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Co-creating Value in Healthcare with Interoperability

Jul 9 2010   8:49AM GMT

HIE Building Blocks:

Posted by: Nirpath
EMPI, HIE, Interoperability and health information exchange

HIE is a central repository or exchanging place, where clinical and administrative information is shared among institutions for clinical care, research or process improvement. It will be successful by participation of all the stakeholders in this process.

To implement an HIE, one should focus on below important subsystems –

  1. EMPI (Enterprise master patient Index) / Patient Index (PIX) Service: This is the Patient Identifying service at each participating system. Due to lack of standard practice, the “PatientID”, which was supposed to be unique, is different for each service, or for each hospital or for each physician. This service has different techniques to collate and give a near exact match of a patient.
  2. Provider Index / Provider data Query (PDQ) Service: Although it is not that complex like its peer Patient, “ProviderID” also has got different “unique identifier”. This service takes care of identifying a near exact match of a provider.
  3. Record Locator Service / XDS Registry: XDS Registry works along with both the above services but, is primarily responsible for managing the search result.
  4. Security Services: This service includes the following items –
    • Authenticating and authorizing each request coming from stranger services and ensuring that it has got the right access.
    • Communication layer security takes care of creating the proper channel e.g. intranet, internet, VPN tunnel or any explicit hand shaking mechanism.
    • Data encryption service takes care of encrypting to the right level before the data is transferred across network in compliance with various federal regulations.
    • Auditing service to give fool proof mechanism to track back in case some spoofing activity being detected or for the sake of just reporting for early detection of any unusual activity.
  5. Standards Protocol (HITSP, IHE, HL7 etc…): As this has to be the smartest to talk to all stakeholders, it has to follow standards on how to talk to different HIEs and any other subsystem. There are different standard bodies, who publish the guidelines to be followed by similar systems.
  6. Messaging Gateway: To collate the patient date from different communities / hospitals, HIE has to follow a standard of “polling” and the connected systems responding to the “polling request”, in a specific standard format, if they have the patient data. IHE developed Cross-Community Access Gateway, or XCA. Using XCA gateways, one can access records from other communities that a given patient may have visited.

Although, it is very complex system, I have tried my best to give a concise view of it.

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