1. Infoway Architecture Update
March 2006
Solution Architecture Group

2. Outline Introducing Infoway EHRS Blueprint Scope Business Context
Clinical/Work Process Architecture
System Architecture
Information Architecture
Integration & Deployment Options
Potential Applications
Summary & Conclusion 2

3. What Does Infoway Do? Innovation & Adoption $60M
End User Adoption & Setting the Future Direction
Interoperable EHR $175M
The Electronic Health Record
Drug Information Systems $185M
Laboratory Information Systems $150M
Diagnostic Imaging Systems $220M
Public Health Systems $100M
TeleHealth $150M
Domain Repositories & Healthcare Applications
Client, Provider & Location Registries $110M
Cross Program Foundation Components
Infostructure includes the design of solution architecture, the definition of standards, and the development of integration tools needed to ensure the interoperability of systems
Registries are required to uniquely identify healthcare providers, clients/patients and locations of care
Drug Information Systems enable physicians to view a patient's complete drug profile online, order a prescription electronically and receive notification of drug interactions automatically.
Diagnostic Imaging Systems enable authorized health care providers to view online a patient's test images, such as MRI, and reports, regardless of where the test was conducted and from any location
Laboratory Information Systems enable secure online viewing of patients' lab test results by authorized providers, regardless of where tests were completed
Telehealth is the use of communications and information technology to deliver health care services over large and small distances, including remote and rural areas.
Public Health Surveillance Systems will support the management and control of infectious diseases such as SARS.
Infostructure $125M
Architecture & Standards

4. EHRS Blueprint Scope EHR Implementations across Canada
EHRS BLUEPRINT V1.0 ADDRESSED BUSINESS CONTEXT (Mission, objectives, stakeholders, benefits)
WORK PROCESS
INFORMATION
SYSTEM
TECHNOLOGY
Conceptual
Blueprint V1 Blueprint V2
Blueprint V2
Blueprint V1 Blueprint V2
Logical
Blueprint V2
Blueprint V2
Blueprint V2
Physical
EHR Implementations across Canada

5. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture 5

6. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture 6

7. Business Context 7

8. Healthcare Industry Clients/Patients Planning & Resources Provides $
Ministry of Health
Elected Government
Planning & Resources
Provides $
Planning & Resources
Tax $$$
Health Authority
Health Authority
Health Authority
Homecare
Community Care Center
Emergency Services
Tax Payer
Providers
Clients/Patients
Pharmacy
Specialist Clinic
Hospital Emergency
Laboratory
Diagnostic 8

9. International Industry: IT Spending Comparisons
IT spending as a % of total expenditures
SOURCE: Gartner Group – as reported in the Health Services Restructuring Commission’s ( report: Ontario Health Information Management Action Plan, June 1999

10. Mean Hospital: IT spending in Canada <2%
Canadian IT budgets as a % of total hospital budget
SOURCE: 2003 Report on I.T. in Canadian Hospitals: Top issues, applications and vendors. Canadian Healthcare Technology, CIHI NHex 2002 (Hospital Expenditures)

11. Why an EHR? The World of Healthcare is Changing…
The New World
Patient & family-focused
Wellness
Continuum of care
Disease Management
Demand Management
Collaborative, evidence-based decisions
Effectiveness
Centralized, specialized care
The Old World
Provider-focused
Illness
Site-of-care
Episode Management
Supply Management
Solitary decision making
Efficiency
De-centralized, generalized care
Sales Hint #XX:
There is a difference between encounter
and episode of care and yes, THM is
assisting organizations in changing the
clinical practice behaviour of its providers
Why high cost, high risk - best hit 11

12. Why an EHR? The World of Healthcare is Changing…
The changes in healthcare require significant capability from the health infostructure, capability which does not fully exist today
Sales Hint #XX:
There is a difference between encounter
and episode of care and yes, THM is
assisting organizations in changing the
clinical practice behaviour of its providers
Why high cost, high risk - best hit 12

13. The Timing Has Never Been Better!
WILL
CAPACITY
CONVERGENCE
Public wants more accessibility
Health Authorities recognize benefits
Increased financial pressures
Healthcare professionals embracing technology
Willingness to collaborate
Better infrastructure
More mature application technologies
Will
Patients want more accessibility and optimal quality of care;
Health authorities recognize the need and benefits;
Healthcare organizations are under constant pressures to treat more patients better under fixed budgets;
Healthcare professionals grow more attuned to technologies and understand their value-add;
Overall, there is a desire and a willingness to collaborate and participate.
Capacity
Infrastructures are being deployed and increasingly available.
Networked application technologies are mature and proven.
Capability
Infoway is mandated as a catalyst to support the creation of interoperable EHR solutions;
Expertise exists in Canada to create and deploy the solutions.
CAPABILITY
Political will
Funding is now available
Infoway mandated to pursue investments

14. EHRS Blueprint: Key Definitions14

15. EHR
An 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. 15

16. EHR Solution
The EHR Solution is a combination of people, organizational entities, business processes, systems, technology and standards that interact and exchange clinical data to provide high quality and effective healthcare.
It is made up of:
Mechanisms to find and uniquely identify people, providers and locations
Patient-centric Electronic Health Record (EHR)
Presentation solutions and intelligent agents
Common services and standards to enable integration and interoperability
Workflow and case management
Decision support services
Services to support health surveillance and research
Services to ensure privacy and security
Physical infrastructure to support reliable and highly available electronic communications 16

17. EHR Infostructure
The EHR Infostructure is a collection of common and reusable components in the support of a diverse set of health information management applications. It consists of software solutions for the EHR, data definitions for the EHR and messaging standards for the EHR.
It is made up of:
Registry systems to manage and provide peripheral information required to uniquely identify the actors and resources in the EHR. Specifically, these are patient/person, provider, the location, end users of applications, the terminologies used to describe diseases, acts or others.
EHR domain repositories that manage and persist subsets of clinical data pertinent to the clinical picture of a client. A diagnostic imaging PACS solution is an example of a Domain Repository.
A Longitudinal Record Service to coordinate the patient centric accesses, updates and location of data across multiple domains and registries.
Standardized common services and communication services to sustain the privacy, security and overall interoperability of the different components within the infostructure, as well as to sustain interoperability and a high degree of abstraction between the EHR infostructure and the Point of Service (PoS) applications.
Standardized information and message structures as well as business transactions to support the exchange of information in and out of the EHR;
An EHR viewer as a generic presentation application allowing end-users to access, search and view relevant and authorized clinical data about clients 17

18. Authoritative, reliable, secure, private
EHRS Outcomes
Providers
Relevant data, granular
Real time
Rapid access from multiple locations, anywhere, anytime
Decision support
Clinical reference data
Guidelines & protocols
Common terms & codes
Case management & workflow
Safety
Improved quality of care
Regulation & accountability
Researchers & Health Surveillance Professionals
Appropriately summarized data
Anonymized
Designed for analysis:
Statistical sampling
Trends
Outbreak detection
Outcome analysis
Regional
Pan-Canadian
Authoritative, reliable, secure, private
Payer/Payee
Relevant data to adjudicate claim
Workflow management
Patient/Public/Clients
Convenient, relevant access to accredited health information
Access to relevant personal health information
Safety
Improved quality of care
Public Sector Health Managers
Registry solutions & initiatives
Objective analysis of results & benefits
Management reports
Funding & resource allocation
Policy

19. Key EHRS Architecture Concepts
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
EHRS Locator
Longitudinal Record Services
Health Information Access Layer
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
How does data get into the EHR?
Data is pushed or published into EHR
From source systems
Viewing data in the EHR
Generally from the applications the providers use in their daily context
E.g. primary care doctor EPR applications have means to view and navigate the EHR
Emergency room doctor from the hospital CDR and EHR

20. EHRS Blueprint Recommended Approach: A Pan-Canadian EHR Service
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
Speed
Real-time on read requests: response time under 2 seconds
Near real-time on updates
Legal Assumption - Exchanges of clinical patient information between systems will be achievable at reasonable speeds while applying consent policies as part of privacy and confidentiality rules and regulations
Scalable
From growth in number of source systems
From growth in point-of-care usage
From growth in territory coverage
From growth in surveillance usage
From growth in administrative usage
Reliable (High Availability)
Redundancy: Power, Network, Servers (Application & Database), Disks
Healthy economic balance in HIS vendor industry
It is possible to maintain healthy business dynamics in the HIS vendor industry while insuring the uptake of a central source of EHR data in all provinces;
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS
EHRS

21. EHR Infostructure: Conceptual Architecture
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
POINT OF SERVICE
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry

