ToC+Deployment+Models

include component="page" wikiName="siframework" page="TOC Header" This is the wiki page to document and discuss the Deployment Models for the TOC initiative.

The deployment models for the TOC Initiative show examples of how organizations might deploy the TOC capabilities created by the TOC Initiative. The following are some of the candidate models that will be developed to help the community. A sample deployment diagram would show how the various systems and their capabilities integrate to implement the user stories using the standards that are selected by the community.

Introduction
The Transition of Care Use Cases focuses primarily on the information which needs to be transmitted between organizations. However, in order to implement a system which supports the S&I Transition of Care Initiative, a fully operational system must be created.

When determining the appropriate deployment model for your organization, there are a number of business and technology decisions which need to be taken into account. The complexity of the solution is highly variable, and must take into account such components as the stakeholders, relevant regulations and policies, the business and infrastructure models of all of the organizations involved. The goal of the Transition of Care Deployment Model is to provide the Community with some guidance on how to start the process of developing the strategic plans for an individual’s deployment model. It must be understood that the guidance provided by this deployment model concentrates on the Transition of Care, and that the requirements of other initiatives, e.g., Query Health and aggregate reporting such as Public Health and Quality Reporting may greatly effect the requirements of the deployment model.

Key Considerations for Participation
The following section is a list of key consideration an organization may want to consider when strategically developing their deployment model. Due to the highly variable nature of organizations, this list is not meant to be exhaustive, but rather provide a spring board for organization to start their analysis.


 * **Stakeholders:** The deployment of a transition of care scenario by definition requires multiple organizations with loose ties to share sensitive data. In order for a solution to be successful, the goals and requirements of all of the Stakeholders must be understood.
 * **Business Model:** Just like an individual organization must understand their operational goals and requirements, it is critical that an overall business model be setup for all of the organization supporting the transition of care transactions.
 * **Technology Model**: An individual organization's strategic and operational technology plans may greatly influence the deployment plans.
 * **Cost**: The development and on-going costs of supporting a system capable of sustaining transition of care requirements must be analyzed to ensure that the deployment model selected is affordable.
 * **Resource Allocation**: Plans must include the development and maintenance of resources to maintain, upgrade and communicate information to participants on a regular basis.
 * **Trust**: Every organization has its own individual philosophy and requirements for ensuring the privacy and security of their clients’ data. In order for one organization to share its data with another, both sending and receiving organizations must ensure that there is an acceptable level of trust between the organizations.
 * **Network Security:** Each organization has a strategic plan for providing network security.
 * **Meaningful Use Rules:** Meaningful use requires that a security risk analysis be conducted (or reviewed) in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process
 * **Regulations and Policies**: The analysis of relevant Regulations and Policies may impact the deployment of the system. (See the ToC Architecture Policies and Services for guidance).

Additional Key Considerations for Participation in HIE
Heath Information Exchange (HIE) Systems may have additional considerations that need to be considered. Some of these may include:
 * **Technology Model**: In the case of an HIE, the model may also need to take into account items such as the use of centralized versus distributed repositories to store patient data..
 * **Trust**: HIE participation will require that each organization in a shared "trust fabric" establish mutual agreements either with one another or through third parties.
 * **Network Security**: Each organization has a strategic plan for providing network security. As part of an HIE, the overall network security requirements must be analyzed.
 * **Red Flag Rules**: As part of an HIE, policies and procedures for handling breach of information must be developed, just as they need to be developed for other Business Associates. (HIE-specific)
 * **Operational Impacts**: The introduction of a Healthcare Information Exchange system may impact how Providers access healthcare data. Analysis and training may be necessary to ensure that data is handled appropriately at all times, and that Providers have the access to data that they require.
 * **Testing and Conformance**: There are certain HIEs that may require EHR certified software. (Both)

Deployment Models
The deployment model table below is an example of how organizations might deploy the TOC capabilities created by the TOC Initiative.



Table Definitions

 * **Part of Healthcare Network:** The provider uses a system that is integrated with a network of providers as with hospitals, multiple-provider outpatient providers clinics, etc. This network has a connection to providers outside this network through an HIE or some other connection to other providers.
 * **Not Part of Healthcare Network:** The provider has their own direct connection to an HIE or some other network connection to other providers.

**Reference Materials**
 * **Reference Material** || **Description** || **Date** || **Owner** ||
 * [|TOC Deployment Table] || Draft deployment model || 09-22-2011 || Tom Caruso, Mayuri Patel ||
 * [|ReceiveLabResultsWithDirect - Atlanta - MEDfx-1.pptx] || HIE Deployment and Lab Result Workflow || 09-22-2011 || Mark Bamberg ||

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