NHIN+Specifications+Tutorial

=How do NHIN Specifications Support a Health IT use case?=


 * Generic Patient Clinical Summary Request Through the NHIN**

In this use case a patient presents at an emergency room in Dallas Texas unconscious. A clinician in the emergency room discovers the patient's drivers license, enters their information into the hospital's electronic medical record (EMR) to perform a patient query. The query is performed in the NHIN health information exchange (HIE) in Dallas Texas that the clinician's organization is a member of. There is no match for that patient in Dallas and the HIE routes the query to another NHIN HIE in Northern Virginia based on the patients demographic data. The HIE in Northern VA discovers a match in its Master Patient Index and is able to route documents to the clinician's EMR through the Dallas HIE. The diagram below illustrates the discrete steps of this use case and the four exchanges over the NHIN between the two HIEs.



Clinician's HIE routs patient query to HIE in Northern VA. Prior to this exchange the HIEs have to perform node-to-node authentication, as specified in the Authorization Framework Specification || * Patient Discovery HIE in Northern VA sends Patient Query Response identifying patient match to HIE in Dallas, TX || * Patient Discovery HIE in Dallas, TX routs clinician's query for patients documents to HIE in Northern VA. || * Query for Documents HIE in Northern VA responds to query by sending C32 format Continuity of Care Document (CCD) to HIE in Dallas TX || * Retrieve Documents
 * ~ Exchange ||~ Specifications Used ||
 * Prior to exchanging information over the NHIN all participants must complete all steps in the Certification Use Case || Certification Prerequisites ||
 * ** Exchange 1 **
 * Messaging Platform
 * Authorization Framework ||
 * **Exchange 2**
 * Messaging Platform
 * Authorization Framework ||
 * **Exchange 3**
 * Messaging Platform
 * Authorization Framework ||
 * **Exchange 4**
 * Messaging Platform
 * Authorization Framework ||

 =Certification Use Case= Before two HIEs can exchange information over the NHIN they first must build a NHIN Gateway, have that gateway certified and obtain a digital certificate. Once the gateway is certified a HIE the two HIEs must discover each others web service endpoints in order to exchange information. For more on the certification process please visit [|ONC's Certification Webpage.]



 =NHIN Specifications=
 * ~ Use Case Step ||~ Specifications Used ||
 * HIEs built NHIN Gateways, undergo unit and integration testing and sign a DURSA agreement || All Specifications ||
 * The NHIN Governance Authority Provides Production Digital Certificates ||  ||
 * The HIEs implement the Production Digital Certificates || Messaging Platform ||
 * The two HIEs discover web services endpoints || Web Services Registry ||
 * The HIEs communicate using the NHIN ||  ||

A NHIN Specification is an assemblance of technical standards and specifications that achieves a specific task that is necessary to enable secure health information exchange over the Internet. The Generic Patient Clinical Summary Request Through the NHIN Use Case from this wiki page requires 7 NHIN Specifications. (Web Services Registry, Messaging Platform, Authorization Framework, Access Consent Policies, Patient Discovery, Query for Documents and Retrieve Documents). These NHIN Specifications are described below. The 7 NHIN Specifications in turn reference 29 industry specifications which are described in the spreadsheet attached in the Referenced Specifications Section.
 * Note: Not all of the Specifications are used in this generic use case

Operational Infrastructure Specifications
The Operational Infrastructure Specifications provide runtime systems that support NHIN exchange 
 * ===Web Services Registry===

Web Services Registry Interface Specification enables nodes to discover each other through interactions with the NHIN Web Services Registry, which lists NHIN nodes, the NHIN web services supported by each node, and how to reach those service end points.

Features
 * based on UDDI v3 specification
 * stored meta-data about NHIN gateway services supported by the NHIN participants

[|Link to Production Specification]

Messaging Infrastructure Specifications
Together the Messaging Platform and Authorization Framework specifications form the foundational messaging, security and privacy mechanisms for the communication between NHIN participants over the NW- HIN. 
 * ===Messaging Platform Specification===

This specification defines the base set of messaging standards and web service protocols which must be implemented by each Health Information Organization (HIO) participating as nodes on the NHIN. The purpose of this specification is to define a common messaging platform to be used by all NHIN nodes in order to promote secure information exchange. This Messaging Platform specification is foundational to the NHIN and applies to every message to be exchanged among NHIN nodes.

The Messaging Platform is not a service, nor is it specifically related as part of a transaction to any of the NHIN services. Rather, it describes the common messaging and security protocols which apply to all NHIN messages and information exchange patterns.

Features
 * Provides a set of security and messaging protocols to enable NHIN data exchange over the internet.
 * References standards including WS-I basic profile 2.0 and security profile 1.1

[|Link to Production Specification] 
 * ===Authorization Framework Specification===

Authorization Framework defines the required exchange of information describing the initiator of a request between Health Information Organizations (HIOs) participating as nodes on the NHIN. The purpose of this information exchange is to enable a responding NHIO to evaluate the request based on the information contained in the initiating NHIOs assertions and its own local policies and permissions. This Authorization Framework specification is foundational to the NHIN and applies to every message.

