1. © 2006 Canada Health Infoway Inc. 1 HIMSS Interoperability Showcase February 15, 2006 Dennis Giokas Chief Technology Officer Canada Health Infoway Inc. Achieving Interoperability Across Canada Standards

2. Outline 2 Introducing Infoway Key Definitions Why an Interoperable EHR? Key Clinical and Business Requirements Solution Architecture Integration Challenges Standards for Interoperability Standards Collaboration and Projects Summary © 2006 Canada Health Infoway Inc.

3. 3 Canada Health Infoway Mission To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission. Vision A high-quality, sustainable and effective Canadian health care system supported by an infostructure that provides residents of Canada and their healthcare providers timely, appropriate and secure access to the right information when and where they enter into the healthcare system. Respect for privacy is fundamental to this vision. Goal Infoways plan is to have an interoperable electronic health record in place across 50 percent of Canada (by population) by the end of 2009. Shared Governance Facilitates Collaboration Canada Health Infoway is an independent not-for-profit organization, whose Members are Canadas 14 federal, provincial and territorial Deputy Ministers of Health.

4. 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. 4 © 2006 Canada Health Infoway Inc.

5. 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 5 © 2006 Canada Health Infoway Inc.

6. 6 EHR Key Clinical & Business Requirements Patient centric, life-long longitudinal record of clinical data Support for accurate, complete, timely delivery of information Allowing private and secured access to data made available in the EHR Focused on clinically relevant data shared beyond organizational boundaries Shared across multiple organizations, jurisdictions Scalable to allow continuous, extensive growth of clinical information with a ROI More POS applications sourcing data to EHR More users accessing and using data from EHR Towards more physician order entry and decision support Interoperable, integrated Standards based

7. 7 Different Approaches To Achieving the EHR © 2006 Canada Health Infoway Inc.

8. 8 Clients/Patients EHR: How Do We Do This? Sharing Information From Multiple Systems Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Community Care Center Clinic Emergency Services Specialist Clinic INTEGRATED VIEW

9. © 2006 Canada Health Infoway Inc. 9 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

10. © 2006 Canada Health Infoway Inc. 10 Clients/Patients Locations of Electronic Clinical Data Today: Number of Systems to Integrate Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Community Care Center Clinic Emergency Services Specialist Clinic Canada has approximately 40,000 systems

11. EHR Infostructure 11 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 to support integration with the EHR, data definitions for the EHR and messaging standards for integration and interoperability. © 2006 Canada Health Infoway Inc.

12. 12 Key EHRS Architecture Concepts EHR SOLUTION (EHRS) EHR INFOSTRUCTURE (EHRi) EHR Viewer Point of Service Application EHRS Locator Longitudinal Record Services HIAL Ancillary Data & Services Health Information Data Warehouse EHR Data & Services Registries Data & Services

13. © 2006 Canada Health Infoway Inc. 13 EHRS EHRS In Canada Federated Databases, Peer-to-Peer, Message Based 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 HIAL 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 HIAL

14. © 2006 Canada Health Infoway Inc. 14 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

15. © 2006 Canada Health Infoway Inc. 15 EHR Infostructure: Services Drill-Down 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 Client Registry Provider Registry Location Registry Terminology Registry 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 DataConfiguration Physician/ Provider 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

16. © 2006 Canada Health Infoway Inc. 16 EHR Infostructure: Standards Based Connectivity 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 Client Registry Provider Registry Location Registry Terminology Registry POINT OF SERVICE Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Data Privacy DataConfiguration Longitudinal Record 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 HIAL Communication Bus Common Services EHR IP HIAL EHR IP EHR IP Standards EHR SCP Standards

17. © 2006 Canada Health Infoway Inc. 17 JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse POINT OF SERVICE Communication Bus EHR Infostructure: Communication Bus COMMUNICATION BUS MESSAGING Transformation Services Routing Services Encrypt/Decrypt Services En/Decoding Services Parser Services Serialization Services PROTOCOL App Protocol Services Network Protocol Services

18. © 2006 Canada Health Infoway Inc. 18 JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse POINT OF SERVICE Security Mgmt Data Privacy DataConfiguration Communication Bus Common Services EHR Infostructure: 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

19. © 2006 Canada Health Infoway Inc. 19 JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse POINT OF SERVICE 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 EHR Infostructure: Longitudinal Record Services

20. © 2006 Canada Health Infoway Inc. 20 JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse POINT OF SERVICE EHR Viewer Physician/ Provider EHR Infostructure: EHR Viewer 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

21. Standards-based Solutions Standardized Architecture Standardized Interfaces Standardized Data Structures Standardized Data Vocabularies Standardized Functional Behaviour 21 © 2006 Canada Health Infoway Inc.

22. 22 Infoways role is to set standards and requirements for robust, interoperable products and outcomes 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

23. © 2006 Canada Health Infoway Inc. 23 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 the Infoway Knowledge Way Business-driven Adoption of existing standards where ever possible HL7 V3 for all new message development Establishment of pan-Canadian EHR standards is coordinated via an open, transparent and inclusive Stakeholder Collaboration Process as defined by our stakeholders http://knowledge.infoway-inforoute.ca

24. © 2006 Canada Health Infoway Inc. 24 Standards Collaboration Process (SCP) The EHR Standards Steering Committee which leads and approves pan-Canadian EHR information standards within the context of Infoway investment programs The EHR Standards Advisory Committee which recommends information standards for approval by the EHR Standards Steering Committee and coordinates and guides the activities of pan-Canadian Standards Groups A number of pan-Canadian Standards Groups that guide the standards requirements of individual Infoway programs An expert group of resources available to provide cross-program technical and subject matter expertise in standards

25. © 2006 Canada Health Infoway Inc. 25 EHR Infostructure: Standards-based Connectivity JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse POINT OF SERVICE EHR IP Standards EHR IP HIAL EHR IP HIAL Architecture Standards EHRS Blueprint EHR Use Cases EHR Data Model EHR Services Model EHR Interoperability Profiles Data & Messaging Standards Client Registry HL7 v2.4 & HL7 v3 (complete) Provider Registry HL7 v3 (in ballot) Drug Information Systems HL7 v3 (in ballot) Laboratory HL7 v3 (in development) Diagnostic Imaging/Teleradiology (complete) iEHR Clinical Messaging HL7 v3 (in development) iEHR Technical Standards (in planning) Public Health Standards HL7 v3 (in development) Clinical Terminology Strategy (complete) Terminology Standards (SNOMED, LOINC, ICD10-CA, CCI)

26. © 2006 Canada Health Infoway Inc. 26 Summary Supporting Clinicians Provider adoption – Approach designed to support use cases across continuum of care with timely and accurate information for the clinician Mass customized views of data tailored to provider needs that is authoritative, reliable, responsive Semantic harmonization of health information across service delivery points Healthcare Information Solution Architecture Interoperability that is cost effective Common model of integration, secure and private, scalable, extensible, preserves current investments – an application abstraction layer that provides a common integration view and EHR view across Canada Standards – common messages and nomenclatures adopted across Canada Enables high degree of flexibility in reconfiguration of health services delivery networks

27. © 2006 Canada Health Infoway Inc. 27 Website:www.infoway-inforoute.ca E-mail:dgiokas@infoway-inforoute.ca Thank you!