Reliable Infrastructures for eHealth

2

Provider and HL7

Perspective

EpidemiologyHistory andIntroductionNHS Insight

HIPAA and Finance

NorwegianPerspective

Medical BusinessProcess Map

EpidemiologyPilot

EpidemiologyPanel

OASIS eHealthTechnical

Committee

Reliable Infrastructures in eHealth

Welcome and Introduction

The reality of a reliable infrastructure for the exchange of healthcare information across the

Internet can only be achieved when, international standards organizations agree to

coordinate efforts and extend foundational standards to the healthcare domain in a way that

is relevant to the entire community.

Workshop Agenda

Module Time

Provider and HL7 Perspective 9:15 – 9:45

NHS Insight 9:45 – 10:15

HIPAA and Finance 10:30 – 11:00

Norwegian Perspective 11:00 – 11:30

Medical Business Process Map 11:30 – 12:00

Applying Standards to the Business Process Map 4:00 – 4:45

Epidemiology History and Introduction 1:00 – 1:15

Epidemiology Panel 1:15 – 3:00

Epidemiology Pilot 3:15 – 4:00

OASIS eHealth Technical Committee 4:45 – 5:00

3 Innovation Process

4

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Norwegian Perspective

Business CentricMethodology TC

SemanticRegistry TC

USAForum 9000

BCM-EPR SCNorway

EPR Forum

Home HealthcarePilot

Semantic ContentMgmt. SC

NorwaySINTEF

OMG

W3C

eGOVNorwayeGOV TC

Informatics Stds.OpenEHR, HL7, etc.

Content AssemblyMechanism TC

METU

CUNY

Motivation Time People

Specifications Schema

Workflow

Contract

Directory S

ervices

Presentation

Artifact relationships

Data/Codes Services/Functions Network Source: BCM Lubash Pyramid

Core Components

Core Components

WSDL

WSDL

XForms

XForms

TransportRouting, Packaging


Collaboration PartnerAgreements- CPA


MSHSOAP

MSHSOAP

MessagesMessages

RolesRoles

Collaboration PartnerProfiles - CPP


NounsNouns

EventsEvents

Digital

Bag

RulesRules

VerbsVerbs

Content Assembly Mechanism - CAM


BP Specification

BP Specification

ProcessProcess

5

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Electronic PRocess for Home Healthcare

Dan PattynChief Technical Officer

Forum 9000Quality Systems for

Quality Care

6

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


• Extending the ebXML Model to eGovernment Service Solutions• e-Healthcare for the Home• e-Government in local communities• e-Building

• Deliverables• Templates and Specifications for eprXML based implementations of semantic interoperability in different• Communities of Interest• Open Implementation Framework• Legacy System Migration and/or Integration

The Electronic PRocess (EPR)Pilots

7

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


EPR Pilot 1: Hjemmebasert Pleie&OmsorgIntegrert tjenesteplanlegging og rapportering.(Oppgavebeskrivelse/Rapportering med PDA-phone. SIM-kort = Digital signatur )

8

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


EPR Pilot 2: Digitalt ByggesakskontorElektronisk samarbeidsarena (Oppgavebeskrivelse/Rapportering/Inspeksjon med PDA-phone. SIM-kort = Digital signatur )

9

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


EPR Uses Workcards as a GUI Metaphor

Participant and ContextBased

Architecture

Participant can be:1. Traditional User2. Machine or Device acting

as a Proxy for a User

Environmental Context dynamically modifies Declarative Display Metaphor

10

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


e-Healthcare Pilot Participants

Business CentricMethodology TC

SemanticRegistry TC

USAForum 9000

BCM-EPR SCNorway

EPR Forum

Home HealthcarePilot

Semantic ContentMgmt. SC

NorwaySINTEF

OMG

W3C

eGOVNorway

eGOV TC

Informatics Stds.OpenEHR, HL7, etc.

