0
Underpinnings of the     Interoperability Reference            Architecture                           (HISO 10040)        ...
The Problem• Patient centred integrated/shared care paradigms  hinge on more interconnectivity• We all know about silos: 1...
State of the world• US: advanced provider-centric systems but little inter-  connectivity (HL7 v2/CDA)• Canada: CHI provid...
State of the nation• Core EHR by 2014 – are we getting there?• National planning, regional implementations• Shared Care an...
The Principles1. Align to national strategy: as per national and regional plans2. Invest in information: use a technology ...
HISO 10040 Building Blocks  10040.1     10040.2   10040.3  R-CDRs        CCR       CDA    XDS     SNOMED CT             op...
What is ECM?• IT IS A REFERENCE LIBRARY - for enabling consistency in HIE  Payload• Superset of all clinical dataset defin...
Creating Payload          ?
ECM Working Principle                                          Exchange Content Model                                     ...
Authoring & HISO process• Initiated & funded by Health Sector Architects Group  (SAG), an advisory group to the NHITB• 4 c...
Archetypes• The way to go for defining clinical content   CIMI (led by S. Huff @ Intermountain & Mayo)   In many nat’l p...
Logical building blocks of EHREHRFoldersCompositionsSectionsEntriesClustersElementsData values
BP Measurement Archetype
Extending ECM• Addition of new concepts• Making existing concepts more specific   – powerful Archetype specialisation mech...
ECM > HIE Payload
Case Study: Medication• Essential to get it right – first in patient safety!• Single definition of Medication will be reus...
Current state & projects• PMS: each vendor own data model• GP2GP: great start for structure• NZePS: started with propriety...
Why bother?       (with a standard structured Medication definition)“If you think about the seemingly simple concept of   ...
Medication timingDose frequency            Examplesevery time period         …every 4 hoursn times per time period   …thre...
Medication timing cont.Time specific                 ExamplesMorning and/or lunch and/or   …take after breakfast andevenin...
Medication timing cont.Event related                ExamplesAfter/Before event           …after meals                     ...
Medication timing – still cont.Treatment duration            ExamplesDate/time to date/time        1-7 January 2005Now and...
Medication timing – even more!Triggers/Outcomes      ExamplesIf condition is true   …if pulse is greater than 80          ...
Modelling Medication Definition• NZePS data model (v1.9) & draft 10043  Connected Care CDA templates• Start from Nehta ePr...
Nehta Medication Model
Results & Outlook• Extended model 100% covering NZePS  (community ePrescribing)• Must consider secondary care• Need to loo...
Value Proposition• Content is ‘clinician’s stuff’ – not techy; yet most existing standards are  meaningless for clinicians...
Thank you – Questions?Empowered by openEHR - Clinicians in the Driver’s Seat!
Underpinnings of the New Zealand Interoperability Reference Architecture
Underpinnings of the New Zealand Interoperability Reference Architecture
Underpinnings of the New Zealand Interoperability Reference Architecture
Underpinnings of the New Zealand Interoperability Reference Architecture
Underpinnings of the New Zealand Interoperability Reference Architecture
Upcoming SlideShare
Loading in...5
×

Underpinnings of the New Zealand Interoperability Reference Architecture

830

Published on

This one I presented at the HINZ conference 7-9 Nov 2012 at Rotorua, New Zealand.

ABSTRACT:
As we are moving into new paradigms of care, sharing of health information becomes crucial. We need new systems and more interconnectivity to support this. The regional approach to eHealth solutions in New Zealand hinges on establishing trusted and interoperable systems. The Interoperability Reference Architecture is a first step towards providing overall principles and standards to reach this goal. A core group from the Sector Architects Group was formed and prepared the first draft of this document. After initial internal feedback it went through wider consultation – including public. Good feedback was received, including international. It then went through formal HISO processes and was approved as a national interim standard. The Reference Architecture comprises three pillars which define: 1) XDS based access to clinical data repositories, 2) a common content model underpinned by CCR and openEHR Archetypes to which all health information exchange should conform, and 3) use of CDA as common currency for payload. A trial implementation is yet to be conducted, however we used the Content Model to align ePrescribing data model with the Australian model in order to validate the methodology. The Reference Architecture will provide an incremental step-by-step implementation approach to interoperability and thus minimise risk.

