Overview

As part of the Comprehensive HIE Interoperability Workgroup, this page organizes the efforts to describe the technical approaches towards seamless interoperability between existing clinical information-sharing capabilities and the capabilities of the Direct Project.

Presentation from June 11 meeting:
NHIN_IG_06112010_Comprehensive_HIE_2.ppt
NHIN_IG_06112010_Comprehensive_HIE_2.ppt

Definitions

Full Capabilities HIO

Full Capabilities HIO refers to a Healthcare Information Organization (HIO) which provides its members with the capabilities to locate and share clinical information within the HIO and outside of the HIO. Inside the HIO, these capabilities include patient identification, on-demand queries, and satisfying the core user stories of the Direct Project. Outside the HIO these capabilities include the services described by the current Nationwide Health Information Network protocols when information sharing occurs outside of its boundaries. Note that for the purposes of the following discussions, this support means just technical capabilities, not necessarily support for participation in the Nationwide Health Information Network Limited Production Exchange, which brings additional non-technical requirements.

Partial Capabilities HIO

Partial Capabilities HIO refers to a Healthcare Information Organization (HIO) which provides its members with MPI and data location capabilities, but does not provide capabilities to satisfy the core user stories of the Direct Project. This means that a Partial Capabilities HIO does not support the current Nationwide Health Information Network protocols for locating and sharing clinical information outside the HIO, since such support will enable it to satisfy the core user stories of the Direct Project.

Belonging

When discussing a Source or Destination "belonging" to a Full Capabilities HIO, this includes the cases where a single provider organization is an HIO, as well as the cases where the HIO is a combination of provider organizations and providers of varying sizes

Seamless Interoperability

"Seamless Interoperability" refers to the ability of the users to maintain a single workflow regardless of the type of information exchange used to satisfy the user stories.

Background

At the face-to-face meeting on May 6, a diagram showing a comparison between the Nationwide Health Information Network Exchange and Direct Project models was used to illustrate the intersection between the Direct Project and comprehensive HIE services. This became known as "Karen's Cross", and an updated diagram was later provided. The following scenarios attempt to highlight the various intersection points in order to make explicit any assumptions and considerations that may be missed in the general diagram.

Scenarios

The purpose of the scenarios is to expose the interaction points between the Direct Project protocols and the comprehensive HIE capabilities of an HIO. Other workgroups are expected to consider these interaction points when developing the messaging, packaging, security and directory specifications.

Source and Destination part of the same Full Capabilities HIO

When both the source and destination are part of one Full Capabilities HIO, the communications between them will be governed by the policies and agreements of the HIO. Therefore, these types of communications out of scope for the Direct Project. An example of how an existing HIO handles this case has been provided.

Source belongs to a Full Capabilities HIO, Destination does not belong to a Full Capabilities HIO

When the Source belongs to a full HIO, the HIO is expected to provide its members with services which enable them to communicate with Destinations which are not part of a full capabilities HIO. This requires a "bridging" between the Direct Project protocols used for communicating outside the HIO, and the capabilities of the destination. Such a bridging may include a "step-up" and "step-down" of the format used by the Destination.

Backbone Protocol Support

Whether the Destination is part of a combined Destination/Destination HISP system, or it uses a third-party Destination HISP, the HIO needs to communicate with a Destination HISP. This means that to the "outside world" the HIO represents a combined Source and Source HISP. In this case, only the backbone protocol is in scope for consideration for comprehensive HIE interoperability.
Specifics:

HIO provides Destination HISP services to Destination

The HIO with comprehensive HIE capabilities may wish to enable entities with only Destination capabilities to receive information from members of the HIO. In this case, the edge protocol is in the scope for consideration for comprehensive HIE interoperability. Since the transfer of information from the Source to the Destination HISP occurs within the HIO, it is out of scope for the Direct Project. Note that this doesn't require the implementation of complete Destination HISP capabilities, since all that is offered to the Destinations is to receive information from members of the HIO.
Specifics:

Source does not belong to an HIO, Destination belongs to an HIO

This is the opposite of the previous case, and a similar set of cases exists. When a Destination belongs to an HIO with comprehensive HIE capabilities, the HIO is expected to provide its members with services which enable them to communicate with Sources which are not part of an HIO with comprehensive HIE capabilities. The following options for the Source and Source HISP exist::

Backbone Protocol Support

Whether the Source is part of a combined Source/Source HISP system, or it uses a third-party Source HISP, the HIO needs to communicate with a Source HISP. This means that to the "outside world" the HIO represents a combined Destination and Destination HISP. In this case, only the backbone protocol is in scope for consideration for comprehensive HIE interoperability.
Specifics:

HIO provides Source HISP services to Source

The HIO with comprehensive HIE capabilities may wish to enable entities with only Source capabilities to send information to members of the HIO. In this case, the edge protocol is in the scope for consideration for comprehensive HIE interoperability. Since the transfer of information from the Source HISP to the Destination (in abstract model terms) occurs within the HIO, it is out of scope for the Direct Project. Note that this doesn't require the implementation of complete Source HISP capabilities, since all that is offered to the Sources is to receive information to members of the HIO.
Specifics:

Source and Destination belong to different HIOs

Since the discussion is limited to HIOs with comprehensive HIE capabilities, in this scenario it is expected that the communications between the HIOs will use the existing Nationwide Health Information Network specifications. While on one hand this makes this scenario out of scope, on the other hand it still has impact on the selection and development of the Direct Project protocols and specifications. Implementing the relevant Direct Project services should not be a burden for HIOs that have already invested in implementing the existing Nationwide Health Information Network specifications.
Specifics: