1. Interoperability and Orion Health James Hardacre May 25th 2011
This presentation is a short outline of Orion Health’s approach to interoperability, with a special focus on our activities in the NHS

2. Outline Orion Health: what we do
Our 3-pronged approach to interoperability
Our ITK Proof of Concept experience
NHS Trust experience: Heart of England
As a specialist in healthcare integration, interoperability is something we take very seriously. I’m going to quickly describe what we do, how we approach interoperability, and provide a short description of our experience with the proof of concept trials with the Interoperability Tool Kit (ITK) – which we worked on with Connecting for Health in 2009.

3. Orion Health Overview
Specialists in Healthcare Integration for 18 years
Technology is important, experience ensures success
We integrate best-of-breed health information systems…
Between health IT systems
Between health organizations
On the desktop
With functionality and ease
Mission
“Provide Universal Access to Patient Information”
Usual short introduction to Orion Health
Our Clinical Portal is designed to provide a unified view of relevant patient data across a Trust or a series of NHS organisations….
BUT today our focus is on the integration of data at the back-end – where we have a technology called Rhapsody (some of you may have heard of it).
In a few minutes, David is going to talk about his experience using HL7 in integrating his Trust in Birmingham – the technology underpinning that effort is Rhapsody Integration Engine.

4. Global presence demands a comprehensive approach to interoperability
1993: Founded in New Zealand
First HL7 project: 1994
2011: 8 offices in 6 countries, clients in 30 countries, 470 employees 2
So, Orion Health is active not just in the NHS, but in healthcare systems around the world. This means that we must take seriously questions of interoperability. From the beginning we have been heavily involved in using standard interfaces.
Indeed, one of Orion Health’s very first projects was the creation of infrastructure for New Zealand’s National Health Identifier (NHI). This was the first nationwide deployment of an electronic health ID number for every patient, anywhere in the world. The infrastructure behind it was based on HL7 messaging, and was also one of the earliest national deployments of the HL7 standard.
This experience has stood us in good stead for other nationally-significant projects – including the infection disease and bioterrorism monitoring system in the USA, used by Centers for Disease Control (CDC) in Atlanta which is based on our Rhapsody technology.
So, we’ve been in this from the beginning.

5. Our 3 approaches for interoperability
Native support for standards
Support for international efforts
Eg. IHE HL7
Local ITK cooperation
I want to talk very briefly about 3 aspects of our interoperability approach

6. Native support for standards
Health-specific integration products
Native libraries of common protocols
HL7 2.x & 3.x , XML, etc. etc.
Re-useable communication points
Exportable interface configurations
Riff on this for a couple of minutes – no more.
You can add a couple of bullet points if you wish

7. Support for international efforts
Rhapsody: now an FDA Class I medical device
IHE
Connectathons in Europe and USA
IHE profiles now in use in France for the national EHR interoperability standard
Internationally, we’re very serious about technical and quality standards.
Just last week, our Rhapsody integration engine was registered as a Class I Medical Device with the US Food and Drug Administration (FDA)
This means we are now entering a rigorous certification process,
Users even in the NHS will benefit from the fact that Rhapsody must now be passed regularly through a rigorous quality management programme.
Integrating the Healthcare Enterprise (IHE) – another important activity in which we are involved, particularly in relation to the implementation of regional Health Information Exchange projects in the United States.
Interesting to note – IHE profiles have been adopted by France as the standard method for accessing and loading data onto their national spine (called DMP – Dossier Medial Personnel – Personal Medical Record). And all French IT vendors are now having to certify their applications with the government to ensure that they can interoperate with the DMP infrastructure.
So – national interoperability is not just something that is going on with ITK!

8. ITK Activities 2009 - ITK Discharge Summary PoC
ITK Spine Mini-Services Project
Currently Underway
In 2009, Orion Health worked alongside Connecting for Health and a number of other vendors to undertake a Proof of Concept (PoC) for the transmission of Discharge summaries
(We may want to mention we’re currently moving forward with a Spine connectivity project with ITK - this may be commercial in confidence)

9. ITK PoC – Discharge Summary Profile
3 source systems:
Orion Health Clinical Portal
System C
MediSec
SRC BlueWire
Generating CDA XML discharge documents
Receiving Systems:
PCTI & Liquid Logic
The PoC involved 3 source systems for the Discharge Summaries
Orion Health Clinical Portal
System C
MediSec
Bluewire
The CDA XML documents generated with routed via Rhapsody to receiving systems provided by PCTI and Liquid Logica

10. Discharge Summary generated in hospital system
Brief overview of what the PoC systems looked like, from an Orion Health perspective:
1) Discharge summary completed in the documentation module of our Clinical Portal

11. Sending confirmation in Rhapsody
2) Sample of what the sending confirmation message looked like in the Rhapsody monitoring console
(sorry not very excite)

12. Received in target system
The XML CDA document was received and rendered in the target system

13. But now, over to the real world…
David Hextell,
Head of Systems Development
Heart of England NHS Foundation Trust

14. THANK YOU