1. A Model of eHealth Interoperability Craig Kuziemsky, Telfer School of Mgmt, University of Ottawa. James Williams, Community Care Information Management. CASCON 2 nd E-Health Interoperability Workshop November 2, 2010

2. Overview Interoperability Overview Interoperability Challenges Process and collaborative interoperability eHealth Interoperability Framework Implications and Conclusions

3. Why Interoperability Matters Healthcare delivery is becoming increasingly complex as it shifts from care provided by a single provider and setting to collaborative care provided by multiple providers across multiple settings. As patients get care in an increasing number of organizations, there is a need for healthcare providers to collaborate and communicate. Many inefficiencies and quality problems arise from a lack of access to relevant information. The move towards integrated networks and collaborative care delivery is a fundamental challenge for our healthcare system because it is not designed for it.

4. Interoperability Overview At basic level, interoperability is the means of connecting two or more computer systems The 2001 study from the Institute of Medicine ‘Crossing the Quality Chasm: A New Healthcare System for the 21 st Century’ described the quality of care delivery as inadequate and that to improve care delivery would require a commitment to an agenda of efficient, effective, timely, safe, and equitable patient centered care (Institute of Medicine, 2001). Interoperability is the means for achieving those objectives and the true test of interoperability will be how well it helps us achieve them

5. Interoperability is multi-faceted: 1.all interoperability is not the same but rather different levels of interoperability exist. 2.interoperability cannot solely be looked at as a technical challenge but instead it must be looked at as a technical, social, legal, cultural, etc. Interoperability Overview cont.

6. Benson (2010) describes technical, semantic and process interoperability: Technical - machine-readable aspects of data representation and addresses the problem of connecting distributed systems on a network Semantic - addresses the need for interoperability of the concepts and vocabulary that is exchanged across computer systems Process- refers to interoperability of the work processes and people who interact with the technology

7. Technical: – Data interoperability standards, such as HL7. Semantic: – Medical coding standards: ICD-10, SnowMed. – Access control models: role based access. – Policy Languages: EPAL, XACML. Process: – Coordinating care delivery and decision making. Interoperability Overview cont.

8. Interoperability Implementation Challenges The OpenEHR project consists of a reference information model and a set of archetypes (Garde et al., 2007). Ad-hoc communication can be supported if it is communicating archetype data, but that could be problematic given the diverse communication needs of healthcare. Interoperability frameworks such as the SemanticHEALTH roadmap (Stroetmann et al., 2009) have similarly pointed out that technical standardization are no longer the most prominent interoperability issues but rather they have been surpassed by political, institutional, organizational and legal issues.

9. Process/collaborative Interoperability Challenges HIS are used by people to conduct healthcare processes and therefore we need to consider the actual processes as part of interoperability The real challenges to interoperability are not technical but rather are in aligning work processes. These processes are context specific. Recognizing contextual factors is key.

10. Contextual Factor: Uses

11. Contextual Factors: Uses

12. Contextual Factor: Uses

13. eHealth Interoperability Framework Interoperability needs to be looked at from the multiple levels in which it resides We define 4 levels and a set of contextual factors

14. Interoperability Level 1 Data exchange Level Knowledge Level Collaborative Level Data Exchange Metadata Health 2.0, Shared Workspaces, E-Communication & collaboration Interoperability Level 2 Interoperability Level 4 Interoperability Level 3 Clinical Level Semantic network, NLP Domain specific Models, CPG’s Technical Aspects Contextual Factors – Social, political, organizational, Technological, Legal

15. Implications and Conclusions EHR design and implementation is a part of the national e- Health architecture in numerous countries including the United Kingdom, Canada, the United States and Denmark. Numerous struggles with EHR mandates exist due to resistance from the users of EHR systems because of process interoperability issues (Ford et al., 2009). We need to design healthcare IT to play an active role as a communication and process facilitator and not just an integrator and transmitter of data (i.e. support processes) Understand the contextual factors that influence interoperability

16. Questions Craig Kuziemsky - kuziemsky@telfer.uottawa.ca kuziemsky@telfer.uottawa.ca James Williams - jamesbw@uvic.cajamesbw@uvic.ca