Wednesday, September 28, 2011

Texas Health Information Exchange Interoperation Guidance. A Really Interesting Set of Documents With Some Relevance To OZ!

I was alerted to this press release over the last weekend.

Accenture Completes Assessment for Texas Health Services Authority

September 07, 2011
Accenture Completes Assessment for Texas Health Services Authority
Project to Support Health Information Exchange and Interoperability
 AUSTIN, TX; September 07, 2011 – Accenture (NYSE: ACN) has completed an assessment and plan to support implementation and interoperability standards for a state-wide health information exchange (HIE) for the Texas Health Services Authority (THSA).
Accenture identified the technology standards, architecture, and strategy to ensure consistency with state and federal requirements. The strategy will support interoperable health information management and exchange among unaffiliated organizations. Accenture also developed an enterprise architecture blueprint (EAB) for state-level HIE services and a plan to manage the EAB lifecycle to help ensure compatibility as standards evolve.
“Accenture is proud to partner with the Texas Health Services Authority to help realize the statewide Health Information Exchange vision for Texas,” said Rick Ratliff, global connected health managing director, Accenture Health.  “This initiative is a significant step toward improving healthcare quality and enabling an insight driven health system.”
Accenture also produced a technical implementation specification document for local and regional HIEs as a reference guide for healthcare IT implementation.  Additional information on Texas’ HIE Interoperability Guidance is available from the Texas Health Services Authority.
About Texas Health Services Authority
The Texas Health Services Authority (THSA) was created by the Texas Legislature through House Bill 1066 in 2007 as a public private partnership, legally structured as a nonprofit corporation, to support improvement of the Texas health care system by promoting and coordinating health information exchange (HIE) and health information technology throughout the state. The THSA is working under contract with the Texas Health and Human Services Commission (HHSC) to implement HIE strategic and operational plans for the State of Texas.
Here is a the main page from the THSA.

Texas HIE Interoperability Guidance

Wednesday, August 24, 2011
Texas HIE Interoperability Guidance
In order to facilitate statewide Health Information Exchange (HIE), the Texas HIE Strategic and Operational Plan provides that the Texas Health Services Authority (THSA) will develop technology standards, including reference guides and policies, to support vendor neutrality and ensure statewide and federal program interoperability.
The THSA, with input from stakeholders, has developed the following documents to serve as HIE interoperability guidance for organizations supporting HIE in Texas.
· Technical Standards Landscape Review - This document contains information gathered during an assessment of the State of Texas, Federal Government, and industry Healthcare IT landscapes to identify the relevant architecture, interoperability, and security standards being used or proposed to be used to support the secure exchange of health information among unaffiliated and (technically) heterogeneous organizations.  Texas HIEs can use this document as a reference tool to understand the overall technical standards landscape within the U.S.
· Enterprise Architecture Blueprint - This Enterprise Architecture Blueprint (EAB) document describes the architecture vision for the Texas HIE space for the next six years, divided into three two-year increments.  The EAB includes a set of high-level use cases chosen to reflect the Texas HIE vision and desired capabilities for the next two years (years 1-2).  It also includes planning considerations for years 3-4, and very high-level strategic direction for years 5-6.
· EAB Lifecycle Management Plan - This document is based upon information gathered during the development of the EAB and the Technical Standards Landscape Review, and is intended to identify the processes for managing the lifecycle of the enterprise architecture. This includes identifying the appropriate parties to implement change management, such as monitoring and updating as appropriate the standards used to establish interoperability between the local, regional and state level HIEs, as well as the standards utilized for the identified use cases in order to facilitate the continued support of Texas HIE and its connecting organizations.
· Technical Implementation Specifications - This implementation specification document is intended to serve as a technical reference guide for local and regional HIEs to use in implementing their networks.  The intent of the document is to define a high-level solution that HIEs and Health Information Service Providers can implement to meet the desired capabilities of Texas HIE as defined by THSA.  Technical standards have been identified and documented for each functional component defined in this specification.  Standards and profiles are also documented for the messaging and data flows required for communication between components.
----- End Extract
The same site also has some other interesting material - examples are here

