Message

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Standards-based Messaging Communications
Barriers, Boundaries, and Solutions in Public
Health
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Agenda

• Why do we need standards-based messaging in
  Public Health?
• Three Approaches to System Integration
• Manual Integration
• Brute Force Integration - Tightly Coupled
• Ideal Integration - Loosely Coupled
• How does standards-based messaging enable ideal
  integration
• Case Study State of Hawaii, Department of
  Epidemiology
• Generation 1 Manual reporting
• Generation 2 Somewhat automated
• Generation 3 Fully automated

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Why do we need standards-based Messaging in
public health?

• Bioterrorism
• Tie systems disparate systems together on
  different platforms
• HIPAA
• Existing systems are built on multiple platforms
  with different messaging capabilities
• Non-technical boundaries also exist trust,
  organizational, geographical
• Additional boundaries security
• Systems, organizational structures, agreements,
  partnerships are ever-changing - Organizations
  cant afford to reinvent the wheel when things
  change
• System integration traditionally used proprietary
  code with little or no reuse.

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Generation 1 Manual Integration

• Characteristics
• Both sides agree on what, how, when, even why
• MANY points of failure
• Changes, both technical and non-technical highly
  effect interface and/or delay communication

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Tightly Coupled Applications

• Characteristics
• Both parties had to agree to format of message,
  protocol for message communication, communication
  methods, security, etc.
• Often required manual efforts to initiate
  integration with little to no error checking,
  message retry
• Systems are often built on multiple platforms
  and languages

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Loosely Coupled Applications

• Characteristics
• Systems are, when possible, self-defining
• As systems are changed or replaced, impacts to
  downstream systems are not affected
• Relies on standards to ensure message flow and
  are compatible

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How does standards-based messaging enable ideal
integration

• Self-defining interfaces
• WSDL
• Message Format agreed upon (mostly) upfront
• HL7 (XML version also helps make it
  self-defining)
• X.12 EDI (HIPAA-approved transaction sets)
• Standard Communication format/protocols
• HTTP(s)
• SOAP
• Secure helps alleviate trust issues
• Use of X.509 digital certificates
• RSA 3DES, Diffie-Hullman encryption

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Case Study Hawaii DOH

• Hawaii Dept. of Epi wanted real-time knowledge of
  infectious or emerging diseases throughout the
  state.
• Hawaiis public health lab contributed a VERY
  small portion of the lab results to Epi.
• 70 of reportable disease results come from 4
  partner labs Diagnostic Labs of Hawaii,
  Clinical Labs of Hawaii, Kaiser labs of Hawaii,
  and Tripler Army Medical labs.
• One lab had strong systems and strong IT
  personnel, other 3 did not.

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Generation 1 No integration

• Characteristics
• paper reports compiled
• Couriered
• Different formats from each lab
• By the time the data arrived and was compiled,
  the data was too old to do any good outside of
  marginal research value
• Too much human involvement, thus error-prone

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Generation 2 Mostly Manual

• Characteristics and Drawbacks
• electronic file created from labs LIS and
  uploaded via manual modem file send.
• Daily transmissions from all three labs were
  received on time an average of 74 of the time. A
  variety of technical problems accounted for
  delayed or missing reports, including such
  mundane problems as accidentally unplugging the
  computer used for transmission.
• On average, missing data were re-transmitted
  within three days, but re-transmission sometimes
  took over a week. Approximately 12 of records
  received were either not reportable findings,
  were negative results, or were otherwise
  incorrect. This required considerable staff time
  for data cleaning and editing.
• Relied on human intervention to filter data to
  provide only positive results of diseases deemed
  by law to be reportable
• No automatic re-transmission
• As people moved in organization or left, they
  had to be retrained
• the electronic reporting yielded more than twice
  as many reports as paper reporting

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Generation 3 Fully automated

• Characteristics and Drawbacks
• real-time transmission
• encryption provides security/privacy
• uses public internet
• requires little human intervention 90
  automated
• Automatically filters out reportable results
•   Not always positives allows for testing
  success of new tests (specifically, flu)
• Further anonymizes HIV/AIDS results to further
  protect patients

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What is eWebIT?

• A suite of products consisting of eLink, eView,
  and eConfirm
• eLink interface engine technology capable of
  embracing both new technologies as well as
  enabling legacy applications
• eView state of the art web screen generator
  that expands the backend integration tools of
  eLink into front-end application
• eConfirm Single sign-on solution that uses a
  non-invasive approach to manage third party
  system access, access audits, and overall user
  desktop management

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Supported Device Connections

• Device connections enable eLink to receive a new
  unit of work, often over a specific communication
  protocol
• TCP/IP
• SNA (LU6.2)
• Directory poll / timer
• IBM MQueue Series, MSMQ
• RS232 / Serial
• Screen scraping (Mainframe, AS/400, UNIX,
  Meditech, TDS, etc)
• Windows / Web browser scraping

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Available Libraries

• Various libraries are accessible from translators
  including
• Data parsing (XML, HL7, X12, Fixed width,
  delimited, binary and proprietary)
• Comparison / Validation / Boolean logic / Routing
• Database access via SQL and stored procedures to
  Oracle, Microsoft SQL, Informix or ODBC
• File and directory access
• Object invocation via COM, Corba and Enterprise
  Java Beans
• Internet protocols such as HTTP(s), FTP and LDAP
• Formatting (EBCDIC, Binary coded)
• Floating point and whole number arithmetic
• Date/time functions
• Operating System specific such as running
  external programs and accessing the Windows
  registry
• Encryption and digital signatures

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eLink Architecture
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Hawaii ECDRS Architecture