Content AssemblyMechanism TC

METU

CUNY

11

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Perspective

Perspective

Tools

The eGovernment Challenge

Experience Enablers MiniaturizationEnvironmental SensingEmbedded IntelligenceAdaptive LearningNetworked Communication

Experience Innovation LeversGranularityExtensibilityLinkageEvolvabilityEventsEvent Context

1. Need Structured Specifications2. Medical EcoSystem Centric3. Collaborative Services Centric4. Dynamic Contextual Information5. Context Control Mechanisms6. Shift from “System” to

“Workspace” Focus7. Occasionally Connected

Workspaces

12

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Medtronic CareLink Patient Co-Creation Experience

Primary Doctor

Medical Specialists

Patients with Similar

Condition

Pacemaker Manufacturer

Emergency Services

Doctor on Call at Out-of-Town

Hospital

Scan and Diagnostics

Clinic

Source: The Future of Competition, Figure 1-1, Page 9

Patient

13

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Vo ca bula r ie s

E v e nts

W orkflow

W ordprocessor

Spreadsheet

Outliner

Da i ly P r o c e d u r e s P e r io d -E n d P r o c e d u r e s F in a n c ia l R e p o r t in g P r o c e d u r e s

Work Order

PrepareSource

DocumentPost

Journals,Ledg ers

PrepareJournalVoucher

Journal Voucher

Post GeneralLedg er

Journal Voucher

O btain AccountBalances for

W orksheet

Worksheet

PrepareTria l

Balance

Trial Balance

Analyze AccountBalances. Prepare

Adjusting Entriesand Adjusted Trial

Balance

Journal VoucherPost General

Ledg er

Journal VoucherAdjustableTrial Bar

PrepareFinancial

Statements

FinancialStatements

O btain Post

C lo sin g Tria lBalance

Post C losing T B

J.V. F ile

Journal VoucherPost General

Ledg er

Journal Voucher

Prepare

C lo singEntries andPost to GL

Tabulations

Artifacts

Exam ples:PowerpointGraphics toolHTML fram es

Models

Co lla bo ra tio nA gre e m e nt ( CPA )

Pattern(s)

Com m unity ofInterest

Do cum e nts

Rule s

Transactions

Exam ples:Graphics toolCASE toolStructure Tool

Exam ples:WordOpen OfficeDocum ent tool

Exam ples:ExcelLotusHTML tables

Collaboration

Cla ss ifi ca tio ns

Vocabularies

Exam ples:RegistryLotus NotesHTML / PortalsGroove

Step 2 :Build Templates with

Familiar Business Tools

Eve n tsR u le s

T ra n sa ctio nT ra n sa ctio n

Sch e maSch e ma

C o n tra ctC o n tra ctA g reem en t P a ttern

W o rk f lo wW o rk f lo wM o d elin g &B u sin ess P a ttern s

re q u e st

p ro ce ss

re q u e st

p ro ce ss

re sp o n se

p ro ce ss

re je ct

a cce p tp ro p o se

co u n te r

E x cha n g eE x cha n g e

S p e cif ica tio nS p e cif ica tio nM o d el & S ch em a s

N o u n s

Ve rb sT ra n sp o rt

R o le sC o n ce p tC o n ce p tR eg istry

Te

mp

la

te

Te

mp

la

te

--dr

iv

en

dr

iv

en

B u s in e s s G o a lsB u s in e s s G o a lsG o a l P a ttern

CAM templateAsse mb ly

C o n te xt

Step 3 :Deploy with DeclarativeComponent Operations

Business Layer

Conceptual Layer

Business Drivers: Model / Process / ConstraintsTarget Constructs & Patterns Target Constructs & Patterns

