Introduction to the Interoperability Reference Architecture

HealthBaseenterprise architecture Introduction to the Interoperability Reference Architecture November 2011

HealthBaseenterprise architecture About us• Dr David Hay – Chair, HL7 New Zealand• Alastair Kenworthy – Information Strategy, MoH• Alan Le Maitre – HIQ• Dr Koray Atalag – NIHI

HealthBaseenterprise architecture Agenda• Development of the reference architecture• Content of the reference architecture• Architecture building blocks• HISO public comment process• Further development 3

HealthBaseenterprise architecture Development of the Interoperability Reference Architecture

HealthBaseenterprise architecture Setting the scene • Vision: a patient- focused, integrated healthcare model, based on shared care • Scope: an architecture for inter-system exchange of health information 5

HealthBaseenterprise architecture Our activity• TWG commenced February 2011• Presentation to SAG April 2011 (also June and September)• 1st draft published on hive.org.nz/ May 2011• Standards proposal to HISO June 2011 (also presented March and August)• Presentation to PCIM Group August 2011• Vendor consultations September 2011• Public comment October 2011 6

HealthBaseenterprise architecture Content of the Interoperability Reference Architecture

HealthBaseenterprise architecture Design principles1. Align to national strategy2. Be business needs focussed3. Work with sector4. Use proven standards5. Invest in information6. Adopt services approach7. Develop single content model for exchange 8

HealthBaseenterprise architecture Key componentsWorking Interoperability Components Model Driven Design Use Case Exchange Content Model Extensions text Core Extended Workflow Detailed Clinical Models HIE Fabric Data Service Data Taxonomy Service Using HSSP CDA Template Library Registry - Repository Model Patient Identity Source (Distributed Data Management) Document Registry Document Consumer Provides Data Services CDA Document Document Source Document Repository Provides CDA Document 9

HealthBaseenterprise architecture Health Information Exchange National Services Regional Services Regional Enabling Regional CDR Services Sector Indices Laboratory IS Record Locator NHI, HPI etc.. HIE Adapter Health Information Exchange (HIE) Data Data Data Data Service Service Service Service HIE Adapter HIE Adapter Integrated Family Pharmacy Dispensing Maternity Shared Care Health System System System HIE Adapter GP PMS Hospital PAS Immunization Register Provider Services and Personal Services 10

HealthBaseenterprise architecture Interoperability Reference Architecture Building Blocks

HealthBaseenterprise architecture HISO 10040• HISO 10040 Health Information Exchange• 10040.1 HIE Clinical Data Repository Utility Services – Service based access to shared repositories using IHE XDS• 10040.2 HIE Content Model – Based on Continuity of Care Record (CCR) – Expressed using archetypes (ISO 13606, openEHR) and ISO/IEC 11179 dataset definitions• 10040.3 HIE Structured Documents – HL7 CDA 12

HealthBaseenterprise architecture 10041.1 Utility Services National Services Document Registry Patient Identity Source NHI and HPI Document National Repositories Specialty Regional Document PoC Document Registry Consumer PoC Document Source or Image Orders & Continuity Source Results of Care Regional Gateway Regional Document Repositories Imaging Medicines & Other 13

HealthBase 10041.2 HIE Content Modelenterprise architecture (CCR, DCMs) CORE Model (Based on ASTM Continuity of Care (CCR)) Extensions: ??? Extended Model (e.g. Maternity) (Based on Core Model) Core text Information Core Extension: Extension: Core Static Model Detailed Clinical Model Maternity Palliative (DCM) Care Care Extension: Extended Cancer Extended Detailed Clinical Model Static Model Registry (DCM) Core Meta-Data Extended Meta-Data 14

HealthBaseenterprise architecture Continuity of Care Record 15

HealthBaseenterprise architecture Detailed Clinical Models 16

HealthBase 10041.3 Structured Documentsenterprise architecture (HL7 CDA) Document • Document template has specific set of sections Header Author • Document identified by a templateId Demographics … Body Section Clinical Information Section Clinical Information Section Clinical Information • Entries map reference the Exchange Content Model • Each section has specific contents• Specific characteristics, e.g. context, wholeness, identified by a template Id persistence • Incremental Interoperability• Not workflow • Templates for sections, documents 17

