1. 1 Weaving interoperability: combining local, regional and national solutions on hospital level IMIA HIS Conference, Oeiras, July 3, 2006 Juha Mykkänen, Mikko Korpela HIS R&D Unit, University of Kuopio, Finland

2. 2 2 In this presentation HIS, sub-systems and interoperability Local, regional and national health information infrastructure initiatives in Finland HIS architectural components: hospital view Some challenges for advanced interoperability Emerging interoperability best practices Summary + discussion

3. 3 3 IMIA HIS, Heidelberg, April 2002: "need a common description for components in health information systems" - still a valid need components = units of composition, reuse and interoperability: –scope, availability, granularity, physical and conceptual nature –healthcare-specific scope: infrastructure, administration, care support, direct care, diagnostics, communication, simulation –information and semantics, instance / type / context / meta levels –functionality and interactions - capabilities + collaboration –relation to reference architectures and specific application architecture –technical aspects - data communication, interfaces, technical infrastructure, integration platforms etc. –cross-cutting aspects: security, management, flexibility, extensibility –relationship to systems lifecycle - development paradigm, migration Mykkänen, Tuomainen 2006, Information and Software Technology, submitted.

4. 4 4 Process model of a hospital – systems are for processes Core process: Direct care Support processes: Laboratory Radiology … Input: illness Output: wellness? Auxiliary processes: Management, … Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou Role of information systems in hospitals

5. 5 5 Rehabilitation Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou Beyond the hospital – seamless care

6. 6 6 Health information infrastructure developments / Finland Kuopio Helsinki Hospitals and health centres –primary care = health centres: ~100 % use EPR systems –hospitals: replacing legacy core applications > 10 years –continuous heterogeneity in processes, applications, infrastructures –managerial and clinical process developments - e.g. DRG, decision support Regional –new organisational models of health services (e.g. laboratories, regional clusters) –regional information systems, references to back-end HIS data –shared electronic services (e.g. prescriptions, electronic booking) –disease-specific specialised systems National –national services: EHR for professionals, code sets/vocabularies etc. –migration from regional to national services Citizen –e-services emerging first for professionals, then patients –PHR: little real integration to professional-oriented EPRs

7. 7 7 Sample high-end composition of the hospital-wide information system today: Helsinki-Uusimaa hospital district HUS,Sinikka Ripatti 2004 Hospital level

8. 8 8 Example of a major vendor’s architecture Medici Data Oy, Juha Sorri 7.10.2004 HMIS core EPR system Loosely connected systems Common context & services Launching Common user Hospital level inner circles: optimised usability, reduced maintenance and redundancy, tightly integrated application families and components outer circles: flexibility, cross-organisational processes

9. 9 9 Migration situation in a major hospital KYS, Pekka Sipilä, 2006 Old HIS systems New HIS systems Health center systems Hospital level

10. 10 Elements of a HIS architecture: hospital view Common core services: Starting point for HIS Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing presumptions: –heterogeneous specialised applications, existing (legacy) systems –practicality, feasible implementation threshold in multi-vendor environment –extensibility –service- orientation supported by generic middleware

11. 11 “Pluggable” specialized clinical subsystems Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing alternatives: –non-pluggable clinical subsystems –no clinical subsystems

12. 12 Standard structured EPR/EHR data storage Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing alternatives: –system-specific data views –point-to-point queries –(personal / virtual health record - outside organization)

13. 13 Front-end viewer for health professionals (EHR-S) Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing alternatives: –context management –no point-of- decision integration –(additional) workflow management systems

14. 14 Information exchange by messages across facilities Potentially same data structure Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing alternatives: –central repository (for some scenarios - see next slide) –peer-to-peer negotiations / mediation

15. 15 Clinical on-line access across facilities Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing alternatives: –peer-to-peer negotiations / mediation

16. 16 Patient’s / citizen’s front-end Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing add: –opposite direction –patient-provider communications

17. 17 HIS challenges for interoperability healthcare process specifics –balance between customer, provider and organisational objectives –complexity, legality, communication, multi-professionality, exceptions –externalisation of healthcare processes from HISs –requires flexibility of architectures, definition of migration paths explosion of potential interoperability solutions –architectures, evaluation of standards, development and maintenance costs evidence –identification of real needs, requirements traceability –collection of application experience of domain-neutral best practices in HIS generic innovation vs. local introduction –reduced local tailoring, increased reuse on many levels –gaps: product development - healthcare process development - academia?

18. 18 Interoperability apex 2006 Semantic and process integration –structured and coded information, shared terminologies, ontology-based semantics –clinical decision support, integration and adaptation of HIS into defined or even evidence-based workflows Service-oriented architectures –paradigm for open, flexible and business-aligned systems, cohesive & reusable services –process management and automation (vs. exceptional healthcare workflows) –infrastructure services (e.g. EHR access, codes and terminolofies, access control) and added value services (e.g. decision support) –e.g. Healthcare Services Specification Project / HL7+OMG Profiles = constraints on application of generic mechanisms –technical: e.g. Web services interoperability (WS-I) –functional: e.g. HL7 EHR-S Functional Model –semantic: e.g. CEN/OpenEHR archectypes, HL7 templates –standardisation: e.g. Integrating Healthcare Enterprise (IHE)

19. 19 Summary and discussion topics hospitals will long remain one central point for health services provision, but will not remain "the centre" –challenges for advanced interoperability remain on local, regional, national and international level: common frameworks needed –regional and national initiatives demand local acceptance and user benefits described elements are based on Finnish practical experience, international standardization, China, Africa one basis for generic framework architecture adjustable to the specific contexts in Portugal, Germany, UK, USA, … Mozambique? how can the service interfaces and semantics be developed for global reusability & local adaptability? gradually? –understanding of and support for healthcare processes –semantic and functional views addressed → International standardization of relevant aspects with users and industry → ’IT for Health’ at IFIP World IT Forum 2007 www.witfor.org → IMIA recommendations, Health Informatics in Africa HELINA 2007 www.helina.org

20. 20 Healthcare application integration: PlugIT, 2001­2004: www.plugit.fi, Finnish Agency for Technology and Innovation Tekes grants no. 40664/01, 40246/02 and 90/03 Service-oriented architecture and web services in healthcare application production and integration: SerAPI, 2004­2007: www.centek.fi/serapi, Tekes grants no. 40437/04, 40353/05 Healthcare work and information systems development in parallel: ZipIT 2004-2007 Tekes grants no. 40436/04 and 790/04, and ActAD­HIS, 2004-2005 Finnish Work Environment Fund grant no. 104151 : www.centek.fi/zipit Packaging Finnish e-health expertise for international use: Export HIS, 2004­2006 www.centek.fi/exporthis (Tekes grant no. 70062/04,), e-Health Partners Finland, 2006-2007 www.uku.fi/ehp (Tekes grants no. 40140/06, 70030/06) Informatics development for health in Africa: INDEHELA­Methods (Academy of Finland grants no. 39187,1998­2001), INDEHELA­Context (201397 and 104776, 2003, 2004­2007): www.uku.fi/indehela Open Integration Testing Environment: Avointa, 2004­2006: www.centek.fi/avointa Tekes grant no. 40449/04 Acknowledgements and more information

21. 21 Assets to support benefits of electronic health information interoperability separation of care management from patient-specific health information increasingly documented and formalised requirements, processes and practices in healthcare common concept models, vocabularies and terminologies, extended to ontological languages and tools component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments guidelines, methods and reference models for acquisition, integration and systems development projects Mykkänen, Specification of Reusable Integration Solutions in Health Information Systems, forthcoming.