3 Canada Health Infoway Mission Vision Goal 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.VisionA 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.GoalInfoway’s 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 CollaborationCanada Health Infoway is an independent not-for-profit organization, whose Members are Canada’s 14 federal, provincial and territorial Deputy Ministers of Health.
9 EHR Key Clinical & Business Requirements Life-long longitudinal record of clinical dataSupport for accurate, complete, timely delivery of informationAllowing private and secured access to data made available in the EHRFocused on clinically relevant data shared beyond organizational boundariesShared across multiple organizations, jurisdictionsScalable to allow continuous, extensive growth of clinical information with a ROIMore POS applications sourcing data to EHRMore users accessing and using data from EHRTowards more physician order entry and decision supportLongitudinal View AssumptionsCare 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 decisionsSaves time – more patient can benefit from careReduces potential for errorReduces costsValue is tangible and high enough to enable changeCare professionalsCare organizations management and board of directorsShared across territories AssumptionsLegal - 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 - AssumptionsNet 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 domainsMaintain high level of service for rural populationsState of readiness of care providers varies greatlyInternal interoperability enabled and evolvingCDR in early adoption cycleThe 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.
11 EHR: How Do We Do This? Sharing Information From Multiple Systems HomecareClients/PatientsClinicEmergency ServicesINTEGRATED VIEWCommunity Care CenterPharmacySpecialist ClinicLaboratoryHospital EmergencyDiagnostic
12 Guiding Principles for EHRS Patient-centricMass customized views of all clinical dataValue add for the providerTimely, accurate informationEnable sharing at local, regional, cross-jurisdictionalInteroperable, integratedStandards basedReplicable solution – patterns, componentsLeverage legacy systems & solutionsDesign for phased rollout with near term resultsScalableExtensible to support future growthCost-effectiveSecure & privateAllow for innovation & competitionComprehensive
13 Methods of Sharing EHR Information The “Big Databasein the Sky”All Point-of-Service (POS) systems share same data storeBroadcast to all ora logical subset ofsystemsReplication of data from one system to all other relevant/ participating POS systemsEvery POS system holds same informationThe “Big Index inthe Sky”EHR Index or locator service that holds links to all POS systems where information residesEach POS system interfaces to other systemsUse of ashared referenceinformation sourcePOS systems populate itPOS systems or viewers reference itExternal to the “operational” store
14 Key EHRS Architecture Concepts EHR SOLUTION (EHRS)EHR INFOSTRUCTURE (EHRi)EHRS LocatorAncillary Data & ServicesHealth Information Data WarehouseLongitudinal Record ServicesEHR Data & ServicesRegistries Data & ServicesHIALHow does data get into the EHR?Data is pushed or published into EHRFrom source systemsViewing data in the EHRGenerally from the applications the providers use in their daily contextE.g. primary care doctor EPR applications have means to view and navigate the EHREmergency room doctor from the hospital CDR and EHRPoint of Service ApplicationPoint of Service ApplicationEHR Viewer
15 EHRS In Canada Federated Databases, Peer-to-Peer, Message Based EHR SOLUTION (EHRS)EHR SOLUTION (EHRS)EHR INFOSTRUCTURE (EHRi)EHR INFOSTRUCTURE (EHRi)Longitudinal Record ServicesLongitudinal Record ServicesAncillary Data & ServicesHealth Information Data WarehouseHIALEHR Data & ServicesRegistries Data & ServicesAncillary Data & ServicesHealth Information Data WarehouseHIALEHR Data & ServicesRegistries Data & ServicesPoint of Service ApplicationPoint of Service ApplicationEHR ViewerPoint of Service ApplicationPoint of Service ApplicationEHR ViewerSpeedReal-time on read requests: response time under 2 secondsNear real-time on updatesLegal 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 regulationsScalableFrom growth in number of source systemsFrom growth in point-of-care usageFrom growth in territory coverageFrom growth in surveillance usageFrom growth in administrative usageReliable (High Availability)Redundancy: Power, Network, Servers (Application & Database), DisksHealthy economic balance in HIS vendor industryIt 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;EHRSEHRSEHRSEHRSEHRSEHRSEHRS
16 Canada has approximately 40,000 systems Locations of Electronic Clinical Data Today: Number of Systems to IntegrateHomecareClinicClients/PatientsEmergency ServicesCanada has approximately 40,000 systemsCommunity Care CenterPharmacySpecialist ClinicLaboratoryHospital EmergencyDiagnostic
17 Integrating Health Information Systems: Key Challenges Protecting PrivacyGovernance, accountability & data custodianshipControlling accessManaging & applying consent directivesControlling feeds and queries to the dataTrust relationships & contractsExistence & availability of dataDiscovery capabilityAvailability in electronic formatTimelinessHarmonizationData structures (format)Vocabularies (encoding, normalization)SemanticsHeterogeneous technology environmentsNumber of organizations, connection points & systemsCosts inherent to integration