HealthBaseenterprise architecture HISO Public Comment Process

HealthBaseenterprise architecture Public comment• Public comment closed 17 Oct 2011• Review panel held 27 Oct 2011• 14 respondents• 100+ comments• HISO 10040.1: 28 comments, 26 agreed• HISO 10040.2: 46 comments, 14 agreed• HISO 10040.3: 37 comments, 20 agreed 19

HealthBaseenterprise architecture Bouquets and brickbats• ‘In our view, use of XDS is not a good approach to information sharing for the New Zealand environment’• ‘The ISO/IEC 11179 metadata standard may itself be vapourware’• ‘The HISO 10040 standard is based on an inadequate underlying model of clinical medicine’• ‘The current chimerical HIE Content Model offering looks more like a standards soup’ 20

HealthBaseenterprise architecture Bouquets and brickbats• ‘A very readable document, easy to follow – well done to the authors’• ‘We applaud the IT Health Board and HISO for their efforts to create and adopt industry standards for interoperability’ 21

HealthBaseenterprise architecture Comments on 10040.1 (XDS)• What is a Regional CDR in XDS terms?• What is an affinity domain?• How many regions are we talking about and what’s the purpose of repositories at national level?• Shouldn’t this standard for interoperability include eForms?• What place is there for HL7 v2 transport?• Do we use NHI or PAS as the patient identity source?• Where in the world is XDS actually used? 22

HealthBaseenterprise architecture Where in the world is XDS? 23

HealthBaseenterprise architecture Dossier Médical Personnel 24

HealthBaseenterprise architecture Dossier Médical Personnel 25

HealthBaseenterprise architecture PCEHR in Australia• ‘IHE has developed a number of integration profiles which have been adopted internationally to provide services consistent with the Australian PCEHR vision. These profile components are called Cross Enterprise Document Sharing (IHE - XDS)’ [http://ihe-australia.wikispaces.com/PCEHR]• PCEHR Concept of Operations requires repositories to support either XDS or RLUS 26

HealthBase Comments on 10040.2enterprise architecture (HIE Content Model)• What is ‘core health information’?• Which approach to Detailed Clinical Models?• Extension versus specialisation• Suitability of CCR• Importance of the problem list 27

HealthBaseenterprise architecture Content model development• ‘Revision should involve creation of a simple (but not simplistic) continuity of care model that (a) is problem centred, (b) allows representation of problems as they evolve over time, and (c) facilitates clear representation of clinical meta-information (linking hypotheses to observations)’ 28

HealthBaseenterprise architecture Content model development– CCR supports a problem list, – Whether the subject is aware of which may be any length, of the the problem – and if not, why not patient’s current and resolved – can be recorded problems – There’s a link to medications –– A problem may be classified as when a listed problem is an either a condition, diagnosis, indication for certain medication symptom, finding, complaint or – Clinical documents may be functional limitation associated with problems– Problems can be described using – Problems may be recorded as the SNOMED CT and/or in narrative cause of allergies or adverse– Problems have a status of either reactions active, inactive, chronic, – The existence of a problem may intermittent, recurrent, or be flagged as an alert resolved – Orders and results may be linked– Problem episodes are recorded to problems– The problem list can be ranked or – A problem may be an indication filtered by date of onset or order for a procedure of importance, e.g. for a referral – A problem may be a reason for an– The source of problem encounter information may be recorded, including who and when

HealthBaseenterprise architecture Comments on 10040.3 (CDA)• Questions about the value of document orientation• Questions about the HL7 v3 RIM• Salutary lessons related to the NHS• Document lifecycles• Document stewardship and custodianship• How do we manage ‘state’ and workflow?• Virtual / on-demand documents• Document security 30

HealthBaseenterprise architecture Ratification of HISO 10040• HISO 10040 ballot round after public comment• Expected to become interim standard in December 2011• Proof-of-concept work to follow• Becomes full standard once there is a successful implementation 31

HealthBaseenterprise architecture Further development

HealthBaseenterprise architecture Further development 33

HealthBaseenterprise architecture Conclusion• SAG has created an Interoperability Reference Architecture in support of the Health IT Plan• The three essentials – CCR-based content model, CDA structured documents and XDS transport – have been formulated as architecture building blocks• These building blocks have been put through the HISO process towards becoming sector standards• Proof of concept work will be undertaken in support of future regional implementations

HealthBaseenterprise architecture Thank you

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Introduction to the Interoperability Reference Architecture

by Health Informatics New Zealand on Nov 25, 2011

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