22. Guiding Principles for EHRS
Patient-centric
Mass customized views of all clinical data
Value add for the provider
Timely, accurate information
Enable sharing at local, regional, cross-jurisdictional
Interoperable, integrated
Standards based
Replicable solution – patterns, components
Leverage legacy systems & solutions
Design for phased rollout with near term results
Scalable
Extensible to support future growth
Cost-effective
Secure & private
Allow for innovation & competition
Comprehensive

23. Generations of EHR Capabilities
Gen 5 The Mentor
Full
Gen 4 The Colleague
Gen 3 The Helper
Functionality
Gen 2 The Documentor
Gen 1 The Collector
Minimal
End of 2009
Source: Gartner (December 2005)
Availability of Products

24. A Few Misconceptions About EHR Solutions
A person’s health data is in only one physical EHR
All data for a person must be in the EHR to have value and generate adoption
A jurisdiction is a province/territory
The EHR is a data warehouse to support research and surveillance
Reality
EHR: an integrated service covering all available EHR Solutions; a client’s record is seen as coming from a single integrated EHR
Quality, safety & effectiveness enhanced with only subsets of clinically relevant data available for sharing
Any geo-political entity mandated to govern the operation of an EHR Solution
The EHR: an information support service available to caregivers in the daily context of care provision work activities

25. Business/Clinical Scope25

26. EHRS Serving Healthcare Service Delivery
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Poin of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
Ancillary Data & Services
Health Information Data Warehouse
Longitudinal Record Services
Health Information Access Layer
EHR Data & Services
Registries Data & Services
Point of Service Application
Point of Service Application
EHR Viewer
Diagnostic
Hospital Emergency
Specialist Clinic
Homecare
Clients/Patients
Community Care Center
Emergency Services
Pharmacy
Laboratory
Diagnostic
Hospital Emergency
Specialist Clinic
Homecare
Clients/Patients
Community Care Center
Emergency Services
Pharmacy
Laboratory

27. Public Health Business Requirements
Focuses on managing health status of populations
Managed and executed through complex network of public/private organizations acting at different levels of the health system (Federal, Provincial/Territorial, Regional, Local, Individual)
Involves:
Research & analysis to identify/define population health programs
Surveillance activities to detect and pro-actively react to potential population health problems
Application of health programs to prevent the appearance and/or dissemination of preventable diseases
Active management of communicable disease outbreaks
Active management of the delivery of health services to individuals in the context public health related programs
Current focus limited to:
Surveillance and detection (focused on human health-related diseases)
Outbreak Management
Public Health Alert Management
Disease Information Dissemination
Immunization Management
Communicable Disease Case Management

28. Integrating Public Health in the Architecture
New services required to support:
Surveillance & Detection: introduces a formal business need for the Health information data warehouse introduced in V2
Outbreak Management: requires the addition of a new category of service called Ancillary Services where a specific service is introduced to address outbreak management
Disease Information Dissemination: introduces the need for a formal terminology registry system that would maintain information about diseases and other key terminologies required for many services of the EHRi
Terminology registry would go beyond simply maintaining to allow for maintenance, dissemination of education, etc. associated with diseases
Public Health Alert Management
Public health disease alert reporting requires use of specific applications also positioned as ancillary services
Public health alerts dissemination relies on terminology registry and HIAL Alerts and Notification services
Immunization Management
Immunization programs and their management requires a specific application that would live under the ancillary services category
Delivery of immunisation would be tracked by the drug information domain as part of the EHR
Communicable Disease Case Management
Delivery of health services in relation with the treatment of a CD case would be tracked by the shared health record and other domains as part of the EHR
Management of a CD case from the perspective of the public health specialists involved in detection and tracking would require a specific application that would live under the ancillary services category

29. Integrating Public Health in the Architecture
Some Public Health business requirements can be sustained by the
existing services of the EHR Infostructure
Public Health Alert Management: HIAL and LRS to provide for mechanism to help with detection & reporting on communicable diseases
Immunization Management: Drug Information Domain is the home of immunisation information as part of the core clinical data in client’s health records. HIAL and LRS to provide mechanisms to communicate the data and coordinate its location and access within the EHRi
Communicable Disease Case Management: CD Cases, from the perspective of the EHR are treated like any other health delivery encounter

30. EHRS Serving Public Health Service Delivery
Immunization “Registry“
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry
Case Management
Reference Management
PHS Data Warehouse Services
Alert Notification Services
Messaging
Content & Knowledge Management
Security & Privacy Services
PHS Systems
Operational data
PHSA CM OM AM
IM*
Other PH System(s)
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, Community, etc… EPR
Physician Office EMR
EHR Viewer
Public Health Surveillance Portal
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider
POINT OF SERVICE
Public Health Providers

31. Telehealth Business Requirements
Telehealth: the use of information & communication technologies to deliver health services in contexts where the providers and clients are in separate locations
Telecommunication infrastructure is a pre-requisite
Telehealth solutions enable health service delivery channels:
Tele-consultations
Tele-education
Tele-homecare
Tele-triage
Videoconferencing stations, communication enabled medical devices
Videoconferencing stations used for training/education
Active or passive monitoring of remote patients for pre-/ post-op procedures, chronic diseases management, etc
Centralized call centers to offer first line delivery of service to clients as part of primary care and emergency response
Scheduling solutions – a key enabler required for the effective use of telehealth service delivery
EHR Infostructures support telehealth applications as per any other Point-of-Service Application

32. EHRS Serving Telehealth Scheduling
Longitudinal Record Services
Common Services
EHRS Serving Telehealth Scheduling
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Provider Registry
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
Terminology Registry
Security Mgmt Data
Privacy Data
Configuration
HIAL
Patient Info
End-user Info
Event History
Clinical Profile
Scheduling
Video Session
Referring Physician Site
Attending Physician Site
TSA Database
Physician/ Provider
Physician/ Provider
POINT OF SERVICE
TSA APPLICATION

33. EHRS Blueprint: Tele-Consultation
EHR INFOSTRUCTURE (EHRi)
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
Live Video-Conferencing Session
Tele-Consultation Devices Data
Local Electronic Medical Record
Telehealth Application
Telehealth Application
Local Electronic Patient Record
Telehealth consultation applications typically involve two or more locations connecting dynamically so that multiple caregivers located in different places can interact through the use of ICTs (Information and Communication Technologies) to provide health services to a client.
Telehealth consultation applications come in many different flavors and are all consider eligible from a technology perspective for Infoway funding.
Telehealth applications will typically include:
Basic multimedia computer hardware including casing, processor, RAM, large capacity hard disk, audio soundcard, microphone, screen, graphics adapters, backup devices, camera, second screen (optional)
Specialized medical devices to conduct remote telehealth based delivery of service (vital signs, ECGs, diagnostic testing, etc…)
Operating system and basic video conferencing software as well as software to interconnect specialized devices and computer
Any case or medical record management software to help caregivers record telehealth session events and any relevant clinical data associated to them
Internet browser for access to Integrated EHR Clinical Viewer
Link to EHR:
As EHR Infostructures get built, caregivers acting in remote locations will be able to access the health records of patients they care for from the remote community health centers where they practice.
In the early days of the EHR, caregivers will be able to access health records information namely for patients that are provided acute and/or specialized care. Namely the patients traveling to access specialized care or testing procedures. Since the information available in EHR Infostructures in the beginning will mostly come from acute care settings as well as private and public labs and diagnostic centers, it is mostly the patients accessing these services that will have valuable information available for viewing.
Telehealth applications, especially the software components as part of a telehealth workstation that handle records keeping, are likely candidates for integration to the EHR infostructure. This would allow telehealth based service delivery events to be recognized as part of the health event index maintained by an EHR for each patient and would also allow any relevant clinical information generated in these telehealth sessions to be recorded and available from the EHR of a patient.
Lutselk’e, NWT
Edmonton, AB 33

