allan oas, director of architecture, registries and public health surveillance

iEHR Architecture

Presentation to Pan-Canadian Registries Standards GroupsFeb 7 and Feb 10, 2005Kelowna, BC

Allan Oas, Director of Architecture, Registries and Public Health SurveillanceSolution Architecture Group (SAG)Canada Health Infoway Inc.

2Interoperable EHR Architecture

Cross Program Services

Domain Repositories and

Healthcare Applications

End User Adoption and Setting the Future Direction

The Electronic Health Record

Architecture and Standards

Context: Infoway Investment Programs 2003 - 2009

Client, Provider and Location Registries

Innovation & Adoption

Drug Information

Systems

Laboratory Information Systems

Public Health

Systems

Diagnostic Imaging

Systems

Interoperable EHR

Infostructure

TeleHealth


EHR Solution (EHRS)

Summary of Key EHRS Architecture Concepts

EHR Patient-centric, lifetime, federated databases All clinically relevant data that needs to be

shared Encounter information Structured, integrated and semantically

consistent Registries to identify people, providers and

locations of care

EHR Data & Services

EHR Repository

Services

DomainRepository

ServicesRegistryServices

Communication BusCommunication Bus

Common Services

H I

A L

Health Information Access Layer (HIAL) Standards, common and communications

services to integrate applications across the continuum of care and healthcare delivery jurisdictions

Enables integrated access and view Creates data and application abstraction layers Most cost effective approach to integration

Applications

Appl Appl ApplAppl

Applications Clinical data to share is “pushed” from source

systems into EHR in near real time EHR data is “pulled” into the provider’s

application for one integrated view


Results of planning sessions with jurisdictions: Large and Medium Interoperability Models

Larger size JurisdictionsProvincial Client and Provider Registries

Provincial Lab and Drug Repositories

Supra-regional EHR and DI Repositories

Local EMR, CIS and EHR viewer applications

Client Registry

ProviderRegistry

DI Repository

DrugRepository

Laboratory Repository

DI Repository

EHR

Communication BusCommunication BusCommon Services

HIA

L

Region 1 Region 2RE

GIO

NA

L\J

UR

ISD

ICT

ION

AL

LO

CA

L/R

EG

ION

AL

CIS

EHRViewer

EMR CIS

EHRViewer

EMR

Medium size JurisdictionsProvincial Client and Provider Registries

Provincial Lab, Drug, DI and EHR Repositories

Local EMR, CIS and EHR viewer applications

Client Registry

ProviderRegistry

DrugRepository

DI Repository

EHR


HIA

L

RE

GIO

NA

L\

JUR

ISD

ICT

ION

AL

LO

CA

L


CIS

EHRViewer

EMR CIS

EHRViewer

EMR


Results of planning sessions with jurisdictions: Small jurisdictions

Small Jurisdictions A single integrated CIS solution may

deliver all of the EHRS services at the jurisdictional level

Local physician office systems or viewers provide access

Client Registry

ProviderRegistry

DrugRepository

DI Repository

EHR


HIA

L

RE

GIO

NA

L\

JUR

ISD

ICT

ION

AL

LO

CA

L


EHRViewer

EMR

CIS

EMR


Context: EHR Solution (Infoway Blueprint)Distributed, Message-based, Peer-to-Peer Network of EHRS Systems

EHRS EHRS EHRS EHRS EHRS EHRS EHRS

EHR Infostructure (EHRi)

RegistryServices

EHR Data & Services

DomainRepository

Services


Common Services

H I

A L

EHR Repository& Services

Applications

Appl Appl ApplAppl

EHR Solution (EHRS)EHR Infostructure (EHRi)

RegistryServices

EHR Data & Services

DomainRepository

Services


Common Services

H I

A L

EHR Repository& Services

Applications

Appl Appl ApplAppl

EHR Solution (EHRS)EHRS

Locator


Context: Healthcare Provider’s View of EHR

EHR Solution (EHRS)

EHRClient

RegistryProviderRegistry

DomainRepository

(Lab)

DomainRepository(Pharmacy)

DomainRepository(Diagnostic

Imaging)

EMRDrug ProfilePatient History

Laboratory

Patient Info

Diagnostic Imaging


Common Services

HIA

L

EHR Solution (EHRS)

