Michael van Campen Affiliate Director, HL7 Board of Directors and Chair, HL7 Canada Jean Duteau Co-chair of HL7 Modeling & Methodology, Implementable Technology Specifications, and Tooling workgroups (2/11/10, Workshop 2, 9.30)

1. Enabling Interoperability through Standards & Architecture Michael van Campen, Jean Duteau HL7 New Zealand Conference, November 2, 2010

2. Michael van Campen Has been involved in the HL7 organization for 15+ years (internationally and in Canada) Affiliate Director on the HL7 Board of Directors HL7 Canada Chair Involved in many HL7 activities in Canada and abroad Most importantly... Opinions expressed today are solely my own They may be shared by others... Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 2

3. Jean Duteau Has been involved with HL7 implementations since 2000, both v2.4/2.5 and v3 Worked with Canada Health Infoway as a Standards Subject Matter Expert (SME) and a Jurisdictional SME Current Modeling facilitator for Pharmacy, Past Publishing facilitator for Patient Care Co-chair of Modeling & Methodology, Implementable Technology Specifications, and Tooling workgroups Currently involved in HL7 activities in Canada, United States, and Europe Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 3

4. Outline Standards and Architecture Interoperability EHR Blueprint Local, National & International Requirements Constraining / Extending The Infoway Standards Collaborative Wrap up / Q&A Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 4

6. EHR Blueprint

7. Use of StandardsNov 2, 2010 © 2010, Gordon Point Informatics Ltd. 5

8. Need for Interoperability As part of providing a healthcare system that provides timely, valid, and reliable information, you need to share data between healthcare providers, across care disciplines, and across care settings Physician Labs Emergency Care Specialist Care Patient Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 6

9. Need for Interoperability We tend to look to electronic healthcare systems to be the backbone for providing this information Their ability to collect, manage and transmit this information works to our advantage To do this, we require these systems to be “interoperable” We need them to work together to support our healthcare system Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 7

10. Need for Interoperability Physician Labs Emergency Care Specialist Care Patient Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 8

11. FunctionalInteroperability (the conversation) Semantic Interoperability (the data) Interoperability “Ability of two or more systems or components to exchange information and to use the information that has been exchanged” [IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990] Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 9

12. EHR Framework/Architecture/”Blueprint” Need for a framework for interoperability Identify solutions that need to be in place to provide care no matter where the patient is and no matter where the provider is: Individual Point of Service applications Health Information Warehouses (Data Repositories) Infrastructure to support and connect systems In Canada, this framework is called the EHRS Blueprint Conceptual architecture for an interoperable HER Basically, a description of the components that are necessary to provide each individual’s health record when (and where) it is needed Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 10

13. Canada Health Infoway’s EHR Blueprint Many systems in play, with most of them supporting the following clinical information areas: Radiology (RIS) Lab orders and Results (LIS) Prescription Drugs (DIS) These clinical systems were not connected Led to the paradoxical situation of a person’s health information being collected electronically in many places but not being available at the point of care when needed This led to the concept of an interoperable Electronic Health Record (iEHR) that would be available whenever needed Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 11

14. Challenges to implement EHR Solution Privacy Concerns Governance Accountability Finding data and retrieving it Timeliness of data Discovery of data Harmonization between systems Data structures Vocabularies Semantics Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 12

15. Canada Health Infoway In late 2002, Infoway completed and published the first version of the blueprint (called the EHR System Blueprint) This provided Foundation for an interoperability conceptual model Common vision and allowed the Canadian jurisdictions and Infoway to work together towards a common pan-Canadian architecture as well as common standards for semantic interoperability In 2006, Infoway produced version 2 of the blueprint New Privacy and Security architecture New domain models for Public Health and Telehealth Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 13

16. EHR Solution (EHRS) EHR Infostructure (EHRi) EHRS Blueprint v2 Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 14 Registry Data & Services Ancilary Data & Services EHR Data & Services Data Warehouse Once the basic elements are in place, implementation of anEHR Viewer facilitates the sharing of EHR information,especially for those who do not have an EHR-enabled application. Longitudinal Record Services Health Information Access Layer (HIAL) The base of the EHR is information systems storing Information about a patient in various points of care. A central EHR repository and/or domain repositories such as Lab or Drug combine their information at a jurisdictional level to provide a full clinical picture. Registry services provide for the accurate and unambiguous identification of patients, providers, andservice delivery locations. The infrastructure can support additional value-add services to the EHRS. Public Health Surveillance would be an example of such a service. Additional value is added by incorporating data warehouses for different purposes into the info structure. By doing so, it gains from the support services. The EHR Infostructure (EHRi) integrates the clinical datastores, the registries, the ancilary services and a middlewarelayer called the Health Information Access Layer Point of Service Application Point of Service Application EHR Viewer

