Enterprise Architecture & Design Authority

Transcription

1 Enterprise Architecture & Design Authority Technical Architecture: Interoperability and its impact on healthcare systems ehealth Ireland: Eamon Coyne (HSE) and Dr. Alexander Berler (IHE/GNOMON) Driving Healthcare Transformation

2 The Challenge What if you had a mobile phone plan that only allowed you to call other customers of your carrier? That s the situation for most healthcare providers today, when they join a data sharing network. Sláinte Care Implementation Strategy: For health professionals, the lack of visibility of a patient s health history is a serious obstacle to planned, coordinated care delivery away from acute settings Delivering ehealth Ireland Office of the Chief Information Officer 2

3 Interoperability what is it? In relation to ehealth it can be defined as follows In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. (definition HIMSS 2013) Delivering ehealth Ireland Office of the Chief Information Officer 3

4 Components of a national ehealth Strategy what components contribute to Interoperability? Leadership and Governance Strategy and Investment Services and Applications Legislation, policy and compliance Workforce Standards and Interoperability Infrastructure From National ehealth Strategy Toolkit WHO ITU Delivering ehealth Ireland Office of the Chief Information Officer

5 EHR Data Exchange EHR

6 Levels of interoperability

7 Security, Privacy, Governance The many dimensions of Interoperability Legal & Regulatory Policy Care Process Information Applications & Services IT Infrastructure Legal and regulatory constraints Information Exchange Collaboration agreements Collaborative care and workflow processes Defining structure and coding of information Tranport and Exchange services Integration in healthcare systems Generic Communication protocols From Refined ehealth European Interoperability Framework EU ehealth Network, 23/10/2015 Delivering ehealth Ireland Office of the Chief Information Officer 7

8 Benefits of ehealth Interoperability Standards Service users all relevant information relating to their care is available when and where it is needed, the risk of an adverse event is reduced, quality is improved, and the unnecessary duplication of tests and investigations eliminated. Specifically, patients will benefit from safer and more timely care. By facilitating the efficient sharing of information, interoperability standards play a crucial role in patient-centred shared care, providing the patient with services in the most appropriate setting, which will increasingly be in the community for suppliers, standards provide greater market certainty, a basis for certification (a marketable asset), simpler procurement processes and the prospect of growth in export markets where the standards used are international for purchasers and implementers, standards simplify procurement including the assessment of compliance, improved confidence that the product purchased will be interoperable, and greater potential to avoid vendor lock-in for policy makers and regulators, there are clear benefits in the use particularly of international standards through the promotion of solutions which have proved to be successful elsewhere, as well as providing insights into where problems have been encountered. Source: 8

9 What profiles and standards From standards to interoperability specifications. Profile based approach is most cost-effective There are at least 3 ways to approach interoperability: profile based, customised standards approach and infrastructure vendor approach. Of these three approaches, Profile based interoperability has the lowest implementation costs and the lowest life cycle costs. 9

10 Practical Approach to Achieving Interoperability The practical approach to achieving interoperability that has been successfully applied by various ehealth projects in Europe and internationally can be summarised in the following seven steps: 1. Identify use cases 2. Select profiles and standards that support the use case (e.g. by selecting a realisation scenario). 3. Refine data content, including document templates, metadata, master files, terminology. 4. Write interoperability specifications (implementation guides) 5. Organise testing by preparing test cases and a test environment for implementers to demonstrate component interoperability and by organising cross-implementer connectivity testing. 6. Educate end-users on interoperability: Develop communications materials to familiarise endusers on the benefits and impact of Interoperability. 7. Support or participate in communities of practice to promote sustainable standards-based implementation and offer feedback to standards and profiling organisations. Source: 2.pdf 10

11 Common ehealth Use Cases Business Use Cases Supporting Profiles Key Base Standards in Profiles Patient Summary in Regional or National eprescription and edispensation in Cross- Border in Regional or National Lab Results in Regional or National Medical Imaging in Regional or National Telemonitoring eprescription and edispensation in Cross- Border Patient Summary in Cross- Border PIX* OR PDQ*, XDS*, CT*, ATNA*, BPPC*, XUA*, XDS- MS* OR XPHR* PIX* OR PDQ*, XDS*, CT*, ATNA*, BPPC*, XUA*, XDS- MS* OR PRE*, DIS* PIX* OR PDQ*, XDS*, CT*, ATNA*, BPPC*, XUA*, XD- LAB* PIX* OR PDQ*, XDS*, CT*, ATNA*, BPPC*, XUA*, XD-I* PIX* OR PDQ*, XDS* or XDR* or XDM*, CT*, ATNA*, BPPC*, XUA*, HRN+, WAN+ or DEC*/RTM*, LAN+ or PAN+ XCPD*, XCA*, CT*, ATNA*, BPPC*,XUA*, PRE*, DIS* XCPD*, XCA*, CT*, ATNA*, BPPC*,XUA*, XPHR* HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA, DICOM HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA, IEEE1073 HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA HL7 V2.4 or V3, OASIS EBRS, OASIS SAML, NTP, IETF, HL7 CDA 11

12 27 IHE Profiles recognised under EU regulation 1025/2012 Regional, National, Cross-border: - Share - Patient Id - Imaging - Summaries - Lab - Privacy XDS.b XDR XDS-I.b XPHR XD LAB XCF XDM XDS-MS PRE XUA XCA XCPD XD-SD DIS BPPC Regional, National, Hospital Patient Id & Security PIX ATNA PDQ CT Hospital-HIS PAM SVS Hospital-Rad SWF.b SWF PIR Hospital-Lab LCSD LAW LTW Source: Delivering ehealth Ireland Office of the Chief Information Officer