34. EHRS Blueprint: Tele-Homecare
EHR INFOSTRUCTURE (EHRi)
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
Local Electronic Medical Record
Homecare Application Server
Tele-Homecare Data Feed
Tele-Consultation Devices
Homecare Client Application
Montreal, QC
Telehealth consultation applications typically involve two or more locations connecting dynamically so that multiple caregivers located in different places can interact through the use of ICTs (Information and Communication Technologies) to provide health services to a client.
Telehealth consultation applications come in many different flavors and are all consider eligible from a technology perspective for Infoway funding.
Telehealth applications will typically include:
Basic multimedia computer hardware including casing, processor, RAM, large capacity hard disk, audio soundcard, microphone, screen, graphics adapters, backup devices, camera, second screen (optional)
Specialized medical devices to conduct remote telehealth based delivery of service (vital signs, ECGs, diagnostic testing, etc…)
Operating system and basic video conferencing software as well as software to interconnect specialized devices and computer
Any case or medical record management software to help caregivers record telehealth session events and any relevant clinical data associated to them
Internet browser for access to Integrated EHR Clinical Viewer
Link to EHR:
As EHR Infostructures get built, caregivers acting in remote locations will be able to access the health records of patients they care for from the remote community health centers where they practice.
In the early days of the EHR, caregivers will be able to access health records information namely for patients that are provided acute and/or specialized care. Namely the patients traveling to access specialized care or testing procedures. Since the information available in EHR Infostructures in the beginning will mostly come from acute care settings as well as private and public labs and diagnostic centers, it is mostly the patients accessing these services that will have valuable information available for viewing.
Telehealth applications, especially the software components as part of a telehealth workstation that handle records keeping, are likely candidates for integration to the EHR infostructure. This would allow telehealth based service delivery events to be recognized as part of the health event index maintained by an EHR for each patient and would also allow any relevant clinical information generated in these telehealth sessions to be recorded and available from the EHR of a patient.
Dieppe, NB 34

35. EHRS Blueprint: Tele-Triage
EHR INFOSTRUCTURE (EHRi)
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
Tele-Triage Application
Personal Health Record Application
Patient Info
End-user Info
Event History
Clinical Profile
Scheduling
Video Session
EHR Viewer
Telehealth consultation applications typically involve two or more locations connecting dynamically so that multiple caregivers located in different places can interact through the use of ICTs (Information and Communication Technologies) to provide health services to a client.
Telehealth consultation applications come in many different flavors and are all consider eligible from a technology perspective for Infoway funding.
Telehealth applications will typically include:
Basic multimedia computer hardware including casing, processor, RAM, large capacity hard disk, audio soundcard, microphone, screen, graphics adapters, backup devices, camera, second screen (optional)
Specialized medical devices to conduct remote telehealth based delivery of service (vital signs, ECGs, diagnostic testing, etc…)
Operating system and basic video conferencing software as well as software to interconnect specialized devices and computer
Any case or medical record management software to help caregivers record telehealth session events and any relevant clinical data associated to them
Internet browser for access to Integrated EHR Clinical Viewer
Link to EHR:
As EHR Infostructures get built, caregivers acting in remote locations will be able to access the health records of patients they care for from the remote community health centers where they practice.
In the early days of the EHR, caregivers will be able to access health records information namely for patients that are provided acute and/or specialized care. Namely the patients traveling to access specialized care or testing procedures. Since the information available in EHR Infostructures in the beginning will mostly come from acute care settings as well as private and public labs and diagnostic centers, it is mostly the patients accessing these services that will have valuable information available for viewing.
Telehealth applications, especially the software components as part of a telehealth workstation that handle records keeping, are likely candidates for integration to the EHR infostructure. This would allow telehealth based service delivery events to be recognized as part of the health event index maintained by an EHR for each patient and would also allow any relevant clinical information generated in these telehealth sessions to be recorded and available from the EHR of a patient.
Sault Ste-Marie, ON
Kingston, ON
London, ON
Oshawa, ON 35

36. Clinical, Business & Socio-economic Drivers for EHR Solutions36

37. Why is Value Created by an EHR Solution?
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
The 5 Rs of the EHR:
The right information
About the right client
Available to the right person
In the right place
At the right time

38. How Is Value Delivered By An EHR?
The value of the EHR for clients, families and their providers increases with the completeness of the information contained as well as the level of standardization of the data
Point of greatest value
Extent of the Care Continuum Involved (PCP office, Hospital, Long Term Care Homecare, etc.)
Natural Referral Area
Value Drivers:
The settings along that continuum that contribute clinical information.
The number of data domains included.
The extent to which the information is accessible across the referral area. The referral area is determined by the unique characteristics and needs of the patient.
The extent to which the data is normalized to a shared and agreed upon set of standards.
Local Care Area
# of Data Domains Included
(Encounter Summaries, Lab, DI, Drugs, etc.)

39. Why Pursue The EHR: Circle of Care
Homecare
Clinic
Emergency Services
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

40. Why Pursue The EHR: Benefits
Homecare
Clinic
Emergency Services
QUALITY
SAFETY
ACCESSIBILITY
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

41. The EHR is a Key to a Renewed Health System!
EHR solutions provide an
opportunity to
Improve the quality, safety, accessibility and timeliness of care for Canadians
Support more informed healthcare decision making, research and management
Improve the efficiency of the healthcare system and reduce costly duplication
Maximize return on IT investments
Achieve standards based solution allowing interoperability 41

42. EHR Key Clinical & Business Requirements
Life-long longitudinal record of clinical data
Allowing private and secured access to data made available in EHR
Focused on clinically relevant data shared beyond organizational boundaries
Support for accurate, complete, timely delivery of information
Shared across multiple organizations, jurisdictions
Adaptive to the future of healthcare delivery in the 21st Century
Requiring ongoing governance and operations management with 24/7 high availability service
Affordable in relation to complexity and size of integration challenges (connecting large numbers health points of service)
Scalable to allow continuous, extensive growth of clinical and $ ROI
More POS applications sourcing data to EHR
More users accessing and using data from EHR
Allowing natural growth of capabilities towards Generation 3 and beyond
Longitudinal View Assumptions
Care provider professionals recognize high value in having access to the longitudinal view of the clinical picture of a patient. Enough so to accept changes towards their use of HIS in every day practice of care. The foremosts benefits must be:
Better information equal better decisions
Saves time – more patient can benefit from care
Reduces potential for error
Reduces costs
Value is tangible and high enough to enable change
Care professionals
Care organizations management and board of directors
Shared across territories Assumptions
Legal - Provincial policies towards privacy and confidentiality (i.e. HIA) will be written in a way that does not prohibit cross-jurisdictional use of clinical data;
Adaptive to future - Assumptions
Net new – Nation wide, province or state wide EHRS do not currently exist in Canada or elsewhere in industrialized countries.
Healthcare delivery constantly evolving: The future of healthcare in Canada incorporates more specialty care centres in large cities while maintaining high levels of service for rural populations. Expected growth of travelling patients, across regions, across provinces.
Specialty care centres – localized expertise in specific domains
Maintain high level of service for rural populations
State of readiness of care providers varies greatly
Internal interoperability enabled and evolving
CDR in early adoption cycle
The state of readiness towards integration and interfaces with a provincial EHR varies greatly. We expect system interfacing solutions to be omnipresent and CDR solutions to still be in early adoption cycles by the time EHR is ready for mainstream deployment.

43. Different Approaches To Achieving EHR43

44. EHR: How Do We Do This? Sharing Information From Multiple Systems
Homecare
Clients/Patients
Clinic
Emergency Services
INTEGRATED VIEW
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

45. Methods of Sharing EHR Information
The “Big Database
in the Sky”
All Point-of-Service (POS) systems share same data store
Broadcast to all or
a logical subset of
systems
Replication of data from one system to all other relevant/ participating POS systems
Every POS system holds same information
The “Big Index in
the Sky”
EHR Index or locator service that holds links to all POS systems where information resides
Each POS system interfaces to other systems
Use of a
shared reference
information source
POS systems populate it
POS systems or viewers reference it
External to the “operational” store

46. Key Factors Affecting How to Share
Sharing creates some very profound issues & requirements
Unique identification of clients, providers, service delivery locations, etc.
Protecting privacy and confidentiality of patients and providers while simultaneously not limiting the ability to deliver appropriate services
Ensuring information is stored, shared securely
Ensuring compatibility of how data is interpreted/understood
Issues the same no matter which model is chosen to share patient identified information
Canadian governance model for healthcare means these issues are F/P/T jurisdictional responsibilities – requirements vary
People increasingly mobile, especially when considering long periods of time
Provider’s confidence in the mechanisms to enable sharing is crucial

47. The Integration Challenge of EHR Solutions47

48. Integrating Heterogeneous Systems
Homecare
Clinic
Clients/Patients
Emergency Services
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

49. Integrating Heterogeneous Systems: Hospital
ADT
Order/ Results
Electronic Patient Record
Specialized Care
Pharmacy
Scheduling
Laboratory
Clinical Data Repository
Radiology PACS
Emergency
Human Resources
Hospital Emergency
Homecare
Clinic
Clients/Patients
Emergency Services
Finance, inventory, payroll
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

