ehealth partners finland finnish agency for technology and innovation tekes grants no. 40140/06 and...

eHealth Partners Finland

Finnish Agency for Technology and Innovation Tekes grants no. 40140/06 and 70030/06

www.uku.fi/ehp

Architecture, Interoperability, Standards

-recent research in eHP Finland

network

China-Finland eHealth Partnership meeting, Helsinki, 6 Sep 2007

Dr. Juha Mykkänen 穆佑赫University of Kuopio, Health Information Systems R&D Unit


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outline

● recent work items and related projects● recent results, including examples● relation to China-Finland eHP project

guidelines and


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background● applied research responding to challenges related to

systems development and interoperability in healthcare○ point-to-point integration solutions, expensive tailoring,

heterogeneity in technologies, requirements, and standards

● central elements of solutions○ guidelines, methods and reference models for acquisition,

integration and systems development projects○ component- and service-based systems development and

management approaches to support changing requirements and heterogeneous environments

○ separation of care management from health information○ formalised requirements, processes and practices○ common concept models, vocabularies and terminologies○ validation in practice in hospitals and products


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recent related work● SerAPI project, results available in September, examples:

○ regional scheduling (HL7 v3), clinical decision support interfaces, specification of core services (e.g. code sets, context management), patient groupings (for billing/statistics, e.g. DRG), patient lists

○ Service-oriented architecture and development guidelines: service identification, process modeling, architecture specification

○ education related to SOA and HL7 version 3

● Healthcare Services Specification Project and HL7 (international)○ joint HL7/OMG effort for standardizing services and SOA approaches

for healthcare: EIS, RLUS, DSS, CTS2○ SOA for HL7, dynamic model enhancements to HL7 version 3○ Electronic + Personal Health records, Scheduling, Infrastructure etc.

● participation in national initiatives in Finland○ specification of core data sets and speciality data sets○ specification and certification related to national health IT services○ national standards work: HL7 version 3, CDA r2, social services

● IHE (integrating healthcare enterprise) initiative in Finland


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examples of recent results● Evaluation and selection framework for interoperability

standards● e-hospital architectural guidelines development - applying

SOA locally for enterprise architecture (continues via further projects in Finland and IMIA)

● Comparison of model-centric approaches for development of health information systems

● Methods for service-oriented development of systems and integration solutions

● interface and service definitions for○ clinical decision support○ regional scheduling (HL7 version 3)○ patient groupings for billing, benchmarking etc. (e.g. DRG)○ code sets,


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eHealth standardization areas(used in the evaluation framework and national recommendations in Finland)

medicineand

healthcare

information m

odels and elements

terminologies, classifications, codes

processes, pathwaysquality of care

guidelines, knowledge

architecture

healthcare IT and IS

data types and formats

electronic clinical documents

message interfaces

archiving and long term storage

service and API interfacessupport for processessecurity and confidentiality

IT, domain-neutral andcross-domain

electronic health records

standardization relevant to eHealth and HIS

data comm

unicationsidentificationeG

overnmenance and architecture

electronic documents

messaging and enveloping

interface technologiesprocess description and definitionsecuritysoftware production / developm

ent


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standards● e-hospital architectural guidelines development - applying

SOA locally for enterprise architecture (continues via further projects in Finland and IMIA)


● Methods for service-oriented development of systems and integration solutions

● interface and service definitions for○ clinical decision support○ regional scheduling (HL7 version 3)○ patient groupings for billing, benchmarking etc. (e.g. DRG)○ code sets,


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medium-term integration architecture guidelines for hospitals (Finnish setting)

Administration and management

Financials

Materials management

Personnel management

Property and infrastructure management

Sales, CRM, marketing, PR

Clinical subsystems

Surgery

Neonatal

Cardiology

Pathology

Anaesthesiology+ ICU

Gastroenterology

Clinical core

Patient and provider id

Decisionsupport

Pharmacy

Terminology

Etc

EHR repository

Administrative core

Patient / provider demographics

Invoicing

Admisstion, discharge,

transfer

Inpatient and outpatient

management

Resource /operationsplanning

Materials& meal

ordering

Orders / referrals, prescriptions, consultations

Scheduling, Resouce

Management

Patientgrouping,

DRG

User management, security and access control

Integration, data access

Workflow and process management

Professional front-endsPatient/citizen front-end

Lab

Radiology+ PACS

Medication

Results

Problems

Population / community health

Insurance

Reporting, Data warehousing, Management

Workstations Web Mobile Ubiquitous

Statistical reporting

Research

Guidelines, protocols

Equipment

Disease management

1. 2. 3.

1. Common, shared and centralized services2. Context management, added value services3. Loosely-coupled messages, documents, cross-facility invocations

Identification User role Care relationship Consent


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standards● e-hospital architectural guidelines development -

applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA)


● Methods for integration solutions and service-oriented development of health information systems

● interface and service specifications○ >20 related open specifications nationally and internationally○ related testing, certification and conformance research


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model-centric approaches in relation to the phases of information systems development


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discussion: China/Finland guidelines● health information sharing (regional, national)

○ practical large-scale approach (good example in Finland): agreed data sets, shared services, open standards

○ clear separation of patient and professional needs○ combination of international and local standards

● architectures and interoperability○ up-front investment in architecture will provide significant

long-term benefits (bad examples in Finland)○ several solution models need to be combined○ hospital / health centre-specific starting points must be

acknowledged

● all work must be based on accurate requirements specification and supported by evaluation


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Thank you

presenter: Dr. Juha MykkänenUniversity of Kuopio

HIS R&D [email protected]

谢谢


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Architectures and standards in healthcare‘Architecture’ defines how elements and relations between

them make up a whole – e.g., an e-hospital architecture

● Organizational view: Who uses, who stores, who maintains; workflows, processes, service chains – IHE (Integrating the Healthcare Enterprise) workflows, etc.

