1. Integration of hospitals and other medical specialists through international standards, technologies and best practices Christian Ohr ICW Germany, Feb 13th 2008, Sofia NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORD Under the aegis of Ministry of Health

2. 2 Agenda Standards and Interoperability –Examples –Barriers to Adoption and Acceptance IHE Initiative –Leverage instead of reinvent –Profiles –Showcases Strategies to introduce standard-compliance

3. 3 Standards and Interoperability Medical IT Standards –HL7 v2 –HL7 v3 –CDA, CCOW, CCR –DICOM –ISO 11073, 13606, …, CEN … Medical IT Terminologies and Vocabularies –SNOMED CT –LOINC –ICD Industry IT Standards –XML, ebXML –SOAP, WSDL, WS-* –BPM, BPEL

4. 4 Standards – Barriers to Adoption and Acceptance … there are so many to choose from … –Competing standards –Complementing standards … each of them covers only part of the story … –Real-world use cases and scenarios span over: Health domains Technical layers … they are too generic and add extra overhead … –Even using a small part of it requires you to use the whole stack … they are interpretable … –Using the standard and still don’t understand each other (“plug-and- play”) –Constraining the standard by defining profiles

5. 5 Standards – Barriers to Adoption and Acceptance … none of them cover your special needs … –Project-, region- or country-specific requirements –Process to generalize these features and propose them for the official standard is often troublesome and time-consuming … consciously ignored … –“not invented here”-principle –recognition, funding, significance … unconsciously ignored … –Missing knowledge about existence –Limited accessibility of standard documents

6. 6 IHE Initiative IHE –Driven by users and industry –Workflows in Frameworks –Goal: “enable health information systems to share and exchange medical data more easily” –www.ihe.netwww.ihe.net Leverage standards instead of reinvent standards

7. 7 IHE Initiative Profiles –define how a particular system can exchange its information with another, to meet specific (clinical) needs –Use-case driven –Clear distinction between use-case and technical implementation –Leverage existing standards for information exchange (at times, the chosen ones seem arbitrary and heterogeneous) –Detailed, also covers boundary conditions –Dependencies between profiles Domains –Groups of profiles –cardiology, eye care, IT infrastructure, lab, pathology, patient care coordination, patient care devices, quality, radiation oncology and radiology

8. 8 IHE Connectathons Largest interoperability testing event in health care –vendors refine and test their products for conformance with IHE integration profiles and interoperability with corresponding healthcare IT systems. –Chicago, Jan/Feb 2008: 70 companies, ~ 400 participants –Results are published

9. 9 Strategies how to introduce standard compliance Adding another interface to an existing product is a non-trivial task –Doesn‘t match existing interfaces –Uses different technology –Bloats the core product with integration issues –…–… "Any [software] problem can be solved by adding another layer of indirection.” (Steven M. Bellovin) Exceptions –the problem of too much indirection (complexity) –improve performance –minimize usage of [computing] resources

10. 10 ICW - General portfolio PATIENT / CITIZEN PHYSICANS / -NETWORKS / PHARMACIES HOSPITALS / -ASSOCIATIONS HEALTH INSURANCE COMPANIES - Patient Information - HomeCare Integration - Fitness and Prevention - Rehabilitation - Patient Information - HomeCare Integration - Fitness and Prevention - Rehabilitation Chronically ill patients Young mothers Elderly Health conscious Athletes - Teleconsultation - Patient Integration - eHealth Integration - Networking of Physician‘s Electronic Medical Record - Hospital Networking - Referrer - Patient Integration - Telemedicine Virtual Medical Record - DMP Management - Card Management - Kiosksystems - Teleconsulting - Telemonitoring Care Management Insurance Companies Call Center Pharmacies Radiology Physician‘s offices Physician networks Patient Integration Patient Information Case Record Tele- monitoring Hospitals Hospital Associations Healthcare Professionals

11. 11 Example: introduce messaging middleware ICW Professional Suite (PXS) Health care provider – primary systems, hospitals

12. 12 Example: introduce messaging middleware ICW Professional Suite (PXS) Health care provider – primary systems, hospitals Messaging Middleware Passed IHE PIX profile tests

13. 13 Example: introduce messaging middleware ICW Professional Suite (PXS) Health care provider – primary systems Messaging Middleware Integration Process Management Messaging Middleware Integration Process Management Passed IHE PIX profile tests

14. 14 ICW e-card Project – (ePrescription) Card Terminal ICW Box Connector GP Software Card Terminal Pharmacy Software VPN Tunnel ICW Box Connector ePrescription Service Contract Data Service Certificate Authority NHIF

15. 15 8. Dispense ePrescription 1. Patient authentication1. Successful authorization 2. Requests patient ePrescription 3./ 9. Transfers Request for ePrescription/ dispensing Connector 4. Reads ePrescription Info from card 5. ePrescription is transferred together with ePrescription ID 6. Visualize ePrescription 7. Cross check print out and deliver drugs 10. Delete ePrescription Info on card X.509 ICW e-Card project – pharmacy processes

16. 16 8. Dispense ePrescription 1. Patient authentication1. Successful authorization 2. Requests patient ePrescription 3./ 9. Transfers Request for ePrescription/ dispensing Connector 4. Reads ePrescription Info from card 5. ePrescription is transferred together with ePrescription ID 6. Visualize ePrescription 7. Cross check print out and deliver drugs 10. Delete ePrescription Info on card. X.509 ICW e-Card project – pharmacy processes SICCT ISO 7816-1,2,3,…15 X.509, CVC IPSec, TLS, L2TP gematik X.509, CVC gematik

17. 17 ICW project – Building of eHealth portal and Personal Health Record ICW e-Government Health Record (MSAAR) Portal Authorization Physician Patient‘s Home

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19. 19 Summary Adoption of standards is often troublesome –Choice, complexity, abstractness, applicability, support IHE puts standards in context with real-world health care integration scenarios –Description of use cases, required standards and boundary conditions –offers an exciting compliance test platform ICW actively supports standardization activities –Member in many standardization boards (national + international) –Coordination of standard activities by own department –Standards compliance in core products ICW products and projects started in Bulgaria –Relevant to the standards accepted by eHealth industry –Relevant to European plans and initiatives –Oriented to the integration of legacy (existing) systems and not to the rejection of these systems. The message of ICW is „Connect, don‘t reject!“

20. Thank you christian.ohr@icw.de NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORD Under the aegis of Ministry of Health