Implementation Layer

Physical - Message & PresentationPhysical - Message & Presentation

Extension Layer

Contract -Collaboration Partner Specific Constraints

Pu

blish

Baseline Specification per CoIBaseline Specification per CoI

Concepts in OntologyConcepts in Ontology

Business Goals

Frameworks & Standards

Legacy

Authoritative Sources

1

2

3

4

Step 1 :Use Layers to Define

Business Needs

While Referencing the Information Architecture

14

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Motivation Time People

Specifications Schema

Workflow

Contract

Directory S

ervices

Presentation

Artifact relationships

Data/Codes Services/Functions Network

Source: BCM Lubash Pyramid

Core Components

Core Components WSDLWSDL

XFormsXForms





MSHSOAP

MSHSOAP

MessagesMessages

RolesRoles



NounsNouns

EventsEvents

Digital Bag

RulesRules

VerbsVerbs



BP SpecificationBP Specification

ProcessProcess

Semantic Interoperability Standards Stack

15

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Commitment Pattern Template

Contract Patterns - Agreement Patterns - Commitment Patterns

Request Dialysis

Accept Alter

Accept

SendAgentPrimary Care Physician

RecieveAgentDialysis Clinic

Action Event

Information RuleWhat Why

How When

Two Hours from Receipt of RequestResponseByDate

Priority: UrgentPriority

Friday 4 Apr 04 2 pmProvisional Schedule

Dialysis TreatmentTask

Dialysis TreatmentRequest

Priority: Urgent

Friday 4 Apr 04 2 pmAccepted Schedule


Dialysis TreatmentAccept

ActionEvent

InformationRuleWhatWhy

HowWhen

Priority: UrgentProposed New Schedule

Friday 4 Apr 04 2 pmAccepted Schedule


Dialysis TreatmentAlter

16

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Open Implementation Framework Services for Occasionally Connected Applications

Where / Who

Action Event

Information Rule

What Why

How When

Action Event

Information Rule

What Why

How When

Service OrientedOpen Implementation

Framework

(Autonomous Portal Agent) Where / Who

ProcessServices

Collaboration Services

Digital Bag

Metadata Services

Digital Bag

Digital Bag

17

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Social Network Aspects of Digital Bags

Home Dialysis Equipment

ProcessServices


Digital Bag

Metadata Services

Digital Bag

Digital Bag Digital Bag


ProcessServices

Digital Bag

Metadata Services



ProcessServices

Digital Bag

Metadata Services


Social Network

Primary Care Physician Social Worker

18

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


EventsRules

TransactionTransaction

SchemaSchema

ContractContractAgreement Pattern

WorkflowWorkflowModeling & Business Patterns

request

process

request

process

response

process

reject

accept propose

counter

Exchange Exchange

SpecificationSpecificationModel & Schemas

Nouns

VerbsTransport

RolesConceptConceptRegistry

Tem

plat

eTe

mpl

ate --

driv

en

driv

en

Business GoalsBusiness GoalsGoal Pattern

CAM templateCAM template

Context

Business Agreement Languages (RINs)

Choreography & Coordination Lang.

(BPSS)

Business Collaboration Specification

Collaboration Profile Agreement (CPA)

Context Driven Information

Exchanges (CAM)

Semantic Registry

19

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Perspective

Perspective

Tools

The eGovernment Challenge

• Federated Registry Services• Informational and Terminological

Model Integration• e-ID Services• e-Authentication Services• Declarative Access Rights

20

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


eGOV SuperStructure Portal

Digital BagCollaboration Services

ProcessServices

Digital Bag

Metadata Services



ProcessServices

Digital Bag

Metadata Services

Collaboration ServicesCollaboration Services

ProcessServices

Digital Bag

Metadata Services


Digital Bag

eGOVNorwayRegistry

Digital BagDigital Bag


ProcessServices

Digital Bag

Metadata Services


AccessPoint

CredentialServiceProvider

E-Authentication Service hands off Authenticated User

21

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


• Secure Authenticated Delivery and Tracking: • Messaging system, envelope format and payload with exchange source profile controls• PKI Adoption Challenges (from PKI Action Plan)

• Software Applications Don’t Support It• Costs Too High• PKI Poorly Understood• Too Much Focus on Technology, Not Enough On Need• Poor Interoperability

PKI Challenges Source:http://www.oasis-open.org/committees/pki/pkiactionplan.pdf

Issues

22

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


• Integration of BCM Choice Point technology to provide flow control and linking and switching for EPR. • Create BPSS of discrete workflow components – especially intra-enterprise exchanges. • Create BCM contract and CPA templates for EPR participant roles and agreements.

• Look at applicability of CAM templates for formalizing information quality control and context rules.