50. Integrating Heterogeneous Systems: Hospital
Clinic
Scheduling
Accountiing/ Billing
Electronic Medical Record
Homecare
Clinic
Clients/Patients
Emergency Services
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

51. Canada has approximately 40,000 systems
Locations of Electronic Clinical Data Today: Number of Systems to Integrate
Homecare
Clinic
Clients/Patients
Emergency Services
Canada has approximately 40,000 systems
Community Care Center
Pharmacy
Specialist Clinic
Laboratory
Hospital Emergency
Diagnostic

52. Integrating Health Information Systems: Key Challenges
Protecting Privacy
Governance, accountability & data custodianship
Controlling access
Managing & applying consent directives
Controlling feeds and queries to the data
Trust relationships & contracts
Existence & availability of data
Discovery capability
Availability in electronic format
Timeliness
Harmonization
Data structures (format)
Vocabularies (encoding, normalization)
Semantics
Heterogeneous technology environments
Number of organizations, connection points & systems
Costs inherent to integration

53. EHRS Blueprint Recommended Approach: The Cost of Integration As A Key Driver53

54. Integrating Health Information Systems: Point-to-Point Connectivity
SYSTEMS TO CONNECT
Appl 1
App 1
App 1
Appl 2
Costs basis
Cost of one integration
Simple = $32K; Medium = $95K; Complex = $190K
Futile approach
38,783 systems in Canada
Simple = 4,527; Medium = 20,081; Complex = 14,175
1.5 B integration points
B $CDN
App 1
Contracts 2
App 1
SYSTEMS TO CONNECT
Appl 1
App 1
App 1
App 1
Appl 2
Appl 3
App 1
App 1 6
SYSTEMS TO CONNECT
App 1
Appl 1
App 1
App 1
App 1
Appl 2
App 1
We need a different approach
App 1
Appl 3
App 1
App 1
App 1
Appl 4
App 1 12
Interfaces = N (N-1)

55. Integrating Health Information Systems: Hospital Networks Approach
SYSTEMS TO CONNECT
Appl 1
App 1
App 1
Appl 2
Costs basis
Cost of one integration
Simple = $32K; Medium = $95K; Complex = $190K
Hypothesis
1,126 Hospital networks, each includes 71 systems to integrate and group (EAI) in 44 points of integration
1,892 (44 x 43) integrations per network totalling 2.1 M (1,126 x 1,892) integrations in Canada
Assuming existence of standardized protocol for interfaces
M $CDN (if Simple – 32K)
M $CDN (if Medium – 95K)
App 1
Contracts 2
App 1
SYSTEMS TO CONNECT
Appl 1
App 1
App 1
App 1
Appl 2
Appl 3
App 1
App 1 6
SYSTEMS TO CONNECT
App 1
Appl 1
App 1
App 1
App 1
Appl 2
App 1
App 1
Appl 3
App 1
App 1
App 1
Appl 4
App 1 12
We need a different approach
Interfaces = N (N-1)

56. Integrating Health Information Systems: EHRS Blueprint Approach
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
Costs basis
Cost of one integration
Simple = $32K; Medium = $95K; Complex = $190K
Hypothesis
All hospitals/long term care organizations use an integration engine and count as 1 integration point
Simple = 4,575; Medium = 8,134; Complex = 6,597
19,306 integration points
Assuming existence of standardized interface and protocols
2.170 M $CDN

57. Rational for Recommended Approach
Only cost effective scenario to handle degree of application integration required
Maximized ability to deliver proper response time and consistent access to data across thousands of source systems
Maximized ability to apply privacy and security policies in a harmonized and consistent fashion
Enables evolutionary path to semantic harmonization of health information across service delivery points
Enables high degree of scalability from local health services integration, to regional, provincial or territorial and cross-jurisdictional
Enables high degree of flexibility in reconfiguration of health services delivery networks

58. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture 58

59. EHRS Work Process Architecture
The EHR Clinical Reference Framework: Life of the Lamberts
Depiction of the use of an EHR Solution in different contexts of health service delivery
14 different storyboards created
Extensible by adding new use cases
System or security administration use cases not represented
Life of the Lamberts
Patient centric framework
Focused on different members of a family and their health status evolution
Focused on health related events
Represented with UML use case notation
Developed under Magic Draw case tool
Published as artefacts under the Artefact Repository
Available in HTML and PDF format
Available in Magic Draw format and XMI for upload to other case tools

60. EHRS Reference Architecture
HIAL
Comm Step Put New Patient
Life Of The Lamberts
POS APPLICATION
SIGNIFICANT REUSE HERE
Encounter
COPD Storyboard
Encounter
Clinical Activity
Clinical Events
EHR IP
Add New Patient
New Family Physician Activity
New Family Physician Activity
Clinic Visit Admission
Storyboard
EHR IP
Storyboard
Clinical Activity
Clinical Events
EHR IP
Clinical Events
EHR IP
EHR IP
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider
POINT OF SERVICE
EHRS Reference Architecture 60

61. Documenting EHRi Services Requirements
Longitudinal Record Services
Common Services
Documenting EHRi Services Requirements
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
HIAL
Provider Registry
HIAL
HIAL
HIAL
HIAL
HIAL
HIAL
HIAL
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
HIAL
Terminology Registry
HIAL
HIAL
Security Mgmt Data
Privacy Data
Configuration
HIAL
HIAL
HIAL
IP “Put”
IP “List”
IP “Get”
IP “List”
IP “Get”
EHR IP Data
EHR IP Data
EHR IP Data
EHR IP Data
EHR IP Data
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
Hospital, LTC, CCC, EPR
Physician Office EMR
Physician Office EMR
EHR Viewer
EHR Viewer
POINT OF SERVICE
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider
EHRS Reference Architecture

62. People Use Cases: Caregiver Perspective
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
First class of deliverables are contextual & informational
They describe the end-user functional requirements and assumptions for use of an EHR Solution
Establish when POS applications expected to interact with an EHRi in the context of daily work activities for caregivers
Infoway not attempting to document all forms of potential uses of an EHR
Scope is broad enough to cover large spectrum of healthcare and public health service delivery to achieve representative set
Security Mgmt Data
Privacy Data
Configuration
HIAL
Communication Bus
Common Services
EHR INTERFACE REQUIREMENTS DOCUMENTATION
Life of the Lamberts
Storyboards
Encounters
Clinical Activities
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Public Health Provider
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider
POINT OF SERVICE

63. EHR Interoperability Profile (EHR IP)
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Second class of deliverables normative; specify the interfaces between POS applications and EHR
Establishes a language to describe types of service requests made to an EHRi
Positions which data to be exchanged by referring to data views of the data model
Assumes SOAP-based web services calls where XML encoded HL7 V3 message requests and responses are carried between POS applications and the EHRi
HIAL
EHR INTEROPERABILITY PROFILE
EHR IP
Communication Steps
POINT OF SERVICE
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider

64. EHR Infostructure IP (EHR I-IP)
Common Services
EHR Infostructure IP (EHR I-IP)
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Business Rules
EHR Index
Message Structures
Normalization Rules
Longitudinal Record Services
Client Registry
Provider Registry
Location Registry
Terminology Registry
INFOSTRUCTURE INTEROPERABILITY PROFILE
Infostructure IP
Infostructure Services Catalogue
Generic Interface Specification
Security Mgmt Data
Privacy Data
Configuration
HIAL
POINT OF SERVICE
Third class of deliverables normative; specify inner workings within EHR Infostructure to orchestrate and process transactions
Express sequencing of activities to process transactions
Express expected capabilities of services within an EHRi to process transactions

65. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture 65

66. EHR Infostructure: Services Drill-Down
Longitudinal Record Services
Common Services
EHR Infostructure: Services Drill-Down
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Provider Registry
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
Terminology Registry
Security Mgmt Data
Privacy Data
Configuration
HIAL
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Public Health Provider
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider
POINT OF SERVICE

67. EHR Infostructure: Standards Based Connectivity
Longitudinal Record Services
Common Services
EHR Infostructure: Standards Based Connectivity
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
HIAL
Provider Registry
HIAL
HIAL
HIAL
HIAL
HIAL
HIAL
HIAL
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
HIAL
Terminology Registry
HIAL
HIAL
Security Mgmt Data
Privacy Data
Configuration
HIAL
HIAL
HIAL
EHR SCP Standards
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP Standards
EHR IP Standards
EHR IP Standards
EHR IP Standards
EHR IP Standards
EHR IP Standards
EHR IP Standards
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
POINT OF SERVICE
Public Health Provider
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider

