© 2006 Canada Health Infoway Inc. 1 HIMSS Interoperability Showcase February 15, 2006 Dennis Giokas...

1© 2006 Canada Health Infoway Inc.

HIMSS Interoperability Showcase

February 15, 2006

Dennis Giokas

Chief Technology Officer

Canada Health Infoway Inc.

Achieving Interoperability Across Canada

Standards

Outline

2

Introducing Infoway

Key Definitions

Why an Interoperable EHR?

Key Clinical and Business Requirements

Solution Architecture

Integration Challenges

Standards for Interoperability

Standards Collaboration and Projects

Summary

© 2006 Canada Health Infoway Inc.


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.

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.


The EHR is a Key to a Renewed Health System!

EHR solutions provide an opportunity to

• Improve the quality, safety, accessibility and timeliness of care for Canadians

• Support more informed healthcare decision making, research and management

• Improve the efficiency of the healthcare system and reduce costly duplication

• Maximize return on IT investments

• Achieve standards based solution allowing interoperability



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

Different Approaches To Achieving the EHR



Clients/Patients

EHR: How Do We Do This?Sharing Information From Multiple Systems

Pharmacy

Laboratory

DiagnosticHospital Emergency

Homecare

Community Care Center

Clinic Emergency Services

Specialist Clinic

INTEGRATED VIEW


Methods of Sharing EHR Information

The “Big Databasein the Sky”

• All Point-of-Service (POS) systems share same data store

Broadcast to all or a logical subset ofsystems

• Replication of data from one system to all other relevant/participating POS systems

• Every POS system holds same information

The “Big Index inthe Sky”

• EHR Index or locator service that holds links to all POS systems where information resides

• Each POS system interfaces to other systems

Use of a shared referenceinformation source

• POS systems populate it

• POS systems or viewers reference it

• External to the “operational” store


Clients/Patients

Locations of Electronic Clinical Data Today: Number of Systems to Integrate

Pharmacy

Laboratory

DiagnosticHospital Emergency

Homecare

Community Care Center

Clinic Emergency Services

Specialist Clinic

Canada has approximately 40,000 systems

EHR Infostructure

11

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.



Key EHRS Architecture Concepts

EHR SOLUTION (EHRS)

EHR INFOSTRUCTURE (EHRi)

EHR ViewerPoint of Service

ApplicationPoint of Service

Application

EHRSLocator

Longitudinal Record Services

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


HIAL

EHR SOLUTION (EHRS)



Application

Point of Service

Application

AncillaryData &

Services

HealthInformation

DataWarehouse

EHRData &

Services

RegistriesData &

Services


HIAL


Integrating Health Information Systems: Key Challenges

• Protecting Privacy• Governance, accountability & data custodianship• Controlling access• Managing & applying consent directives• Controlling feeds and queries to the data• Trust relationships & contracts

• Existence & availability of data• Discovery capability• Availability in electronic format• Timeliness

• Harmonization• Data structures (format)• Vocabularies (encoding, normalization)• Semantics

• Heterogeneous technology environments

• Number of organizations, connection points & systems

• Costs inherent to integration


EHR Infostructure: Services Drill-DownJURISDICTIONAL INFOSTRUCTURE

Ancillary Data& Services

Registries Data& Services

EHR Data& Services

DataWarehouse

OutbreakManagement

PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging

LaboratoryHealth

Information

ClientRegistry

ProviderRegistry

LocationRegistry

TerminologyRegistry

POINT OF SERVICE

Hospital, LTC,CCC, EPR

PhysicianOffice EMR

EHR Viewer

Physician/Provider

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security MgmtData

Privacy Data Configuration

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health Provider


HIALCommunication Bus

Common Services


EHR Infostructure: Standards Based ConnectivityJURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

