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From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

RESTful Health Exchange (RHEx)Content ApproachWebEx #5

August 23, 2012

Powering Secure, Web-Based Health Data Exchange

wiki.siframework.org/RHEx

3

Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

What is RESTful Health Exchange (RHEx)?

• An open source, exploratory project to apply proven Web technologies to demonstrate a simple, secure, and standards-based health information exchange

• Sponsored by the Federal Health Architecture (FHA) program in FY12– Helps to address Nationwide Health Information Network (NwHIN)

Power Team recommendation to develop a specification for RESTful exchange of health data

– Informs a path forward for a RESTful health data exchange

• Demonstrates RESTful health information exchange in two phases– Phase 1: Security and Transport Approach (April-July 2012)

– Phase 2: Content Approach (July-September 2012)

4wiki.siframework.org/RHEx

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RHEx Architecture Stack

Phase 1

Phase 1

Phase 2

6

Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

7

Components of the RHEx Content Layer

ContentOrganization

Content Payload

What data will be exposed?

How should data be organized and

managed?

8

Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

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Content Organization Goals

• Establish traversable hierarchical organization of data

• Provide common structured interaction using standard HTTP methods and RESTful Principles

• Support representation of data at appropriate levels of granularity aligned with Use Case– TATRC Pilot Use Case (discussed later in briefing)

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Content Organization Options

• Atom Publishing Protocol (AtomPub)

– Original Web 2.0 protocol for publications and posting on Web resources

• Open Data Protocol (OData)

– Extends AtomPub

– Data represented by Entity Data Model

– Provides specificity at the field and data type levels

– Not healthcare specific

• hData

– Similar to AtomPub, but more constrained

– Data can be represented using multiple standards

– Provides specificity at the granular document levels

– Developed with healthcare domain in mind• Hierarchical structure supporting linked documents

• Provides a means for discoverability of changed content

– Can interoperate with other protocols• OData can be integrated in the hData hierarchy

• Fast Healthcare Interoperability Resources (FHIR) Content Profile can be developed

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Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

12

Content Payload Goals

• Establish Common Data Model for Exchange– Semantic and Syntactic Interoperability

• Use existing standards• Provide extensible solution to manage multiple data

standards• Align content with use case

– TATRC Pilot Use Case (discussed later in briefing)

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Content Payload Options

• Healthcare Standards– HL7 CDA

• HITSP C83/C80/C154/C32• greenCDA for C32

– HL7 2.6 REF_I12– HL7 V3

• REPC_MT210001UV

– Consolidated Clinical Document Architecture (CDA)– DICOM

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Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

TATRC Pilot Motivation

• Pilot is designed to develop proof of concept for a World Wide Web model for health data exchange– Test the application of REST to health data exchange– Help to address the NwHIN Power Team recommendation

• Worked with selected federal partners to identify critical capability gap and select a prototype use case– Consult results are not consistently sent to PCP today,

impacting healthcare for Veterans and Service Members• Phase 2 pilot designed to evaluate Content Organization

and Payload concepts

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TATRC = Telemedicine & Advanced Technology Research Center

consult results

TATRC Pilot Use Case – Consult/Referral

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PCP Consulting Physician

consult request

PCP = Primary Care Physician URL-1 = Consult Requests Details URLURL-2 = Consult Results Details URL

URL-2Message

MessageURL-1

URL-1

URL-2

URL-1

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Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

18

RHEx Content Approach in TATRC Pilot

• Context– Designed to summarize a patient’s electronic health record

for the purpose of clinical consultation and referral– Components were modeled to support pilot use case:

specialist consultation for knee replacement • Content Organization choice:

– Hybrid approach• Patient data is organized into an hData Record on the Consulting

Provider’s EHR– Each section has zero or more entries– Unique Uniform Resource Identifier (URI) links are used for authorized patient record

data access

• Patient data is exposed as links to greenC32 representations on PCP EHR

• Content Payload choice:– greenC32 schemas used as content payload

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Approach to Content Organization, 1 of 2

hData Abstract Content Model Diagram

Supports coarse documents

OData could be implemented as a Section Feed

Supports hierarchy of patient data

Describes content available and resource URIs

URIs can point to DICOM images or granular patient data, such as allergy or medication

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Approach to Content Organization, 2 of 2

Course Grained Link Example

Granular Content Link Example

21

Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

RHEx TATRC Pilot Phase 2 Model Vision

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greenC32

Patient

Procedures

Allergies

Medications

Lab Results

Vital Signs

PCP EHR Consulting Provider EHR

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RHEx Content Payload for TATRC Pilot

Existing data standards

Resource Directory Description Language

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Overview

• Orientation– What is RESTful Health Exchange?– RHEx Architecture Stack

• The RHEx Content Layer– Content Organization– Content Payload

• RHEx Content Approach in TATRC Pilot– Content Organization– Content Payload

• Questions and Wrap-up

25

Summary

• RHEx Content Layer includes Content Organization and Payload– Options exist for each

• Concepts for Content Organization and Payload are being evaluated in the TATRC Pilot– Hybrid approach to Content Organization

• hData is used as the Content Organization for RHEx at Consulting Provider

– Supports multiple data standards– Developed with healthcare domain in mind

• greenC32 sections represented at Primary Care Provider

– greenC32 used for Content Payload• Builds on existing standards• Provides a format that is easier for developers to use

Questions & Wrap-up

• Questions?

• For more information: – http://wiki.siframework.org/RHEx

• Discussion on the Google Groups forums:– https://groups.google.com/forum/?fromgroups#!forum/restfulhealthexchange

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BACKUPS

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Green Process