The Requirements of
Health Information Exchanges –
and How HealthShare Addresses Them

Before the advent of InterSystems HealthShare, most health information exchanges were custom-built, one-off solutions that started with raw technology such as a database, integration engine, application server, enterprise master patient index (EMPI), clinical viewer, and so on, and involved huge amounts of custom development.

At the other end of the spectrum, some health information exchanges have employed “packaged solutions” that lacked the flexibility, extensibility, and support for the variety of standards and deployment architectures required for real-world health information sharing.

Health information exchanges typically have the following requirements:

• Consent: The system needs to provide a framework to capture the consent declarations of consumers and enforce those declarations across the exchange.
• Patient-centric View: Clinical data extracted from a wide variety of different source systems, in different formats, need to be transformed, exchanged, aggregated and presented in an integrated, patient-centric view, preferably episode-centric, using a common interface.
• Flexible Architecture: Federated, consolidated, and hybrid approaches must be supported, enabling large numbers of small institutions and healthcare providers to share data efficiently, effectively, and reliably.
• SOA and Web Services: The components of the system need to be loosely-coupled services, preferably Web services, allowing for incremental addition of new services as the exchange evolves.
• Dynamic Bi-directional Data Flow: Data must be extracted from and imported into electronic health record applications.
• Clinical DSS: The system must provide support for basic clinician decision support such as reminders, alerts, etc..
• Aggregated Data Analysis: Support for public health purposes such as population based analysis, quality improvement, surveillance, evaluation, etc.

HealthShare is uniquely designed to satisfy the requirements of health information exchanges while dramatically reducing the risks and costs associated with such efforts.

Architecturally, HealthShare enables configuration of a "virtual" electronic health record (EHR) - where all clinical data remains under control of the source systems at each healthcare institution, or using a central repository of patient information, or as a combination of the two.

Functionally, HealthShare provides technology that represents the main components required by any EHR, supporting all standards required for deploying and managing components in a modern service oriented architecture (SOA), and with built-in support for dashboards, events and alerts, and other clinical decision support features. This technology is delivered on a comprehensive integration platform that facilitates rapid customization and enables incremental addition of functionality as the exchange evolves. The comprehensive technology provided by HealthShare includes:

• Consent: HealthShare provides a comprehensive consent management framework that supports system-wide opt-out, data provider opt-out, and data type opt-out (e.g., medications, labs, etc.)
• Identification: Key to providing a reliable patient-centric view of clinical data, HealthShare supports its own native Identity Manager, Initiate’s Identity Hub, and QuadraMed’s EMPI. All three MPI solutions follow industry-standard algorithms and workflows, and support both probabilistic and deterministic patient matching.
• Exchange: The HealthShare Exchange service connects data providing systems to the HIE, and manages bi-directional data flow with those systems.  It provides a framework through which data is exchanged, transformed, consumed, and aggregated for later viewing by a clinician. This service conforms to the architectures prescribed by the IHE (Integrating the Healthcare Enterprise) and CfH (Connecting for Health) organizations, and also implements common data exchange standards such as Web services and ebXML, as well as data content standards such as HL7v2, HL7v3 (including CDA, CCD, and related HITSP-specified formats such as C32), CCR, X12, and NCPDP.
• Terminology: HealthShare includes a framework that facilitates the translation between different standard medical vocabularies, including SNOMED, ICD 9/10, CPT, RxNorm, and LOINC. Through this framework, HIE organizations — as well as the data providing and consuming systems on their network — can define translation map tables which HealthShare will use at run-time to convert between coding systems, where possible. HealthShare’s terminology service may include translation maps that were created natively in HealthShare, or through partner technology offered by either Health Language or Apelon.
• Security: HealthShare encrypts all data at rest using AES and 256-bit keys. It encrypts all data in motion using SSL/TSL, records all accesses to the EMPI and clinical systems in tamper resistant logs, and authenticates users via a variety of standards such as Kerberos.
• Access: With the HealthShare EHR framework in place, any IHE- or HITSP-conformant clinical application may access the data and services that have been exposed by the HIE. HealthShare itself includes a fully integrated, sophisticated, browser-based Clinician Portal as part of the platform, which is particularly useful in projects where existing clinical applications within the HIE don’t yet support the IHE or HITSP integration profiles.

Until now, creating the software infrastructure for health information exchanges has been a complex and time-consuming endeavor. InterSystems HealthShare is an innovative solution that provides a fast path to connected healthcare.