BCM-EPR Tasks

23

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


OASIS ebXML Business Centric Methodology TChttp://www.oasis-open.org/committees/tc_home.php?wg_abbrev=bcmhttp://www.oasis-open.org/ committees/download.php/5931/BCM%20Executive%20Brochure.pdf http://www.businesscentricmethodology.com

OASIS ebXML Registry Semantic Content SC http://www.oasis-open.org/ committees/sc_home.php?wg_abbrev=regrep-semantic

OASIS Content Assembly Mechanism TChttp://oasis-open.org/committees/cam/

EPR Forumhttp://www.eprForum.org

Additonal Information and Contacts

24

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


OASIS Business Centric Methodology Technical Committee (TC) Chairs: Mike Lubash – [email protected] Mattocks - [email protected]

OASIS Business Centric Methodology EPR Subcommittee (SC) Chairs: Hans A. Aanesen – [email protected] ; eprXML System ArchitectDan Pattyn – [email protected] ; BCM MethodologistDavid Webber – [email protected] ; XML Specialist

OASIS ebXML Registry Semantic Content Management Subcommittee (SC) Chairs: Carl Mattocks - [email protected]

Norway EPR ForumHans A. Aanesen – [email protected]

Additonal Information and Contacts

25

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Perspective

Perspective

Tools

Value Co-Creation via Customer Centric Collaboration

• Customer relationships based on experiences rather than products

• The product is no longer the basis of value

• Real-time customer experiences on-the-fly, shaped by the customer "context" is the value proposition

• Real-time insights required to deliver on-demand customer value and service that's meaningful to individuals within the context of their day and location

26

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Norwegian Perspective

Backup Slides

27

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


1994 Cooperative Clinical Information Systems

1988-1992 Role Interaction Networks (RINs)

2002 Open Source Commodity Portals

1990-1992 Agility Forum

1994 World Wide Web

1999 W3C XML, RDF

Metaprocess ArchitecturalFramework

1996 Foundation for Intelligent Physical Agents (FIPA)

2000-2003 FIPA AgentCities Project1997 SINTEF WORKWARE Interactive Process Modeling

2000 ebXML, Semantic Registry and OASIS Stds.

2003 OASIS Business Centric Methodology (BCM)

2001 IOM Crossing the Chasm Report

28

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Open Implementation Framework Prototype

-Workflow Form Debugger / Stepper- Execution Workflow Tracking and Workflow Resumption after interruption- Reactive ECA Rule Engine integrated with Schedule and Workflow (Sharable Schedules among users who are patients)

Metadata Services

Patients are Users-Plug & Play Web Forms for portable medical records- Plug & Play Workflows, Medical Protocols, Clinical Guidelines- User-Defined Patient Lists and PopulationsCustomizable Workflows- Hierarchical Modeling: Question ItemsFormsWorkflowsComplex Workflows- Automatic Creation of Web Forms Automatic Generation of DBMS Schema Automatic Linking of Code Between Forms and Data- Five Minutes to LearnPreview / Test forms during editing Forms Repository

Care Team Collaboration Services

Digital Bag

Traditional Architecture- Mozilla Web Browser- Apache with SSL Web Server- ZOPE Application Server- PostgreSQL RDBMS- Linux, Windows OS-Skinnable User Interface

Simple-to-U

se Developm

ent Tools ZO

PE Web M

anagement Interface,

DTM

L/SQL/Python

MetaData Engineering Architecture- Meta Meta Model Support- Deployment Metadata for Introspection- Web Browser Metadata Creation Tools- Systematic Method of Metadata Management for Interactive Process Models (SINTEF)- Portable via Simple XML upload / download- Separation of patient identifiers from other data

Pro

cess Services Process Virtual Machine

- jCAM, Blackboard, ruleCore RuleEngine, etc.

29

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


OASIS Business Case

$

Time

Semantic Interoperability Barrier

Structuring Barrier

$

$Data

Exchange Costs

Data Quality Costs

30

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Value Stream Management in a Co-Creation Environment

“Artifacts with Durable Business Value” can be re-sequenced for more value extraction

If Value is created by Context, how much infrastructure investment is needed for definition, capture, and movement of Context

Distributed Context Management with Persistent State Information

Distributed Decision Support based on Environmental Context

Currently need Standards Effort focused on a Collaboration Environment with ebXML business primitives that add value to Service Oriented Architecture (SOA)

31

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Specification Value Stream Management

Current PracticeMonolithic “blob” of linear text in proprietary word processor format - “ignorance wrapper”

