integration of the nimis project with the hse …...project deliverables: transformation programme...

NIMIS Integration Spec Document No. 2: Integration of NIMIS with HSE-NCI

NIMIS Integration Specification Document No. 2

Integration of the NIMIS Project with the

HSE-National Client Index Service

NIMIS Integration Spec Document No. 2: Integration of the NIMIS Project with the HSE - National Client Index Service.

Status Draft Date 12.03.09 Author Neil O’Hare Version 1.3 Distribution to: NIMIS Project Team Roisin Doherty (HSE-NCI-Project Manager-ICT) Ivan McConkey (PCRS- ICT Manager) Dougie Beaton (HSE-NCI-Project Manager-Business)

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Introduction

This document outlines the possibility of utilising the identity register currently

maintained and operated by the HSE’s Primary Care Reimbursement Service

(PCRS).as the HSE’s National Client Index (NCI) or Enterprise Patient Master Index

and how the NIMIS project could or may integrate with same.

Requirements for NIMIS Solution Vendors Potential bidders will be expected to review the attached and demonstrate how their

proposed solution would integrate with this approach and identify potential

advantages / disadvantages with this approach, along with possible weaknesses in

the approach. Alternatively bidders can propose an alternative solution that would

yield the required NIMIS project objectives and benefits.


Introduction to the HSE - National Client Index Project In 2007 the HSE commenced the Transformation Programme. Programme 1 - “Develop integrated services across all stages of the care journey” - identified the establishment of a ‘National Client Index’ (HSE-NCI) as a critical enabling project. Subsequently the HSE ICT Strategy identified the HSE-NCI as a key project. The NIMIS programme specified a NCI service as a key requirement. A National Client Index (NCI) is an INDEX which facilitates access to patient records that may be stored in multiple locations and systems. The NCI is established by examining existing client records and building the index using a combination of automated and manual actions using specific client matching criteria. An Enterprise Master Patient Index (EMPI) is the common term used to describe the technology which manages the index. The HSE already operates an Enterprise Master Patient Index system. This system was procured to provide a central client index technology for the HSE. This index is used by the HSE, Finance Shared Service, Primary Care Reimbursement Service (PCRS). PCRS supports the delivery of primary healthcare by providing reimbursement services to primary care contractors for the provision of health services to members of the public in their own community. The diagram below identifies the current patient identification data sources that feed into the HSE-NCI at present.




HSE-NCI’s relation to a Unique Patient Identifier (UPI):

The Department of Health and Children recommended the implementation of a unique identifier in the Health Sector as part of the Health Information Strategy, 2004. This UPI does not need to be in place for the HSE-NCI to be implemented. However, the presence of a UPI would improve the capability of the HSE-NCI to link records from different sources where this UPI is collected by source systems.

NCI (EMPI) Processes and Functionalities

The core services and functions of an NCI are:

• to store and link client identifiers from different data sources across the health system,

• to provide a client footprint in the health system through a record of points of service and service domain encounter points, and

• to provide a Common Identification Service to other systems.



EMPI’s relation to Clinical Systems:

The purpose of the EMPI is to store patient’s demographic data. Patient encounter and visit information is maintained in a service providers information system or client management system or other eHealth applications.


Requirements of NIMIS

The NIMIS project has a number of over-arching objectives. These are:

1) The installation of PACS/RIS solution to deliver a filmless solution for Radiology & Cardiology imaging nationally;

2) To deliver a paperless solution for Radiology including ordering and result reporting;

3) The implementation of Speech Recognition technology for reporting of diagnostic images;

4) To promote and act as a facilitator to the HSE Transformation Programme.

Objectives and Benefits Realisation

As previously identified, the NIMIS project should realise a number of specific objectives and benefits. Some of these are dependant on the correct identification of the patient for optimum realisation. The following tries to identify these objectives and benefits and places a criticality as to their reliance on the HSE-NCI using the following colour coding scheme:

Critically Dependant on the HSE-NCI or equivalent.

