Using Open Source Technologies to Deliver a Healthcare Interoperability Platform that Improves Medical Outcomes and Enables Public Health Surveillance

Nagesh Bashyam (Harris Corporation)
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Background: The Executive Order 13335 [Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator] dated April 27, 2004, established the position of National Health Information Technology Coordinator (Office of the National Coordinator – ONC) to provide leadership towards realizing a nationwide interoperable secure health information technology infrastructure. This vision includes developing a secure health information exchange infrastructure that enables widespread adoption of Electronic Health Records, medical information that follows the consumer, clinician access to authorized electronic patient information, and public health and bioterrorism surveillance. The Nationwide Health Information Network (NHIN) is a set of standards, services and policies that enable secure health information exchange over the Internet. The NHIN standards, services and policies are implemented as a secure open source SOA solution via the federally funded CONNECT project.

Presentation Theme: The presentation would provide the audience with an opportunity to learn about some of the significant challenges identified in developing the open source CONNECT solution such as the choice of technology stack for an open source platform, collaboration between federal and private entities, community involvement and outreach, using open standards for information exchange, security and trust establishment, processes for effective open source development, adoption of the product among the healthcare community and the flexibility required to adapt to a changing healthcare industry.

CONNECT Architecture: The CONNECT product is developed as an open source SOA solution with two primary layers that address the healthcare industry interoperability challenges; An Interoperability or Gateway layer that provides standard business services conforming to the NHIN specifications which enables secure HIPAA compliant information exchange between medical organizations using the Internet. The second layer is called the Adapter layer which provides pluggable interfaces for legacy systems to be integrated into the NHIN as shown in the Figure satisfying the external interface contracts that are exposed by the gateway to the NHIN.

Real World Results: The CONNECT solution is used by Social Security Administration (SSA) to exchange health information with MedVirginia for disability claim determination. The mean case processing time for cases transmitted on the NHIN is 59 days as compared to Virginia DDS state average of 84 days based on the SSA-MedVirginia case study by Sue S.Feldman for E-Health Research. CONNECT is also used in the DOD-VLER phase 1a to enable information exchange between VA, KP and the DOD AHLTA CDR system. In the non-government arena, California based Redwood MedNet and Nebraska based Thayer County Health Services have securely bridged their HIE’s to successfully exchange live patient records containing lab information, medication history and CCD documents in real time to improve patient care and reduce costs. As the CONNECT solution is adopted more widely de-identified patient care information will be transferred to public health organizations for public health and bio-terrorism surveillance.

Conclusion: The above successes demonstrate the impact of a secure open source CONNECT solution that transforms the medical industry. This presentation will provide the audience with an opportunity to understand the open source challenges and successes that were encountered in developing and implementing the CONNECT solution for NHIN, and the future of the CONNECT product in open source community and the healthcare industry.

Nagesh Bashyam

Harris Corporation

Nageshwara Bashyam (Technical, Key Personnel) has 15 years of experience in the design and development of information technology solutions. He is currently the Chief Architect for Harris Healthcare solutions responsible for creating the Harris Healthcare Enterprise Architecture and is also responsible for providing technical guidance to the NHIN CONNECT team as needed. Prior to this, he was the software architect, systems architect, and integration lead for the Field Data Collection Automation (FDCA) project which is a large scale enterprise system consisting of 150,000 mobile devices, 15,000 workstations deployed across the country in 500 locations for the Bureau of Commerce. As part of the development of this system he performed many architecture trade studies to identify the right technology for complex problems such as Directory Services, Content Delivery across the country, Asynchronous Data Delivery, Workflow automation using BPEL, Mobile Applications using GPS, Security scanning tools, Audit solutions, and Identity and Access management solutions. He also provided the security architecture and guidelines to resolve many vulnerabilities to provide a secure infrastructure for the country’s major activity of the decade. He was instrumental is designing and implementing the COOP/Disaster recovery operations for the system. In addition to the technical activities he was the chair of the CCB’s and instituted the change management and software release and promotion processes coordinating across more than 10 organizations on a weekly basis. Prior to the FDCA program, Mr. Bashyam was the technical architect who was instrumental in designing and implementing a Train Control and Planning System for Norfolk Southern that optimized railroad traffic to improve overall efficiency of the freight railroad network. As part of this program, he was key in architecting the infrastructure services for Custom Portals, Messaging, Data Acquisition, Track Database services, Disaster Recovery, software delivery and distribution process. In addition to the infrastructure he was the lead for the Movement Planning team which was the core business team that was transforming the railroad business by providing optimization solutions for railroad operations.

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