eHealth - Mark Yendt


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eHealth - Mark Yendt

  1. 1. The MARC-HI EHR Project Mohawk Applied Research Centre Health Informatics Electronic Health Records Mark Yendt – Faculty, Electrical and Computer Engineering Technology [email_address]
  2. 2. MARC-HI <ul><li>Started at Mohawk College in 2007 </li></ul><ul><ul><li>Focus on applied research </li></ul></ul><ul><ul><ul><li>Complementary to academic research performed by Universities </li></ul></ul></ul><ul><ul><li>Private sector partnerships essential to success </li></ul></ul><ul><ul><li>Results of research can be implemented into and used to improve existing real-world systems. </li></ul></ul>
  3. 3. What is EHR? <ul><li>EHR – Electronic Health Record </li></ul><ul><li>A secure and private lifetime record of an individual's health and care history, available electronically to authorized health care providers </li></ul><ul><ul><li>For example, all Medications, Lab Tests, Diagnostic Imaging Tests and Medical conditions are obtained through a single logical location. </li></ul></ul>
  4. 4. Why is the EHR important? <ul><li>Healthcare professionals make clinical decisions based on knowledge </li></ul><ul><ul><li>Better knowledge translates to better care </li></ul></ul><ul><ul><li>Knowledge starts with accurate, relevant clinical information </li></ul></ul><ul><li>The EHR creates the capability to share relevant clinical information when it is needed </li></ul>
  5. 5. EHRs in the Healthcare Industry - Today <ul><li>A majority of all hospitals have computerized record keeping systems (HIS) – </li></ul><ul><ul><li>Detailed data on current episode of care is electronically available </li></ul></ul><ul><li>In Ontario, only 8% of family doctors have computerized record keeping (EMR) – </li></ul><ul><ul><li>Summary data is mostly kept in paper form </li></ul></ul><ul><li>No standard interoperability mechanism is being used to allow all care providers to communicate with each other </li></ul><ul><ul><li>Some communication services between different systems has been implemented using a peer-to-peer negotiated protocol </li></ul></ul>
  6. 6. The Interoperable EHR - Future <ul><li>Canada Health Infoway is Canada's catalyst for collaborative change to accelerate the use of electronic health information systems and electronic health records (EHRs) across the country </li></ul><ul><li>Infoway has designed the Canadian Electronic Health Record Solution (EHRS) Blueprint to support interoperable EHR systems </li></ul><ul><ul><li>This &quot;Blueprint&quot; document describes important aspects of the design </li></ul></ul>
  7. 7. EHR Infostructure - Conceptual Architecture JURISDICTIONAL INFOSTRUCTURE POINT OF SERVICE (POS) Terminology Repository Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Immunization Management PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Hospital, LTC, CCC, EPR Physician Office EMR EHR Viewer Physician/ Provider/ Patient Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Data Privacy Data Configuration Physician/ Provider Physician/ Provider Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider Longitudinal Record Services HIAL Communication Bus Common Services Client Registry Provider Registry Location Registry Content Source: Canada Infoway, Copyright 2007
  8. 8. EHRS Blueprint Component Architecture <ul><li>Designed to use Web Services </li></ul><ul><li>Jurisdictional implementation envisioned to use a Service Oriented Architecture (SOA) </li></ul><ul><li>HL7v3 messaging for communication between POS systems and Jurisdictions </li></ul><ul><ul><li>XML to be used as the implementation technology for the messaging </li></ul></ul><ul><ul><li>All valid messages defined using XSD (XML Schema Definition) </li></ul></ul><ul><ul><li>All encoded data to use standardized data encoding including LOINC for lab data and SNOMED-CT for Terminology </li></ul></ul><ul><li>Ultimate goal is to integrate all 150,000 health care providers across country </li></ul>
  9. 9. MARC-HI EHR Project <ul><li>Build a Reference implementation of the Canadian Electronic Health Care Solution. </li></ul><ul><ul><li>Use the Canada Health Infoway Blueprint as the guiding document </li></ul></ul><ul><li>Goals of the reference system include: </li></ul><ul><ul><li>Providing feedback on effective development strategies to implementing jurisdictions. </li></ul></ul><ul><ul><li>Give guidance to the Standards Collaborative Working Groups (SCWGs) within Infoway to support effective implementations </li></ul></ul><ul><ul><li>Building a conformance/prototype testing environment to evaluate interoperability between federated systems </li></ul></ul><ul><ul><li>Integrate project back into the classroom </li></ul></ul><ul><ul><ul><li>get faculty and students involved </li></ul></ul></ul><ul><ul><li>Making the results available as open source through Open Health Tools </li></ul></ul>
