Presented by Peter Jordan Solution Architect, Patients First

1. Health Information Exchange Standards Compliance via Integration Testing…
Peter Jordan, Solution
Architect
Andrew Terris, CEO
HINZ Conference 2013
Paper Presentation
28 November 2013
1

2. Introduction
HISO 10040 Health Information Exchange
10040.1
R-CDRs
XDS
10040.2
CCR
SNOMED CT
Archetypes
10040.3
Documents
CDA
• Testing HIE Standards – CDA compliance
• NZ Solution – Integration as a Service & certification
• Discussion & Conclusions - meeting the challenges

3. HIE Integration Testing

4. New Zealand Solution
• Maturing CDA Landscape
• NZ CDA Toolkit – Specifications, but not standards
• HISO Standards – Simplified CDA Templates
• Vendor Products – Native CDA Capability
• Integration as a Service
• Certification and Integration – NHITB Strategy
• Integration Test Platform – Web Site & Web Service

5. Certification & Integration
•
•
•
•
•
•
Patients First – Evaluate Primary Care
PMS Review – Clinicians & Technologists
Regime – Structured & Standards-Based
Analysis – 75% objective, 25% subjective
Initial Focus – Interoperability Standards
Plug & Play – Vendor & User Confidence

6. Integration Test Platform
• ITP Services
• Validation Tool – tests messages & documents
• Downloads – sample test instances
• Reporting – test results by application & version
• ITP Interfaces
• Web Site – additional rendering examples & links
• Web Service – RESTful business functionality
• ITP Validation Levels
• Message Transport – CDA document wrappers
• Document Formatting – Structural & Document Template
• Data Content – Header, Section, Entry & Item Templates

9. Practical Discussion
Will the Integration as a Service approach succeed?
• Feedback – Generally positive
– PMS vendors (GP2GP v2) & DHB CIOs
• Operational Principles – Broad consensus:
– HISO as certifying authority, Patients First the endorsed test agency
– ITP as enabler, rather than enforcer, of standards – educative feedback
• Usage – UAT moving into production for InterRAI & GP2GP v2
• HISO Standards – Simplified CDA Templates
– Hierarchical Descriptions - (c/f XML Schematron –arcane conformance statements)
– Human-understandable error and warning messages
– Richer validation provided by OO languages
• Service-Oriented – Web Form and RESTful interfaces
– Centrally hosted and targeted testing – persists beyond project lives
– No silo-based testing of entire product suite deployments

10. Summary & Conclusions
• Progress
- All CDA types used in national projects
- Adding clinical coding analysis
• Going Forward
- Compliance testing as part of product certification
- Objective criteria for informed purchasing decisions
• Acknowledgements
- Alastair Kenworthy & Dr. Peter Sergent.
- HL7 NZ and various HIT/PMS software vendors!
“Interoperability is not a boat race. One team can’t win by
rowing better than another. We are all rowing the same boat.”

11. Reference Sources
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
W3C. Extensible Markup Language (XML). http://www.w3.org/XML/
HL7. Clinical Document Architecture Release 2. http://www.hl7.org/implement/standards/index.cfm
Atalag K, Hay D, Kenworthy A, Le Maitre A. Interoperability Reference Architecture. Version 1.0 December 2011
HISO 10040.3. Health Information Exchange: Structured Documents. Version 1.0 April 2012
http://www.ithealthboard.health.nz/sites/all/files/HISO%2010040.3%20HIE%20Structured%20Documents%20v1.pdf
HISO 10043. CDA Common Templates. Draft 10 April 2013 http://www.ithealthboard.health.nz/sites/all/files/vPC%20CDA%20Common%20Templates.pdf
HISO 10047. Comprehensive Clinical Assessments for Older People. Draft 10 April 2013
http://www.ithealthboard.health.nz/sites/all/files/VPC%20Comprehensive%20Clinical%20Assessments%20for%20Older%20People.pdf
Jordan P. Clinical Document Architecture Implementations - Lessons Learned To Date. HINZ Conference 2012
http://www.hinz.org.nz/uploads/file/2012conference/Papers/P9_Jordan.pdf
Tech Target. Integration as a Service: Definition. http://searchcloudapplications.techtarget.com/definition/integration-as-a-service at June 2012
Wikipedia. Integration Testing: Definition. http://en.wikipedia.org/wiki/Integration_testing at 3 June2013
Rishel W. Gartner Blog Network. Health Interoperability January 9, 2013 http://blogs.gartner.com/wes_rishel/category/interoperability/
MSDN. Improving XML Document Validation With Schematron. http://msdn.microsoft.com/en-us/library/aa468554.aspx#schematron_topic4
HL7 Book. The Eclipse Instance Editor. http://hl7book.net/index.php?title=Eclipse_Instance_Editor
Lantana Consulting Group. CDA Validator. https://www.lantanagroup.com/validator/
AHML. Australian Healthcare Messaging Laboratory. http://www.ahml.com.au/
NIST. Meaningful Use Test Methods. http://healthcare.nist.gov/use_testing/index.html
Intelliware Software. e-Health Testing Platform. http://www.intelliware.com/case_study/e-health-testing-platform/
IHE. Integrating The Healthcare Enterprise. http://www.ihe.net/
PMS Requirements – final report http://174.142.164.230/~whmroot/_patientsfirst.org.nz/wp-content/uploads/2013/02/PMS-Requirements-Final-Report-v1-.1.pdf
Commonwealth Fund – eMR adoption http://www.commonwealthfund.org/News/News-Releases/2012/Nov/International-Survey.aspx
http://174.142.164.230/~whmroot/_patientsfirst.org.nz/wp-content/uploads/2013/02/PMS-Review-Findings-2011-Executive-Summary-Report-FINAL.pdf
Wikipedia. Representational State Transfer: Definition. http://en.wikipedia.org/wiki/Representational_state_transfer

12. Questions & Suggestions
• Additions to the Integration Test Platform?
• Thanks for attending!
peter.jordan@patientsfirst.org.nz
andrew.terris@patientsfirst.org.nz