Features
 * Supports the Local Autonomy principle.
 * Defines NHIN specific constructs that must be provided to characterize the requestor (name, roles, purpose of use, assertions, etc)



[|Link to Production Specification]


 * ===Access Consent Policies Specification===

Access Consent Policy (ACP) is an element of an optional SAML statement described in the NHIN Authorization Framework specification. The purpose of this specification is to:
 * 1) Describe the content and format of Access Consent policies covering the electronic exchange of health information between NHIOs, and
 * 2) Describe how Access Consent policies may be exchanged among NHIOs



[|Link to Production Specification]

Discovery and Information Exchange Services
Together the Patient Discovery, Query for Documents and Retrieve Documents Specifications represents the three steps in the typical NHIN Query/Retrieve information exchange pattern. 
 * ===Patient Discovery Specification===

The purpose of the Patient Discovery Specification is to allow one node on the NHIN to query another in order to reciprocally establish patient identity and to determine if a node is a potential source of available information for a specific patient. It represents the first of three steps in the typical NHIN Query/Retrieve information exchange pattern.

Features
 * Based on IHE XCPD transaction. Uses HL7 v3.
 * Directed query based on patient demographic data



[|Link to Production Specification] 
 * ===Query for Documents Specification===

Together with the Retrieve Documents Service Specification, Query for Documents enables the NHIN’s Query/Retrieve information exchange pattern. Query for Documents allows an initiating NHIN node to request a patient-specific list of available documents from a responding node using the Patient ID obtained via a prior Patient Discovery transaction. It represents the second of three steps in the typical NHIN Query/Retrieve information exchange pattern.

Features
 * Based on IHE XCA transaction
 * Requests list of available documents meeting the query parameters for a patient



[|Link to Production Specification] 
 * ===Retrieve Documents Specification===

Together with the Retrieve Documents Service Specification, Query for Documents enables the NHIN’s Query/Retrieve information exchange pattern. Retrieve Documents allows an initiating NHIN node to retrieve specific documents from a responding node using the Document Reference IDs obtained via a prior Query for Documents transaction. It represents the final of the three steps in the typical NHIN Query/Retrieve information exchange pattern

Features
 * Based on IHE XCA transaction
 * Requests to retrieve specific documents presumably identified by a prior Query for documents request.



[|Link to Production Specification]

=Referenced Specifications=

The 7 NHIN specifications that are used in this use case inturn reference 29 industry standards and specifications, inturn those 29 documents reference an additional 18 specifications. The 47 Referenced Specifications are described in this attached spreadsheet.


 * note: this document is still under development**

C32 CCD Document
The C32 CCD is the 'payload' of a NHIN information exchange, it describes all of the patient data that is transmitted via the NHIN. Below is a description of the evolution of the C32 CCD. C32 is the HITSP Construct for Summary Documents which describes the document content summarizing a consumer's medical status for the purpose of information exchange. The content may include administrative (e.g., registration, demographics, insurance, etc.) and clinical (problem list, medication list, allergies, test results, etc) information. This Component defines content in order to promote interoperability between participating systems. C32 was created using the HL7 CCD model as a basis. [|Link to the HITSP Construct Details]
 * **HTSP C32**

The CCD specification is an XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange. CCD is an evolution of ASTM's CCR. [|Link to HL7's CCD Wiki]
 * HL7 Continuity of Care Document (CCD)**

The Continuity of Care Record was a document specification for a summary patient record including core data set of the most relevant administrative, demographic, and clinical information facts about a patient ' s healthcare.[|Link to ASTM's CCR] || ||
 * ASTM Continuity of Care Record (CCR)****

=Glossary=


 * ASTM International || ASTM is an international standards organization that develops and publishes technical standards for a wide range of materials, products, systems, and services || [|ASTM Website] ||
 * CCD ||  ||   ||
 * CDA ||  ||   ||
 * consent directive ||  ||   ||
 * Digital Certificates (Production) || A digital certificate is an electronic document necessary to verify a participant’s identity to an end user and make it possible to encrypt the communication between two hosts. || [|More Information about NHIN Certificates] ||
 * Data Use and Reciprocal Support Agreement (DURSA) || The DURSA is a multi-party agreement, a single agreement that establishes the rules of engagement and obligations to which all NHIN Participants agree and that all NHIN Participants sign as a condition of joining the community. All NHIN Participants must sign the DURSA to exchange health information with each other via the NHIN. || [|Full Text of the DURSA] ||
 * Healthcare Information Technology Standards Panel (HITSP) || HITSP was a cooperative partnership between the public and private sectors. The Panel was formed for the purpose of harmonizing and integrating standards to meet clinical and business needs for sharing information among organizations and systems. || [|HITSP Website] ||
 * Health Level Seven (HL7) || HL7 is an all-volunteer, non-profit organization involved in development of international healthcare standards || [|HL7 Website] ||
 * Master Patient Index (MPI) || A Master Patient Index is an index referencing all patients known to an HIE or organization ||  ||
 * messaging standards ||  ||   ||
 * metadata ||  ||   ||
 * web service protocols ||  ||   ||
 * node ||  ||   ||
 * EMR ||  ||   ||
 * HIE ||  ||   ||
 * Health Information Organization (HIO) ||  ||   ||
 * NHIO ||  ||   ||
 * Nationwide Health Information Network (NHIN_ || The NHIN is a set of standards, services and policies that enable secure health information exchange over the Internet || [|ONC Website] ||
 * NHIN Gateway || An instantiation of NHIN interfaces. Enables HIO to communicate with other NHIN participants. ||  ||
 * NHIN governance authority ||  ||   ||
 * NHIN Specification ||  ||   ||
 * Office of the National Coordinator for Health IT ||  ||   ||
 * Query/Retrieve information exchange pattern ||  ||   ||
 * Query/Retrieve information exchange pattern ||  ||   ||