© 2006 canada health infoway inc. 1 january 16, 2007 dennis giokas chief technology officer canada...
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1© 2006 Canada Health Infoway Inc.
January 16, 2007
Dennis Giokas
Chief Technology Officer
Canada Health Infoway Inc.
Architecture and Standards at Infoway
IHE Connectathon 2007
Outline
2
Key Definition
Solution Architecture
Standards for Interoperability
Infoway, the EHR and IHE
Conformance Testing
Some Thoughts Going Forward
EHRAn Electronic Health Record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health providers and the individual anywhere, anytime in support of high quality care.
This record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographies.
3© 2006 Canada Health Infoway Inc.
4© 2006 Canada Health Infoway Inc.
EHRS Conceptual Architecture
JURISDICTIONAL INFOSTRUCTUREAncillary Data
& ServicesRegistries Data
& ServicesEHR Data& Services
DataWarehouse
OutbreakMgmt
PHSReporting
SharedHealth
Record
DrugInformation
DiagnosticImaging
LaboratoryHealth
Information
ClientRegistry
ProviderRegistry
LocationRegistry
TerminologyRegistry
POINT OF SERVICE
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security Mgmt
Privacy DataConfig-uration
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health
Provider
Longitudinal Record Services
HIALCommunication BusCommon Services
5© 2006 Canada Health Infoway Inc.
End-User Perspective: EMR ApplicationJURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Registries Data& Services
EHR Data& Services
Ancillary Data& Services
DataWarehouse
OutbreakManagement
PHSReporting
HealthInformation
Physician Office EMR
Physician/Provider
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Longitudinal Record Services
HIALCommunication Bus
Security MgmtData
Privacy Data Configuration
ProviderRegistry
LocationRegistry
TerminologyRegistry
Common Services
PatientInfo
End-userInfo
PatientHistory
DrugProfile
LaboratoryDiagnostic
Imaging
EMR APPLICATION
EMRDatabase
ClientRegistry Shared
Health RecordDrug
InformationDiagnostic
ImagingLaboratory
6© 2006 Canada Health Infoway Inc.
EHRSEHRS EHRSEHRS EHRS EHRSEHRS
EHRS In Canada Federated Databases, Peer-to-Peer, Message Based
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR ViewerPoint of Service
Application
Point of Service
Application
AncillaryData &
Services
HealthInformation
DataWarehouse
EHRData &
Services
RegistriesData &
Services
Longitudinal Record Services
Health Information Access Layer (HIAL)
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR ViewerPoint of Service
Application
Point of Service
Application
AncillaryData &
Services
HealthInformation
DataWarehouse
EHRData &
Services
RegistriesData &
Services
Longitudinal Record Services
Health Information Access Layer (HIAL)
Standards-basedSolutions
StandardizedArchitecture
StandardizedInterfaces
StandardizedData
Structures
StandardizedData
Vocabularies
StandardizedFunctionalBehaviour
7© 2006 Canada Health Infoway Inc.
8© 2006 Canada Health Infoway Inc.
EHR Infostructure: Standards Based Connectivity
JURISDICTIONAL INFOSTRUCTUREAncillary Data
& ServicesRegistries Data
& ServicesEHR Data& Services
DataWarehouse
OutbreakMgmt
PHSReporting
SharedHealth
Record
DrugInformation
DiagnosticImaging
LaboratoryHealth
Information
ClientRegistry
ProviderRegistry
LocationRegistry
TerminologyRegistry
POINT OF SERVICE
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security Mgmt
Privacy Data Configuration
Longitudinal Record Services
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health
Provider
HIALCommunication BusCommon Services
EHR IPEHR IPEHR IPEHR IPEHR IP
HIAL
HIAL
HIAL
HIA
LH
IAL
HIA
LH
IAL
HIAL HIAL HIAL HIAL HIAL HIAL
EHR IPEHR IP
EHR IPEHR IPEHR IPEHR IPEHR IPEHR IPEHR IP
EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP Standards EHR IP StandardsEHR SCP Standards
9© 2006 Canada Health Infoway Inc.
