Presentation is loading. Please wait.

Presentation is loading. Please wait.

Infoway Architecture Update

Similar presentations


Presentation on theme: "Infoway Architecture Update"— Presentation transcript:

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 (www.hsrc.gov.on.ca) 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 Definitions
14

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 Scope
25

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 Solutions
36

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 EHR
43

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 Solutions
47

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 Driver
53

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 Software
1 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


Download ppt "Infoway Architecture Update"

Similar presentations


Ads by Google