RHEx+Charter

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=Challenge= The health information technology (IT) community has identified a need for a world wide web (WWW) based approach to health information exchange. Two of the key drivers for exploring how to apply the RESTful architectural style widely used on the WWW today in the health domain are described in this section.

The [|NwHIN Power Team draft recommendations to the HIT Standards Committee] in September 2011 identified REST as a widely accepted complementary technology to several important health information exchange specifications, and recommended: // “… Developing specification(s) for “secure RESTful transport for healthcare exchange” would provide healthcare organizations assurance that RESTful implementations built in accordance with the specification(s) would be predictable and secured.” // [|[1]] The March 2012 ONC Notice for Proposed Rule Making (NPRM) also mentions the possible inclusion of additional transport standards such as applying REST in Meaningful Use certification criterion.

// "While we would only permit EHR technology to be certified to these two transport standards [SOAP and SMTP], we intend to monitor innovation around transport and would consider including additional transport standards, such as a RESTful implementation, in this certification criterion. The inclusion of additional standards in this certification criterion would permit EHR technology to be certified to added transport standard(s) and could ultimately enable EPs, EHs, and CAHs to meet MU using EHR technology certified with the added transport standard(s)” // [|[2]]  These inputs from the health IT community highlight the need to further explore a RESTful exchange of health information. RESTful services are the dominant design paradigm used on the World Wide Web today, offering a proven and scalable approach, low costs, minimal technical barriers to entry, and support for a vast variety of devices for traditional and mobile web access. As healthcare organizations explore RESTful options for healthcare exchange optimized for these qualities, consensus is likely to evolve for how to employ REST. However without a tested RESTful reference implementation, best practices will almost certainly emerge but may take considerable time with much expense and duplication of effort. =Scope= RESTful Health Exchange (RHEx) is a fiscal year 2012 project to examine how a RESTful approach might be applied to meet identified health information technology (IT) needs. RHEx is not an S&I Framework Initiative, but rather an affiliated project that continues the tradition of federal partner investment to find innovative solutions to their health IT needs and share the results of their investment with the entire health IT community. RHEx is exploring a RESTful approach to identify where strong community consensus exists and where there is controversy or a lack of strong industry direction.

Thus, RHEx is an open source exploratory project to apply proven web technologies to demonstrate a simple, secure, standards-based health information exchange. It is a technical implementation to inform a path forward. RHEx is being developed in FY12 in two phases: =Value Statement= RHEx is intended to demonstrate how web/mobile friendly methods of exchanging information could facilitate: =Target Outcomes= =Expected Deliverables= =Timeline= =Stakeholders=
 * Phase 1: Security approach for a RESTful health information exchange (April – July 2012)
 * Focus on securing web interactions
 * Use web/mobile friendly methods of exchanging identity information and authorizing users via HTTPS
 * Seek community input on satisfactory and complete RESTful security
 * Phase 2: Content approach for a RESTful health information exchange (July – September 2012)
 * Expand pilot to show full benefit of a RESTful interaction and incorporate the content layer
 * Seek community input on a structured approach to granular health data exchange
 * Patients’ ability to access and view health information;
 * Providers’ ability to obtain and exchange health information to support coordinated patient care; and
 * Organizations’ ability to adopt health information technology (IT) solutions that are easy to implement and maintain.
 * 1) An implementation of a RESTful health data exchange that can inform ONC, Federal Partners and the broader health IT community
 * Ability to answer:
 * Does the theory work in practice?
 * What parts of the exchange have strong community consensus?
 * Make recommendations to adopt or profile existing standards
 * Where is there controversy or lack of strong industry direction?
 * Make recommendations for future S&I Framework Initiatives
 * Answers informed by an actual implementation and strong community participation
 * 1) Transparent sharing of project details with community input obtained throughout the processUseful products that could kick start further efforts (see expected deliverables )
 * 1) Draft standards profiles for relevant standards
 * OpenID Connect Profile
 * Constraints to limit choices/optionality
 * Extensions to convey healthcare specific identity information
 * OAuth 2 Profile
 * Constraints to limit choices/optionalit
 * Extensions to enhance security
 * Content Profile
 * Granular format for health data
 * 1) Reference Implementation
 * Open source code that can be used to implement a system that adheres to the RHEx standards profile
 * 1) Test client
 * Open source software package for an independent tool that can validate conformance of a service to RHEx profile of existing specificatio ns
 * Call for Participation (June 2012)
 * Phase I: Security and identifying aspects of RESTful data exchange (April-July 2012)
 * Community comment on phase 1 profiles starting in July
 * Phase II: Granular, more machine consumable services (July-September 2012)
 * Community comment on all profiles (August – September 2012)
 * Project completion (September 2012)

Federal Health Architecture Program Partners
The Federal Health Architecture (FHA) is an E-Government Line of Business initiative managed by the Office of the National Coordinator for Health IT. FHA was formed to coordinate health IT activities among the more than 20 federal agencies that provide health and healthcare services to citizens.

