Statewide Send and Receive Patient Record Exchange
The Statewide Send and Receive Patient Record Exchange is the result of a collaborative effort to ensure interoperability when creating an NwHIN Direct solution.
While these specifications may be of interest to several healthcare IT professionals, the primary audience targeted by these documents includes:
- Technical management staff representing a Statewide HIE
- Technical management staff representing a community participating within a Statewide HIE
- Developers of clinical systems that create content for use within a HIE
- Developers of integration frameworks that connect systems and create content for use within and between HIEs
The functional specification defines the scope and a series of assumptions for push-based transactions conducted by health endpoints such as ambulatory and inpatient EHRs, HIEs and other clinical systems to exchange a wide array of clinical information. In order to expand the ability to implement push-based transactions, the functional specifications expands upon the interaction between health endpoints and provider directories to define the processes by which users interact with a common service to identify the address of an intended recipient such as an individual provider or entity, the recipient's application capability to conduct exchange with compatible protocols, and the receiving systems ability to process specific payloads.
The technical specification provides guidance for specific functional requirements defined in the Statewide Send and Receive Patient Record Exchange Functional Specification v1.0 that can be accommodated by Direct Protocols. This specification defines the interoperability protocols for health endpoints including ambulatory and inpatient EHRs, HIEs and clinical systems to conduct Direct transactions. These specifications expand upon the current Direct interoperability protocols and define the format for a compatible Provider Directory based on the Integrating the Healthcare Enterprise (IHE) Healthcare Provider Directory (HPD) and aligns with the Standards & Interoperability (S&I) Framework Provider Directory Schema. The resulting Provider Directory format called “HPDPlus” also expands upon the currently defined Direct protocols of S/MIME/SMTP and XD* to provide State HIEs, Regional Health Information Organizations (RHIOs), ambulatory and inpatient EHR vendors and Direct HISPs with the standards-based transactions for health endpoints to communicate with a common Provider Directory and conducts transactions with a single HISP’s domain and across multiple HISP domains or networks.
This Implementation Guide serves as an appendix to the Statewide Send and Receive Patient Record Exchange Technical Specification v1.0. The Implementation Guide provides detailed guidance for the development of an HPDPlus Provider Directory including a detailed list of the elements of the Provider Directory, as well as how to implement an HPDPlus Provider Directory using a Lightweight Directory Access Protocol (LDAP) instance or a Relational Database Model.
The purpose of this document is to provide compliance criteria, test descriptions, standards, and test procedures pertaining to the compliance testing for Direct transport in accordance with the Statewide Send and Receive Patient Record Exchange Technical Specification v1.0 document1 and the XDR and XDM for Direct Messaging Specification document2. The information provided will guide reviewers of this document on how to conduct compliance testing to successfully and securely exchange patient records.
The purpose of this document is to outline the test certification criteria necessary for the Healthcare Provider Directory (HPD) when being used with the S&I Provider Directory data model, also known as HPDPlus. The HPDPlus Provider and Organization Searches will be defined in detailed to include information such as test descriptions, standards, and procedures. This information will provide an overview of how the tests can be structured.
The purpose of this document is to outline the test certification criteria necessary for the Healthcare Provider Directory (HPD) when being used with the S&I Provider Directory data model, also known as HPDPlus. The HPDPlus Provider and Organization Searches will be defined in detailed to include information such as test descriptions, standards, and procedures. This information will provide an overview of how the tests can be structured.
The purpose of this document is to provide compliance criteria, test descriptions, standards, and test procedures pertaining to the compliance testing for Direct transport in accordance with the Statewide Send and Receive Patient Record Exchange Technical Specification v1.1 document1 and its underlying specifications from ONC and the S &I Framework.
The Statewide Send and Receive Patient Record Exchange technical and testing specifications version 1.0 from the EHR/HIE Interoperability Workgroup (IWG) were published over a year ago. Since then there have been updates on specifications from the Direct Projects, as well as updates to specifications related to provider directory from S&I Framework and HIE. Based on a detailed review of these updated specification, the IWG specifications are now updated to align with the latest specifications.
The purpose of this document is to outline the technical design for a Statewide Send and Receive Patient Record Exchange service. This is also referred to as a “Push” Model within state Health Information Exchange utilizing intermediaries such as: Health Information Organizations or Health Information Service Providers for message routing. It is based on the Functional specification for this exchange.