EHREHRClient

RegistryClient

RegistryProviderRegistryProviderRegistry

DomainRepository

(Lab)

DomainRepository

(Lab)




Imaging)


Imaging)

EMRDrug ProfilePatient History

Laboratory

Patient Info

Diagnostic Imaging


Common Services

HIA

L

Communication BusCommunication BusCommunication BusCommunication Bus

Common Services

HIA

L

Applications

Appl Appl


EHR Data & Services

JURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE Communication Bus

Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7

Interoperability Services

Security Consent Configuration

RadiologyCenterPACS/RIS

LabSystem(LIS)

Hospital,Community,etc., EPR

HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository

JurisdictionalLab InfoSystem

HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

EHR APIEHR APIEHR API

Physician/ProviderLab TechnicianRadiologist

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

Lmeans “responds with”

Expanded view of architecture using Blueprint model:Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability


EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L

Communication Bus

SerializationServices

TransformationServices

En / DecodingServices

Parser Services

Encrypt / DecryptServices

App ProtocolServices

Network ProtocolServices

Routing Services

Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability


EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7


PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L



EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L

Common Services

Search /ResolutionServices

ManagementServices

Pub / SubServices

Alert / NotificationServices

InteroperabilityServices

SUBSCRIPTION

MANAGEMENT

CachingServices

Session MgmtServices

CONTEXT

INTEROP

INTEGRATION

ConfigurationServices

Permission MgmtServices

Authent’n MgmtServices

Security Services

SECURITY

Policy MgmtServices

AuditingServices

Log MgmtServices

GENERAL

Exception / ErrorHandlingServicesMapping Services

Service CatalogueServices

Broker Services

Queuing Services



EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7


PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L



EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L

DATA

BUSINESS

EHR Services

Normalization Services

WorkflowServices

ReplicationServices

AssemblyServices

Key ManagementServices

Data Services

ETL Services

Business RulesServices

Domain Business Components(DI, Lab, Pharmacy, Registries)



EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA


Positioning Current InitiativesThe Client Registry


EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L

means “responds with”

Positioning Current InitiativesThe Provider Registry


EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA

L


Positioning Current InitiativesDrug, DI and Lab “Domain” Systems


EHR Data & Services



Common Services

EHR Data & Services

Clinical Portal

EHR API



Hospital,InformationSystem

HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

EHR API

Physician/Provider

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

Physician/Provider

HIA

L

Positioning Current Initiatives (examples)Hospital Information System; Clinical Portal


EHR Data & Services



Common Services

EHR Data & Services

Clinical Portal

EHR API



Hospital,InformationSystem

HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

EHR API

Physician/Provider

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

Physician/Provider

HIA

L

Positioning Current Initiatives (examples)iEHR services, including interfaces to all others


EHR Data & Services


POINT OF SERVICE Communication Bus Communication Bus

Common Services

HIA

L

EHR Data & Services



DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

Health Business Transaction (HBT):Visit to the family physician -- The steps

Health System Transactions==========================1) Log-on to EMR2) User Selects patient3) View selected patient clinical dashboard4) View selected HBT details5) Record new provider referral6) Record new HBT clinical summary7) User closes patient chart8) User logs-off EMR system

Health System Transactions==========================1) Log-on to EMR2) User Selects patient3) View selected patient clinical dashboard4) View selected HBT details5) Record new provider referral6) Record new HBT clinical summary7) User closes patient chart8) User logs-off EMR system

PhysicianOfficeEMR

HL7

EHR API


EHR Data & Services


POINT OF SERVICECommunication Bus Communication Bus

Common Services

HIA

L

EHR Data & Services

Health System Transaction #1“Log-on to Electronic Medical Record System”==========================1) User identification data is entered2) User authentication is validated internally3) EHRi user authentication is validated and a

token representing the user is returned4) Errors/warnings are presented to the user5) User is authenticated and a communication session

context is created in the EHR API6) The EHRi user token is written to the

context and persisted in the EHR API

Health System Transaction #1“Log-on to Electronic Medical Record System”==========================1) User identification data is entered2) User authentication is validated internally3) EHRi user authentication is validated and a

token representing the user is returned4) Errors/warnings are presented to the user5) User is authenticated and a communication session

context is created in the EHR API6) The EHRi user token is written to the

context and persisted in the EHR API



DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Interoperability Profile: Patient visit to family physicianHealth System Transaction #1: User logs-on to the EMR system

