© 2006 Canada Health Infoway Inc. 1 April 26, 2006 Dennis Giokas Chief Technology Officer Canada...

1© 2006 Canada Health Infoway Inc.

April 26, 2006

Dennis Giokas

Chief Technology Officer

Canada Health Infoway Inc.

Standards at Infoway

Overview for HITSP

Outline

2

Introducing Infoway

Key Definitions

Key Clinical and Business Requirements

Solution Architecture

Standards for Interoperability

Standards Landscape

Infoway Standards Collaborative

Standards Projects

Challenges and Lessons Learned


Canada Health Infoway

• MissionTo foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission .

• VisionA high-quality, sustainable and effective Canadian health care system supported by an infostructure that provides residents of Canada and their healthcare providers timely, appropriate and secure access to the right information when and where they enter into the healthcare system. Respect for privacy is fundamental to this vision.

• GoalInfoway’s plan is to have an interoperable electronic health record in place across 50 percent of Canada (by population) by the end of 2009.

Shared Governance Facilitates Collaboration

Canada Health Infoway is an independent not-for-profit organization, whose Members are Canada’s 14 federal, provincial and territorial Deputy Ministers of Health.


Infoway’s Role – Strategic Investor

Infoway focuses on initial investment in a solution & its deployment. Our unique role is in providing strategic leadership.

Funder IntervenerIntervener DeveloperDeveloper

“Invest, advise & monitor”

Invests with Partners Involved in project

planning Monitors progress of

projects and quality of deliverables

Gated funding manages risk

“Work alongside & take over if needed”

“Write code &build modules”

“Fund & ignore”

Strategic Investor

Leadership in setting strategic direction and standards for EHR deployment across Canada

Infoway is Not A Granting Agency A Venture Capital Fund A builder, direct implementer or

holder of proprietary solutions

An active partner, contributing to all aspects of the projects, while establishing a broad knowledge & experience base across Canada

EHRAn Electronic Health Record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health providers and the individual anywhere, anytime in support of high quality care.

This record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographies.



EHR Key Clinical & Business Requirements

• Patient centric, life-long longitudinal record of clinical data

• Support for accurate, complete, timely delivery of information

• Allowing private and secured access to data made available in the EHR

• Focused on clinically relevant data shared beyond organizational boundaries

• Shared across multiple organizations, jurisdictions

• Scalable to allow continuous, extensive growth of clinical information with a ROI

• More POS applications sourcing data to EHR

• More users accessing and using data from EHR

• Towards more physician order entry and decision support

• Interoperable, integrated

• Standards based

7

High Level View of the Solution Architecture

© 2006 Canada Health Infoway Inc.

EHR Infostructure

8

The EHR Infostructure is a collection of common and reusable components in the support of a diverse set of health information management applications. It consists of software solutions to support integration with the EHR, data definitions for the EHR and messaging standards for integration and interoperability.

© 2006 Canada Health Infoway Inc.


Key EHRS Architecture Concepts

EHR SOLUTION (EHRS)

EHR INFOSTRUCTURE (EHRi)

EHR ViewerPoint of Service

Application

Point of Service

Application

EHRSLocator

Longitudinal Record Services

Health Information Access Layer (HIAL)

AncillaryData &

Services

HealthInformation

DataWarehouse

EHRData &

Services

RegistriesData &

Services


EHRSEHRS EHRSEHRS EHRS EHRSEHRS

EHRS In Canada Federated Databases, Peer-to-Peer, Message Based

EHR SOLUTION (EHRS)



Application

Point of Service

Application

AncillaryData &

Services

HealthInformation

DataWarehouse

EHRData &

Services

RegistriesData &

Services



EHR SOLUTION (EHRS)



Application

Point of Service

Application

AncillaryData &

Services

HealthInformation

DataWarehouse

EHRData &

Services

RegistriesData &

Services



Standards-basedSolutions

StandardizedArchitecture

StandardizedInterfaces

StandardizedData

Structures

StandardizedData

Vocabularies

StandardizedFunctionalBehaviour



Standards-based Solutions

Why Standards?