This appendix, and its parent document, the Statewide Send and Receive Technical Specifications Draft v1.1, outline how the Healthcare Provider Directory (HPD) profile can be expanded for use with the S&I Provider Directory data model, the so called HPD Plus. It is expected that the HPD Data model as implemented in LDAP will eventually be upgraded to S&I compliance, though this could take some time. HPD has adopted many extensions specified in HPD Plus recently in IHE Change Proposal 601.
Statewide Patient Data Inquiry Service
The Statewide Patient Data Inquiry Service is the outcome of the conjoined labor of the Interoperability Workgroup. It identifies how the consortium agrees to leverage the IHE Profiles and NwHIN Exchange production specifications to facilitate patient queries and CCD retrieval. The documentation included in the Statewide Patient Data Inquiry Service includes a Functional Specification, Technical Specification, Summary CCD Document, and CDA Source of Information.
While this service may be of interest to several healthcare IT professionals, the primary audience targeted by these documents includes:
- Technical management staff representing a Statewide HIE
- Technical management staff representing a community participating within a Statewide HIE
- Developers of clinical systems that create content for use within a HIE
- Developers of integration frameworks that connect systems and create content for use within and between HIEs
The functional specification lays out the scope and assumptions of the Statewide Patient Data Inquiry Service as well as detailed information of the functions (purpose, input, operations, and output), use cases, and the model for how to operate an inquiry service across and between HIE domains. It was developed to be extensible for the inclusion of other interoperability needs such as a Statewide Master Patient Index (SMPI) and Record Locator Service (RLS) as well as the use intermediaries, like Regional Health Information Organizations (RHIOs). It is also flexible to facilitate a true SOA paradigm and a modified SOA paradigm. The functions outlined in this document are Patient Publish, Document Publish, Patient Consent, End User Authentication, Node Authentication, Patient Query, Document Query, Record Retrieval, and Record Viewing.
The technical specification provides the guidance for implementation to meet the functional specifications. As noted it relies heavily on the IHE and NwHIN specifications and the ability of the applications to leverage those protocols. In addition to providing specification guidance for the Statewide Patient Data Inquiry Service functions (Patient Publish, Document Publish, Patient Discovery, Document Query, and Document Retrieve) and the technical aspects like messaging and authorization. The document also provides guidance on the payload (a Summary CCD Document) agreed to by the Interoperability Workgroup through discussion and formal ratification by the consortium. The group also developed a proposal to address provenance, particularly in cases where an aggregated CCD is expected for retrieved documents.
As part of the Multi-State/Multi-Vendor Electronic EHR/HIE Interoperability Workgroup discussions among workgroup members revealed inconsistencies in how “source of information” is represented in CDA. It can be challenging representing this information consistently for a CDA that comes from a single source. In cases where a “data aggregation” service is used to create a single CDA patient summary from several underlying data providers, such as those used in regional and national exchanges, reporting the “source of information” becomes an even greater challenge. The Workgroup raised and resolved key issues related to CDA content scope, section and entry definition, use of clinical terminologies, and various issues related to preserving the "source of information" when generating CDA. The Workgroup believes it has made a significant contribution to the advancement of CDA, and for the first time, vendors participating in these programs will have a common guide for care transitions today and a roadmap to achieve Meaningful Use Stage 2.
One of the primary efforts of the Interoperability Workgroup was to develop a Summary CCD Document based on the HITSP C32 document, which would serve as the recommended payload for either the Send and Receive specification or the Statewide Patient Data Inquiry Service. The Summary CCD Document lists the content for messages that have been agreed upon by the Clinical Meta Data Element Sub Group to be included in the documents retrieved including the group’s decision on optionality. The document also includes notes on discussion points, hierarchical relationships between the elements and some information on acceptance of null flavors. Section 24, Order is currently optional and there will be future discussions on whether to replace this section with elements from Plan of Care.
The purpose of this document is to outline the test compliance criteria for Patient Data Inquiry Service as defined by the Multi-State/Multi-Vendor Electronic Health Record (EHR)/Health Information Exchange (HIE) Interoperability Workgroup. It is based off of the ratified final version of requirements defined in the Functional Specifications and Technical Specifications.
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