EHRi Transaction (EHRiTx)“Authenticate EHR user”==========================1) Send system authentication and request for

communication session-----------------------------------------------------------------1) Receive response and establish context2) Send/receive user authentication message-----------------------------------------------------------------1) If error/warning, pass as response2) Else a comm. session context is established, user

authentication token are written to it3) Function terminates with success

EHRi Transaction (EHRiTx)“Authenticate EHR user”==========================1) Send system authentication and request for

communication session-----------------------------------------------------------------1) Receive response and establish context2) Send/receive user authentication message-----------------------------------------------------------------1) If error/warning, pass as response2) Else a comm. session context is established, user

authentication token are written to it3) Function terminates with success

1) Receive message2) Open message3) Parse message4) Transform message5) Route message

1) Establish HBT Context2) Enable service3) Broker service call to

security services4) Call security services

with parameters-----------------------------------1) Receive response from

security service2) Send response to

calling application via communication bus

1) Receive service call2) Validate user authentication3) Create User Id token4) Package response5) Call Broker Service with

response

Data Exchanged==============1) System Id2) Local Location Id3) EHRi Location Id4) Session Id5) Timestamp------------------------1) User Id2) User Id Token

Data Exchanged==============1) System Id2) Local Location Id3) EHRi Location Id4) Session Id5) Timestamp------------------------1) User Id2) User Id Token


EHR Data & Services



Common Services

HIA

L

EHR Data & Services

Health System Transaction #2“User selects patient from roster”==========================1) User patient list is displayed from local data2) User points and clicks on a specific patient to

select the patient3) The EMR system establishes this patient ID as part

of its context4) The system proceeds to the clinical dashboard5) The EHR is not involved at this stage and is

unaware of any specific patient having been selected

Health System Transaction #2“User selects patient from roster”==========================1) User patient list is displayed from local data2) User points and clicks on a specific patient to

select the patient3) The EMR system establishes this patient ID as part

of its context4) The system proceeds to the clinical dashboard5) The EHR is not involved at this stage and is

unaware of any specific patient having been selected



DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Interoperability Profile: Patient visit to family physicianHealth System Transaction #2: User selects a patient from the EMR patient index

EHRi Transaction (EHRiTx)“User selects patient from roster”==========================1) Nothing happens with the EHR2) The communication session context

is maintained in the EHR API

EHRi Transaction (EHRiTx)“User selects patient from roster”==========================1) Nothing happens with the EHR2) The communication session context

is maintained in the EHR API

Data Exchanged==============1) None

Data Exchanged==============1) None


EHR Data & Services



Common Services

HIA

L

EHR Data & Services

Health System Transaction“View selected patient clinical dashboard”==========================1) Local patient data is accessed using local Client ID2) An EHRi request is sent for the “clinical patient

picture”, this request carries client ID data andparameters qualifying what to bring back (type ofdata and # of records)

3) If resolution of Client ID fails, a dialog allows forhuman intervention to resolve;

4) Else, response is received from EHRi and data isconsolidated with local data to create list

5) The patient clinical dashboard is displayed and theuser can navigate the different panes

Health System Transaction“View selected patient clinical dashboard”==========================1) Local patient data is accessed using local Client ID2) An EHRi request is sent for the “clinical patient

picture”, this request carries client ID data andparameters qualifying what to bring back (type ofdata and # of records)

3) If resolution of Client ID fails, a dialog allows forhuman intervention to resolve;

4) Else, response is received from EHRi and data isconsolidated with local data to create list

5) The patient clinical dashboard is displayed and theuser can navigate the different panes



DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Interoperability Profile: Patient visit to family physicianHealth System Transaction #3: User views selected patient clinical dashboard

EHRi Transaction (EHRiTx)“Get Client Clinical Dashboard”==========================1) Relying on established session, send clinical

dashboard query message-----------------------------------------------------------------1) Receive response2) If resolution is required on Client or Provider, then

send resolution info to application-----------------------------------------------------------------1) Else HBT context is established and Clinical

Dashboard data is writtent to it2) Function terminates with success

EHRi Transaction (EHRiTx)“Get Client Clinical Dashboard”==========================1) Relying on established session, send clinical

dashboard query message-----------------------------------------------------------------1) Receive response2) If resolution is required on Client or Provider, then

send resolution info to application-----------------------------------------------------------------1) Else HBT context is established and Clinical