Partially Dependant or possible alternative, but not as efficient solution

Project Deliverables: Service Delivery, Efficiencies and Benefits

Ref. Num. Project Deliverable

PD.4 Improved clinical consultation: PD.6 Integration with Radiation Oncology Centres: PD.8 Provision of Out-Of-Hours Cover: PD.9 Cornerstone to development of a full EHR / EPR: PD.11 Improved facilities for academic consultation and teaching: PD.28 Image Transfer Costs: PD.29 Reduced Travel Time

Project Deliverables: System Quality and Patient Risk Issues

The objectives and benefits identified above have a direct impact on service delivery, however there are many benefits that have an impact on the quality of that service



delivery and also facilitate the reduction of many patient risk issues pertaining to medical imaging services.


PD.33 Images follow patient through Care Pathway: PD.34 Patient Data Security: In addition to these benefits / objectives a number of those previously identified as being directly related to Service Delivery also have an impact on Quality and Risk Issues. These are: PD.4 Filmless Hospitals PD.5 Paperless for all Radiology Requests and Results PD.6 Integration with Radiation Oncology Centres PD.9 Cornerstone to the Development of a full EHR / EPR PD.11 Improved Facilities for Academic Consultation and Teaching PD.12 Integration of Radiology and Non-Radiology Imaging PD.13 Improved Access & Availability of Patient Information PD.14 Optimisation of Radiology Reporting PD.15 Increased Clinical Efficiency PD.16 Fewer Repeat Examinations PD.20 Provision of Management Information PD.29 Reduced Travel Time

Project Deliverables: Transformation Programme Needs

Some of the objectives and benefits identified under the Service Delivery and the Quality / Risk headings will have a positive impact on progressing or facilitating the HSE Transformation Programme. These are: PD.4 Filmless Hospitals PD.5 Paperless for all Radiology Requests and Results PD.8 Provision of Out-of-Hours Cover PD.9 Cornerstone to the Development of a full EHR / EPR PD.11 Improved Facilities for Academic Consultation and Teaching PD.33 Images follow the Patient Through their Care Pathway In addition to these, there are a number of additional Benefits in relation to the Transformation Programme.


PD.44 Choice of Treatment Location: PD.45 Aiding Development within Primary Care: PD.46 Facilitate the Progression of the HSE Transformation Programme:



Possible Integration Methodologies with HSE-National Client

Index

The HSE-NCI project is one of the key enabling projects of the HSE’s ICT strategy. The NIMIS project has a requirement for the national unique identification of a patient to realise, in an efficient and safe way, all the identified benefits. Consequently the NIMIS project has been proposed as one of the early adopters of the HSE-NCI strategy. The following identifies possible integration methodologies for the NIMIS project with the HSE-NCI. Work is on-going to clarify the potential for such integration and the consequences of same.

Integration Requirements Work to date has identified a number of aspects that are required to a) facilitate the safe and efficient movement of patient data, and b) to integrate with the HSE-NCI as the EMPI.

• Need the development of both a Content Register and a Consent Register. These are common requirements to multiple applications, not just NIMIS, and really sit better with an EPR implementation.

• To get the level of functionality NIMIS needs, a Content Register is required. The Content Register is a central listing of where and when a patient had images and reports taken and stored. It does not store the actual image and report data, only a pointer / location of this data.

• The Consent Register should form part of the EPR implementation as a general service to multiple applications. It will evolve in complexity and size as additional applications are integrated to the EPR. Three possible interim solutions are: o A Consent Register is developed for the NIMIS implementation, the

developed solution being a “cut-down” version of the full EPR solution. This is possible via a modified “Eligibility Register” within the HSE-NCI solution.

o A Consent Register is not developed, but access to shared images and results is provided only from one hospital sending a “pointer” to the patient’s data to the referral hospital – i.e. they can only see the images they are told about.

o A Consent Register is not developed, but access is left open with inherent system role based access controls. (Note: this method has been utilised in other jurisdictions.)

• The viewing of images and reports from the central data repository / NIMIS repository would normally be carried out via some form of web browser. This solution would allow clinicians to view their patient’s images / reports



• To provide full integration of patient images onto the reporting workstation and into the local PACS/RIS solution (if necessary) would require the implementation of an NCI/EMPI.