13 Past Experience IHE based Interoperability experience has demonstrated significant benefits to national/regional programs: Reduce specification consensus time Simplify implementation efforts Reuse of testing tools and processes Shared implementation experience 13

14 Use of IHE Profiles in ehealth Projects Selecting Profiles for Interoperability Specification Key health systems objectives Business Use case A Profiles for Use Case A Content & Terms Patient summary Lab Report Imaging Info Exchange ECG Report. Profiles Standards IHTSDO Services Patient Demographics X Document sharing Health Provider Directory X document workflow Security and Privacy Consent management Audit Trail... Interoperability Testing

15 Interoperability Testing is key to successful implementations and deployments

16 Irish Test Harness 16

17 Devices (Patient Managed) Next Stop in a future not that far: Interconnected healthcare services networks and devices for the benefit of the patient Mobile Apps Portals ehealth (Reg/Nat) Citizen Records ehealth (Care Delivery) Devices (In Care Delivery) Citizen Provider Citizen Records Well-Being Remote Monitoring Healthcare Records Healthcare Records Medical Devices mhealth, ehealth and Health/Medical Devices as components of the connected health system Delivering ehealth Ireland Office of the Chief Information Officer

18 Example of Continua guidelines and IHE standards in use for Personal Health Devices health information exchange IHE s primary domain is in clinical healthcare settings and their regional/national/cross- border exchanges while PCHAlliance s primary domain is in home and remote health settings. IHE Profiles and PCHAlliance s Continua Design Guidelines are both standard-based, open specifications for health information exchange: Where they overlap they are consistent, resulting in a mature and interoperable information ecosystem Together they ensure that device data whether captured by the patient or in a care delivery setting flows into electronic health records in the same format and coded content Delivering ehealth Ireland Office of the Chief Information Officer 18

19 Irish Open NCP Portal gateway to Europe Ireland successfully exchanged information through the EU Government VPN with Luxembourg and Cyprus through the portal just last week in EU Test Event. Delivering ehealth Ireland Office of the Chief Information Officer 19

20 Leveraging the work from the Open NCP building block Paradigm shift: the patient will manage his data For citizens a mobile app and service that connects you with your own (and your family) medical data across borders and devices like wearables and other personal health devices. Extensive consent functionality gives you control of your privacy settings For Doctors an indispensable tool for patient collaboration and treatment plan adherence. A pragmatic productivity booster. For Healthcare systems a standards compliant future proof platform for patient engagement to treatment adherence and access to the forefront of technology uptake for cross border use cases and IoT integration For developers is more than an app! It is a platform that brings the baseline of conformance and standards adoption to a level that could be utilized by the mhealth ecosystem Delivering ehealth Ireland Office of the Chief Information Officer 20

21 Access to Your Medical Information Integration with National Health Services via epsos Access to your patient summary and your e-prescription Access to the patient summary of your family members Creation of your personal health record Diseases, allergies, medication, vaccinations Upload/Download documents (e.g. lab results) Access to doctors reports All CDA based documents Privacy settings for secure connection with specialists Consent mechanism Configuration of medical data accessed by the doctor Break the glass mechanism Setting of Emergency info visible to the specialist Import data from IoT devices Integration with Google Fit and shealth ie. import data from Google fit and shealth such as weight, steps etc. Connection with Xiaomi Mi Band ie. import data from Mi Band such as step Delivering ehealth Ireland Office of the Chief Information Officer

22 ehdsi Architecture is based on IHE profiles IHE Gazelle used for testing at all levels epsos Project

23 Case Study: Kingdom of Saudi Arabia Saudi ehealth exchange (SeHe) IHE Services all rights 23

24 Prioritisation of interoperability use cases 24

25 Case Study Veneto Region: Data Analytics based document created and stored in the region Asthma prevalence of drug consumption

26 Testing & Tools approach First step Labelling : testing performed in vitro situation using simulators to assess the adherence of Project technical specification (performed in the Arsenàl.IT labs) Second step Pre Production Test: testing performed in real condition (in particular using LHA systems) before starting with new software features

27 Case Study Switzerland: First country that will certify systems by law IHE Services all rights reserved

28 Many specifications, and then? Interoperability in and between EHRcommunities secured via certification! ISO based certification process by law only certified EHR-communities are allowed to participate certification of organization, processes and technology technical certification done with certification platform derived from reference platform (basis is IHE Europe CAS environment) live-testing via Swiss EHR Projectathon

29 Federal Interoperability specifications for the Swiss EHR

30 Setting up the testing continuum within a project/strategy is important (Projectathons) Swiss -EPR end-to-end workflow testing

31 Swiss EPR Projectathon vendors 2 Federal Organisations 30 systems 75 participants 18 monitors EPR Projectathon 2018: 22 Vendors 94 participants IHE Services all rights 31

32 Case Study USA: ehealth Exchange Stats The ehealth Exchange ( Exchange ) is a group of federal agencies and non-federal organizations that came together under a common mission and purpose to improve patient care, streamline disability benefit claims, and improve public health reporting through secure, trusted, and interoperable health information exchange The Sequoia Project. All Rights Reserved.

33 Case Study USA: Building quality on exchanged information establishes trust between stakeholders

34 Some Lessons Learned more to come! Interoperability is a prerequisite to enable new added value healthcare services through IT systems. Governance of Interoperability is important Competence centers need to be appointed as the custodian of interoperability, specification and testing Testing is paramount for the success of complex IT project and the education of Stakeholder members. DO test events! Quality of information exchanged is of crucial important. DO Validate the quality of input and output of information exchange processes. Bringing together the stakeholders is a catalyst for success in a consensus based approach DO involve stakeholders as early as possible Certification of IT components in healthcare is the next step in an organized healthcare information exchange world Technologies are evolving and new challenges are ahead in a connect world. Standards and Integration Profiles provide a solution

35 35