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The MARC-HI EHR ProjectMohawk Applied Research Centre

Health Informatics

Electronic Health Records

Mark Yendt – Faculty, Electrical and Computer Engineering Technology

mark.yendt@mohawkcollege.ca

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MARC-HI Started at Mohawk College in 2007

Focus on applied research Complementary to academic research performed

by Universities Private sector partnerships essential to

success Results of research can be implemented

into and used to improve existing real-world systems.

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What is EHR? EHR – Electronic Health Record A secure and private lifetime record of an

individual's health and care history, available electronically to authorized health care providers

For example, all Medications, Lab Tests, Diagnostic Imaging Tests and Medical conditions are obtained through a single logical location.

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Why is the EHR important? Healthcare professionals make clinical

decisions based on knowledge Better knowledge translates to better care Knowledge starts with accurate, relevant clinical

information The EHR creates the capability to share

relevant clinical information when it is needed

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EHRs in the Healthcare Industry - Today

A majority of all hospitals have computerized record keeping systems (HIS) –

Detailed data on current episode of care is electronically available

In Ontario, only 8% of family doctors have computerized record keeping (EMR) –

Summary data is mostly kept in paper form No standard interoperability mechanism

is being used to allow all care providers to communicate with each other Some communication services between

different systems has been implemented using a peer-to-peer negotiated protocol

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The Interoperable EHR - Future

Canada Health Infoway is Canada's catalyst for collaborative change to accelerate the use of electronic health information systems and electronic health records (EHRs) across the country

Infoway has designed the Canadian Electronic Health Record Solution (EHRS) Blueprint to support interoperable EHR systems

This "Blueprint" document describes important aspects of the design

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JURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE

(POS)

TerminologyRepository

Ancillary Data& Services

Registries Data& Services

EHR Data& Services

DataWarehouse

ImmunizationManagement

PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging

LaboratoryHealth

Information

Hospital, LTC,CCC, EPR

PhysicianOffice EMR

EHR Viewer

Physician/Provider/

Patient

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security MgmtData

Privacy Data Configuration

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health

Provider

Longitudinal Record Services

HIALCommunication Bus

Common Services

ClientRegistry

ProviderRegistry

LocationRegistry

EHR Infostructure - Conceptual Architecture

Content Source: Canada Infoway, Copyright 2007

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EHRS Blueprint Component Architecture

Designed to use Web Services Jurisdictional implementation envisioned to

use a Service Oriented Architecture (SOA) HL7v3 messaging for communication between

POS systems and Jurisdictions XML to be used as the implementation technology

for the messaging All valid messages defined using XSD (XML Schema

Definition) All encoded data to use standardized data encoding

including LOINC for lab data and SNOMED-CT for Terminology

Ultimate goal is to integrate all 150,000 health care providers across country

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MARC-HI EHR Project Build a Reference implementation of the Canadian

Electronic Health Care Solution. Use the Canada Health Infoway Blueprint as the guiding document

Goals of the reference system include: Providing feedback on effective development strategies to

implementing jurisdictions. Give guidance to the Standards Collaborative Working Groups

(SCWGs) within Infoway to support effective implementations Building a conformance/prototype testing environment to

evaluate interoperability between federated systems Integrate project back into the classroom

get faculty and students involved Making the results available as open source through Open

Health Tools

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Vendor-agnostic tooling To demonstrate interoperability

Toolsets and technologies from many leading vendors are being used in the project

SOA Orchestration Development Microsoft (IIs, Biztalk, VS.NET) Intel (SOA Expressway) Software AG (Web Methods) Sun (JCaps / Open ESB / Java development tools)

Databases Oracle (Oracle 10g database, HTB)

Infostructure Services (HL7v3 compliant tools) Initiate (Client Registry) Orion (Web Viewer)

Security Access Control HIPAAT (Consent Management Software)

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Project Status Project started in September 2007 Initial "get something working timeline" was 4 months

Hospital Discharge Summary Initial Demonstration of the project in January 2008 Satyam joined as a partner to the project

$1 Million project contribution Referral added as part of Phase II. Development of Discharge/Referral integrated with:

Initiate Client Registry Orion Web Viewer CIHI Data warehouse Application

Full Demonstration of Mohawk EHR Project at eHealth 2008 in Vancouver

Current Activities include: Building Lab domain Performance evaluations

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Discoveries Small focused team development is an excellent way to

do a proof of concept design Larger teams that are separated (Mohawk / Satyam

team) require a require more formal development methods.

Mohawk developed Lab Specifications Satyam implemented Specifications Developed system is tested and debugged as a team

HL7v3 is complicated! Many tools have difficulty dealing with the messages Nomenclature is abstract Practical training is difficult to obtain

Training courses in HL7v3 are available, but not always directly applicable or practical to problem

Development of technology to simplifies or hide the complexity of the XML messages.

MARC-HI plans to explore this area in future research

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Challenges Existing systems will need an integration

strategy for message construction. Message / Information mapping Unifying Data code representation (LOINC/SNOMED-

CT) Web Services will need to be integrated with

Legacy systems. Tooling to enable this still requires more

effort.

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Opportunities Opportunities:

Developers - Lack of qualified developers for Canadian projects that will be undertaken in the next few years

New Developers will need Training in terminology, HL7, XML, Web Services Canada is a leading edge adopter of HL7v3

Tool development – Current tools not satisfactory Need tools to support:

Nomenclature translation Simplifying implementation Improved automated testing

Participate in the project at MARC-HI NSERC - College and Community Innovation (CCI)

Program – MARC-HI has been invited to submit a full proposal

MARC-HI is looking for local partners currently working in the healthcare IT

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Project Contributors

ecGroup Inc.

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More Information http://www.mohawkcollege.ca/

marc/hi List of presentations and publications

on site Wiki documents project status and

current development activities Canada Health Infoway

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