  10. 10. Vendor-agnostic tooling <ul><li>To demonstrate interoperability </li></ul><ul><ul><li>Toolsets and technologies from many leading vendors are being used in the project </li></ul></ul><ul><ul><ul><li>SOA Orchestration Development </li></ul></ul></ul><ul><ul><ul><ul><li>Microsoft (IIs, Biztalk, VS.NET) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Intel (SOA Expressway) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Software AG (Web Methods) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sun (JCaps / Open ESB / Java development tools) </li></ul></ul></ul></ul><ul><ul><ul><li>Databases </li></ul></ul></ul><ul><ul><ul><ul><li>Oracle (Oracle 10g database, HTB) </li></ul></ul></ul></ul><ul><ul><ul><li>Infostructure Services (HL7v3 compliant tools) </li></ul></ul></ul><ul><ul><ul><ul><li>Initiate (Client Registry) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Orion (Web Viewer) </li></ul></ul></ul></ul><ul><ul><ul><li>Security Access Control </li></ul></ul></ul><ul><ul><ul><ul><li>HIPAAT (Consent Management Software) </li></ul></ul></ul></ul>
  11. 11. Project Status <ul><li>Project started in September 2007 </li></ul><ul><li>Initial &quot;get something working timeline&quot; was 4 months </li></ul><ul><ul><li>Hospital Discharge Summary </li></ul></ul><ul><li>Initial Demonstration of the project in January 2008 </li></ul><ul><li>Satyam joined as a partner to the project </li></ul><ul><ul><li>$1 Million project contribution </li></ul></ul><ul><li>Referral added as part of Phase II. </li></ul><ul><li>Development of Discharge/Referral integrated with: </li></ul><ul><ul><li>Initiate Client Registry </li></ul></ul><ul><ul><li>Orion Web Viewer </li></ul></ul><ul><ul><li>CIHI Data warehouse Application </li></ul></ul><ul><li>Full Demonstration of Mohawk EHR Project at eHealth 2008 in Vancouver </li></ul><ul><li>Current Activities include: </li></ul><ul><ul><li>Building Lab domain </li></ul></ul><ul><ul><li>Performance evaluations </li></ul></ul>
  12. 12. Discoveries <ul><li>Small focused team development is an excellent way to do a proof of concept design </li></ul><ul><li>Larger teams that are separated (Mohawk / Satyam team) require a require more formal development methods. </li></ul><ul><ul><li>Mohawk developed Lab Specifications </li></ul></ul><ul><ul><li>Satyam implemented Specifications </li></ul></ul><ul><ul><li>Developed system is tested and debugged as a team </li></ul></ul><ul><li>HL7v3 is complicated! </li></ul><ul><ul><li>Many tools have difficulty dealing with the messages </li></ul></ul><ul><ul><li>Nomenclature is abstract </li></ul></ul><ul><ul><li>Practical training is difficult to obtain </li></ul></ul><ul><ul><ul><li>Training courses in HL7v3 are available, but not always directly applicable or practical to problem </li></ul></ul></ul><ul><li>Development of technology to simplifies or hide the complexity of the XML messages. </li></ul><ul><ul><li>MARC-HI plans to explore this area in future research </li></ul></ul>
  13. 13. Challenges <ul><li>Existing systems will need an integration strategy for message construction. </li></ul><ul><ul><li>Message / Information mapping </li></ul></ul><ul><ul><li>Unifying Data code representation (LOINC/SNOMED-CT) </li></ul></ul><ul><li>Web Services will need to be integrated with Legacy systems. </li></ul><ul><ul><li>Tooling to enable this still requires more effort. </li></ul></ul>
  14. 14. Opportunities <ul><li>Opportunities: </li></ul><ul><ul><li>Developers - Lack of qualified developers for Canadian projects that will be undertaken in the next few years </li></ul></ul><ul><ul><ul><li>New Developers will need </li></ul></ul></ul><ul><ul><ul><ul><li>Training in terminology, HL7, XML, Web Services </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Canada is a leading edge adopter of HL7v3 </li></ul></ul></ul></ul><ul><ul><li>Tool development – Current tools not satisfactory </li></ul></ul><ul><ul><ul><li>Need tools to support: </li></ul></ul></ul><ul><ul><ul><ul><li>Nomenclature translation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Simplifying implementation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Improved automated testing </li></ul></ul></ul></ul><ul><ul><li>Participate in the project at MARC-HI </li></ul></ul><ul><ul><ul><li>NSERC - College and Community Innovation (CCI) Program – MARC-HI has been invited to submit a full proposal </li></ul></ul></ul><ul><ul><ul><ul><li>MARC-HI is looking for local partners currently working in the healthcare IT </li></ul></ul></ul></ul>
  15. 15. Project Contributors ecGroup Inc.
  16. 16. More Information <ul><li>http:// /marc/hi </li></ul><ul><ul><li>List of presentations and publications on site </li></ul></ul><ul><ul><li>Wiki documents project status and current development activities </li></ul></ul><ul><li>Canada Health Infoway </li></ul><ul><ul><li> / </li></ul></ul>