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Monday, February 21, 2011

Interoperability Workshop: Putting the Pieces together

I love teaching.  It's one of the most rewarding experiences in my job.  This morning (yesterday actually), I joined with Lee Jones, Bob Yencha, and Didi Davis to talk about how you can put the pieces together to build interoperable solutions.

Lee kicked us of with some great slides about what he calls the "Meaningful Frenzy".  There's several poignant slides of a pair of Sumo Wrestlers that really drive home some of the challenges we all have.

I followed up with a description of what a use case is, and talked about many of the Use cases we have already built interoperability solutions we call profiles in IHE.  After that, we walked through "Use Case 3" which describes an emergency room visit for a sore wrist by a 70-year-old woman.  Then the fun began.  I'm used to walking around the room to engage students, but the mikes were all wired, so I was stuck behind the podium.  But for the workshop portion of my talk, I needed to move.  Well, I can project pretty well, so I skipped the mike, and started talking.  The tech guys decided they needed to have me miked anyway (so they could record), and so they got me a wired shirt mike with a 40' cord.  Moving around on stage and back to the floor I got tangled up a few times.

Once I waqs wired, we picked out the important pieces of our use case:
  1. Identifying the patient
  2. Obtaining Consent to Share information.
  3. Referring the patient to a specialist (a cardiologist in this case).
  4. Accessing information from the patients prior visits.
  5. Reporting the results and sharing them with the patients GP.
Some of the IHE profiles that we talked about included PIX/PDQ [1], BPPC [2], XDS-MS, DSUB and MPQ [3], XDS.b and other content profiles.

I can understand why its difficult for people to put the profiles together.  All the profiles do is deal with transactions for a specific use case, to solve a single problem.  What people need to do is think creatively.

Here's a little experiment:  Take the seven profiles that I listed above, and pick two.  What cool thing can you do with those two together?  Let's look at PIX and BPPC.  PIX is how you send information from a Patient Identity Source (say a registration system) to a Patient Identity Cross Reference Manager (e.g., an MPI).  Now, suppose that registration is done through a kiosk, and there's a checkbox to get consents to share information and the patient's signature.  So, to create a new patient in the HIE, you can create an HL7 Version 2 ADT message, and send it from the Kiosk to the MPI.  Now, the MPI can look at a couple of fields in that message to determine what the patient consented to, and it can create a Basic Patient Privacy Consents document which it will register in the HIE.  So, just by putting these two profiles together, we've solved an interesting problem (I've seen a variation of this used in at least one HIE).

We did the same thing with the seven profiles I listed.  But the challenge for most people is putting these things together to make it work.  You have to be creative, and you have to know what the shapes do.  Once you know what the shapes do, you can create an endless variety of solutions.  IHE is to Health IT as Lego is to young engineers.

The rest of the presentation, which included details on another set of building blocks (templates in CDA), and steps beyond that can be found here.

   Keith

P.S.  If you are looking for me at HIMSS, you should be able to find me in the Interoperability Workshop at the Help Desk.  But I'll be late tomorrow.  Have to pick up the motorcycle first...

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