NHIN Direct Project ONC State HIE RetreatSeptember 1st, 2010

What is the NHIN Direct Project?

A project to create the set of standards and services that with a policy framework enable simple, directed, routed, scalable transport over the Internet to be used for secure and meaningful exchange between known participants in support of meaningful use

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NHIN Direct Project

» Open, transparent collaborative process,

» Includes use of wikis, blogs, open source and open content

» http://nhindirect.org

» First phase grounded in real-world implementation in 2010

» Follow key rules of HIT Standards Committee Implementation Workgroup

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Close to 200 Implementation Group Participants

» Alere» Allscripts» American Academy of Family Physicians» Argonne National Laboratory» Atlas Development» Axolotl» CareSpark/MobileMD/Serendipity Health» Cautious Patient» Cerner» Clinical Groupware Collaborative» CSC » eClinicalWorks» EHR Doctors» Emdeon» FEI» GE» Google» Greenway Medical Technologies» Harris Corporation,» High Pine Associates» HLN Consulting» ICA,» Inpriva» Intel» Kryptiq

» LabCorp» Massachusetts eHealth Collaborative» MedAllies» Medical University of SC, » Medicity» MedNet» MedPlus/Quest Diagnostics » Microsoft» Mirth Corporation» MOSS» Nationwide Health Information Technology» NIH NCI» NIST» NYC Dept. of Health and Mental Hygiene’s PCIP» Oregon HIE Planning Team» Redwood MedNet» RelayHealth» Secure Exchange Solutions» Siemens» South Carolina SDE» SureScripts» Techsant Technologies» TN State HIE» VA» VisionShare

State Participation

» SDE participation from• CA, OR, RI, TN, SC (new)• Other states participate with observer roles• Strong participation from TA team, current and legacy (Noam Artz

and Tim Andrews)» HIO participation sub-state from

• NY (HIXNY, Hudson Valley)• TN (CareSpark)• CA (Redwood Mednet)• CT pilot has some coordination with CT SDE

» Much dialog with individual states

NHIN Direct High-Level Project Plan

Oct 2010

Aug 2010

Sept 2010

ImmediateNext 90 Days

Short Term3 to 9 months

Long Term9 to 36 monthsActivity

Standards and Specification Development Activity

Real-world Implementation Activity

Regulatory Activity

Policy Activity

Immediate Initiatives

Short Term Initiatives

Long Term Initiatives

Initial Pilot Implementation

Expansion of Pilots

Nov 2010

Dec 2010

Draft Specification Complete

Transition to an SDO

1st Q 2011 2011 2012-2013

Ongoing Maintenance

Evaluation for inclusion by NHIN and ONC Endorsement

HITPC Tiger Team Framework and Policy Review

Feedback to NHIN Governance

Feedback on initial lessons learned

Ongoing Review and Feedback

Wide-Scale Deployment

Evaluation by HITSC

Overview of the Specification

» Consistent Health Internet Addressing, based on familiar concepts• E.g., drjones@exchange.sunnyfamilypractice.com• Can manage your own exchange domain, assign to a HISP or HIO,

and reassign at a later time• Provides universal cross-HIO addresses and reduces lock-in and

interoperability islands.» Two transport models

• Universal transport uses secure SMTP + S/MIME as the transport– Can be broadly deployed to reach the widest variety of

providers and patients– Still allows for highly structured health care content

• SOAP transport based on IHE/NHIN specifications (XDR AKA NHIN Document Submission– Includes ability to “step-up/step-down” to the universal secure

SMTP transport

Functional Status

Area C# JavaCore SMTP Agent Code complete, partially

unit tested,Early end-to-end testing

Code complete, unit tested,Early end-to-end testing

Local Certificate Resolution

File, DB code complete File code complete

DNS Certificate Resolution

Code complete, partially unit tested, early end-to-end testing

Code complete, partially unit tested, partial end-to-end testing

LDAP-based Certificate Resolution

In progress for private certs and trust anchors

Agent configuration XML complete, DB and web UI in progress

XML complete, DB and web UI not started

XDM packaging In progress? Alpha code

XDD (XDR with minimal metadata)

Waiting on specification Waiting on specification

Client API N/A N/A

Lines of Code

» Rapid and consistent growth on the C# side• C# team had to write much more code (DNS, MIME) than Java

team due to better libraries on the Java side• Unit test and API documentation lagging behind

» Java team has excellent progress on engineering quality (unit tests, documentation)

States and NHIN Direct SpecificationsTh

reat

s Lowered exchange costs may encourage more health systems to “go it alone”National exchange participants may compete for simple exchange capabilities O

ppor

tuni

ties Lower the cost of

providing MU transactionsProvide standards-based migration paths for providersFill in the gaps in coverage with national exchange partnersProvide an upward path for full exchange capabilities

Sta

te S

ervi

ces Governance and

policyCertificationProvider directoriesConnectivity for Medicare providers, rural providers, local labs, State hospitals, etc.NHIN Direct services offered through state exchange or federated with community and regional exchanges

Q&A

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