Implementing Privacy and Security Standards in Electronic Health Information Exchange

Wednesday, August 24, 2011
The University of Houston Health Law & Policy Institute, under contract with the Texas Health and Human Services Commission, prepared a white paper on Implementing Privacy and Security Standards in Electronic Health Information Exchange.  The white paper discusses privacy and security policies necessary to support secure interoperable health information exchange, including authentication, consent, audit, breach, and patient engagement policies.
and here:

Recommendations for Texas Health Information Trust Agreements

Wednesday, August 24, 2011
The University of Houston Health Law & Policy Institute, under contract with the Texas Health and Human Services Commission, prepared a white paper on Recommendations for Texas Health Information Trust Agreements.  The white paper discusses the use of trust agreements to support exchange of health information and for establishing and ensuring privacy, security, and trust within a health information exchange.
First note that this plan and associated documentation covers a population of over 25 million people and is about establishing a state-wide Health Information Exchange that draws from at least 14 separate more local exchanges
Second note that the program has a implementation plan and approach that encompasses a sensible time frame - with implementation running over six or so years.
Third the Standards that are to be used are already nailed for national and other constituencies so that the rules are pretty clear from the outset and will evolve in a predictable way.
Fourth it seems clear from the documentation that consultation with stakeholders was not an after- thought - rather it was baked in from the start!
In a similar light we had the following interview reported last week:

Working Towards an Integrated System

Interview with GE Healthcare’s Vice President of eHealth Solutions, Blair Butterfield.

GE Healthcare announced to launch its eHealth Information Exchange in Australia this week which is seen will make an impact on eHealth in Australia. As current aspirations and concerns about the development of eHealth in Australia continue to unveil, Blair Butterfield shares his experience working on eHealth projects internationally and how Australia could learn and benefit from this.
Interview conducted by Rebecca Merrett
By far the best part of the interview was this question and answer:
What would be some key learnings that you think could help foster the success of eHealth and information sharing in Australia?
I would say the key learnings that we have shared with those that ask on this topic would be:
  • Define standards early
  • Involve the physicians as much as possible in the process because they are the users and custodians of the data
  • Ensure that privacy and consent issues are managed very well to avoid consumer backlash
  • Start small and build incrementally because there will be several iterations to get to the full implementation
  • Be open to learning from other countries successes and failures
If you do all those things right then I think the chances of success go way up.
----- End Extract.
I leave it as an exercise for the reader to see how close the NEHTA / DoHA team have come to doing things properly. (Hint 1 out of 5 at best is my score). Accenture and Texas are doing a good deal better!


Anonymous said...

I've just been through all the Texas documents. I do have a few questions, but nothing major. The one of particular interest is the Implementation Guidance (

This seems to be exactly what we need in Australia, and have been asking for from the vendor community for some time.

I must be wrong here - but this link ( says that this work took five months to complete. MONTHS...

Dr David More MB PhD FACHI said...

Months is correct. See the documents for the delivery plan. Just highlights what could be done in OZ with some decent focus, governance and leadership!


Anonymous said...

UDDI - Good luck with that...

Anonymous said...

“This initiative is a significant step toward improving healthcare quality and enabling an insight driven health system.”

What can I say...


Anonymous said...

Seriously David, you might have more credibility attacking NEHTA if you did a bit of due diligence on some of the other rubbish you hold up as somehow being aspirational...

The technical implementation specification referenced here would reminds me of The Castle - "Tell them they're dreaming..."

Dr David More MB PhD FACHI said...

Thanks for all the content free comments. If you disagree feel free to do so - but be specific - not just generally and non-usefully vague and unhappy.

To me having a plan up front, even if not perfect, is rather better than the mix of building and then planing we are seeing closer to home.