It’s pretty much a given at this point in time that every health IT professional knows there are different standards in healthcare like HL7HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... More and different ways to “follow” these standards. That’s been the case for several years and is unlikely to change any time soon. Luckily for most healthcare providers, there is a #1 in KLAS interface engine that can help you overcome interoperability issues with HL7 data.

I’ve always been told that health IT is 5-10 years behind other industries. That’s hard to argue with and we could fill the web with opinions on why this is the case: privacy, security, data standards, data complexity, and the existence of closed/walled healthcare systems are the common culprits.

Thanks to the electronic cattle prod that is Meaningful Use, times are changing.

An IT area currently undergoing tremendous growth is data communication methods, or data transport protocols. Previously, few health IT departments dabbled with the communication methods that were commonplace throughout the rest of the IT landscape until the concept of external health information exchange was included in the HITECH Act.

How, exactly, are we going to electronically send our unique health data to Memorial Hospital down the street?

The answer is using modern protocols like Web Services, and to a lesser extent Direct Project, which Rob Brull has discussed previously on this blog.

Web ServicesWeb services are a standardized way of integrating applications. Using open standards, businesses can communicate without in-depth knowledge of one another’s systems, beyond the communication protocol. Because all communication is XML-based, web se... More is considered the most flexible and modern communication method and is used for both internal and external communication. Its popularity is rising quickly as more and more health IT professionals realize it has several advantages over more traditional methods used in health care. Methods such as:

TCP/IP over a VPN

The most widely used communication method to connect applications in healthcare. When it comes time to connect with partners outside the hospital’s four walls, one choice is to continue using TCP/IPTransmission Control Protocol/Internet Protocol (TCP/IP) is a low-level communications protocol used to connect hosts on the Internet or a network. TCP/IP connections are established between clients and servers via sockets. TCP/IP is stream-oriented ... More and protect that connection with a VPN tunnel.

By continuing using this traditional method, the facility can utilize the same protocol they are familiar with, TCP/IP, and extend it outside the facility in a secure manner. However, VPN connections can be time consuming to set up and costly to maintain.

Web Services is a direct substitute for VPNs. Patient health data can be sent securely, on demand, using Web Services. The HL7 message payload can be parsed and sent/received automatically using Corepoint Integration Engine.

FTP (secure)

File Transfer Protocol (FTP) often involves moving large file batches to and from external systems securely. Utilizing FTP might be useful if your interface cannot connect through a VPN and thus cannot utilize TCP/IP to deliver messages. FTP uploads a message to an FTP server and also enables files on an FTP server to be downloaded at a specified time interval, or by request.

The FTP can transport data securely using encryption settings based on SSLSSL (Secure Sockets Layer) is a cryptologic protocol for securing communications over a network. The successor to SSL is TLS. See also: TLS/TLS (FTPS) or SSH (SFTP). A user must be able to control the FTP server, or coordinate with those in control, to be able to create, delete, overwrite, and rename files and create directories.

Web Services can be used, just as FTP, to transfer large data files. Just as with FTP, the owner of the target server must supply details about how to connect and to deliver the files. In the case of SOAP-based Web Services, a WSDLA WSDL is an XML-based document for locating and describing a web service. WSDLs contain the identifying information and configuration data for a web service. An application developer will produce a WSDL to make it easier to configure the user’s ap... More (Web Services Description Language) would be provided to define the procedures for delivering messages and files to the target server, which is also called a Web Services Producer

Secure e-mail/Direct Project

True, Direct Project is a newer transport method required by Meaningful Use (and also available in Corepoint Integration Engine). It is, however, considered the “minimum threshold” for data exchange. It has many use cases, as do the other methods listed above, but it is not the most interoperable method of communication.

Secure e-mail, or Direct ProjectThe Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. It was initially called NHIN Direct. The object of the Direct Project is to replace the use of faxes, phones, and paper transactions with a simple and... More, can be utilized to send patient health information from application to application. Direct Project also defines a transport method based on Web Services, referred to as the XDRCross-enterprise Document Reliable Interchange (XDR) – What it’s used for: The exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs ... More and XDMCross-enterprise Document Media Interchange (XDM) – What itss used for: According to IHE, XDM transfers documents and metadata using CDs, USB memory or email attachments. This profile supports environments with minimal capabilities in terms of usin... More profiles for Direct Messaging. XDR and XDM profiles are specifically defined by IHEIntegrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. Visit the IHE website. Synonyms: Integrating the Healthcare Enterprise for communicating healthcare data in a push-based fashion.

While secure e-mail uses SMTP transport as the backbone, XDR and XDM profiles are based on Web Services. Both are equivalent methods of pushing healthcare messages from one place to another.

One advantage Web Services (beyond XDR and XDM) has over SMTP is the built-in complexity to handle query-based communications. Query-based communications are common in an emergency department scenario: A patient arrives at the hospital and the physician needs to query the local HIEHealth Information Exchange (HIE) focuses on the mobilization of healthcare information electronically across organizations within a region or community. HIE provides the capability to electronically move clinical information between disparate health... More for all medical information available about the patient. Web Services communications will be necessary to perform these query-based scenarios. 

We'll take a closer look at Web Services in a future post. In the meantime, feel free to read our White Paper, "Web Services in Corepoint Integration Engine."

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