1. nehta Integrating Standards for the EHR Workshop Helsingor, Denmark 28 th 29th October 2008 Summary for OHT

2. Note: Day 1 of this workshop was for national initiatives and large eHealth programs only –Included representation from: Australia, Canada, Denmark, European Union, Lithuania, Netherlands, New Zealand, Singapore, Sweden, UK Day 2 attendees: –Included all Day 1 attendees plus: –Representatives of Standards Development Organisations: HL7, IHTSDO, OpenEHR –Representatives of Suppliers: Cerner, iSoft, BT, EMIS, Microsoft, Oracle, IBM

3. Why are we here? There are gaps in the existing standards and undeveloped aspects that tend to be patched by the various initiatives in ad hoc ways in order to achieve a working deployment There can be confusing and sometimes heated debate around the technicalities of different standards which can inhibit adoption and polarise the market Tooling and infrastructure to support development, local customisation and implementation of the standards is generally poor, of limited scope, and not integrated Implementation support is limited and often ineffective There is a lack of coordination in setting direction and priorities among national eHealth initiatives which then effect the SDO’s work plans and budgets

4. Day 1 observations / issues Directions of entry into the problem space vary Large uptake of standards, with varied success Cost and complexity of engagement with SDOs high Small countries are particularly disadvantaged Requirements are not adequately or collaborately expressed to SDOs We are not sharing successes and failures The “volunteer” model is not free – many stakeholders spend a lot on this. SDOs are not adequately funded for their assumed remit National standards investment models excede SDOs considerably, but best value not being achieved Standardising clinical concepts a developing theme (e.g. archetypes) Agree that tooling and infrastructure is weak Version control a key concern More holistic, generic approach needed (e.g. Put, List, Get paradigm) No SDO provides all of: –Controlled medical vocabularies –Clinical concepts and business rules –Documents –Messaging –Transactions, interactions, higher level service interaction Need clarity on what is / is not an SDO Need clarity on ISO / CEN role Need to build on European collaboration models in a global way SDOs need clearer scope and remit

5. General conclusions from Day 1 Issues and end goals of national initiatives very similar Architectures differ, but –Can reuse common processes, interchanges, data Commonality needed from processes for –Definition of Requirements –Ensuring standards meet needs –Configurability Commonality of clinical focus areas –Medication –Patient Summary (inc allergies) –Discharge –Laboratory International standards needed for supplier engagement / commitment No nation, no matter how large, can drive the standards agenda Retrieval and usage needs to be more prominent in consideration of standards

6. What do we need to do? Shape the market to enable nations and large initiatives to –Meet their business needs –Achieve value for money for their stakeholders Shape the market to enable international vendors: –To be successful within and across national boundaries –To engage with and drive the development and use of standards –Lower costs of interoperability –Improve timeliness –Prevent regional splits Shape the market to enable SDOs: –To have effective standards that are widely adopted –To understand their stakeholder community –To set strategy and prioritise activity –To achieve better funding flows, directed towards business needs Create a forum for national and other large inititiatives to enable –Collaboration –Sharing Collaborate on requirements definition –Harmonised perspective from national initiatives on the development of standards –What level do we standardise? Improve tooling and infrastructure Establish lightweight governance to –Identify and agree priorities –Realise accountability through the membership –Strengthen membership and reduce conflict and confusion in standards development –Establish conformance criteria for functionality against requirements –Establish conformance criteria for implementation –Arbitrate where overlaps and gaps occur

7. International Initiative Vendor Community SDO’s Requirements & Priorities Country Communities Common Requirements Functional Conformance Criteria Implementers Initiative Members Align Customer Providers

8. Next steps reflecting aims from Day 1, and responses at end of Day 2 Agree whether an initiative is needed and whether there is a credible buy-in? Day 2 Response: Those present agreed it had been a valuable exercise, and collaboration should continue Form a steering group Day 2 Response: Existing steering group agreed to continue (Ken, Karen, Dennis) Agreed to distribute presentations and outcomes of this workshop Develop and agree remit Day 2 Response: Develop options for a tightly scoped Use case which could be used to focus future discussion Facilitate on-line collaboration and teleconference Consider a second workshop – technically focussed – which will explore chosen Use case Develop the governance and behaviour Day 2 Response: Project focussed – must deliver an outcome Light governance Options for a use case (Medications?) Day 2 Response: –Current medications list an option (prescribing too tied to regional legislation) –Allergies is high value, and tightly scoped –Diagnosis – may be simpler, and ubiquitous

9. Critical success factors Forum progresses requirements, and shares them freely Has buy-in from national initiatives, SDOs and suppliers Can bring together an early consolidated list of key requirements Is inclusive, open and transparent Has early successes Is authoritative