68. EHR Infostructure: Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Communication bus
COMMUNICATION BUS
MESSAGING
Transformation Services
Routing Services
Encrypt/Decrypt
Services
En/Decoding
Parser Services
Serialization Services
PROTOCOL
App Protocol Services
Network Protocol Services

69. EHR Infostructure: Common Services
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Security Mgmt Data
Privacy Data
Configuration
Common Services
COMMON SERVICES
INTEROP
Interoperability Services
Search/Resolution Services
INTEGRATION
Service Catalogue Services
Broker Services
Mapping Services
Queuing Services
CONTEXT
Session Mgmt Services
Caching Services
Identity Protection Services
Identity Mgmt Services
Anonymization Services
User Authentication Services
Consent Directives Mgmt Services
Encryption Services
Access Control Services
Secure Auditing Services
Digital Signature Services
General Security Services
SUBSCRIPTION
Alert/Notification Services
Pub/Sub Services
MANAGEMENT
Management Services
Configuration Services
GENERAL
Auditing Services
Log Mgmt Services
Policy Mgmt Services
Exception/Error Handling Services
PRIVACY & SECURITY

70. EHR Infostructure: Longitudinal Record Services
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Business Rules
EHR Index
Message Structures
Normalization Rules
Longitudinal Record Services
LONGITUDINAL RECORD SERVICES
DATA
Key Mgmt Services
ETL Services
BUSINESS
Data Quality Services
Domain Business Components (Registries, EHR, Domains, User, Context)
EHR Index Services
Orchestration Services
Normalization Services
Business Rules Services
Assembly Services
Data Services
Replication Services

71. EHR Infostructure: Longitudinal Record Services
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Business Rules
EHR Index
Message Structures
Normalization Rules
Longitudinal Record Services
The EHR Index maintains a sequential list of all events that affect the clinical picture of a client. It also provides the location where the data relevant to each event is kept in the EHRi. It can be used to retrieve the history of events for a client or to trace the information about a specific event.
LONGITUDINAL RECORD SERVICES
DATA
Key Mgmt Services
ETL Services
BUSINESS
Data Quality Services
Domain Business Components (Registries, EHR, Domains, User, Context)
EHR Index Services
Orchestration Services
Normalization Services
Business Rules Services
Assembly Services
Data Services
Replication Services
EHR INDEX
Event ID (Instance ID of an event)
Parent Folder ID
Focal Class Type
Focal Act Subject (Client ECID)
Focal Act Author (Provider)
Focal Act Service Delivery Location
Focal Act Timestamp
Focal Act Status
Focal Act Language
Focal Act Type:
Act Mood (e.g. Order Request)
Act Class Code (type of class, e.g. Lab order)
Act Code (Class value, e.g. CBC)
Focal Act Source ID (ID provided by POS)
Focal Act Template ID
Focal Act Data Location ID (URI)

72. EHR Infostructure: EHRS Locator Data
CROSS-JURISDICTIONAL INFOSTRUCTURE
EHRi Client ID (resolved ECID)
CR instance ID (OID root)
EHRi instance ID (which instance of an EHRi)
EHRi URI (the URI to access the HIAL)
Optimized for performance
Information type (drug, lab, DI) (derived from HL7 act classes)
First created date
Last updated date
EHRS Locator
JURISDICTIONAL INFOSTRUCTURE
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
POINT OF SERVICE

73. Centralized Service Approach
CROSS-JURISDICTIONAL INFOSTRUCTURE
EHRS Locator
JURISDICTIONAL INFOSTRUCTURE
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
POINT OF SERVICE
Jurisdiction A
Jurisdiction B
Jurisdiction C

74. Distributed Service Approach
CROSS-JURISDICTIONAL INFOSTRUCTURE
EHRS Locator Synchronization
EHRS Locator
EHRS Locator
JURISDICTIONAL INFOSTRUCTURE
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Longitudinal Record Services
Health Information Access Layer
POINT OF SERVICE
Jurisdiction A
Jurisdiction B
Jurisdiction C

75. EHRS Locator: LRS Integrated Approach
Longitudinal Record Services
CROSS-JURISDICTIONAL INFOSTRUCTURE
EHRS Locator
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Provider Registry
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
Terminology Registry
HIAL
POINT OF SERVICE

76. LRS Integrated Services Approach
CROSS-JURISDICTIONAL INFOSTRUCTURE
Client Registry Synchronization
JURISDICTIONAL INFOSTRUCTURE
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
EHR Viewer
Point of Service Application
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Longitudinal Record Services
Health Information Access Layer
Registries Data & Services
Registries Data & Services
Registries Data & Services
POINT OF SERVICE
Jurisdiction A
Jurisdiction B
Jurisdiction C

77. EHR Infostructure: EHR Data Domain Services
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
SHARED HEALTH RECORD
DATA
Key Mgmt Services
BUSINESS
Domain Business Components (Registries, EHR, Domains, User, Context)
Normalization Services
EHRi Interoperability Services
Business Rules Services
Assembly Services
Data Services

78. EHR Infostructure: EHR Viewer
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
EHR Viewer
Physician/ Provider
EHR VIEWER
EHRi Interoperability Services
EHR Viewer Business Objects Components
Normalization Services
End-user Navigation Services
Business Rules Services
End-user Display Services
Data Services

79. EHR Infostructure: Client Registry
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Provider Registry
Location Registry
Terminology Registry
HIAL
POINT OF SERVICE

80. EHR Infostructure: Why A Client Registry?
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Provider Registry
Has Mr. Lambert had any ER visits since I’ve last seen him
one year ago?
Location Registry
Terminology Registry
HIAL
EHR Viewer
Physician/ Provider
Patient Info
End-user Info
Visit History
Drug Profile
Laboratory
Diagnostic Imaging
POINT OF SERVICE
EHR VIEWER

81. EHRi Client Registry: The Challenge
EMPI
1: A 123 Robert Lambert 1 Main St
1: B 456 Bob Lambert 1 Main St
1: C 789 Robert Lambert 1 Main St
1: C 987 Robert Lambert 1 Main St
2: B 444 Robert Lambert 2 Elm St
Pharmacy A
Lab B
??? C
123 Robert Lambert 1 Main St
456 Bob Lambert 1 Main St
444 Robert Lambert 2 Elm St
789 Robert Lambert 1 Main St
987 Robert Lambert 1 Main St

82. EHRi Client Registry: What Data?
The generation (or sourcing) of the EHRI Client Identifier (ECID) is a service offered by the Client Registry.
The ECID is the foundation for interoperability both locally and across EHR Infostructures.
Name
Birthdate
Gender
Address
Phone
SIN
ULI
ECID
MDR ID
Lab ID
Eligibility status
Coverage details
Static, natural person identity information
Dynamic, natural person identity information
Static, artificial person-identifying information
Dynamic, artificial person-identifying information
Core system data about the person

83. EHRi Client Registry: Interoperability Pattern
JURISDICTIONAL
ECID: J1 Root ID. Client ID
ECID: J2 Root ID. Client ID
Client Registry J1
Client Registry J2
Active synchronization of travelling clients only
Client Registry J1.1
Client Registry
J1/2
Applications
Applications
REGIONAL

84. EHR Infostructure: Provider Registry
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Client Registry
Provider Registry
Location Registry
Terminology Registry

85. EHR Infostructure: Why A Provider Registry?
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
POINT OF SERVICE
HIAL
Client Registry
Provider Registry
Location Registry
Terminology Registry
Have any new test results been published for me?
EHR Viewer
Physician/ Provider
Patient Info
End-user Info
Visit History
Drug Profile
Laboratory
Diagnostic Imaging
EHR VIEWER

86. Provider Registry: Data Sources
JURISDICTIONAL
Doctors
Dentists
Unlicensed Providers
EHR SCP Standards Provider Registry
Provider Registry
EHR SCP Standards Provider Registry
Applications
Applications
Applications
REGIONAL

87. Standards-based Solutions: What Does It Mean?87

88. Interoperable EHR Solutions: Key Architectural Requirements
Standardized Architecture
Standardized Interfaces
Standards-based Solutions
Standardized Data Structures
Standardized Data Vocabularies (encoding rules)
Standardized Functional Behaviour 88

89. Standards-based Solutions
Why Standards?
They facilitate information exchange; are a critical foundation for EHR
They create opportunity for future cost reduction as vendors and systems converge on pan-Canadian and international standards
They ease effort required for replication
Mandatory Investment Eligibility Requirements
Compliance to standards (infostructure, architecture)
Initiatives must comply with existing guidelines or standards adopted by Infoway
Where standards or guidelines do not exist, projects must support longer-term interoperability and congruence of solutions
Infoway’s role is to set standards and requirements for robust, interoperable products and outcomes

