1. eHealth Partners Finland Finnish Agency for Technology and Innovation Tekes grants no. 40140/06 and 70030/06 www.uku.fi/ehp Architecture, Interoperability, Standards - recent research in eHP Finland network China-Finland eHealth Partnership meeting, Helsinki, 6 Sep 2007 Dr. Juha Mykkänen 穆 佑 赫 University of Kuopio, Health Information Systems R&D Unit

2. eHealth Partners Finland www.uku.fi/ehp2 outline ●recent work items and related projects ●recent results, including examples ●relation to China-Finland eHP project guidelines and

3. eHealth Partners Finland www.uku.fi/ehp3 background ●applied research responding to challenges related to systems development and interoperability in healthcare ○point-to-point integration solutions, expensive tailoring, heterogeneity in technologies, requirements, and standards ●central elements of solutions ○guidelines, methods and reference models for acquisition, integration and systems development projects ○component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments ○separation of care management from health information ○formalised requirements, processes and practices ○common concept models, vocabularies and terminologies ○validation in practice in hospitals and products

4. eHealth Partners Finland www.uku.fi/ehp4 recent related work ●SerAPI project, results available in September, examples: ○regional scheduling (HL7 v3), clinical decision support interfaces, specification of core services (e.g. code sets, context management), patient groupings (for billing/statistics, e.g. DRG), patient lists ○Service-oriented architecture and development guidelines: service identification, process modeling, architecture specification ○education related to SOA and HL7 version 3 ●Healthcare Services Specification Project and HL7 (international) ○joint HL7/OMG effort for standardizing services and SOA approaches for healthcare: EIS, RLUS, DSS, CTS2 ○SOA for HL7, dynamic model enhancements to HL7 version 3 ○Electronic + Personal Health records, Scheduling, Infrastructure etc. ●participation in national initiatives in Finland ○specification of core data sets and speciality data sets ○specification and certification related to national health IT services ○national standards work: HL7 version 3, CDA r2, social services ●IHE (integrating healthcare enterprise) initiative in Finland

5. eHealth Partners Finland www.uku.fi/ehp5 examples of recent results ●Evaluation and selection framework for interoperability standards ●e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) ●Comparison of model-centric approaches for development of health information systems ●Methods for service-oriented development of systems and integration solutions ●interface and service definitions for ○clinical decision support ○regional scheduling (HL7 version 3) ○patient groupings for billing, benchmarking etc. (e.g. DRG) ○code sets,

6. eHealth Partners Finland www.uku.fi/ehp6 eHealth standardization areas (used in the evaluation framework and national recommendations in Finland)

7. eHealth Partners Finland www.uku.fi/ehp7 examples of recent results ●Evaluation and selection framework for interoperability standards ●e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) ●Comparison of model-centric approaches for development of health information systems ●Methods for service-oriented development of systems and integration solutions ●interface and service definitions for ○clinical decision support ○regional scheduling (HL7 version 3) ○patient groupings for billing, benchmarking etc. (e.g. DRG) ○code sets,

8. eHealth Partners Finland www.uku.fi/ehp8 medium-term integration architecture guidelines for hospitals (Finnish setting)

9. eHealth Partners Finland www.uku.fi/ehp9 examples of recent results ●Evaluation and selection framework for interoperability standards ●e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) ●Comparison of model-centric approaches for development of health information systems ●Methods for integration solutions and service-oriented development of health information systems ●interface and service specifications ○>20 related open specifications nationally and internationally ○related testing, certification and conformance research

10. eHealth Partners Finland www.uku.fi/ehp10 model-centric approaches in relation to the phases of information systems development

11. eHealth Partners Finland www.uku.fi/ehp11 discussion: China/Finland guidelines ●health information sharing (regional, national) ○practical large-scale approach (good example in Finland): agreed data sets, shared services, open standards ○clear separation of patient and professional needs ○combination of international and local standards ●architectures and interoperability ○up-front investment in architecture will provide significant long-term benefits (bad examples in Finland) ○several solution models need to be combined ○hospital / health centre-specific starting points must be acknowledged ●all work must be based on accurate requirements specification and supported by evaluation

12. eHealth Partners Finland www.uku.fi/ehp12 Thank you presenter: Dr. Juha Mykkänen University of Kuopio HIS R&D Unit Juha.Mykkanen@uku.fi 谢谢

