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 RECORDUnder the aegis of Ministry of Health
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
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
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
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
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.net
• Leverage standards instead of reinvent standards
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
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
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
ICW - General portfolioPATIENT / 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
CaseRecord
Tele-monitoring
Hospitals
Hospital Associations
Healthcare Professionals
11
Example: introduce messaging middleware
ICW Professional Suite (PXS)ICW Professional Suite (PXS)
Health care provider – primary systems, hospitalsHealth care provider – primary systems, hospitals
12
Example: introduce messaging middleware
ICW Professional Suite (PXS)ICW Professional Suite (PXS)
Health care provider – primary systems, hospitalsHealth care provider – primary systems, hospitals
Messaging MiddlewareMessaging Middleware
Passed IHE PIX profile tests
13
Example: introduce messaging middleware
ICW Professional Suite (PXS)ICW Professional Suite (PXS)
Health care provider – primary systemsHealth care provider – primary systems
Messaging Middleware
Integration Process Management
Messaging Middleware
Integration Process Management
Passed IHE PIX profile tests
14
ICW e-card Project – (ePrescription)
Health Professional Card Patient Card
Pharmacist Card Patient Card
CardTerminal
ICW BoxConnector
GPSoftware
CardTerminal
PharmacySoftware
VPNTunnel
ICW BoxConnector
ePrescriptionService
Contract DataService
CertificateAuthority
NHIF
15
8. Dispense ePrescription
1. Patient authentication1. Successful authorization
2. Requests patient ePrescription
3./ 9. Transfers Request for ePrescription/ dispensing
Primary System
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
Patient CardPharmacist
ePrescriptionServer
X.509
ICW e-Card project – pharmacy processes
16
8. Dispense ePrescription
1. Patient authentication1. Successful authorization
2. Requests patient ePrescription
3./ 9. Transfers Request for ePrescription/ dispensing
Primary System
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.
Patient CardPharmacist
ePrescriptionServer
X.509
ICW e-Card project – pharmacy processes
SICCT
ISO 7816-1,2,3,…15
ISO 7816-1,2,3,…15
X.509, CVCIPSec, TLS, L2TP
gematik
X.509, CVCX.509, CVC
gematik
17
ICW project – Building of eHealth portal and Personal Health Record
Primary System
ICW e-Government Health Record (MSAAR)ICW e-Government Health Record (MSAAR)
PortalPortal
Authorization
Physician Patient‘sHome
18
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!“
Thank you
NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORDUnder the aegis of Ministry of Health