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
830
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
12
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • These are the three building blocks – or pillars – of the HISO 10040 series that embodies the central ideas of the Reference Architecture for Interoperability10040.1 is about regional CDRs and transport10040.2 is about a content model for information exchange, shaped by the generic information model provided by CCR, with SNOMED as the default terminology, and openEHR archetypes as the chief means of representation10040.3 is about CDA structured documents as the common currency of exchange – not every single transaction type, but the patient information-laden ones
  • Published by HISO (2012); Part of the Reference Architecture for Interoperability“To create a uniform model of health information to be reused by different eHealth Projects involving HIE”Consistent, Extensible, Interoperable and Future-Proof Data
  • Content is ‘clinician’s stuff’ – not techy; yet most existing standards are meaningless for clinicians and vice versa for techiesopenEHR Archetypes are in ‘clinical’ space – easily understood and authored by themArchetypes can be transformed into numerous formats – including CDAArchetypes are ‘maximal datasets’ e.g. They are much more granular than other models when needed. Support more use cases – indeed almost anything to do with EHR (including some workflow). Scope not limited to HIE but whole EHR.One agreed way of expressing clinical concepts – as opposed to multiple ways of doing it with HL7 CDA (CCDA is a good first step though)ECM invest in information fulfilled completely – future proof technology today with ECM for tomorrow’s implementation technology (e.g. FHIR etc., distributed workflows etc.)
  • ... And more
  • ... And more
  • ... And more
  • Objective of this demo is to show the bottom-up content development approach.Certain Archetypes shared by key HIE (eRef, ePrescribing, PREDICT) undergo an iterative localisation processInternational > Multiple Local projects (added & extended) > Added to ECM
  • Transcript of "Underpinnings of the New Zealand Interoperability Reference Architecture"

