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

Before the advent of InterSystems HealthShare, most health information networks 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 networks have employed “packaged solutions” that lacked the flexibility, extensibility, and support for the variety of standards and deployment architectures that regional health information exchanges require.

Health information networks everywhere, including regional health information organizations (RHIOs) in the U.S., the United Kingdom’s Connecting for Health, and national efforts in other countries, 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 networks 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 Initiate’s Identity Hub and Quadramed’s EMPI – the two leading probabilistic matching engines in the industry.
  • Exchange: The HealthShare Exchange service manages dynamic bi-directional data flow. It extracts, transforms, exchanges, and aggregates clinical data being shared by the health information exchange. This service is an implementation of the Markel Foundation RLS (record locator service), which has been adopted by the Connecting for Health Common Framework. It is based on HL7 v3, Web services, XML, and CDA.
  • Terminology: HealthShare supports all the major encoding standards such as LOINC, SNOMED, ICD 9/10, as well as optionally supporting on-the-fly mapping between these different standards.
  • 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: Although the goal is to have existing clinical applications front-end the EHR, this may not be possible at the outset. HealthShare therefore includes a fully integrated, sophisticated, browser-based and patient-centric clinical data viewer as part of the platform.

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