor practice up to hospital chains and national organizations, whether public or private. An Entity is any organization, institution or practice; the only parts of the health care system that are not entities are the patients themselves.
A SNO (Sub-Network Organization – a.k.a Regional Healthcare Information Organization [RHIO]) is any group of entities (regionally or non-regionally defined) that agree to communicate clinical data with one another using a single Record Locator Service (RLS), using shared policies and contractual agreements. A SNO has two sets of interfaces, one internal, which binds its member entities together, and one external, which is where traffic to and from other SNOs and outside entities come from. The NHIN (Nationwide Health Information Network) is the sum of all SNOs. It is a network of networks whose participants agree to the Common Framework. The NHIN is not a separately funded entity; it is a framework of cooperation and compliance. If the individual SNO's externally facing interfaces work, the NHIN will work. There are no required “top level” services in the NHIN; at the national level, adherence to standards and policies, however defined and affected, are the key elements. All the actual infrastructure of the network is either hosted within the SNOs or uses the existing internet.
Sun Confidential: Internal Only 52 Definitions
• ISB – Inter SNO Bridge • RHIN – Regional Health Information Network • EHR – Electronic Health Record • PHR – Personal Health Record • RLS – Record Locator Service • MPI – Master Patient Index
Sun Confidential: Internal Only 53 Continuity of Care Demonstration Scenario
Sun Confidential: Internal Only 54 Continuity of Care Demonstration Scenario
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
Veteran gets into serious skiing accident in Colorado and needs to go to the Emergency Room
Sun Confidential: Internal Only 55 Continuity of Care Demonstration Scenario
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
The emergency room doctors need to quickly review the patient's medical history and the hospital administration needs to verify patient eligibility Sun Confidential: Internal Only 56 Continuity of Care Demonstration Scenario
Payment Lifecycle Management
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA X12 270/271 Forms
The patient is a Veteran, so a claim is sent over to the veteran's administration to verify eligibility.
VA responds with verification of benefits.
Sun Confidential: Internal Only 57 Continuity of Care Demonstration Scenario
Security Solutions - Identity Management Mobility Solutions (SunRay) RHIO CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
ER Doctor needs to access patient information at patient bedside to review patient history. He identifies himself securely and logs onto the CoRHIO using a smartcard, preventing un-authorized access to patient data and providing for Provider Mobility.
Sun Confidential: Internal Only 58 Continuity of Care Demonstration Scenario
Master Patient Index (MDM)
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
All CORHIO patient data is identified using the Master Patient Index and multiple records are transferred inside CORHIO
Sun Confidential: Internal Only 59 Continuity of Care Demonstration Scenario
NHIN
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
Because patient is a Veteran, the VA and MHS healthcare records are accessed and reviewed via NHIN gateways in all locations. Data is consolidated from several locations prior to leaving the MHS and VA Sun Confidential: Internal Only 60 Continuity of Care Demonstration Scenario
Java CAPS Integration RHIO
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
X-Rays are ordered and viewed via the integration software which connects the Colorodo hospital to the radiology labs.
Sun Confidential: Internal Only 61 Continuity of Care Demonstration Scenario
Open Storage
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
Patient is treated and released. Records are stored as required for the lifetime of the patient.
Sun Confidential: Internal Only 62 Continuity of Care Demonstration Scenario
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
Patient injuries make him eligible for disability. Patient makes a disability claim application at the Social Security Administration.
Sun Confidential: Internal Only 63 Continuity of Care Demonstration Scenario
NHIN
CO RHIO
NHIN NHIN SSA NHIN
NHIN MHS
VA
Social Security Administration contacts Hospital via NHIN and is returned the patient's electronic medical record. With the electronic medical record, Social Security is
able to process the disabilitiesSun Confidential: claims Internal Only in days. 64