Dashboard data is writtent to it2) Function terminates with success

Data Exchanged==============1) EHRi Session ID2) EHRi HBT ID3) EHRi User ID4) EHRi Location ID5) Local Client ID6) Client ID Data7) EHRi Client ID8) Local Provider ID9) Provider ID Data10)EHRi Provider ID11)Clinical Dashboard

Query Parameters12)Clinical Dashboard

Query Response: 1)HBT data2)HBT Event Data

Data Exchanged==============1) EHRi Session ID2) EHRi HBT ID3) EHRi User ID4) EHRi Location ID5) Local Client ID6) Client ID Data7) EHRi Client ID8) Local Provider ID9) Provider ID Data10)EHRi Provider ID11)Clinical Dashboard

Query Parameters12)Clinical Dashboard

Query Response: 1)HBT data2)HBT Event Data


EHR Data & Services



Common Services

HIA

L

EHR Data & Services

Health System Transaction“View Selected HBT Details”===============================1) TBD

Health System Transaction“View Selected HBT Details”===============================1) TBD



DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS

HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7 (DI)

HL7 (Lab)

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Interoperability Profile: Patient visit to family physicianHealth System Transaction #4:User drills-down into last patient visit to ER

EHRi Transaction (EHRiTx)“Get HBT Details”==========================1) TBD

EHRi Transaction (EHRiTx)“Get HBT Details”==========================1) TBD

Data Exchanged==============1) TBD

Data Exchanged==============1) TBD

End

[email protected]

http://www.infoway-inforoute.ca/

Appendix: Registries and Clinical System Interoperability Example


JURISDICTIONALINFOSTRUCTURE

POINT OF SERVICE

Pharma

Pharmacist

Client Registry

Drug InformationSystem

Repository

Sea

rch

/ R

eso

lve

Clinical Portal

Physician

DIS APIPATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client

Pharmacy Profile4) Request Drug Profile5) Request DUR6) Enter new prescription

CR API

CLIENT REGISTRATION

1) Search Client2) Create New Client, or3) Update Existing Client

PHARMACY PROFILE

4) Request Drug Profile5) Request DUR6) Enter new Prescription

DIS API

CR APIHL7 (CR)

HL7 (CR)

HL7 (CR)

HL7 v3(CeRx) HL7 v3

(CeRx)

HL7 v3(CeRx)

In this model, each Jurisdiction Infostructure level system uses patient and

other required strong identifiers (e.g., provider, encounter) based on point-of-service generated IDs (e.g., MRNs). The CR-EMPI source systems make the CR-EMPI aware of client identifiers. The point of service applications and Infostructure systems query the CR EMPI for these identifiers in order to access data within any Infostructure System. The level of queries and maintenance of MRNs in the EMPI is not scalable to hundreds or thousands of point-of-service systems. There are performance issues accessing CR/EMPI for every Drug system interaction.

In this model, each Jurisdiction Infostructure level system uses patient and

other required strong identifiers (e.g., provider, encounter) based on point-of-service generated IDs (e.g., MRNs). The CR-EMPI source systems make the CR-EMPI aware of client identifiers. The point of service applications and Infostructure systems query the CR EMPI for these identifiers in order to access data within any Infostructure System. The level of queries and maintenance of MRNs in the EMPI is not scalable to hundreds or thousands of point-of-service systems. There are performance issues accessing CR/EMPI for every Drug system interaction.

CR

AP

I

CR API DIS APIEMPI Query

7) Query patient8) Obtain all related MRNs9) x-ref and join DIS data

EHR Logical Architecture (Not desired)NL Example: Early thinking (No EHR Services)


EHR Data & Services



Common Services

PharmacySystem

Pharmacist

PATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client


EHR API

DrugInformation

SystemRepository

HIA

L

PHARMACY PROFILE


Clinical Portal

Physician

EHR API

HL7HL7


HL7 v3 (CeRx)


In this model, the client registry system “generates” a global unique ID (EHR ID) for patients. The Drug Informaton System (DIS) will use the EHR patient ID to store prescribing and dispensing data. Point-of-service applications query the Client Registry and obtain the EHR patient ID and will use this ID as a token throughout the entire business transaction. This model eliminates the need for communication between the DIS and CR, and reduces the transactions to the CR to one per business transaction.