13. eHealth Partners Finland www.uku.fi/ehp13 Architectures and standards in healthcare ‘Architecture’ defines how elements and relations between them make up a whole – e.g., an e-hospital architecture ●Organizational view: Who uses, who stores, who maintains; workflows, processes, service chains – IHE (Integrating the Healthcare Enterprise) workflows, etc. ●Functional view: What the system elements should provide; – HL7 EHR-S Functional Model, HL7-OMG HSSP, etc. ●Technological view: How system should be implemented – HL7-OMG Services Spec. Project HSSP, Eclipse, etc. ●Information view: Data elements, coding, structures, stores – HL7 RIM (Reference Information Model), HL7 CDA (Clinical Document Architecture), OpenEHR, etc. Adapted from RM-ODP model, ISO/IEC 1995

14. eHealth Partners Finland www.uku.fi/ehp14 SerAPI: Service-based architecture and web services in healthcare Application Production and Integration ●Theme: flexibility, integration and interoperability in healthcare applications ○project in the FinnWell programme of Tekes, Sep 04 – Aug 07 ○14 software companies, 4 public health service provider organizations, 3 research units (University of Kuopio) ○Healthcare processes and services  software products ○Service-oriented architectures (SOA) flexibility and connectivity: support for different processes, transition towards component- and service-based information systems ○Web services open Internet technologies, service interfaces in software products, support for multiple implementation technologies and tools ○Application interfaces, application integration and service-oriented application design based on integration results (interfaces, methods) from the PlugIT project

15. eHealth Partners Finland www.uku.fi/ehp15 SerAPI - participants ●Research groups (University of Kuopio) ○HIS (Health Information Systems) R&D Unit ○Shiftec Unit (Dept. of Health Policy and Management) ○Software engineering (Dept. of Computer Science) ●Healh care organizations ○Hospital district of Helsinki and Uusimaa ○Hospital district of Northern Savo ○Hospital district of Satakunta ○City of Kuopio ●Companies (healthcare application / content development) ○Commit; Oy ○Datawell Oy ○Fujitsu Services Oy ○Finnish Medical Society Duodecim ○Mawell Oy ○Medici Data Oy ○Mediconsult Oy ○Prowellness Oy ○Softera Oy ○WM-data Oy ●Companies (infrastructure) ○Bea Systems Oy ○Intersystems B.V. Finland ○Microsoft Oy ○Oracle Finland Oy

16. eHealth Partners Finland www.uku.fi/ehp16 SerAPI approach: standpoints of processes, applications and technologies

17. eHealth Partners Finland www.uku.fi/ehp17 SerAPI: main activity areas ●Application domains ○three-party collaboration: healthcare provider organizations, companies, research group ○interfaces and application services responding to the needs of health professionals, information management and application development ○e.g. clinical context integration, scheduling, OID identifiers, DRG grouping, patient record location and access, clinical decision support etc. ●Service interfaces and standardization ○Healthcare Services Specification Project / HL7 and OMG – international healthcare service interface standardization ○HL7 Finland Common Services SIG background project ○National recommendations for the development and organization of standardization to support health information systems ●Collaboration ○national (e.g. AVOINTA, ZipIT, Export HIS, FinnWell interoperability group, national and regional projects related to electronic health records ○international (e.g. HL7, OMG, Eclipse, research collaboration) ●Juha.Mykkanen@uku.fi, University of Kuopio, HIS R&D UnitJuha.Mykkanen@uku.fi ●www.centek.fi/serapi/english.htmlwww.centek.fi/serapi/english.html

18. eHealth Partners Finland www.uku.fi/ehp18 Integration specification process (overview) Mykkänen et al., in MEDINFO 2004

19. eHealth Partners Finland www.uku.fi/ehp19 4. Conclusion ●E-hospital is not “turn-key shopping” but a process ●Collaborative process between stakeholders ●Functionality, data standards and software interfaces ●The main steps for one hospital: 1.Evaluate your current state from activity/service viewpoint 2.Identify target: How activities/services to be supported by ICT 3.Identify your migration path with phases, specify Phase 1 4.Select an initial portfolio of products with a shared architecture 5.Select your trustworthy key solution provider with a consortium ● eHealth Partners Finland is a consortium of international-level research groups and companies willing to contribute along your path to e-hospital

20. eHealth Partners Finland www.uku.fi/ehp20 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?

21. eHealth Partners Finland www.uku.fi/ehp21 Interoperability apex 2007 ●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)