• On the PAS side it needs to be determined if the current PAS systems can integrate with the HSE-NCI for NIMIS sites. It would also need to ensure that PAS information from existing PACS sites could be fed to the HSE-NCI for matching. With the current iSoft PAS implementation this identifies three possible integration situations (shown below).

• It is not proposed that a back-population of systems / data with a unique identifier, generated by HSE-NCI, would be performed.

• Re existing image data, it is suggested that we do not do a data take-on from existing long term archives of existing PACS sites. We may look for a trigger mechanism for historical data, once retrieved into a local Short Term Archive, to be copied to NIMIS repository, and consequently into Content Register.

• If a patient does not want their data stored on the local or central system, then such images may need to be printed in hardcopy format and deleted from the system.

• If the patient wishes a radiology episode kept private, then the system should be capable of marking or identifying the episode / images as such and restricting its storage on the central store. A similar situation should exist where images should not be made available on a central store.

InThe following presents

tegration Options three possible integration options between the local PAS

Bi-Directional interface with the HSE-NCI (with look-up

S has no interface with HSE-NCI, but look-up facility available.

here integration with the local PAS is not possible, a further two options are

l-Time look-up / interaction between the NIMIS solution (possibly at the

MIS solution and the HSE-NCI.

system, the HSE-NCI (acting as the NCI / EPMI) and the NIMIS solution. These options are as follows:

1) Local PAS has a2) Local PAS has a Uni-Directional interface with the HSE-NCI

facility) 3) Local PA

Wavailable:

4) ReaCDR level) and the HSE-NCI solution;

5) Batch mode processing between the NI



NOTE: The above options are presented in order of preference for the HSE.




Option 1:

NIMIS - HSE-NCI Integration Option 1

RISPACS VR

Local PACS /RIS System

Image StoreShort Term Archive

Patient Data Store

NCI RegisterConsent Register

PACS/RISArchive

NIMIS Repository

Image Repository - A

Report Repository - A

(4)

PAS/HIS

Local PAS /HIS

(2)

(2)

(5)

(3)

Web Viewer

Thin ClientImage Viewing

Content Register

(7)

(6)

(1)

HSE-NCI

(8)

Process:

(1) Patient arrives at hospital and is registered on local PAS.

(2) Integration between PAS and HSE-NCI to identify patient / create new patient. HSE-NCI number fed back to local PAS and from there to NIMIS.

(3) Entry made in “Consent Register” with data sharing consent of patient recorded

(4) Images acquired on PACS/RIS with details from local PAS. Images / reports sent to NIMIS Repository. HSE-NCI number assigned to all images / patient reports.

(5) Location / identifiers for patient images automatically entered in “Content Register” subject to approval from “Consent Register” - step (6).

(7) Physician in hospital wants to view external images of patient. Utilises web / thin client viewer.

(8) Gets an indication / list of matched images from Content Register – can then view selected images via web interface.


Requirements:

• Interface Spec between PAS and HSE-NCI: Bi-Directional – registration data

passed to HSE-NCI for real-time look-up. If patient identified then HSE-NCI

number fed back to PAS for use in subsequent imaging. HSE-NCI data can

be updated from current registration data.

• Possible additional integration between NIMIS and HSE-NCI to provide

retrospective matching on image data once stored on Central Data / NIMIS

Repository, specifically for older data.

• Identify capability of current or proposed new PAS being modified to take an

additional entry (i.e. HSE-NCI number from HSE-NCI “look-up” process).

Option 2:

RISPACS VR



Patient Data Store

NCI Register

PACS/RISArchive

NIMIS Repository



PAS/HIS

Local PAS /HIS

(2)

Consent Register

(6)

(4)

Web Viewer


Content Register

(6)

(1)

(7)


HSE-NCI



Process


(2) Possible HSE-NCI look-up facility available in hospital that would allow identification of patient based on info in HSE-NCI. - Facilitates auto-matching when data exported to HSE-NCI.

(3) Uni-directional interface between PAS and HSE-NCI to feed registration information to HSE-NCI Register. HSE-NCI number not fed back to PAS, and consequently NIMIS.

(4) Entry made in “Consent Register” with data sharing consent of patient recorded

(5) Images acquired on PACS/RIS with details from local PAS. Images / reports sent to NIMIS Repository. HSE-NCI number NOT assigned to all images / patient reports.