In this model, the client registry system “generates” a global unique ID (EHR ID) for patients. The Drug Informaton System (DIS) will use the EHR patient ID to store prescribing and dispensing data. Point-of-service applications query the Client Registry and obtain the EHR patient ID and will use this ID as a token throughout the entire business transaction. This model eliminates the need for communication between the DIS and CR, and reduces the transactions to the CR to one per business transaction.

Search / ResolveGet EHR ID

CLIENT REGISTRATION


HL7(CR)

ClientRegistry H

IAL

GenerateEHR

Client ID

HIA

L


Sample EHR Logical Architecture (Interim State)NL Example: Basic EHR Infostructure, CR, DIS)


EHR Data & Services


POINT OF SERVICECommunication BusCommunication Bus

Common Services

HIA

L

PharmacySystem

EHR Data & Services

Pharmacist

PATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client


EHR API

DrugInformation

system

Search / ResolveGet EHR ID

PHARMACY PROFILE


CLIENT REGISTRATION


Clinical Portal

Physician

EHR API

HL7HL7

HL7(CR)


HL7 v3 (CeRx)


In this model, the client registry generates a global unique id (EHR ID) for patients. The DIS will use the EHR patient ID to store prescribing and dispensing data. EHR services will use the CR to map any local MRN found within transactions to the corresponding EHR patient ID. The POS applications do not necessarily have to be aware of the EHR patient ID or they can continue to provide this ID themselves after querying the CR (compatible with prior model).

In this model, the client registry generates a global unique id (EHR ID) for patients. The DIS will use the EHR patient ID to store prescribing and dispensing data. EHR services will use the CR to map any local MRN found within transactions to the corresponding EHR patient ID. The POS applications do not necessarily have to be aware of the EHR patient ID or they can continue to provide this ID themselves after querying the CR (compatible with prior model).

EHR Services

Business Components

DISCR

Dat

a A

cces

s

EHRIndex

ClientRegistry H

IAL

GenerateEHR

Client ID HIA

Lmeans “responds

with”

Sample EHR Logical Architecture (Target State)NL Example: Initial EHR Infostructure (CR, EHR, DIS)


EHR Data & Services



Common Services

Pharmacy System

EHR Data & Services

Pharmacist

EHR API

Clinical Portal

EHR API

HL7



PACS/RIS

LabSystem(LIS)


HL7 HL7 HL7

DrugInformation

System

HIAL

DiagnosticImaging

Repository


HIAL HIAL

EHR Services

Business Components

DISCR

Dat

a A

cces

s

PR

LR

DI-r

JLIS



HL7 v3(CeRx)

HL7 (CR)

HL7 (PR)

HL7 (LR)

HL7

HL7 (DI)

HL7 (Lab)

In this model, the client, provider, location registries and EHR Services generate (respond with) global unique ids for patient, providers, encounters, and other required strong identifiers. All Infostructure systems use these unique Ids to store clinical data about a person. The EHR Services will map any local ID to the corresponding EHR ID. The Domain services (DIS, DI, Lab) systems rely on the EHR Services to ensure that the necessary EHR IDs are provided with every transaction.

In this model, the client, provider, location registries and EHR Services generate (respond with) global unique ids for patient, providers, encounters, and other required strong identifiers. All Infostructure systems use these unique Ids to store clinical data about a person. The EHR Services will map any local ID to the corresponding EHR ID. The Domain services (DIS, DI, Lab) systems rely on the EHR Services to ensure that the necessary EHR IDs are provided with every transaction.

EHR DataRepository

EHRIndex

GenerateEHR

Client ID

ClientRegistry H

IAL

GenerateEHR

Provider ID

GenerateEHR

Location ID

ProviderRegistry H

IAL

LocationRegistry H

IAL

PhysicianOfficeEMR

HL7

EHR API

Physician/Provider

Physician/Provider

HIA



Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability

End

[email protected]

http://www.infoway-inforoute.ca/

allan oas, director of architecture, registries and public health surveillance

Documents

director of architecture

relevant data

source systems

real timeehr data

blueprint model

ehrs services

providers application

integrated viewsdfdfdfdfdfdfd