•They facilitate information exchange; are a critical foundation for EHR

•They create opportunity for future cost reduction as vendors and systems converge on pan-Canadian and international standards

•They ease effort required for systems integration

Mandatory Investment Eligibility Requirements

•Compliance to standards (infostructure, architecture)

•Initiatives must comply with existing guidelines or standards adopted by Infoway

•Where standards or guidelines do not exist, projects must support longer-term interoperability and congruence of solutions

Infoway’s role is to set standards and requirements for

robust, interoperable products and

outcomes

Standards


EHR Infostructure: Standards Based Connectivity

JURISDICTIONAL INFOSTRUCTUREAncillary Data

& ServicesRegistries Data

& ServicesEHR Data& Services

DataWarehouse

OutbreakMgmt

PHSReporting

SharedHealth

Record

DrugInformation

DiagnosticImaging

LaboratoryHealth

Information

ClientRegistry

ProviderRegistry

LocationRegistry

TerminologyRegistry

POINT OF SERVICE

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security Mgmt

Privacy Data Configuration


Hospital, LTC,CCC, EPR

PhysicianOffice EMR

EHR Viewer

Physician/Provider

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health

Provider

HIALCommunication BusCommon Services

EHR IPEHR IPEHR IPEHR IPEHR IP

HIAL

HIAL

HIAL

HIA

LH

IAL

HIA

LH

IAL

HIAL HIAL HIAL HIAL HIAL HIAL

EHR IPEHR IP

EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP

EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP StandardsEHR SCP Standards


Principles for Establishing Pan-Canadian EHRS Standards

• Infoway has created Principles for Establishing pan-Canadian EHRS

• Standards to provide guidance in the adoption of standards-based solutions

• 11 Principles – accessible via the Infoway Knowledge Way

• Business-driven

• Adoption of existing standards where ever possible

• HL7 V3 for all new message development

• Establishment of pan-Canadian EHR standards is coordinated via an open, transparent and inclusive Stakeholder Collaboration Process as defined by our stakeholders

• International collaboration and balloting of standards work

• http://knowledge.infoway-inforoute.ca


Canadian Standards Community

Standards Organizations

• Standards DevelopmentOrganizations (SDOs)

• Licensing and Maintenance

• Certification and Conformance

• Approval and Endorsement

• Integrators

• Funders & Investors

Infoway(Infoway Standards

Collaborative)

ProvincialStandardsCouncils

ISO

SCC

PartnershipHL7

Canada

HL 7 Inc. WHOACR/NMEA

CIHI

LEGEND

International

National

Multi-Jurisdictional

Provincial

CAC (ISO TC 215)

CSA Infoway

Mulit-ProvincialCollaboratives



ISO WorkingGroups Special

InterestGroups

TechnicalCommittees

IHE

IHE Canada

IHE North America

Complexity of the Standards Landscape


Infoway Standards Projects

1- Need Identification & Business Definition1- Need Identification & Business Definition

2- Options Analysis & Selection Decision2- Options Analysis & Selection Decision

3- Development & Stable for Use Decision3- Development & Stable for Use Decision

4- Test/Pilot & Approval4- Test/Pilot & Approval

5- Training/Education5- Training/Education

6- Implementation6- Implementation

7- Conformance7- Conformance

8- Maintenance & Support8- Maintenance & Support

Standards Selection Decision Point (e.g. Use existing, adapt, develop)

Stable for Use decision point (optional)

11

22

33

44

55

66

77

88

Final Approval decision point

StandardsCollaborative

ProgramProjects

Note: Process is not linear


Infoway Standards Collaborative

Scope

• Infoway will be home for development, ongoing operations, SDO liaisons, and pan-Canadian collaboration and coordination of standards

• Includes collaboration and coordination functions of HL7 Canada, Partnership, ISO (as shared with Canadian Standards Association), DICOM Liaison

• Scope is standards within Infoway’s mandate for the EHR and eClaims standard (NeCST)

• Type of standards include: Messaging, Vocabulary and Interoperability Profiles


Conformance for pan-Canadian Standards

Definition of Conformance

• Conformance includes the development of pan-Canadian standards business requirements, the conformance testing against these business requirements, and certification.