90. Principles for Establishing Pan-Canadian EHRS Standards
Infoway has created Principles for Establishing pan-Canadian EHRS
Standards to provide guidance in the adoption of standards-based solutions
11 Principles – accessible via Infoway Knowledge Way
Business-driven
Adoption of existing standards where ever possible

91. Principles for Establishing Pan-Canadian EHR Standards
Standards initiatives to be driven by the business of healthcare with a clearly defined business need
Existing standards work must be leveraged wherever possible and practical with an approach that includes adoption, or adaptation of existing standards, before development
Health Level 7 V3 messaging standard required for all new message development related to EHR
Infoway investments predicated on a commitment to implement pan-Canadian EHR standards
Standards to be established, tested, refined and evaluated within the context of early adopter implementations
Infoway will support early adopter investment projects that have the establishment of pan-Canadian standards as their goal
Summary only – 18 principles

92. Principles for Establishing Pan-Canadian EHR Standards
Establishing standards is an evolutionary process and will not be perfect the first time; implementation of standards that are not fully balloted may be needed
Infoway is committed to supporting Canada’s leadership role in influencing EHR international standards
Infoway will work with other countries undertaking similar EHR initiatives to leverage their work and bring synergies to the projects as they move toward internationally balloted standards
Infoway will partner with CIHI, HL7 Canada, IHE Canada and other standards organizations in the establishment of pan-Canadian EHR standards
Establishment of pan-Canadian EHR standards is coordinated via an open, transparent and inclusive Stakeholder Collaboration Process as defined by our stakeholders
Summary only – 18 principles

93. Standards Collaboration Process (SCP)
An integral element of and key requirement for the establishment of a pan-Canadian interoperable Electronic Health Record (EHR)
The EHR Standards Collaboration Process includes those jurisdictions, standards-related organizations, healthcare professionals and vendors that will build, operate and use an interoperable EHR
The EHR Standards Collaboration Process will establish pan-Canadian standards for Infoway investments through collaboration and consensus
GOVERNANCE
EHR Standards Steering Committee
Pan-Canadian EHR Standards Advisory Committee
PAN-CANADIAN DEVELOPMENT
Interoperable EHR
Telehealth
STRATEGIC COLLABORATION/COORDINATION
Lab
Diagnostic Imaging
Infostructure/EHR
Expert Working Groups
Drugs
Registries
Infostructure
Pan-Canadian Standards working groups

94. Pan-Canadian EHR Standards: Status
Pan-Canadian Standards
Groups
Drugs
Client Registry
Provider Registry
DI/Tele-radiology
Laboratory
Clinical Terminology
iEHR Technical Standards (coming soon)
iEHR Clinical Standards (coming soon)
Public Health (coming soon)
Program Projects
EHRS Blueprint V1
EHR Data Definition & Standards
Standards Collaboration Process
Standards Tactical Plan
Artefacts Repository
Telehealth ISO Interoperability
Telehealth CCHSA Accreditation
CeRx (formerly Rx5) HL7 V3 Messaging
Client Registry
Provider Registry
IRIS (Infoway Reference Implementation Suite)
Laboratory Nomenclature & Messaging
NeCST: electronic claims messaging
EHR Clinical Terminology Integration
EHR Profiles for Interoperability between DI, Registries & Consumers
EHR Blueprint Evolution Project
Privacy & Security Architecture Project
Health Surveillance
Telehealth
Lab
Diagnostic Imaging
Drugs
Registries
Interoperable EHR

95. EHR Infostructure: Standards-based Connectivity
Registries Data & Services
POINT OF SERVICE
Ancillary Data & Services
EHR Data & Services
Data Warehouse
JURISDICTIONAL INFOSTRUCTURE
Physician/ Provider
Lab Clinician
Radiologist
Pharmacist
Public Health Provider
EHR IP
EHR IP Standards
EHR SCP Standards
HIAL
Architecture Standards
EHRS Blueprint
EHR Use Cases
EHR Data Model
EHR Services Model
EHR Interoperability Profiles
Terminology Standards
CTI project (underway)
Terminology implemented in data messaging standards
Data Messaging Standards
Client Registry (in ballot)
Provider Registry iIn ballot)
Pharmacy CeRx (in ballot)
Laboratory (in Planning)
Diagnostic Imaging/Teleradiology (in planning)
iEHR Clinical Messaging (in planning)
iEHR Technical Standards(in planning)
Public Health Services Standards
Public Health Surveillance Standards

96. Service-oriented Architecture (SOA): What Does It Mean?96

97. Level of Encapsulation Can Vary: Five Normal Forms of Encapsulated Software1 2 3 4 5
External access
Other data
Own data
Encapsulated software
Programmatic interface
Overloaded, incomplete; any data
One complete function; any data
Own data only
Exclusive data
Opaque data
Source: Gartner

98. SOA as an Enabler Applications of SOA in EHRi Solutions
Repurposed legacy applications to offer services as part of SOA-based EHR Infostructure
New breed of services to enable coordinated transactions in an EHR Infostructure (e.g. Longitudinal Record Services)
Use of commercially available solutions to enable components of EHR Infostructure
Two Degrees of Separation
Services exposed outside of an EHRi in the form of supported EHR Interoperability Profiles for an entire Infostructure perceived as a single system with transactional services
Services within an EHR Infostructure to optimize scalability, maintainability and functional flexibility

99. First Degree: The EHR Service
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
POINT OF SERVICE
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry
EHR SERVICE
Get Client ID Resolution
List Laboratory Orders
Get Laboratory Result
List Laboratory Results
Get Prescription
List Medications
Stream DI Image
List DI Results
Get DI Report
Get Outbreak Case Data
List CD Report Events
Get Provider Information
List Service Delivery Locations
List Encounter Events
Get Encounter Summary
Get Clinical Dashboard
Get Client Demographic

100. Second Degree: Inside The EHR Infostructure
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
POINT OF SERVICE
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry
EHRi SERVICES
CR Services
PR Services
LR Services
Terminology Services
Detection & Reporting Services
Shared Health Record Services
Drug Services
DI Services
Lab Services
Normalization Services
Assembly Services
A & A Services
Brokering Services
Consent Services
Session Services
Logging Services
Outbreak Services
Rules Services
Orchestration Services
EHR Index Services
Any Point-of-Service Application
EHR IP

101. Functioning Principles
101

102. Functioning Principles/Rules
Home/no-home EHR
EHRi Identifier Management
EHR Index
EHRS Locator
POS to EHRi interface
Level of transparency of EHR to POS applications
Transaction scope
Trust Models valid for an EHRi
Normalization
Auditing, logging, use of logs
HL7 V3 (Messaging and templates)
Level of parameterization
Primary Purpose for EHRi repositories
Other uses of the HIAL (POS to POS)
Multilingual capabilities
Runtime environment
Performance principles – targets
POS Integration environment
Error Handling
Consent
Authentication & Authorization
OIDS as a principle
Prospective Events

103. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture
103

104. EHRi Conceptual Data Model
Governance
Event Linkage
Event
Role
People
Resource
Environment
Place
Capability
High-level model representing generalized concepts
Event driven model to represent instances of clinical service impacting a patient record
Broad range of event typing – governance, people playing roles, delivery, environment, resource
Derived from the Canadian conceptual health data model (CCHDM)
Aligned and mapped to HL7 V3 RIM
Mapped against several local and international EHR data models – Quebec, Alberta, Ontario, Australia, etc.
More detailed views available – transactional views, domain views

105. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture
105

106. HIAL Integration Layer: Evolutionary Path
106

107. Interim State: No EHR Services (Undesirable)
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.
Interim State: No EHR Services (Undesirable)
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
EHR Data & Services
Client Registry
Drug Information System Repository
CR API
CR API
DR API
HL7 (CR)
HL7 v3 (CeRx)
Search/Resolve
Client Registration
1) Search client
2) Create new client
3) Update existing client
Pharmacy Profile
4) Request drug profile
5) Request DUR
6) Enter new prescription
PATIENT ENCOUNTER
Client Registration
Search client
Create new client
Update existing client
Pharmacy Profile
Request drug profile
Request DUR
Enter new prescription
Need a “walk-through” description
“Source Systems” to the CR not shown, but assumed to be primary or key point-of-service and claims/insurance systems
Drug Info System Repository contains community pharmacy system client identifier numbers or its own internal client ID numbers in this scenario
What is a “Clinical Portal”, and for what Physicians (hospital or community or both?)
HL7 v3 (CeRx)
Pharmacy System
CR API
DR API
EHR Viewer
CR API
DR API
HL7 (CR)
Pharmacist
Physician
POINT OF SERVICE