OutbreakManagement

PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging

LaboratoryHealth

Information

ClientRegistry

ProviderRegistry

LocationRegistry

TerminologyRegistry

POINT OF SERVICE

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security MgmtData



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 Bus

Common 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 Standards

EHR SCP Standards


JURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

POINT OF SERVICE

Communication Bus

EHR Infostructure: Communication Bus

COMMUNICATION BUS

MESSAGING

TransformationServices

RoutingServices

Encrypt/Decrypt

Services

En/Decoding

Services

ParserServices

SerializationServices

PROTOCOL

App ProtocolServices

Network ProtocolServices





EHR Data& Services

DataWarehouse

POINT OF SERVICE

Security MgmtData


Communication Bus

Common Services

EHR Infostructure: Common Services

COMMON SERVICES

INTEROP

InteroperabilityServices

Search/ResolutionServices

INTEGRATION

Service CatalogueServices

Broker Services

Mapping Services

Queuing Services

CONTEXT

Session MgmtServices

Caching Services

Identity ProtectionServices

Identity MgmtServices

AnonymizationServices

User AuthenticationServices

Consent DirectivesMgmt Services

EncryptionServices

Access ControlServices

Secure AuditingServices

Digital SignatureServices

General SecurityServices

SUBSCRIPTION

Alert/NotificationServices

Pub/SubServices

MANAGEMENT

ManagementServices

ConfigurationServices

GENERAL

AuditingServices

Log MgmtServices

Policy MgmtServices

Exception/ErrorHandling Services

PRIVACY & SECURITY





EHR Data& Services

DataWarehouse

POINT OF SERVICE

BusinessRules

EHRIndex

MessageStructures

NormalizationRules


LONGITUDINAL RECORD SERVICES

DATA

Key MgmtServices

ETLServices

BUSINESS

Data QualityServices

Domain Business Components(Registries, EHR, Domains, User, Context)

EHR IndexServices

OrchestrationServices

NormalizationServices

Business RulesServices

AssemblyServices

DataServices

ReplicationServices

EHR Infostructure: Longitudinal Record Services





EHR Data& Services

DataWarehouse

POINT OF SERVICE

EHR Viewer

Physician/Provider

EHR Infostructure: EHR Viewer

EHR VIEWER

EHRi InteroperabilityServices

EHR ViewerBusiness Objects Components

NormalizationServices

End-userNavigation Services

Business RulesServices

End-userDisplay Services

DataServices

Standards-basedSolutions

StandardizedArchitecture

StandardizedInterfaces

StandardizedData

Structures

StandardizedData

Vocabularies

StandardizedFunctionalBehaviour



Infoway’s role is to set

standards and requirements

for robust, interoperable products and

outcomes

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 replication

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


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

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


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


EHR Infostructure: Standards-based ConnectivityJURISDICTIONAL INFOSTRUCTURE



EHR Data& Services

DataWarehouse

POINT OF SERVICE

EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards

EHR IPEHR IPEHR IPEHR IPEHR IP

HIAL

HIAL

HIAL

HIA

L

HIAL HIAL HIAL HIAL HIAL HIAL

EHR IPEHR IP

EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP

HIA

LH

IAL

HIA

L

Architecture Standards

• EHRS Blueprint

• EHR Use Cases

• EHR Data Model

• EHR Services Model

• EHR Interoperability Profiles

Data & Messaging Standards

• 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 (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)


Summary

Supporting Clinicians• Provider adoption – Approach designed to support use cases across

continuum of care with timely and accurate information for the clinician• Mass customized views of data tailored to provider needs that is authoritative,

reliable, responsive• Semantic harmonization of health information across service delivery points

Healthcare Information Solution Architecture• Interoperability that is cost effective• Common model of integration, secure and private, scalable, extensible,

preserves current investments – an application abstraction layer that provides a common integration view and EHR view across Canada

• Standards – common messages and nomenclatures adopted across Canada• Enables high degree of flexibility in reconfiguration of health services

delivery networks


Website: www.infoway-inforoute.ca

E-mail: [email protected]

Thank you!

© 2006 Canada Health Infoway Inc. 1 HIMSS Interoperability Showcase February 15, 2006 Dennis Giokas...

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