Scope

• Functional, message level interoperability, privacy and security, usability

• Infoway and the eHealth Collaboratory will share responsibilities for conformance on pan-Canadian Standards

• Infoway (Standards Collaborative) will undertake the development of business requirements, including the development of conformance statements, for the pan-Canadian approved standards;

• The eHealth Collaboratory (Collaboratory) will undertake the building of the conformance testing environment, the development of the testing processes and will undertake the actual conformance testing against the established business requirements.


Infoway Standards Collaborative Functional Model

Group Director

Governance

Standards

Collaboration

Process

Support, Conformance,

Maintenance

Education,

Training, Events

Standards

Development

SDO Secretariat

& Liaison• Complete to approval• Test/pilot• Stds. Maintenance• Implementation support• Conformance/Certification• Change Management• SNOMED• LOINC• Others terminologies• Structural codes for iEHR• OIDs• Artifacts repository

• Training artifacts• Training services• Train-the-trainer• Marketing/Communications• Partnership• HL7 Canada education• IHE Canada education

• HL7 Inc.• IHE• ISO• SNOMED• LOINC• DICOM• HL7 Canada• IHE Canada• CAC/Z295• Distribution and Rights

Management• HISCs

Example – not meant to represent any organizational model

CTO

• Strategy• Development• Investment oversight• Approvals – Investment

deliverables• Compliance (gated

funding)• Benefits Evaluation• Adoption


Standards Collaboration Process (SCP)

• The EHR Standards Steering Committee which leads and approves pan-Canadian EHR information standards within the context of Infoway investment programs

• The EHR Standards Advisory Committee which recommends information standards for approval by the EHR Standards Steering Committee and coordinates and guides the activities of pan-Canadian Standards Groups

• A number of pan-Canadian Standards Groups that guide the standards requirements of individual Infoway programs

• An expert group of resources available to provide cross-program technical and subject matter expertise in standards


Standards Portfolio

Architecture Standards

• EHRS Blueprint

• EHR Use Cases

• EHR Data Model

• EHR Services Model

• EHR Interoperability Profiles

Data & Messaging Standards

• eClaims (Primary Care, Oral, Vision, Chiro/Physio) HL7 v3 (complete)

•Client Registry HL7 v2.4 & HL7 v3 (complete)

• Provider Registry HL7 v3 (in ballot)

•Drug Information Systems HL7 v3 (in ballot)

• Laboratory HL7 v3 (in development)

•Diagnostic Imaging/Teleradiology DICOM, IHE (complete)

• iEHR Clinical Messaging HL7 v3 (in development)

• iEHR Technical Standards (in planning)

• Public Health Standards HL7 v3 (in development)

•Clinical Terminology Strategy (complete)

• Terminology Standards (SNOMED, LOINC, ICD10-CA, CCI)


Standards Projects – Typical Deliverables

•Business Requirements•Use Cases

•Standards Specifications•Messaging schemas•Codesets•IHE Profiles

Imp

leme

ntatio

n Guide

Training, Marketing Materials; White Papers; Project Governance Artifacts (project reports, decision criteria)


Lessons Learned & Key Challenges

• Standards Collaboration Process is a success! • Stable for Use Standards and Selected Standards Strategies in 1 year• Active engagement and collaboration across the country and internationally

• Needed additional decision points along the Standards Life Cycle

• Appropriate level of detail and amount of information to make decisions is different for different committees

• Translating between technical and business “speak”

• Stakeholder and expert overburden

• Being very clear and specific on what decisions and words mean• E.g. select vs adopt vs mandate

• Standards readiness – for test/pilot, for implementation projects

• Policy and EHR implementation issues versus standards issues

• One strategy or one development methodology doesn’t fit all


Website: www.infoway-inforoute.ca

E-mail: [email protected]

Thank you!


