Mastering Data Management

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Connecting with other HIEs means allowing data to securely flow both ways

Over the past few weeks, we’ve discussed the components you’ll need to build and secure your health information exchange, from registries and repositories to HITSP standards and more. However, if you’re pursuing an HIE, you’re inevitably discussing how to connect your HIE with other exchanges beyond your organization.

Fueled by stimulus money, HIEs are gaining increasing prominence at the state level, and many regions are also beginning to connect data across state borders.

IHE developed the Cross-Community Access Gateway, or XCA, profile to solve this very problem. Via XCA gateways, you can access records from other communities a given patient may have visited. The XCA Gateway comes in two distinct flavors: initiating and responding.

Initiating gateways work in conjunction with the local HIE XDS Registry and other communities’ responding gateways.

For example, a query from a content consumer is initiated against the PIX/PDQ manager to discover Bill Klaver's Global ID (GID). Once the GID is known, the client asks the initiating gateway to retrieve all known shareable content for that GID. The initiating gateway not only queries the local XDS registry but issues a query to all registered responding gateways from other communities.

As part of the results from a responding gateway, a Home Community ID (HCI) is returned. At the client application, the list of available content is displayed. If the user chooses a piece of content from a remote HIE, the initiating gateway uses the HCI ID to retrieve the records from across several community networks.

What if the patient is new to your community but is a more permanent member of another community? Can you discover how that patient is represented at the highest level within that community?

The answer is yes: by using the second cross community, called XCPD, or Cross-Community Patient Discovery, a query can be initiated from your community to another community to discover the patient’s identity in that remote community. In general, XCPD helps discover a patient’s ID in foreign domains.

Together, the XCA/XCPD gateway supports all incoming and outgoing inter-community connection. For example, I reside in Illinois and have most of my medical records there. If, however, I had a minor medical problem while vacationing in Wisconsin, the Wisconsin hospital would use its XCA/XCPD gateway to query the Illinois HIE and determine where I had records.

Data is still secure and protected, as we discussed last week, since HIEs should take measures including secure communications, encrypting data, authentication/authorization and a responsible amount of reporting and auditing.

Beyond connecting with other HIEs, you must also be prepared to connect with the Nationwide Health Information Network (NHIN), the federal health architecture.  NHIN provides the secure, nationwide, interoperable health information infrastructure that aims to connect healthcare data from many different sources.

The Office of the National Coordinator (ONC) promotes NHIN as a “network of networks” in that it is intended to link together regional, state and other exchanges.  Specifically, the Connect Gateway sets the standards for secure data exchange. This spring, NHIN Direct was announced with a goal of enabling interoperability among smaller entities, such as physician practices and laboratories.

Currently, workgroups are collaborating to develop the standards and specifications that will guide NHIN Direct participation. As the workgroups announce their recommendations, stay tuned for the inevitable discussion around whether they go far enough or too far.

Now that I’ve added plenty more things for you to think about in your HIE roadmap, next week I’ll wrap everything into a single process.

This is part of Bill Klaver's series, Building a Health Information Exchange Through International Standards. For other posts in the series, visit the Table of Contents.