Open Source Programmers Collaborate To Improve the CONNECT Gateway

Health Information Exchange

A Health Information Exchange (HIE) is a network of healthcare information systems electronically connected across organizations within a region or a community using a common communication protocol for the transparent exchange of health information.  HIEs provide the capability to move clinical information among disparate health care information systems while maintaining the meaning and context of the data being exchanged.  The goal of an HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.  HIEs are also useful for public health authorities to assist in analysis of the health of a population.  Federal Health Architecture is intended to deliver free, scalable solution to help organizations to tie health information systems into the NHIN.  Thus far the project has yielded at least one success (outside of the federal government) where data have been successfully transferred between a civilian hospital and the VA.

In February 2009, the CONNECT software gateway was used for the first time in a limited production environment when the SSA began receiving live patient data from MedVirginia through the NHIN.  The agencies built CONNECT using open source components, made it available under an open source license in order to encourage innovation and ease the cost of adoption.

Key issues with testing and/or implementing CONNECT include:
•    Too many manual steps where human typing errors can occur (setting environmental variables incorrectly, typos, setting incorrect directories, etc);
•    Having to manually edit scripts and different files to update with IP address, add XML pieces, etc;
•    Once Gateway is set-up, no way to communicate to another Gateway unless you set-up another Gateway;
•    Log files are confusing; and
•    Need better out of box experience.

The license found at the Connect websites allows the user many rights (including the right to withhold developments done privately from the project as a whole).  Many open source libraries require the community to give back new features/ source code to the project.  Guidance and documentation on how to connect into the NHIN framework is available at http://www.connectopensource.org/display/NHINR21/Guidance+on+Joining+the+NHIN+Using+the+CONNECT+Gateway.  The interface schema for the Connect gateway is available at http://www.connectopensource.org/download/attachments/14450700/CONNECT_+Release_2_1_Integrated_Interface_Description_Document_070709.pdf?version=1.  Currently the software can be compiled and run in a MSFT Windows environment, however, organizations including the open source community and Red Hat are working on a *nix version what will allow the distribution of a VMware image for easy testing and review by organizations that are potentially interested in using the software for resolving internal communication issues in large health systems and also to connect to the NHIN.  The software is available for download at http://www.connectopensource.org/display/NHINR21/Release+2.1+Home.
The success of NHIN thus far was made possible by the Federal Health Architecture and open source software.  The Federal Health Architecture (“FHA”) is an E-Government Line business initiative.  The FHA made software, called CONNECT and supporting documentation available at www.connectopensource.org, available to help health information technology systems communicate to the Nationwide Health Information Network (NHIN), a federal initiative to facilitate the electronic exchange of health information.

The NHIN seeks to achieve these goals by:
•    Developing capabilities for standards-based, secure data exchange nationwide;
•    Improving the coordination of care information among hospitals, laboratories, physicians offices, pharmacies, and other providers;
•    Ensuring appropriate information is available at the time and place of care;
•    Ensuring that consumers’ health information is secure and confidential;
•    Giving consumers new capabilities for managing and controlling their personal health records as well as providing access to their health information from electronic health records (EHRs) and other sources; and
•    Reducing risks from medical errors and supporting the delivery of appropriate, evidence-based medical care.

The FHA is responsible for:
•    Leveraging federal expertise by creating a federal health information sharing environment;
•    Supporting federal efforts to develop and adopt health IT standards and services; and
•    Ensuring that federal agencies can seamlessly exchange health data among themselves, with state, local and tribal governments, and with private-sector healthcare organizations.

Organizations are now emerging at the community, state and federal level to detail/ create the necessary protocols that will allow health information exchange efforts to succeed.  These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.  The NHIN is a commercial/government effort working to build an electronic infrastructure to allow data to move among different organizations and applications.

To promote a more effective marketplace, greater competition, and increased choice through accessibility to accurate information on healthcare costs, quality, and outcomes, the Office of the National Coordinator (ONC) is advancing the NHIN as a “network of networks” which will connect diverse entities that need to exchange health information, such as state and regional health information exchanges (HIEs), integrated delivery systems, health plans that provide care, personally controlled health records, Federal agencies, and other networks as well as the systems.

From the press release Federal Health Architecture Delivers Free, Scalable Solution Helping Organizations Tie Health IT Systems into the NHIN (dated April 2009)(http://www.connectopensource.org/display/Gateway/2009/04).

“The CONNECT software is the outcome of a 2008 decision by more than 20  federal agencies to connect their health IT systems to the NHIN.  Rather than  individually building software required to make this possible, the federal  agencies, through the Federal Health Architecture, created CONNECT. This shared  software solution can be used by each agency within its own environment. CONNECT  implements the core services defined by the NHIN including standards for  security to protect health information when it is exchanged with other trusted  health organizations.”