Client Registry

Standard Business Functions Key Dates

Messaging: HL7 v2.4 & v3.0

Vocab: HL7 Domain Tables

EIP: Currently Available at:

1. Messaging Package Overview

2. Implementation Guide,

3. V2.4 Conformance Profiles,

4. Client Registry Schemas

http://forums.infoway-inforoute.ca/RC502/CRPCSG/CR-pCSG_Materials/[email protected]@

1. Add Client – to a registry

2. Update Client – to data in a registry

3. Delete Client – to delete a client record added in error to a registry

4. Link Client – linking of two records (both records remain active)

5. Unlink Client – the unlinking of two records in a registry

6. Merge Client – merging of two records

7. Unmerge Client – unmerging of two records

8. Get Client Demographics Query Request – to request demographic data when the client identification is known

9. Get Client Demographics Query Response

10. Query Client – list of clients matching query parameters

11. Query Client Response

International

• HL7 PATC Committee Ballot – passed Sept 2005

• HL7 Membership Ballot – due Jan06

• ISO-TC215 “Subjects of Care” – harmonized

• IHE Integration Profiles (PIX/PDQ) being re-purposed for HL7v3 – approved for 2006 Roadmap

National

• HL7 Canada – Realm localization ballot reconciliation March 2006

• Stable for Use approval by SSC March 2006. SAC Approved as Stable for Use January 2006

All Review cycle documents:

http://forums.infoway-inforoute.ca/RC502/SCP%20Review%20Cycle%20for%20CR/[email protected]@


Provider Registry


Messaging: HL7 v3.0

Vocab: Provider Role Types, HL7 Domain Tables

EIP:

Currently Available at:

1. Messaging Package Overview


3. Provider Registry Schemas

http://forums.infoway-inforoute.ca/RP502/PRPCSGG/PR-pCSG_Materials/[email protected]@

1. Add Provider/Request Confirmation Response

2. Add Provider Notification (Broadcast)3. Revise Provider Notification (Broadcast)4. Revise Provider Request/Confirmation

Response5. Provider Details Query/Provider Detail

Response6. Find Associated Identifiers

Query/Response

International

• HL7 PMTC Membership Ballot – passed Sept 2005

National

• HL7 Canada – Realm localization ballot reconciliation March 2006

• Stable for Use approval by SSC March 2006. SAC Approved as Stable for Use January 2006

All Review cycle documents: http://forums.infoway-inforoute.ca/RP502/SCP%20Review%20Cycle%20for%20PR/[email protected]@


CeRx (Drug)


Messaging: HL7 v3.0

Vocab: Investigating HL7 Domain Tables, CCI, DIN, Encode FM, LOINC, Anatomical Therapeutic Classification, Investigating SNOMED CT, Uniform Codes for Unit of Measure, IETF RFC 1766, Mime Media Types, URLSchema, Active Ingredient Code

EIP:


Sept 2005 Version – 4 zip files –

1. Messaging Overview


3. Schemas

4. Vocabulary

5. Technical & Business artefacts

http://forums.infoway-inforoute.ca/CeRx/CeRx_Discuss/CeRx_Materials/Specs/V01_20050921/[email protected]@

Core Prescribing and Dispensing Functions1. Prescribing2. Dispensing3. Patient Medication Queries4. Prescription Status Management 5. Support (Generic Undo)6. Updates (Notes)7. Clinical Access ControlRelated EHR Data with Drug Domain Significance8. Allergy/Intolerance9. Medical Conditions10. Basic patient Observations11. ImmunizationLeverage Drug Knowledge Bases12. Drug Queries13. ContraindicationsRelated Functions14. ADR15. Professional Service16. Infrastructure

International

• HL7 Pharmacy SIG – Committee Ballot for core CeRx items - Jan 2006

National

• Implementable Specifications Published Dec 2005

• Approval as Stable for Use Spring 2006


Cross Enterprise Document Sharing for Imaging EHR Interoperability Profile (XDS-I)


Interoperability Profile: XDS-I

EIP:


1. XDS-I White Paper Final

2. DI-TR pCSG Use Case Scenarios v4 Final

3. 2 Technical Review artefacts

http://forums.infoway-inforoute.ca/DI/SCP%20Review%20Period%20for%20XDS-I/[email protected]@

XDS-I Interoperability Profile specifies a solution for sharing imaging documents, specifically

Medical Images in DICOM format Medical Images in JPEG format Radiology reports in plain text and PDF format All other DICOM objects

The objective of this interoperability profile is to address the technical challenges of sharing images and reports between operational Picture Archiving and Communications Systems (PACS) and Radiology Information Systems (RIS).