18 EHR Infostructure: Services Drill-Down JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehouseOutbreak ManagementPHS ReportingShared Health RecordDrug InformationDiagnostic ImagingLaboratoryHealth InformationClient RegistryProvider RegistryLocation RegistryTerminology RegistryPOINT OF SERVICEHospital, LTC, CCC, EPRPhysician Office EMREHR ViewerPhysician/ ProviderBusiness RulesEHR IndexMessage StructuresNormalization RulesSecurity Mgmt DataPrivacy DataConfigurationLab System (LIS)Lab ClinicianRadiology Center PACS/RISRadiologistPharmacy SystemPharmacistPublic Health ServicesPublic Health ProviderLongitudinal Record ServicesHIALCommunication BusCommon Services
19 EHR Infostructure: Standards Based Connectivity JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehouseOutbreak ManagementPHS ReportingShared Health RecordDrug InformationDiagnostic ImagingLaboratoryHealth InformationClient RegistryProvider RegistryLocation RegistryTerminology RegistryPOINT OF SERVICEBusiness RulesEHR IndexMessage StructuresNormalization RulesSecurity Mgmt DataPrivacy DataConfigurationLongitudinal Record ServicesHospital, LTC, CCC, EPRPhysician Office EMREHR ViewerPhysician/ ProviderLab System (LIS)Lab ClinicianRadiology Center PACS/RISRadiologistPharmacy SystemPharmacistPublic Health ServicesPublic Health ProviderHIALCommunication BusCommon ServicesEHR IPHIALEHR IP StandardsEHR SCP Standards
20 EHR Infostructure: Communication Bus JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehousePOINT OF SERVICECommunication BusCOMMUNICATION BUSMESSAGINGTransformation ServicesRouting ServicesEncrypt/DecryptServicesEn/DecodingParser ServicesSerialization ServicesPROTOCOLApp Protocol ServicesNetwork Protocol Services
21 EHR Infostructure: Common Services JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehousePOINT OF SERVICESecurity Mgmt DataPrivacy DataConfigurationCommunication BusCommon ServicesCOMMON SERVICESINTEROPInteroperability ServicesSearch/Resolution ServicesINTEGRATIONService Catalogue ServicesBroker ServicesMapping ServicesQueuing ServicesCONTEXTSession Mgmt ServicesCaching ServicesIdentity Protection ServicesIdentity Mgmt ServicesAnonymization ServicesUser Authentication ServicesConsent Directives Mgmt ServicesEncryption ServicesAccess Control ServicesSecure Auditing ServicesDigital Signature ServicesGeneral Security ServicesSUBSCRIPTIONAlert/Notification ServicesPub/Sub ServicesMANAGEMENTManagement ServicesConfiguration ServicesGENERALAuditing ServicesLog Mgmt ServicesPolicy Mgmt ServicesException/Error Handling ServicesPRIVACY & SECURITY
22 EHR Infostructure: Longitudinal Record Services JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehousePOINT OF SERVICEBusiness RulesEHR IndexMessage StructuresNormalization RulesLongitudinal Record ServicesLONGITUDINAL RECORD SERVICESDATAKey Mgmt ServicesETL ServicesBUSINESSData Quality ServicesDomain Business Components (Registries, EHR, Domains, User, Context)EHR Index ServicesOrchestration ServicesNormalization ServicesBusiness Rules ServicesAssembly ServicesData ServicesReplication Services
23 EHR Infostructure: EHR Viewer JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehousePOINT OF SERVICEEHR VIEWEREHRi Interoperability ServicesEHR Viewer Business Objects ComponentsNormalization ServicesEnd-user Navigation ServicesBusiness Rules ServicesEnd-user Display ServicesData ServicesEHR ViewerPhysician/ Provider
25 Standards-based Solutions Why Standards?They facilitate information exchange; are a critical foundation for EHRThey create opportunity for future cost reduction as vendors and systems converge on pan-Canadian and international standardsThey ease effort required for replicationMandatory Investment Eligibility RequirementsCompliance to standards (infostructure, architecture)Initiatives must comply with existing guidelines or standards adopted by InfowayWhere standards or guidelines do not exist, projects must support longer-term interoperability and congruence of solutionsInfoway’s role is to set standards and requirements for robust, interoperable products and outcomes
26 Principles for Establishing Pan-Canadian EHRS Standards Infoway has created Principles for Establishing pan-Canadian EHRSStandards to provide guidance in the adoption of standards-based solutions11 Principles – accessible via the Infoway Knowledge WayBusiness-drivenAdoption of existing standards where ever possibleHL7 V3 for all new message developmentEstablishment of pan-Canadian EHR standards is coordinated via an open, transparent and inclusive Stakeholder Collaboration Process as defined by our stakeholders
27 Standards Collaboration Process (SCP) The EHR Standards Steering Committee which leads and approves pan-Canadian EHR information standards within the context of Infoway investment programsThe 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 GroupsA number of pan-Canadian Standards Groups that guide the standards requirements of individual Infoway programsAn expert group of resources available to provide cross-program technical and subject matter expertise in standards
28 EHR Infostructure: Standards-based Connectivity JURISDICTIONAL INFOSTRUCTUREAncillary Data & ServicesRegistries Data & ServicesEHR Data & ServicesData WarehousePOINT OF SERVICEEHR IP StandardsArchitecture StandardsEHRS BlueprintEHR Use CasesEHR Data ModelEHR Services ModelEHR Interoperability ProfilesData & Messaging StandardsClient 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)EHR IPHIAL
29 Summary Supporting Clinicians Provider adoption – Approach designed to support use cases across continuum of care with timely and accurate information for the clinicianMass customized views of data tailored to provider needs that is authoritative, reliable, responsiveSemantic harmonization of health information across service delivery pointsHealthcare Information Solution ArchitectureInteroperability that is cost effectiveCommon 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 CanadaStandards – common messages and nomenclatures adopted across CanadaEnables high degree of flexibility in reconfiguration of health services delivery networks
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