METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

RIDE OverviewAsuman Dogac

Middle East Technical UniversityAnkara, Turkey

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

RIDE Partners METU-SRDC, Turkey OFFIS, Germany IFOMIS, Germany EUROREC, EU CNR, Italy NTUA, Greece DERI, Ireland IHE-D, Germany OLE, Belgium

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

RIDE Roadmap

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Goals and Challenges Goal 1: Establishing a Europe-wide Secure

Network to Exchange Medical Summaries (EHR) across Member States European Healthcare Network proposed is the sum of

the intercommunicating Member State Networks Minimum necessary specification is provided to make

the framework as widely adoptable as possible The technologies that can be used to implement such a

network includes: CEN prEN 13606, or IHE Profiles, or HL7 messaging, or, …

All will be detailed as possible alternatives in the RIDE Roadmap specification Version 1

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Authenticate

Local System

Local DataRepository ALocal Data

Repository A

Member State A Locator Service

MEMBER STATE A

Mary Brown

Local Physician

Medical Summary+Digital Signature

Medical Summary Metadata

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

MEMBER STATE B

Dr. Hans

Schmidt

Mary Brown

Health Professional

Registry

Health Professional

Registry

Authenticate

Local System

Request Medical Summary Member State E

Locator Service

Member State D Locator Service

Member State C Locator Service

Member State A Locator Service

Record Reference

ChooseRecord

Local DataRepository ALocal Data

Repository A

Healthcare ProviderRegistry

Member State B Locator Service

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Hospitals, Clinics,etc

Individual Healthcar

e Providers

Regional Health

Organization

Healthcare Professional Registry

Healthcare Provider Registry

Patient Identity Registry

Locator Service

Audit Services

Professional Identity Service

Provider Identity Service

Member State Healthcare Network Interface

Member State Healthcare Network

European Healthcare Network

Member State Healthcare

NetworkMember State

Healthcare Network

Member State Healthcare

NetworkMember State Healthcare Network

European Healthcare Network

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Functionalities of the European Healthcare Network Transmission of complete requested Medical Summary to a

remote clinician at another Member State, Providing authorization services to determine appropriate

clinician access to Medical Summaries, respecting patient’s privacy and patient’s consent,

Providing a technical infrastructure which will support secure communication (authentication of systems, message integrity, message confidentiality) between two healthcare provider systems even when they are located at different Member States,

Providing patient identity matching between Member States,

Providing document (Medical Summary) integrity, attestation for possible legal cases about medical errors,

Providing auditing systems to monitor and audit the medical events and transactions

To provide this Member State Networks need to provide some functionalities

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Member State Data Repositories… Each Member State network has:

One or more Data Repositories which store and provide Medical Summary documents

A Data Repository is nothing but a location or a set of locations storing Medical Summaries

A Data Repository also stores Digital Signature documents of Medical Summaries and also has access control mechanisms based on patient consents

A Health Professional Registry which stores and provides health professional’s identity information

A Healthcare Provider Registry which maintains the identifiers of healthcare providers (clinics, doctor offices, hospitals, etc) and other related information like location of facility, speciality and public certificates

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Member State Network Services…

The Locator Service which indexes all submitted medical summaries and serves to provide locations of medical summaries in the Member State Healthcare Network

Medical summaries are indexed with the patient demographic information and other metadata attributes

Metadata format and terminologies used in the metadata needs to be standardised

The locator service, when receives a document request, after authentication, serves this request by checking its own indices as well as forwarding the request to the Locator Services of the other Member States

However, to improve efficiency and response time, the locator service may mandate the Member States to be checked to be stated in advance

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Member State Network Services… The Locator Service uses a matching algorithm that determines

which records are likely matches This is a challenge for Europe because the work on matching is

highly sensitive to local characteristics of the data set The locator service may additionally provide a subscription

based service where an authorized user can request info when a piece of content is updated

Health Professional Identity Service provides professional identity information as signed security assertions

Healthcare Provider Identity Service serves as an interface to the Healthcare Provider Registry to provide the provider identity information

Each Member State provides an Auditing service which records all the medical and administrative event logs passing through its Locator Service

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

The Architecture also provides the infrastructure for…

Electronic Health Records Electronic Health Records – Images and Signals Documentation of Current Medication Episodic Medical Summary Collaborative Medical Summary Permanent Medical Summary Emergency Dataset Laboratory Results

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Challenges…

Standards for metadata and terminologies How to match patient identifiers Standards for Audit Records Interoperability of Medical Summary content Achieving chain of trust Standards for identifying the clinicians and the

roles of Clinicians Authenticating the Healthcare Providers Standards for patient consent forms Digital signatures for patient consent …

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Semantic Interoperability Semantic interoperability aims to give the machines the

ability to process semantics (Humans already have this ability !)

Semantic interoperability builds on top of the technical interoperability layer

Without technical interoperability, it does not make sense to talk about semantic interoperability layer

For sharing EHRs there are alternative proposals which can be used to achieve technical interoperability

Technical interoperability for the described scenario is not achieved yet!

There is not a single full scale deployed implementation to achieve the mentioned functionality!

And there are gaps in the standards to achieve this!

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Interoperability as Addressed in the RIDE Project

RIDE roadmap is intended to enumerate possible alternatives but will avoid recommending a particular technology direction

The proposed architectures will fully support privacy and security of healthcare data

RIDE will provide proof-of-concept public domain implementations of each possible alternative so that the interested parties can download and use it to get a first hand experience: An architecture based on CEN prEN 13606 proposals will be

available soon A set of IHE Profiles to be demonstrated at WoHIT in session 15 HL7 Web services to be available soon …

Note further that to ensure interoperability there is a need for certifying interface conformance

EHR certification is being addressed in the QREC Project Further interface certification is needed

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

A Proposal for implementing the Proposed Architecture through CEN prEN 13606 EHR Content can be defined through EHRcom Policy content can be defined through CEN prEN

13606-4 EHR content can be made available from a local,

regional or national repository Member State networks can be designed as a (or

a collection of) Communicating Communities Communicating Community Identifier, Enterprise

Identifier and Identification of message by Originator are provided by the Community Registries

Locator Service can be implemented through EHR Related Agent

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

A Web Service based Architecture Local or regional or national repository will

provide the following asynchronous two Web Services: EHR Info Message type Web service

6.1.4.8 Query EHR info message type 6.1.4.2 Provide EHR information message type

EHR Message Type Web Service 6.1.4.9 Request EHR message type 6.1.4.3 Provide EHR message type

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

EHR Related Agent Functionality Given Patient Identifier or Patient Demographics

information it should return The end points of the EHR Info Message and the EHR Message

Web services To provide this functionality, either the EHR Agent

dynamically searches to find such Web services, or, it searches them in the background and provides a registry of previously found Web services

“All message types defined in this standard shall use HL7 message wrapper “

HL7 Web Services Profile details how to implement HL7 Web services

This profile can be used which also handles the security and trust issues

METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Thank you very much for your Attention!