Michael van Campen Affiliate Director, HL7 Board of Directors and Chair, HL7 Canada (2/11/10, Workshop 2, 9.30)

1. HL7 Around the World Michael van Campen 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. Outline Standards Development & the Role of the Affiliate HL7 – Pulse of the Nation Current Challenges Moving Forward Wrap up / Q&A Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 3

5. Affiliate RoleNov 2, 2010 © 2010, Gordon Point Informatics Ltd. 4

6. Definition(s) (for consideration) Health Informatics Standard “An agreed upon rule or format applied to support the definition, exchange and use of data related to any aspect of Health care Information Technology (HIT) activity” * * eHealth Ontario, http://www.ehealthontario.on.ca/programs/eHealthStandards.asp Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 5

7. FunctionalInteroperability (the conversation) Semantic Interoperability (the data) Definition(s) (for consideration) 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. 6

8. Why this Need? BEFORE: Point-to-Point Interfaces Pharmacy Admission Finance PublicHealth Diagnostic Imaging Lab Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 7

9. Why this Need? AFTER: Reusable HL7 interfaces (interface engines) Lab Pharmacy Admission Finance HL7 Public Health Diagnostic Imaging Many more approaches exist, but this illustrates how HL7 can reduce the number of interfaces, as well as standardize them! Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 8

10. Standards Stepping Stones Build up from a strongFoundation Capabilities Msgs/Svcs/Docs E.g. Rx Order, Lab Result, Claim Infostructure E.g. Data Types, CMETs, Archetypes Structures E.g. Name, Address, Identifier Terminology E.g. Diagnosis codes, Gender, Address Type Data E.g. Referral Date, Prescription Number, Claim Number, Patient Name

11. Standards – How did we get here? Health informatics standards have been evolving for 25+ years The absence of “any” standards helped form organizations such as HL7 in 1987 Today, standards are developed by many “competing” organizations, sometimes at cross purposes Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 10

12. Standards Development Landscape Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 11

13. The Standards Development Continuum How far up the chain does one go? Benefits are realized as you move from left to right… case in point (next slide) Local National Multi-Nation SDO X-SDO Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 12

14. Reaping the Benefits – Case Study (1/2) Local 1998: The province of BC was developing an eClaims standard for Chiropractic and Physiotherapy claims National 2000: Confirmed that a national information architecture was needed for “all” claims, such as pharmacy, medical, vision, oral health Discovered the requirement for real-time adjudication Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 13

15. Reaping the Benefits – Case Study (2/2) SDO 2003: HL7 balloting and engagement confirmed information architecture and baseline requirements 2004: Discovered requirement for fee schedule references in Australia (Health Insurance Commission) Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 14

16. Role of the Affiliate Localize international standards for use in their Affiliate Contribute towards the development of international standards Coordinateactivitiesof the Affiliate Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 15

17. Standards Work – It’s not easy!! High Pain Threshold  Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 16

18. HL7 – Pulse of the Nation Current Challenges Moving Forward Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 17

19. Current Challenges v2 / v3 Memorandum of Understanding (MOUs) Imbalance in Representation Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 18

20. HL7 v2.x HL7 v2.x allowed HL7 to be seen as a strong Standards Organization There really was no one else playing the game HL7 v2.x solved many of the quick-hit interoperability problems, but still lacked Consistent information model(s) International focus Strong methodology Tooling, more than MS Word Non-institutional perspectives Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 19

21. HL7 v3 – A True Leadership Move HL7 introduced the game changer in health interoperability in HL7 v3 Reference Information Model Methodology Strong(er) terminology bindings Contemporary tooling and methods HL7 was seen to be at the forefront of interoperability technology Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 20

22. HL7 v3 – The Holy Grail? HL7 v3 promised: Tighter specifications Consistent definitions Rich semantic meaning to information Strong terminology binding Strong tooling Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 21 Grade: A+

23. V3 Normative Specifications - Growing 22

24. HL7 v3 – The Execution But suffered from: Incomplete and inconsistently applied models Poor translation / transition from HL7 v2 to v3 “true” support from the organization Tooling woes Lack of market penetration Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 23 Grade: C+

25. HL7 v3 – The Factor The rollout of HL7 v3 caused the HL7 organization to lose focus on factors outside of the organization Not everyone bought in, for various reasons Those that had bought in covered up any of the growing pains Traction was (is) slow Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 24

26. Current Challenges v2 / v3 Memorandum of Understanding (MOUs) Imbalance in Representation Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 25

27. Protecting Our Turf – the MOU Game MOU – Memorandum of Understanding Provides a mechanism to stake out one’s territory Specifies behaviours Helps to ensure no one encroaches on your turf Case in point – X12 and Claims HL7 can include claims functionality, but not in the US Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 26

28. MOUs in Play HL7 currently has the following MOUs or Associate Charter Agreements: ADA, AHIP, ANSI, ASC-X12, ASTM, CDISC, CEN/TC 251, CHCF, Continua, DICOM, eHI, GS1, IEEE, IHE, IHTSDO,MedBiquitous, NCPDP, NAACR, The Health Story Project Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 27

29. MOUs – The Factor Memorandum of Understanding – the easy answer Provided absolutely little or no opportunity to resolve, harmonize or consolidate efforts No clear alignment of common interests Entrench the Status Quo Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 28