FHA and its federal partners are helping build a federal health information technology environment that is interoperable with private sector systems and supports the President’s plan to enable better point-of-service care, increased efficiency and improved overall health in the U.S. population [|[3.]]

Office of the National Coordinator (ONC)
ONC is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).

ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 [|[4.]]

S&I Framework Community
Standards and Interoperability Framework has a collaborative community of volunteers from the public and private sectors who are focused on providing the tools, services and guidance to facilitate the functional exchange of health information. The S&I Framework uses a set of integrated functions, processes, and tools that enable execution of specific value-creating initiatives [5].

Telemedicine and Advanced Technology Research Group (TATRC)
An office of the headquarters of the US Army Medical Research and Material Command (USAMRMC), a performing medical reconnaissance and special operation to address critical gaps that are underrepresented in DoD medical research programs. TATRC fosters research on health informatics, telemedicine/m-Health, medical training systems, and computational biology, and promotes and manages science and engineering in other key portfolios [|[6.]]

Pilot Participants
All participants involved with RHEx related pilot activities. RHEx pilots are intended to explore a RESTful approach and inform a path forward on a RESTful approach that could become another tool in the Nationwide Health Information Network (NwHIN) portfolio to complement existing tools such as the Exchange and the Direct Project.

HIT Standards Committee
The Health IT Standards Committee (HITSC) is charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information [|[7]].

NwHIN Power Team
Operating as a workgroup under the HITSC, the Nationwide Health Information Network (NwHIN) Power Team provides guidance and feedback to ONC for the development of objective criteria for evaluating the readiness of specifications for adoption as national standards [|[8.]] =Alignment with Meaningful Use= In Vol. 77, No. 45 of the Federal Register released Wednesday, March 7, 2012 on the topic of “Proposed Rules”, (see the [|Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology] [|[9]] ONC issued the following statement on REST in the context of existing accepted protocols of SOAP and SMTP:

// “While we would only permit EHR technology to be certified to these two transport standards, we intend to monitor innovation around transport and would consider including additional transport standards, such as a RESTful implementation, in this certification criterion. The inclusion of additional standards in this certification criterion would permit EHR technology to be certified to added transport standard(s) and could ultimately enable EPs, EHs, and CAHs to meet MU using EHR technology certified with the added transport standard(s).” // =Potential Risks=
 * 1) Managing Expectations as a FY12 Affiliated Project
 * RHEx is a fiscal year 2012 (FY12) project to use an actual implementation to inform a path forward on a RESTful health exchange approach. It is not expected that a full solution will be obtained by the end of FY12.
 * RHEx is not an S&I Framework Initiative; it is an affiliated project. The RHEx project will not follow the full S&I Framework processes but will align with them to the extent practical with the given resources.
 * 1) Alignment with other relevant efforts
 * The RHEx project wishes to leverage existing World Wide Web and health domain standards and align with other related efforts and seeks community participation in identifying and characterizing the relevant relationships.

[1]“HIT Standards Committee NwHIN Power Team Final Recommendations”, September 28, 2011:[[] page 24. Accessed May 16, 2012. [2] “Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology” NPRM, March 7, 2012: [] pages 17-18. Accessed May 16, 2012. [3] "Federal Health Architecture (FHA", July 10, 2010 []. Accessed May 16, 2012. [4] "Office of the National Coordinator", May 21, 2012:[]. Accessed May 24, 2012.  [5] "S&I Framework Introduction and Overview", April 10, 2012: http://wiki.siframework.org/Introduction+and+Overview. Accessed May 24, 2012  [6] "TATRC Telemedicine & Advanced Technology Resource Center," April 9, 2012 []. Accessed May 16, 2012.  [7] "Health IT Standards Committee (A Federal Committee)", May 8, 201 [Accessed|http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__health_it_standards_committee/1271. Accessed May 16, 2012.] [8] "HIT Standards Committee NwHIN Power Team Final Recommendations”, September 28, 2011: [[[] [9]“Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology” NPRM, March 7, 2012: [] pages 17-18. Accessed May 16, 2012.

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