The interoperability profile standardizes the format, transactions and protocols for communcationg imaging information between systems as well as defines the interoperability expectations with client registries.

International

• IHE International Approval August 2005

• IHE Vendor Connectathon – Jan 2006

National

• Implementable Interoperability Profile XDS-I Published Nov 2005

• SCP Review – SSC Approval as Stable for Use March 2006


Laboratory


Messaging: HL7 v3.0

Interoperability Profiles

Vocab: HL7 Domain Tables, LOINC, SNOMED CT, SI Units and others that will be identified as the project progresses

EIP: Blueprint EIPs supported will be identified during the project

Will be Available at:

http://forums.infoway-inforoute.ca/Labs/[email protected]@

For the exchange of lab information between LIS-JLIS-EHR:

Order Requests, Referral of Orders, Redirect of Orders, Revise Orders, Cancel Orders, Order Promises, Order Status, Filler Orders, Unsolicited Results, Query Results, Result Query Response, Result Status

International

• HL7 Balloting Mid 2006-Spring 2007

National

• Implementable Specifications Published Fall 2006

• SCP Review – SSC Approval as Standard Selection Strategy March 2006

• Stable for Use approval of specification – Fall 2006


Public Health Surveillance


Messaging: HL7 v3.0


Vocab: HL7 Domain Tables, SNOMED CT, CCI, ICD10-CA, Free Text, and others that will be identified as the project progresses



Infoway Knowledgeway

http://knowledge.infoway-inforoute.ca/CHIPortal/Home/

58 Transactions in 5 packages: Package 1: Case & Outbreak

Management Package 2: Immunization Management Package 3: Vaccine & Materials

Management Package 4: Alert Management Package 5: Other

International

• HL7 Balloting Mid 2006-Early 2007

National

• Specifications Published December 2006

• Stable for Use approval of specification – Early 2007


iEHR Standards Project


Messaging: HL7 v3.0

Vocab: HL7 Domain Tables, SNOMED CT, CCI, ICD10-CA, Free Text, and others that will be identified as the project progresses



Infoway Knowledgeway

http://knowledge.infoway-inforoute.ca/CHIPortal/Home/

Package 1Encounter HistoryDischarge SummaryPackage 2Clinical Summary Service Delivery LocationPackage 3ObservationsReferral NotesHealth Conditions

International

• HL7 Balloting Mid 2006-March 2006

National

• Implementable Specifications Published Summer 2006

• Stable for Use approval of specification – Fall 2006


Clinical Terminology Integration Project


Messaging: none


Vocab: SNOMED CT, CCI, ICD10-CA, Free Text

EIP:

Information Currently Available at:

http://forums.infoway-inforoute.ca/CTI/[email protected]@

Selected Terminologies for: Diagnosis, State of Diagnosis, Family History,

Genetic Condition, Non-Drug Agent Adverse Reaction. , Non-Drug Offending Agent Type , Non-Drug Offending Agent Description, Severity relating to Non-Drug related Severities of Adverse Reactions, Allergy: Non-medication Allergy , Risk Factor, Exposure, Intervention, Clinical Symptom / Health Problem (Clinical Finding), Physical Assessment Finding, Psychological/Mental Assessment, External Cause, Place of Occurrence, Anatomical Site, Episodicity, Course, Occurrence, Number, Onset, Patient Health Problem

International

National

• SCP Review – SSC Approval as Standard Selection Strategy March 2006

© 2006 Canada Health Infoway Inc. 1 April 26, 2006 Dennis Giokas Chief Technology Officer Canada...

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