Nearly everyone involved with Health and Human Services (HHS) agencies believes that better information leads to better care. There is also the recognition that this information has become dispersed and fragmented over time. Legislative shifts, different funding sources and increased demand has led to proliferation of information systems supporting delivery of HHS programs. This paper proposes a model for information sharing across this systems portfolio, such that the mission of providing better care may still be achieved.

The model manifests as an information exchange, the resources wherein can be securely accessed by a variety of stakeholders. The model comprises of the following patterns – Identity Resolution, Composite Customer View, and Authorization and Consent – bound together in a Service Oriented Architecture (SOA). Various methods of integrating the composite customer view into business processes are also discussed. The entire model pivots on the central principle of person-centric care, wherein information is brought together from multiple systems and channels of service to holistically fulfill the client’s needs.

To assemble information about a customer from multiple sources, first an identity must be established for the customer that spans these sources. The model uses a Master Client
Index (MCI) for this purpose, which includes various demographic and other attributes of the customer that define his identity. The MCI is built from the various source systems, and is in effect an index of indices.

When a user requests customer information on the exchange, the request goes through the MCI for identity resolution. Once a customer’s identity has been resolved, the system can then make federated callouts to multiple source systems to obtain relevant data. This data is then assembled by subject area, and presented to the user, as per the Composite Customer View pattern described in this paper.

This information sharing model would not be executable in the absence of an Authorization and Consent pattern. While information sharing across the agency is essential for personcentric care, such sharing must respect the relevant policy and statutory controls. These controls come from multiple sources – HIPAA, 42 CFR Part 2, WIC 827 (CA Child Welfare), WIC 5328 (Ca Mental Health), State Penal Code, Title 17 CCR (Public Heath), etc. This labyrinth of regulations can be an insurmountable barrier to effective information sharing. This paper describes a robust, fine grained and flexible access control model that enables the agency to maintain compliance, without impeding the authorized flows of information across the enterprise.

The model described in this paper was formed and implemented at the County of San Diego, as part of the Connect Well San Diego project, itself a part of the Live Well San Diego program. Variants have been implemented at the counties of Los Angeles and Sonoma, and the Ministry of Social Development in New Zealand. 

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