30. Current Challenges v2 / v3 Memorandum of Understanding (MOUs) Imbalance in Representation Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 29

31. HL7 International 35 Affiliates – who’s missing? Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 30

32. Strong US Focus Strong US presence at HL7 International This is a good thing and a bad thing HL7 is perceived (in some circles) as a US organization with international participation Not an International Organization Affiliate model Shows international “flavour” in HL7, but fails to address How the US can develop realm materials Preponderance of influence (from a country perspective) Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 31

33. Affiliate Model Today, there is an imbalance in the organization across the US and the Affiliates Membership Balloting Governance Finances Let’s not forget strong vs. weak Affiliates Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 32

34. Current Challenges - RECAP v2 / v3 Memorandum of Understanding (MOUs) Imbalance in Representation Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 33

35. HL7 in the Past 10 Years Losing Sight of the Prize, resulting from HL7 v2 & v3 dichotomy Focus on MOUs and turf protection US interests vs. International interests In other words, content with the status quo or minor incremental change We lost our edge... What happened??? Who was watching the chicken coop??? Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 34

36. New Kids on the Block IHE Covering the compliance space, a logical extension to HL7 IHTSDO Strong terminology models, which need to be tightly tied with information models Now perceived as a true international SDO OpenEHR Archetypes as useful information structures Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 35

37. Standards Fragmentation Standards development is fragmented “I need to attend how many meetings?” “and where?” A non-sustainable model, not only for HL7, but for all healthcare Standards development Spend more time reconciling and attending meetings than doing work! Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 36

38. Moving Forward v2 / v3 Memorandum of Understanding (MOUs) Imbalance in Representation Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 37

39. Moving Forward on Challenge 1: v2 / v3 Develop comprehensive Product Strategy Understand needs of stakeholders Local, national and international in focus Include Documents constructs such as the Clinical Document Architecture (CDA) Service Aware Interoperability Framework (SAIF) This is under development by the HL7 Board Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 38

40. Moving Forward on Challenge 2: MOUs Mergers & Acquisitions Looking back, a better approach (in hindsight) to MOUs might have been a Mergers & Acquisitions approach SDO consolidation Winners and losers Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 39

41. A Success Story – Canada Multiple SDO constituencies in Canada Fragmented standards groups Under the Infoway Standards Collaborative (SC) banner, all SDOs participate ISO, HL7, IHTSDO Others to be added as needed Starting to see this in other countries Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 40

42. SC Governance Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 41

43. Moving Forward on Challenge 3a: HL7 Int’l Make HL7 International, eh One Member One Vote (OMOV) Initiated by Charlie McKay and Rene Spronk in 2007 Committee struck to address membership inequality Met over a number of years / WGMs, resulting in 4 concrete steps and the characteristics of an International Organization... Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 42

44. OMOV Changes Remove cap of 8 votes for larger Affiliates # votes determined as 10% of Affiliate membership Development of a Global Membership Directory Will allow for further advancements of OMOV in the future Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 43

45. Principals of an International Organization Strong global perspectives and outreach Products have clear global value Ability to meet needs of both national and global requirements Consistency in membership Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 44

46. Towards Internationalization Commit to establishing one regional office, likely in the EU as a pilot Refer to the organization as HL7 International Change the name of the Affiliate Council to International Council The US will define a process through which a representative from the US will participate on the International Council Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 45

47. What’s Next? OMOV disbanded at September 2009 HL7 WGM in Atlanta New Internationalization Task Force Scope is broader than OMOV Looking at all aspects of HL7 from an International perspective Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 46

48. Moving Forward on Challenge 3b: JIC Joint Initiative Council (JIC) on SDO Global Health Informatics Standardization Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 47

49. Joint Initiative Highlights First Meeting, Brisbane, Aug/07 Initial [Process] Highlights SDO work program inventory First draft JWG processes Initial joint projects SDO joint issues addressed 13606 ballot, Ballot synchronizing, Comment disposition, Revisions, Templates Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 48

50. Joint Initiative – The Content Data Types (Grahame Grieve) Pharmacovigilance and Identification of Medicinal Products 13606 / HL7 V3 Implementation Guide BRIDG Domain Analysis Model for Protocol Driven Biomedical Research Clinical Trials Registration and Results Glossary Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 49

51. Wrap Up & Q&A Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 50

52. Our Convergence Journey… Past Many standards HL7 v3, MOUs, US focus Present JIC Future SDO Consolidation? Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 51

53. HL7 is the Right Answer HL7 attracts experts from every discipline HL7 Standards are world-class HL7 is International in most respects and global in reach Culture is supportive of new perspectives Tooling initiatives promise more stability HL7 constantly re-invents itself with new process, product and learnings Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 52

54. Summary Get our house in order HL7 Internationalization Support the Joint Initiative Forget the MOU Conquer or be Conquered M&A Lastly… You can help! Get involved! Nov 2, 2010 © 2010, Gordon Point Informatics Ltd. 53

55. March 3, 2010 © 2010, Gordon Point Informatics Ltd. 54 Thanks! Michael van Campen Gordon Point Informatics Ltd. Michael.vancampen@gpinformatics.com gpi