108. Interim State: HIAL Without LRS
The Client Registry system “determines” 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.
Common Services
Interim State: HIAL Without LRS
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Client Registration
1) Search client
2) Create new client
3) Update existing client
EHR Data & Services
Search/ Resolve
Client Registry
Drug Information System Repository
Get EHR ID
HIAL
HIAL
HL7 v3 (CeRx)
HL7 (CR)
Pharmacy Profile
4) Request drug profile
5) Request DUR
6) Enter new Prescription
Determine EHR Client ID
HIAL
Security Mgmt Data
Privacy Data
Configuration
HIAL
PATIENT ENCOUNTER
Client Registration
Search client
Create new client
Update existing client
Pharmacy Profile
Request drug profile
Request DUR
Enter new prescription
Pharmacy System
HL7
HL7
EHR Viewer
EHR IP
EHR IP
Pharmacist
Physician
POINT OF SERVICE

109. Interim State: HIAL Without LRS
The Client Registry determines 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 client ID. The POS applications do not necessarily have to be aware of the EHR client ID or they can continue to provide this ID themselves after querying the CR (compatible with prior model).
Common Services
Interim State: HIAL Without LRS
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Client Registration
1) Search client
2) Create new client
3) Update existing client
EHR Data & Services
Client Registry
Search/Resolve
Get EHR ID
HIAL
Drug Information System Repository
HL7 (CR)
HL7 v3 (CeRx)
Longitudinal Record Services
HIAL
Business Components
EHR Index
Data Access
Determine EHR Client ID
Pharmacy Profile
4) Request drug profile
5) Request DUR
6) Enter new Prescription
CR API
DR API
Security Mgmt Data
Privacy Data
Configuration
HIAL
PATIENT ENCOUNTER
Client Registration
Search client
Create new client
Update existing client
Pharmacy Profile
Request drug profile
Request DUR
Enter new prescription
Pharmacy System
HL7
HL7
EHR Viewer
EHR IP
EHR IP
Pharmacist
Physician
POINT OF SERVICE

110. Target State: Full Featured EHR Infostructure
The client, provider, location registries and EHR Services determine (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.
Target State: Full Featured EHR Infostructure
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
POINT OF SERVICE
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry

111. EHRS Infostructure: Deployment Models
111

112. Large & Medium Deployment Models
Common Services
Communication Bus
Client Registry
Provider Registry
Laboratory Repository
Drug Repository
Larger size Jurisdictions
Provincial Client and Provider and Location Registries
Provincial Lab, Drug Repositories and HIAL
Supra-regional LRS, Shared Health Record and DI Repositories and EHR Viewer
EHRS Locator across regions
Local EMR, CIS and other applications
REGIONAL/ JURISDICTIONAL
REGION 1
Longitudinal Record Services
REGION 2
Longitudinal Record Services
DI Repository
Shared Health Record
DI Repository
Shared Health Record
HAIL
LOCAL/REGIONAL
CIS
EHR Viewer
EMR
CIS
EMR
EHR Viewer
Common Services
Communication Bus
Client Registry
Provider Registry
Laboratory Repository
Drug Repository
Medium size Jurisdictions
Provincial Client and Provider and Location Registries
Provincial Lab, Drug, DI, Shared Health Record, LRS, HIAL and EHR Viewer
EHRS Locator across Provinces
Local EMR, CIS and other applications
Longitudinal Record Services
REGIONAL/ JURISDICTIONAL
Shared Health Record
DI Repository
HAIL
LOCAL
CIS
EHR Viewer
EMR

113. Small Jurisdictions HIAL
Common Services
Longitudinal Record Services
Communication Bus
Small Jurisdictions
PROVINCIAL
Client Registry
Provider Registry
DI Repository
Shared Health Record Drug/Lab
HIAL
LOCAL
CIS
EHR Viewer
EMR
Provincial Client, Provider & Location Registry
integrated hospital CIS solution fulfilling the roles of the Provincial EHR Services, Laboratory and Drug services
Provincial DI Service
Provincial HIAL & EHR Viewer
Local physician office systems & other CIS connect as POS Systems
This is based somewhat on the iEHR discussion with Yukon Territory, however their plans are not yet complete.

114. Model 1: Single EHR Infostructure
Longitudinal Record Services
Common Services
PROVINCIAL
Communication Bus
Registry & Data Services
EHR Data & Services
Client registry
Provider Registry
Location registry
Terminology Registry
Drug Information
EHR Data & Services
Shared Health Record
Diagnostic Imaging
Laboratory
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
HIAL
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
POINT OF SERVICE
Public Health Provider
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider

115. Model 2: Shared EHR Infostructure
Common Services
PROVINCIAL
Communication Bus
Registry & Data Services
EHR Data & Services
Client registry
Provider Registry
Location registry
Terminology Registry
Drug Information
REGIONAL
Longitudinal Record Services
Longitudinal Record Services
REGION 1
REGION 2 …
Shared Health Record
Diagnostic Imaging
Laboratory
Shared Health Record
Diagnostic Imaging
Laboratory
Shared Health Record
Business Rules
EHR Index
Message Structures
Normalization Rules
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
HIAL
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
POINT OF SERVICE
Public Health Provider
Pharmacist
Radiologist
Lab Clinician
Physician/ Provider
Physician/ Provider
Physician/ Provider

116. Model 3: Distributed EHR Infostructures
PROVINCIAL
Registry & Data Services
EHR Data & Services
Client registry
Provider Registry
Location registry
Terminology Registry
Drug Information
POINT OF SERVICE
EHR Data & Services
REGIONAL
POINT OF SERVICE
EHR Data & Services
REGIONAL
POINT OF SERVICE
EHR Data & Services
REGIONAL
Region 1
Region 2
Region X
Least leverage
Most leverage
No solution
Different specification
Different standards
Specification & standards
Data model
Business process
Business rules
User Interface
Same solution
Use shared service
Reuse drives down cost, accelerates timelines, reduces risk and enables interoperability

117. Registry & Data Services
Business choices?
Who, where, when, what
Clinical value
Adoption
Solution development choices?
Services/functions
Data persistence
Communication standards
Data standards
Integration tooling
Evolution plan?
What functionality when
EHR Service evolution path
Deployment configuration choices?
Provincial vs regional
Single Solution/many deployments
Multiple solutions
Deployment Decisions
PROVINCIAL
POINT OF SERVICE
Registry & Data Services
EHR Data & Services
Business Rules
EHR Index
Message Structures
Normalization Rules
Client registry
Provider Registry
Location registry
Terminology Registry
Drug Information
Diagnostic Imaging
Shared Health Record
Laboratory
Longitudinal Record Services
Security Mgmt Data
Privacy Data
Configuration
HIAL
Communication Bus
Common Services
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer
Physician/ Provider
Lab System (LIS)
Lab Clinician
Radiology Center PACS/RIS
Radiologist
Pharmacy System
Pharmacist
Public Health Services
Public Health Provider

118. Architecture Perspectives
Business Architecture
CONTEXT
Potential Applications
Clinical Work Process Architecture
Integration & Deployment Models
System Architecture
Information Architecture
118

119. EHR Infostructure Deployment
JURISDICTIONAL INFOSTRUCTURE
Ancillary Data & Services
Registries Data & Services
EHR Data & Services
Data Warehouse
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Business Rules
EHR Index
Message Structures
Normalization Rules
Security Mgmt Data
Privacy Data
Configuration
Longitudinal Record Services
HIAL
Communication Bus
Common Services
Client Registry
Provider Registry
Location Registry
Terminology Registry
Strategic planning
Change management
System development/integration
EHR SCP message development
Testing (compliance)
System implementation
Education & training
Operation & maintenance

120. EHRS Data: Value Enabler For Existing Applications
EHR Infostructure (EHRi)
Client data
Provider data
Location data
Privacy data
Security data
Encounter data
Blood/allergy/ immunization data
Encounter summaries
Clinical notes
Observations/ problems/conditions
Orders/Results data
Referrals data
Lab data
Pharmacy data
Diagnostic Imaging data
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
HIAL
Data loading
Data feeds
EHR SCP Standards
Enhanced presentation
EHR SCP Standards
Enhanced presentation
EHR SCP Standards
Chronic Disease Health Education
Health Prevention
EHR SCP Standards
Custom projects
Data Mining
EHR SCP Standards
ADT
CDR
PMS Rx
Lab DI
here are all the other things that can and/or will need to be done to bring this vision to reality – this is where there is some real value for providers
Initial data load/ data feeds/integration of systems
Hospitals/private clinics/ emergency/homecare/specialty centers/LT care
Laboratories/pharmacy / diagnostics
Self-care
Research/surveillance