    1. 1. Underpinnings of the Interoperability Reference Architecture (HISO 10040) Koray Atalag1, Alastair Kenworthy2, David Hay31.NIHI – University of Auckland2.Ministry of Health3.Orion Health
    2. 2. The Problem• Patient centred integrated/shared care paradigms hinge on more interconnectivity• We all know about silos: 1+1 >2 when shared• It’s all about People, processes and technology• Standards crucial – but need an overarching framework – No one size fits all! depends on needs, resources – Myriad of standards, methods etc. – Not so much success so far worldwide • Narrow opportunity window in NZ to enable sector- wide consistency & interoperability (too many projects in-early flight or kicking off)
    3. 3. State of the world• US: advanced provider-centric systems but little inter- connectivity (HL7 v2/CDA)• Canada: CHI providing leadership & standards (v2/v3/CDA)• UK: bootstrapping from CfH disaster, focus on high value/established systems (HL7/13606)• Nordic: well established, (↑13606 / HL7 v2/CDA)• EU: very patchy – HL7/↑13606/openEHR• Asia: patchy -propriety / HL7 / little 13606/openEHR• Brazil/Paraguay: mainly openEHR & HL7 v2/CDA• Australia: Nehta/PCEHR, v2/v3/CDA & openEHR
    4. 4. State of the nation• Core EHR by 2014 – are we getting there?• National planning, regional implementations• Shared Care and PrimarySecondary – Shared care projects: long term conditions, maternity, well child etc. • Clinical Data Repository (CDR) as enabler – GP2GP, Transfer of Care, eMedications – Medicines reconciliation, specialist CIS – Others: NZULM, new NHI/HPI• Good emphasis & support for standards
    5. 5. The Principles1. Align to national strategy: as per national and regional plans2. Invest in information: use a technology agnostic common content model, and use standard terminologies3. Use single content model: information for exchange will be defined and represented in a single consistent way4. Align to business needs: prioritise the Reference Architecture in line with regional and national programmes5. Work with sector: respect the needs of all stakeholders6. Use proven standards: adopt suitable and consistent national and international standards wherever they exist (in preference to inventing new specifications)7. Use a services approach: move the sector from a messaging style of interaction to one based on web services
    6. 6. HISO 10040 Building Blocks 10040.1 10040.2 10040.3 R-CDRs CCR CDA XDS SNOMED CT openEHR Acknowledge Alastair Kenworthy
    7. 7. What is ECM?• IT IS A REFERENCE LIBRARY - for enabling consistency in HIE Payload• Superset of all clinical dataset definitions – normalised using a standard EHR record organisation (aka DCM) – Expressed as reusable and computable models – Archetypes• Top level organisation follows CCR*• Further detail provided by: – Existing relevant sources (CCDA, Nehta, epSoS, HL7 FHIR etc.) – Extensions (of above) and new Archetypes (NZ specific)• Each HIE payload (CDA) will correspond to a subset (and conform)* kind of – CCDA may be more appropriate
    8. 8. Creating Payload ?
    9. 9. ECM Working Principle Exchange Content Model Conforms to Message Payload (CDA) Source System Recipient System Map Map Source to Web Service ECM to ECM Recipient Exchange Data ObjectSource data Recipient data
    10. 10. Authoring & HISO process• Initiated & funded by Health Sector Architects Group (SAG), an advisory group to the NHITB• 4 co-authors – from Interoperability WG• Initial feedback from SAG then publish on HIVE• ABB produced - condensed version of IRA (2011)• Public comment and evaluation panel October 2011• Ballot round February 2012• Interim standard April 2012• Trial implementation with Northern DHBs, 2012/13
    11. 11. Archetypes• The way to go for defining clinical content  CIMI (led by S. Huff @ Intermountain & Mayo)  In many nat’l programmes (eg. Sweden, Slovenia, Australia, Brazil)• Smallest indivisible units of clinical information with clinical context• Brings together building blocks from Reference Model (eg. record organisation, data structures, types)• Puts constraints on them: – Structural constraints (List, table, tree, clusters) – What labels can be used – What data types can be used – What values are allowed for these data types – How many times a data item can exist? – Whether a particular data item is mandatory – Whether a selection is involved from a number of items/values
    12. 12. Logical building blocks of EHREHRFoldersCompositionsSectionsEntriesClustersElementsData values
    13. 13. BP Measurement Archetype
    14. 14. Extending ECM• Addition of new concepts• Making existing concepts more specific – powerful Archetype specialisation mechanism: – Lab result > HbA1C result, Lipid profiles etc. Problem First level specialisation Text or Coded Term Diagnosis Second level specialisation Clinical description Date of onset Coded Term Diabetes Date of resolution + diagnosis No of occurrences Grading + Diagnostic criteria Diagnostic criteria Stage  Fasting > 6.1  GTT 2hr > 11.1  Random > 11.1
    15. 15. ECM > HIE Payload
    16. 16. Case Study: Medication• Essential to get it right – first in patient safety!• Single definition of Medication will be reused in many places, including: – ePrescribing – My List of Medicines – Transfer of care – Health (status & event) summary – Specialist systems – Public Health / Research• Currently no standard def in NZ (coming soon 10043 Connected Care)• NZMT / NZULM & Formulary > bare essentials
    17. 17. Current state & projects• PMS: each vendor own data model• GP2GP: great start for structure• NZePS: started with propriety model, now waiting for standard CDA. – PMS vendors implementing Toolkit based Adapter• Hospitals: some using CSC MedChart• Pharmacies?• Others? Actually we’re not doing too bad 
    18. 18. Why bother? (with a standard structured Medication definition)“If you think about the seemingly simple concept of communicating the timing of a medication, it readily becomes apparent that it is more complex than most expect…”“Most systems can cater for recording ‘1 tablet 3 times a day after meals’, but not many of the rest of the following examples, ...yet these represent the way clinicians need to prescribe for patients...” Dr. Sam Heard
    19. 19. Medication timingDose frequency Examplesevery time period …every 4 hoursn times per time period …three times per dayn per time period …2 per day …6 per weekevery time period range …every 4-6 hours, …2-3 times per dayMaximum interval …not less than every 8 hoursMaximum per time period …to a maximum of 4 times per day Acknowledgement: Sam Heard
    20. 20. Medication timing cont.Time specific ExamplesMorning and/or lunch and/or …take after breakfast andevening lunchSpecific times of day 06:00, 12:00, 20:00Dose durationTime period …via a syringe driver over 4 hours Acknowledgement: Sam Heard
    21. 21. Medication timing cont.Event related ExamplesAfter/Before event …after meals …before lying down …after each loose stool …after each nappy changen time period before/after …3 days before traveleventDuration n time period …on days 5-10 afterbefore/after event menstruation begins Acknowledgement: Sam Heard
    22. 22. Medication timing – still cont.Treatment duration ExamplesDate/time to date/time 1-7 January 2005Now and then repeat after n …start, repeat in 14 daystime period/sn time period/s …for 5 daysn doses …Take every 2 hours for 5 doses Acknowledgement: Sam Heard
    23. 23. Medication timing – even more!Triggers/Outcomes ExamplesIf condition is true …if pulse is greater than 80 …until bleeding stopsStart event …Start 3 days before travelFinish event …Apply daily until day 21 of menstrual cycle Acknowledgement: Sam Heard
    24. 24. Modelling Medication Definition• NZePS data model (v1.9) & draft 10043 Connected Care CDA templates• Start from Nehta ePrescribing model – Analyse models and match data elements – Extend where necessary as per NZ requirements • Add new items or rename existing • Tighter constrains on existing items (e.g. cardinality, code sets, data types)
    25. 25. Nehta Medication Model
    26. 26. Results & Outlook• Extended model 100% covering NZePS (community ePrescribing)• Must consider secondary care• Need to look in more detail: – Consolidated CDA – epSoS (European framework) – Other nat’l programmes• Generate Payload CDA using transforms
    27. 27. Value Proposition• Content is ‘clinician’s stuff’ – not techy; yet most existing standards are meaningless for clinicians and vice versa for techies – Archetypes in ‘clinical’ space – easily understood & authored by them• Single source of truth for entire sector – One agreed way of expressing clinical concepts – as opposed to multiple ways of doing it with HL7 CDA (CCDA is a good first step)• Archetypes can be transformed into numerous formats – including CDA• Archetypes are ‘maximal datasets’ – Much easier to agree on• Scope not limited to HIE but whole EHR; workflow supported• ECM principle invest in information fulfilled completely – future proof content today for tomorrow’s implementation technology (e.g. FHIR etc., distributed workflows etc.)
    28. 28. Thank you – Questions?Empowered by openEHR - Clinicians in the Driver’s Seat!
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×