17. EHRS Blueprint – Conceptual Architecture Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 15 Longitudinal Record Services Common Services Communication Bus JURISDICTIONAL INFOSTRUCTURE Ancillary Data& Services EHR Data& Services DataWarehouse Registries Data& Services OutbreakManagement PHSReporting SharedHealth Record DrugInformation DiagnosticImaging Laboratory HealthInformation ClientRegistry ProviderRegistry BusinessRules EHRIndex MessageStructures NormalizationRules LocationRegistry TerminologyRegistry Security MgmtData Privacy Data Configuration HIAL Hospital, LTC,CCC, EPR PhysicianOffice EMR EHR Viewer Lab System(LIS) RadiologyCenterPACS/RIS PharmacySystem Public HealthServices Physician/Provider Physician/Provider Physician/Provider Lab Clinician Radiologist Pharmacist Public Health Provider POINT OF SERVICE

18. Enhancements to the EHRS Blueprint Current work is underway to produce the 2015 EHRS Blueprint This extension will take advantage of the existing information and provide for more intelligent use of this information The core concepts of the 2015 Blueprint will be: Electronic Orders Clinical Decision Support Consumer Health Chronic Disease Management Timely Access to Services Each of those concepts has a set of clinical narratives that express various themes Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 16

19. 2015 Core Concepts Electronic Orders Torn ACL addresses appointment scheduling, referrals and various orders Consumer Health Diabetes addresses the interactions of various consumer health solutions (Google Health, HealthVault, etc.) with the EHR and healthcare providers Chronic Disease Management Chronic Obstructive Pulmonary Disease (COPD) addresses Chronic Disease Management (CDM) for patients across care settings and disciplines Timely Access to Services Improving Patient’s access to Health Services, including the proactive management of Wait Times Clinical Decision Support Elements of Clinical Decision Support are explored throughout the other four scenarios Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 17

20. 2015 Architecture Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 18

21. How does Standards Interact? For interoperability, one of the means to facilitate information exchange is to standardize not only the architecture but also the means of transporting the data from one point to another Standards can also enable cost reduction as vendors converge on international standards Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 19

22. Infoway’s Approach to Standards Create standards for the business cases that have an identified need Leverage existing standards wherever possible – adopt first, adapt next, create last. For most clinical data, HL7 v3 messaging are the preferred standard Investment is provided to implementations that commit to the pan-Canadian standards Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 20

23. Creating Standards Work with other countries that have similar EHR initiatives Partner with other national standards bodies (for example, HL7 Canada, IHE Canada) Define a process to work with the stakeholders to establish standards Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 21

24. Local, National & International Requirements Constraining / Extending The Infoway Standards Collaborative Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 22

25. International Constrain Extend ISO WHO HL7 IHTSDO Etc. National Canada UK Aus. SC US Etc. CIHI Jurisdictional Ontario BC AB ON QC Etc. CR PR Discharge eReferral Etc. Minimize Differences Constraining / Extending Standards

27. Orders

28. Administrations

29. Supply (Dispenses)

30. Expresses all of the requirements that each of the member countries bring forward:

31. Multiple prescriptions in one order

36. Patient and Record Target are expressed in a different model

37. Dose Quantity is expressed in a different manner

39. Local, National & International Requirements Constraining / Extending The Infoway Standards Collaborative Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 30

40. SC Governance Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 31

41. Standards Life Cycle – In Place and Working… Tools and Templates Change Management Licenses Standards Knowledge Management Evaluation Liaison Adoption Strategies Promotion & Communication Source: Canada Health Infoway Oct 28, 2010 © 2010, Gordon Point Informatics Ltd. 32

43. InfoDesk

44. Implementation

45. Internal Alignment

46. SC / SME

47. SDO (e.g. HL7)

48. SMR

50. Understand

52. Approve / Reject

54. Test

56. Wrap Up & Q&A Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 35

57. Outline - REVIEW Standards and Architecture Interoperability EHR Blueprint Local, National & International Requirements Constraining / Extending The Infoway Standards Collaborative Wrap up / Q&A Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 36

58. March 3, 2010 © 2010, Gordon Point Informatics Ltd. 37 Thanks! Michael van Campen Gordon Point Informatics Ltd. Michael.vancampen@gpinformatics.com Jean Duteau Gordon Point Informatics Ltd. Jean.duteau@gpinformatics.com gpi