LAND and SEE Architecture


IMPACT will create a system for information exchange between health care providers within pilot sites that allows groups with EHRs and those without to share information about their patients electronically. Tools to generate, translate, and view the electronic UTF will be integrated with Health Information Exchanges (HIEs) and made available to other states.

The assumptions are that each organization or facility will need to have some mechanism by which they can enter and obtain the information in the electronic UTF, or CCD+. Those groups with existing electronic health records (EHRs) can record most, if not all, required clinical data fields within their EHR and thus will be able to use the LAND (Internet-based “Local” Adaptor for Network Distribution) portion of the IMPACT architecture. LAND will use a thin “Data Courier” application on the EHR’s network to gather CCD (and eventually CCD+) documents from the EHR and securely transport them to the receiving facility.  If the document does not contain all of the CCD+ elements required for the particular transfer, LAND will provide a web portal mechanism to gather the missing data elements. The completed CCD+ is then routed to the receiving facility by the case (discharge) manager using LAND’s portal via a health information exchange or via DIRECT message transmission.

When the CCD+ is sent to a facility that does not have an EHR system, staff from that facility will be able to access the routed CCD+ document from within their “Surrogate EHR Environment” (SEE). SEE will be hosted by a trusted authority and accessed via a web browser. Non-EHR users will be able to use SEE to view, edit, and send CCD+ documents to the next facility via a health information exchange or via DIRECT message transmission. Within the SEE environment, users will also be able to print, securely email, and/or fax copies of the CCD+.

The LAND and SEE architecture is ideally suited to integrate seamlessly into a state’s Health Information Service Provider (HISP) architecture. A HISP typically consists of an anonymous “pipe” which does not have the ability to inspect the message content. There typically are also secure “fixtures” attached to the “pipe” that work with protected health inform.

Advantages of LAND and SEE

  • Most users (particularly physicians and nurses) will only work out of one system
  • Data are re-used whenever possible. Data Courier application may also be able to leverage MDS and OASIS data.
  • No central shared clinical data repository, while retaining the ability to exchange all necessary clinical data
  • Case (or Discharge) Managers can control when and where to route documents since they’re often the only ones that know that information
  • Non-EHR users get same functionality as EHR users
  • Relatively low-cost to deploy and support
  • Easily scalable and replicable

Most role-based authentication uses EHR, using work that local organizations have already done.