Standards Investment Portfolio
Architecture Standards
• EHRS Blueprint
• EHR Use Cases
• EHR Data Model
• EHR Services Model
• EHR Interoperability Profiles
Data & Messaging Standards• eClaims (Primary Care, Oral, Vision,
Chiro/Physio, Pharmacy) HL7 v3 (complete)
•Client Registry HL7 v2.4 & HL7 v3 (complete)
• Provider Registry HL7 v3 (complete)
•Drug Information Systems HL7 v3 (complete)
• Laboratory HL7 v3 (in development)
•Diagnostic Imaging/Teleradiology DICOM, IHE XDS-I (complete)
• iEHR Clinical Messaging HL7 v3 (in development)
• iEHR Technical Standards (in planning)
• Public Health Standards HL7 v3 (in development)
•Clinical Terminology Strategy (complete)
• Terminology Standards (SNOMED, LOINC, ICD10-CA, CCI)
10© 2006 Canada Health Infoway Inc.
Infoway, the Interoperable EHR Agenda and IHE
Leverage IHE integration profiles as much as possible• DI domain
• Co-authoured XDS-I content supplement• Funded development of XDS-I MESA tool set• Driven XDS/XDS-I through the Standards Collaboration Process – declared as a pan-Canadian
Standard (with “Stable for Use” designation)
• Client Registry• Authoured/funded a change proposal to PIX and PDQ to support our client registry (HL7 v3)
messaging standard• Funded development of MESA tool set changes
• EHR infostructure• Reviewing ITI integration profiles for consideration as pan-Canadian “standards”• The EHR Index will comply to the XDS Registry actor…but support event notifications, and
other data types
Coordinate with IHE to avoid duplication• Leverage IHE technical committees to develop new profiles and/or propose changes to
existing profiles e.g. support for HL7 v3 messaging, enhance the XDS Registry, participate in the XDS federation discussion
• Leverage MESA tools for conformance testing • Provide resources to profile development/change proposals through IHE Canada
11© 2006 Canada Health Infoway Inc.
Conformance for pan-Canadian Standards
Definition of Conformance
• Conformance includes the development of pan-Canadian standards business requirements, the conformance testing against these business requirements, and certification.
Scope
• Functional, message level interoperability, privacy and security, usability
• Infoway Standards Collaborative and the eHealth Collaboratory will share responsibilities for conformance on pan-Canadian Standards
• Standards Collaborative will undertake the development of business requirements, including the development of conformance statements, for the pan-Canadian approved standards;
• The eHealth Collaboratory (Collaboratory) will undertake the building of the conformance testing environment, the development of the testing processes and will undertake the actual conformance testing against the established business requirements.
12© 2006 Canada Health Infoway Inc.
eHealth Collaboratory
Purpose
• The eHealth Collaboratory has been established to provide independent certification and procurement support services to dramatically improve clients’ ability to deploy standards-based, interoperable and usable healthcare IT systems
Vision
• Will be nationally recognized as the trusted authority that provides an effective service offering enabling the Pan-Canadian EHR
13© 2006 Canada Health Infoway Inc.
Collaboratory Key Conformance Test Offerings
• Functionality• Do solutions offer the required functionality as specified in the Pan-Canadian
standards?
• Interoperability• Do solutions interoperate as required? At the message level? At the interoperability
profile level?
• Privacy and Security• Are solutions adhering to basic privacy and security standards?
• Usability• In a clinical setting, are the solutions easy to use, safe and likely to have high
adoption?
14© 2006 Canada Health Infoway Inc.
Collaboratory Services
• Currently developing and will maintain a set of persistent test harnesses and reusable tools
• Will provide web-based interaction with repositories and remote-access toolset
• Vendor’s point of service systems will be certified against standardized tests by the Collaboratory - results will be available online
• Jurisdictional EHR systems (the back-end Drug, Lab, DI, etc.) will be conformance tested to ensure they correctly implement the standards
15© 2006 Canada Health Infoway Inc.
Summary
The Interoperable EHR is becoming a reality in Canada!
• Our messaging and vocabulary strategy, requirements and specifications go beyond departmental integration and are designed to support:
• Lifelong, longitudinal, patient-centric summary of key clinical data which has value over time – the Interoperable EHR
• Large scale, loosely coupled, federated systems interoperability requirements using a peer-to-peer message oriented communications model
• Semantic interoperability between systems
• “Interoperability Profiles” need to move beyond the departmental and tightly coupled systems integration to support an Interoperable EHR set of functions
• Design patterns of List, Get, Put• With registry, consent, privacy/security, audit, decision support, alert, and business
process orchestration capabilities• XDS registry moving towards a full EHR Index
16© 2006 Canada Health Infoway Inc.
Website: www.infoway-inforoute.ca
E-mail: [email protected]
Thank you!