Developer's Integration Lab DIL Overview

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Powerful Results. Delivered.
OSEHRA Summit Topic Why Interoperability Is
So Damn Hard Presenter Mario Hyland Senior
Vice President, AEGIS _at_Interopguy
September 5, 2014
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How Important is Patient Safety?
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Introduction

• AEGIS has been supporting Interoperability
  Testing within the HealthIT space with VA/HHS
  (ONC).
• HHS/ONC Nationwide Health Information Exchange
  (NwHIN) (IHE/HL7/OASIS-SAML)
• Healtheway Compliance Testing Body (CTB)
  Certification process for the eHealth Exchange
• OSEHRA Open Source Interoperability Work Group
  with a focus project of the DIL.
• NIST HITECH Award HITTI
• HL7 Conformance Testing Platform

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Challenges facing Standards Adoption

• Definition of Interoperability (lets agree to
  use IEEE).
• Participants and Systems Not Ready for
  Certification or Accreditation
• Dependence on Self-Attestation
• Understanding the Standards and Specifications
• Common (or Consensus based) Interpretation.
• Conformance vs Interoperability
• Syntactic vs Semantic Interoperability
• Interoperability vs Continuous Interoperability

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State of Maturity HealthIT Standards
Topic Open Source Development Objective
Adherence to a Standard can be demonstrated thru
implementation testing
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Why Interoperability is Challenging

• Systems Interoperability Challenges
• Organizational exchange of information
• Interruption thru Implementation
• Common Testing Approach (Happy Path)
• Limited Exception Negative Testing (due to
  dependence on Peer-to-Peer testing)
• Change (yes, there will be change)
• Standards will be put under new intense pressure.
  

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Robustness Principle

• "Be conservative in what you send, be
• liberal in what you accept"
• http//en.wikipedia.org/wiki/Robustness_principle
  
• Conservative Happy Path
• Liberal Negative and Exception Path

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How to Mitigate Interoperability Risk

• We offer a way to Mitigate Interoperability Risk
• Because you will face Interoperability Issues
• Interoperability Strategies
• Standards based Testing (feedback loop)
• Test Early and Test Often
• Infuse Interoperability into the Development
  Cycles thru TDD (Test Driven Development)
• Embrace the goal of Continuous Interoperability
  thru process

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How to Integrate TDD into Agile Process
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Developers Integration Lab

• Developers Integration Lab (DIL)
• Self Service Bi-Direction message based test lab
• Global accessibility 24x7/365 days
• End-to-End Systems Testing
• Beyond Happy Path
• 70 Negative testing
• Cloud Shared Service
• Conformance
• Interoperability

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DIL Architecture
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Standards view thru Statistics

• 2013 - 1,387 Implemented Test Cases
• 522 Conformance Rules applying over 36,000
  checkpoints.
• Over 77,391 Test Case Executions starting in
  April 2013
• By Healtheway's CTB candidate participants and
  vendors.

NwHIN Specification 2010 2011
Patient Discovery 170 177
Query for Documents 178 179
Retrieve Document 26 39
Totals 537 576
1,113 Test Cases for NwHIN specifications
The DIL is Actively Exercising Health IT
Standards.
ONC SI Framework ARRA project
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DIL Statistics

• More than 200 Organizations Registered on the
  DIL to test
• 45 active Healtheway 2014 onboarding candidates
  (through Sept.)

Healtheway 2013 Onboarding Candidates Healtheway 2013 Onboarding Candidates
Product Vendors 8
HIE Participants 34
Federal Agencies 3

• Key Findings
• Neither vendors or participants are ready when
  they started certification testing.
• 2-4 month learning curve to demonstrate
  compliance to baseline specifications and
  required message conformance/interoperability
  expectations.

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DIL Statistics

• The DIL provides objective analysis of health
  information standards implementation and exchange
  problem areas

• DIL execution data record the root cause(s) of
  conformance/interoperability failures
• System/product failures
• Test case definition defect
• Specification lacks sufficient implementation
  guidance

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Industry Approach to Interoperability

• ONC Roadmap to Interoperability (10 Years)
• Patient Privacy (Consent Policy DS4P)
• Unstructured vs Structured Data
• Granularity
• Data Providence
• Leverage Existing HIT Infrastructure
• FDASIA Report (Risk Management)
• Jason Report (API Architecture)

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OSEHRA Interoperability Work Group

• goals
• Publish thought leadership pieces
• Participate in speaking engagements
• Contribute content to the OSEHRA public comment
  platform
• Captures User Experiences and Technical
  Challenges
• Support Rapid Integration of Standards
• Influence technology, public policy, laws and
  regulations
• Develop resources, tools and test labs

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Contact Us -
AEGIS.net, Inc. 2275 Research Boulevard, Suite
500 Rockville, MD 20850 www.aegis.net

• Mario Hyland
• Senior Vice President
• mario.hyland_at_aegis.net
• [phone] x707
• [phone] (c)

DUNS 152858358 CAGE Code 3YHD9
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DIL Statistics

• HIE participant learning curves vary widely. One
  example

Early failures -gt Learning - gt Refinement -gt
Success
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DIL Statistics

• HIE participant learning curves vary widely. BEST
  CASE

2 calendar months from DIL registration to CTB
test case results submission for CCHIT
review/Healtheway CC onboarding approval.
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DIL Statistics

• Once past the system configuration learning
  curve, DIL Test Execution is FAST

12 MINUTES to actually execute the test cases
required for Healtheways 2013 onboarding program.
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DIL Statistics

• Product Vendor learning curve example

• Early failures -gt Learning - gt Refinement -gt
  Success
• Vendors should take more timeand make use of the
  DIL more extensivelythan individual participants.

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State HIE - SUT
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DIL Test Account
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DIL Test Scenario/Case
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State HIE Patient Info (SUT)
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DIL Test Results
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DIL Exception Reporting
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DIL Message Debugging
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DIL Message Analyzer
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DIL Test History
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DIL Role Based Features

• Developers Integration Lab (DIL)
• Test Users / Participants
• Test Case Developers
• Test Rules Engine
• Community Representatives
• Certification / Test Validation
• DIL Administrator

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DIL Test Case Developer
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DIL Test Rules Engine
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DIL Community Rep
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DIL Certification / Validation
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DIL Administration
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