(6) Location / identifiers for patient images automatically entered in “Content Register” subject to approval from “Consent Register” - step (6). If auto-matched, possible assignment of HSE-NCI number to images / reports in NIMIS Repository and “Content Register” (7).


(9) Gets an indication / list of matched images from Content Register – can then view selected images. May also be given list of similar, but un-matched records from which he selects appropriate patient.

Requirements:

• Interface Spec between PAS and HSE-NCI: Uni-Directional – registration data

passed to HSE-NCI for real-time look-up. If patient identified then HSE-NCI

number manually entered onto PAS for use in subsequent imaging. HSE-NCI

data cannot be updated from current registration data.

• Possible additional integration between NIMIS and HSE-NCI to provide

retrospective matching on image data once stored on Central Data / NIMIS

Repository, specifically for older and unmatched data.

• Identify capability of current PAS being modified to take an additional entry

(i.e. HSE-NCI number from HSE-NCI “look-up” process).




Option 3:


HSE-NCI


Patient Data Store

RISPACS VR



PACS/RISArchive

NIMIS Repository Content Register



(4)PAS/HIS

Local PAS /HIS

(2)

(5)

(3)

Web Viewer


(7)

(1)

Process:


(2) Possible HSE-NCI look-up facility available in hospital that would allow identification of patient based on info in HSE-NCI. Demographic / episodic info passed to NIMIS.

(3) No entry made in “Consent Register” with data sharing consent of patient recorded as may not be recorded on exiting PAS and no connection to HSE-NCI from PAS.

(4) Images acquired on PACS/RIS with details from local PAS. Images / reports sent to NIMIS Repository. HSE-NCI number NOT assigned to all images / patient reports.

(5) Location / identifiers for patient images automatically entered in “Content Register” but NOT subject to approval from “Consent Register” as no entry into Consent Register.



(7) Gets an indication / list of matched images from Content Register – can then view selected images. May also be given list of similar, but un-matched records from which he selects appropriate patient. For images acquired at this hospital, will see all images as “Consent Register” interface not applicable.

Requirements:

• Interface Spec between PAS and HSE-NCI: None

• Ability to provide local “look-up” of HSE-NCI in an attempt to identify patient on

EMPI.

• Possible integration between NIMIS and HSE-NCI to provide retrospective

matching on image data once stored on Central Data / NIMIS Repository.

• Identify capability of legacy PAS being modified to take an additional entry (i.e.

HSE-NCI number from HSE-NCI “look-up” process).




Option 4:

RISPACS VR



Patient Data Store


PACS/RISArchive

NIMIS Repository



(4)PAS/HIS

Local PAS /HIS

(2)

(6)

Web Viewer


Content Register

(7)

(8)

(1)

HSE-NCI

(5)


Process:


(2) No HSE-NCI look-up facility available in hospital. Demographic / episodic info passed to NIMIS.

(3) No entry made in “Consent Register” as may not be recorded on exiting PAS and no connection to HSE-NCI from PAS.

(4) Images acquired on PACS/RIS with details from local PAS. Images / reports sent to NIMIS Repository.

(5) NIMIS CDR interacts with HSE-NCI in real-time to identify an HSE-NCI number and assign same to received images / patient reports. If auto-match not possible, local data originating site takes responsibility for patient matching / data correction.

(6) Location / identifiers for patient images automatically entered in “Content Register” but NOT subject to approval from “Consent Register” as no entry into Consent Register.




(8) Gets an indication / list of matched images from Content Register – can then view selected images. May also be given list of similar, but un-matched records from which he selects appropriate patient. For images acquired at this hospital, will see all images as “Consent Register” interface not applicable.

Requirements:

• Interface Spec between NIMIS and HSE-NCI.

• Real-time or rapid batch mode processing on interface.

• Ability to provide local “look-up” of HSE-NCI in an attempt to identify patient on

EMPI.

Option 5:

Similar to Option 4 except that the NIMIS – HSE-NCI interface is on a batch-mode

basis. The frequency of the batch-mode processing will determine the speed of

availability of the images for viewing nationally.

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