Little focus on Business Protocols

Little emphasis on sequence and interactions

Roles and Responsibilities

Exception Handling

Focus on Documents

No common and controlled vocabularies

No fine granularity configuration management

No Structured Documentation

Product Planning by looking in the “Rear View Mirror”

Value BarriersNo common understanding

No packaging of business operational procedures (services)

No accountability based on roles and responsibilities

Artifacts have no Durable Business Value because of the lack of re-composable document fragments

No Reuse

No Reconfiguration

Scaleability Problems

Data Scale Barriers

Structuring Barriers

Integration Barriers

Precludes Automation & Outsourcing

IT / Business Alignment Issues

32

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Cross-Enterprise Service Centric Digitization

Transaction Centric Digitization of Simple Task & Processes

Process Re-Engineering

Process Improvement

Value Co-Creation via Customer Centric Collaboration

Extreme Mobility Infrastructure

Occasionally Connected Application

Wearable Computing

Business Process Evolution

33

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


The Digital Bag- A Universal Nomadic Work Object -

• A Digital Bag is an architectural model for a universal nomadic work object that maintains data, process and work context independently from any one system.

• In technical terms, a Digital Bag is a compound XML document that exists independently from all applications, persistent data stores and processing technologies.

34

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Digital Bag Architectural Model

• directory services information• data in appropriate format and structure for the collective intent of participants

• work flow processes

• work process metadata, which determine what work steps are intended for the current instance of the digital bag, the genealogy of the instance as created, and the recent history of interactions executed between the current digital bag instance and any participant.

35

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Epidemiology and Introduction

36

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Epidemiology and Introduction

Feeling feverish, tired, or achy?

When we think of plagues, we think of AIDS, Ebola, anthrax spores, and, of course, the Black Death. Influenza never makes the list. But in 1918 the Great Flu Epidemic felled the young and healthy virtually overnight. An estimated forty million people died as the pandemic raged. More American soldiers were killed by the 1918 flu than were killed in battle during World War I. And no area of the globe was safe. Eskimos living in remote outposts in the frozen tundra succumbed to the flu in such numbers that entire villages were wiped out. If such a plague returned today, taking a comparable percentage of the U.S. population with it, 1.5 million Americans would die, which is more than the number killed in a single year by heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer's combined.

37

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Ring around the rosies,A pocket full of posies,

Ashes, ashes!We all fall down.

Plague

38

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


-Napoleon lost thousands of his men to typhus in Russia - as did the Russians who caught it from the enemy. Many historians believe that Napoleon would have won were it not for the might of his opponents "General Winter, General Famine and General Typhus."

Interesting Point

39

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


In May 2002, the World Health Assembly passed a resolution, Global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionuclear material that affect health.

http://www.who.int/csr/delibepidemics/en/http://www.who.int/emc/pdfs/WHA55.16.pdf

Deliberate Epidemics

40

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


According to the February 6, 2004 Taipei Times

Not stated in the WHO recommendations and demands is the economic consequences of a major outbreak of an infectious disease. It is estimated that economic losses suffered in the SARS outbreak of 2002/2003 was in the tens of billions of dollars. In the case of the Avian Flu, Thailand alone shuttered its poultry industry (estimated to be worth $1 billion per year)

Economic Consequences

41

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


World Health Organization

Perspective

Tools

EB 107.R13

The WHO:

3. Demands Member States report cases promptly and transparently and to provide requested information to WHO;

4. Calls upon Member States to enhance collaboration with WHO and other international and regional organizations in order to support epidemiological and laboratory surveillance systems, and to foster effective and rapid responses to contain the disease;

6. Requests Member States to exchange information and experience on epidemics and the prevention and control of emerging and re-emerging infectious diseases in a timely manner, including among countries sharing land borders.

World Health OrganizationEB107.R13Global health security: epidemic

alert and response

42

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


WHO Communicable Disease Surveillance & Response (CSR)

43

Provider and HL7

Perspective


HIPAA and Finance



EpidemiologyPilot

EpidemiologyPanel


Committee


Thank You and Conclusions

Reliable Infrastructures for eHealth

Documents

Transcript of Reliable Infrastructures for eHealth