Friday, August 29, 2008

Cool Technology of the Week

In my role as Chair of the Healthcare Information Technology Standards Panel (HITSP), I've worked with 500 stakeholder organizations to harmonize the standards for clinical summaries, labs, e-prescribing, public health reporting, quality measurement, and personal health records.

These standards are now beginning to be implemented widely in the private and public sector since being mandated for Federal procurement in January of 2008.

Massachusetts and its hospitals have embraced these new standards and today we're sending thousands of transactions with them. One of our more exciting implementations went live earlier this month - lifetime medical record exchange with the Social Security Administration (SSA) for disability processing.

Using HITSP standards for data content (CCD) and transmission (SOAP), BIDMC has built a web service to provide real time exchange of data with the Social Security Administration. The client and the web service communicate using XML messages that follow the SOAP standard. The client sends a SOAP message containing patient demographics and a copy of the digitized consent and the web service responds with a SOAP message containing the Continuity of Care Document of the patient. Transport layer security is enforced via SSL. Message layer security is enforced using X.509 certificates and digital signature. All SOAP messages are digitally signed by sender’s certificate. Both the digital signature and the sender’s certificate are validated for data origin authentication.

A deidentified sample of an actual SSA transmission is available online.

It contains:

Patient Demographics:

Birth time
Phone number
Next of Kin information

Condition/Problems: (fully coded)

Current Problem list from webOMR
All inpatient visit diagnosis in the date range requested
All ED visit diagnosis in the date range requested
All Outpatient visit diagnosis in the date range requested

Results (human readable) limited to date range requested

All Lab results (chem, hem, urinalysis, blood gases, blood bank, etc.)

All reports from:
CT Scan Reports
Pathology/Biopsy Reports
X-ray Reports
MRI Reports
Cardiac Catheterization Reports
EEG (electroencephalogram)
ECG/EKG Reports
PET Scan Reports
Pulmonary Function Test Reports and Tracings
Graded Exercise Test/Exercise Tolerance Test Reports (cardiac tests)

Procedures (fully coded) limited to date range requested

Inpatient procedures
ED procedures
Outpatient procedures

Encounter (human readable) limited to date range requested

All discharge summaries from Inpatient stays – (identical to MA Share document)
All Operative notes
All ED visit summaries
All Notes on patient from webOMR
Phone calls
Encounter summaries

Thus, we've leveraged the internet (not private networks or VPNs), existing web standards (SOAP, SSL), and a structured, vocabulary controlled XML exchange (CCD) to rapidly implement interoperability with patient consent.

I've read some articles and heard some rumors that HITSP efforts are not XML based, are not vocabulary controlled, and are not embracing existing web standards. The SSA project illustrates the reality of how HITSP interoperability specifications empower connectivity at low cost with little effort using XML, vocabularies, and existing web standards.

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