121. End-User Perspective: EHR Viewer
Longitudinal Record Services
Common Services
End-User Perspective: EHR Viewer
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Provider Registry
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
Terminology Registry
Security Mgmt Data
Privacy Data
Configuration
HIAL
Patient Info
End-user Info
Visit History
Drug Profile
Laboratory
Diagnostic Imaging
EHR Viewer
Physician/ Provider
POINT OF SERVICE
EHR VIEWER

122. End-User Perspective: EMR Application
Longitudinal Record Services
Common Services
End-User Perspective: EMR Application
Communication Bus
JURISDICTIONAL INFOSTRUCTURE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Data Warehouse
Client Registry
Outbreak Management
PHS Reporting
Shared Health Record
Drug Information
Diagnostic Imaging
Laboratory
Health Information
Provider Registry
Location Registry
Business Rules
EHR Index
Message Structures
Normalization Rules
Terminology Registry
Security Mgmt Data
Privacy Data
Configuration
HIAL
Patient Info
End-user Info
Patient History
Drug Profile
Laboratory
Diagnostic Imaging
Physician Office EMR
EMR Database
Physician/ Provider
POINT OF SERVICE
EMR APPLICATION

123. EHRS Data: Enables New Classes of Applications
EHR Infostructure (EHRi)
Client data
Provider data
Location data
Privacy data
Security data
Encounter data
Blood/allergy/ immunization data
Encounter summaries
Clinical notes
Observations/ problems/conditions
Orders/Results data
Referrals data
Lab data
Pharmacy data
Diagnostic Imaging data
EHR SOLUTION (EHRS)
EHR INFOSTRUCTURE (EHRi)
Health Information Access Layer
Ancillary Data & Services
Health Information Data Warehouse
EHR Data & Services
Registries Data & Services
Decision support
The Helper
The Mentor
EHR SCP Standards
Automated workflow
Drug interactions
Abnormal results
EHR SCP Standards
New applications
Patient monitoring
EHR SCP Standards
Custom projects
Data mining
EHR SCP Standards ? ? ? ? ? ? ? ? ?
Patients

124. Deployment Configurations: COTS-based Solutions
124

125. COTS: CIS with Integrated Viewer
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Client Registry
Outbreak Services
PHS Reporting Services
Drug Information System
Diagnostic Imaging
HIAL
Provider Registry
HIAL
Consent Management
HIAL
HIAL
Location Registry
HIAL
Authentication/Acess Control
CLINICAL INFORMATION SYSTEM
Shared Health Record
Laboratory
Auditing/Logging
EAI
Terminology Registry
Communication Bus
HIAL
Interoperability
General
Integration
Subscription
Context
Management
Laboratory Shared Health Record
Longitudinal Record Services
EHR Viewer Server
EHR IP Transactions: Get, Put, List; Pan-Canadian EHR Standards
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer Client

126. COTS: CIS with External Viewer
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Client Registry
Outbreak Services
PHS Reporting Services
Drug Information System
Diagnostic Imaging
HIAL
Provider Registry
HIAL
Consent Management
HIAL
HIAL
Location Registry
Laboratory Shared Health Record
HIAL
Authentication/Acess Control
CLINICAL INFORMATION SYSTEM
Longitudinal Record Services
Auditing/Logging
EAI
Communication Bus
Shared Health Record
Laboratory
Terminology Registry
HIAL
Interoperability
General
Integration
Subscription
Context
Management
EHR IP Transactions: Get, Put, List; Pan-Canadian EHR Standards
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer Client

127. COTS Based: EAI Centric
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
Registries Data & Services
Ancillary Data & Services
EHR Data & Services
Client Registry
Outbreak Services
PHS Reporting Services
CIS: Shared Health Record & Laboratory
Drug Information System
Diagnostic Imaging
HIAL
Provider Registry
HIAL
Consent Management
HIAL
HIAL
HIAL
Location Registry
HIAL
Authentication/Acess Control
Auditing/Logging
EAI
Terminology Registry
Communication Bus
HIAL
Interoperability
General
Integration
Subscription
Context
Management
EHR IP Transactions: Get, Put, List; Pan-Canadian EHR Standards
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
EHR IP
Public Health Services
Pharmacy System
Radiology Center PACS/RIS
Lab System (LIS)
Hospital, LTC, CCC, EPR
Physician Office EMR
EHR Viewer Client

128. EHRS Blueprint: In Summary
128

129. EHRS Blueprint As Design Pattern & Standard
Provides specifications for provider
organizations & the vendor community
to design and develop:
EHR infostructure
Interfaces to allow existing systems to interoperate using EHR infostructure
New applications that take advantage of the EHR infostructure to provide added value to service providers, patients; to promote wellness of Canadians
Provides design pattern & set of
standardized specifications that:
Provide flexibility to meet the variety found in existing service delivery settings while providing an ability for jurisdictions to evolve their solution set, leveraging their current investments in systems
Allowing the managed addition of contributors to and users of Electronic Health Records
129

130. From Concept to Implementation
Infoway’s interoperable EHR
investment program provides
the primary vehicle for
transitioning the Blueprint from
architecture to working
components through:
partnering with jurisdictions ready to build interoperability between existing systems
jurisdictions ready to incorporate their registries and domain repositories
The second vehicle for
testing and refining the
Blueprint specifications is
adoption by the vendor
community and acquisitions
of “interoperable ready”
applications
Major vendors have incorporated the Infoway architectural approach into their product strategies
The Blueprint can provide the framework for jurisdictions to evaluate vendor provided solutions and ensure they will work with their evolving EHR infostructures
This process will be the
test-bed for the EHRS
Blueprints specifications
Elements of the EHRS Blueprint specifications will be updated by these project teams as the concepts are tested and refined
Implementation guidelines will be produced to assist others in implementing these capabilities
CONCEPT
IMPLEMENTATION

131. Maintaining the Blueprint as a Pan-Canadian Standard
Infoway understands the importance of having a stable, managed specification for interoperability
Jurisdictions and provider organizations need to be confident that their commitment to implementing EHR infostructure is based on a sound specification that will be maintained and managed
Implementations of the infostructure will reveal where the specification needs to be adjusted to optimize performance and ensure reliability
For this reason, the EHRS Blueprint specifications will be subject to the pan-Canadian Standards Collaboration Process established by Infoway
Ensuring pan-Canadian participation in requirements definition
Providing foreknowledge of the financial and change management requirements to all affected groups and organizations
Providing a scope and change-management model for the Blueprint specifications themselves
131

132. The Architecture In Summary: EHR Repository
Concepts
Patient’s data is stored and accessed from one logical EHR
Patient’s longitudinal clinically relevant information, authoritative & reliable
EHR co-exists with provincial domain repositories
EHR may be implemented at any jurisdictional level
EHR has a common definition across Canada
Benefits
Interoperability, performance, scalability
Provider adoption, supports use cases across continuum of care, timely and accurate for provider
Preserves investments, does not unnecessarily duplicate data
Flexibility, configurable to local & provincial needs
Cost effective, standards-based, Interoperability

133. The Architecture In Summary: HIAL
Concepts
HIAL (Health Information Access Layer) provides common way to interoperate with EHR, registries, domain repositories
Provider applications interoperate through HIAL to access EHRS
Provides peer-to-peer trusted communication and value-added common services to enable interoperability across the continuum of care and across jurisdictions
Benefits
Common and standards based is most cost effective, secure & private; applications focus on clinical logic vs. integration logic
Cost effective environment for broad set of provider applications, standards based integration
Secure & private, efficient, scalable, cost effective and standard runtime environment, responsive

134. The Architecture In Summary: EHRi
Concepts
Common standards will enable integration & interoperability
Standard message data protocol for external communications is HL7 V3
Registries have common definition across Canada
Benefits
Reduces design, development, test & operational costs
True interoperability, international standard will incent vendors
Interoperability, cost, security & privacy

135. The Architecture In Summary: Applications
Concepts
Messages initiated by point-of-care applications populate EHR with clinical data
Provider applications read data out of the EHR via the HIAL in addition to their operational data stores
Use cases, business rules and visualization of data is a function of the point-of-care application
Benefits
Low cost and common model of integration, secure and private, scalable, extensible, preserves current investments
Mass customized views of data tailored to provider needs, secure and private, scalable, authoritative, reliable, responsive
Vendors compete and innovate, extensible, value added services for providers

136. Thank you! Website: infoway-inforoute.ca