● Functional view: What the system elements should provide; – HL7 EHR-S Functional Model, HL7-OMG HSSP, etc.

● Technological view: How system should be implemented – HL7-OMG Services Spec. Project HSSP, Eclipse, etc.

● Information view: Data elements, coding, structures, stores – HL7 RIM (Reference Information Model), HL7 CDA (Clinical Document Architecture), OpenEHR, etc.

Ada

pted

from

RM

-OD

P m

odel

, IS

O/IE

C 1

995


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SerAPI: Service-based architecture and web services in healthcare Application Production and Integration

● Theme: flexibility, integration and interoperability in healthcare applications○ project in the FinnWell programme of Tekes, Sep 04 – Aug 07○ 14 software companies, 4 public health service provider organizations, 3

research units (University of Kuopio)○ Healthcare processes and services software products○ Service-oriented architectures (SOA)

• flexibility and connectivity: support for different processes, transition towards component- and service-based information systems

○ Web services• open Internet technologies, service interfaces in software products,

support for multiple implementation technologies and tools○ Application interfaces, application integration and service-oriented

application design• based on integration results (interfaces, methods) from the PlugIT

project


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SerAPI - participants● Research groups (University of

Kuopio)○ HIS (Health Information

Systems) R&D Unit○ Shiftec Unit (Dept. of Health

Policy and Management)○ Software engineering (Dept. of

Computer Science)● Healh care organizations

○ Hospital district of Helsinki and Uusimaa

○ Hospital district of Northern Savo

○ Hospital district of Satakunta○ City of Kuopio

● Companies (healthcare application / content development)○ Commit; Oy○ Datawell Oy○ Fujitsu Services Oy○ Finnish Medical Society

Duodecim○ Mawell Oy○ Medici Data Oy○ Mediconsult Oy○ Prowellness Oy○ Softera Oy○ WM-data Oy

● Companies (infrastructure)○ Bea Systems Oy○ Intersystems B.V. Finland○ Microsoft Oy○ Oracle Finland Oy


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SerAPI approach: standpoints of processes, applications and technologies


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SerAPI: main activity areas● Application domains

○ three-party collaboration: healthcare provider organizations, companies, research group

○ interfaces and application services responding to the needs of health professionals, information management and application development

○ e.g. clinical context integration, scheduling, OID identifiers, DRG grouping, patient record location and access, clinical decision support etc.

● Service interfaces and standardization○ Healthcare Services Specification Project / HL7 and OMG – international

healthcare service interface standardization○ HL7 Finland Common Services SIG background project○ National recommendations for the development and organization of

standardization to support health information systems● Collaboration

○ national (e.g. AVOINTA, ZipIT, Export HIS, FinnWell interoperability group, national and regional projects related to electronic health records

○ international (e.g. HL7, OMG, Eclipse, research collaboration)● [email protected], University of Kuopio, HIS R&D Unit● www.centek.fi/serapi/english.html


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Integration specification process(overview)

Contex ts tud ies , tec hnology

ev a luations

D e s crip tio no f cu rre n t s ta tu s

Pilo tingp la n

- l is t o f in i tia l in tegration needs-s pec i fic a tion gu ide l ines-c ontent defin i tions for s pec i fic a tions-ex am ple s o lu tions- tem plates- too ls

-ex is ting in tegration s o lu tions-p i lo t s ys tem s-ex is ting tec hnolog ies and too ls-ex is ting produc tion and qua l i ty proc es s

Pro jectp la n

Hea lth se rv icep rovide r (e .g .

ho sp ita l)

Mo de ra to r(Plu g IT p ro je ct)

Applicationvendors

W ork proc essimprovement

Integrationneed

R equ iremen tsan a lys is

So lu tio nspecifica tio n

Imp leme n ta tion(p ilo t)

Ac c eptanc eDeploy mentAdaptation

1.INTEGRATIONREQUIREMENTS

2. PLATFORM-INDEPENDENT INTERFACE

SPECIFICATION3. TECHNOLOGY-

SPECIFIC INTERFACESPECIFICATION

4. IMPLEMENTATIONDESCRIPTION

s p e cifica tio nw o rk

s p e cifica tio nw o rk

im p le m e n ta tio nw o rk

-docum entation-evaluation-integration proces s developm ent-generalization-m ethodvalidation

-hea l th k now-how-p i lo t s ys tem s-ex is ting tec hnolog ies- func tiona l and qua l i ty requ i rem ents

i te ra tio n , n e w ve rs io n s

p ro d u ctim p le m e n ta tio n

O p en , reu sa b lein teg ra tion spe cifica tion s

lo ca l re q u ire m e n ts

Myk

kän

en e

t al

., i

n M

ED

INF

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004


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4. Conclusion

● E-hospital is not “turn-key shopping” but a process● Collaborative process between stakeholders● Functionality, data standards and software interfaces● The main steps for one hospital:

1. Evaluate your current state from activity/service viewpoint2. Identify target: How activities/services to be supported by ICT3. Identify your migration path with phases, specify Phase 14. Select an initial portfolio of products with a shared architecture5. Select your trustworthy key solution provider with a

consortium

● eHealth Partners Finland is a consortium of international-level research groups and companies willing to contribute along your path to e-hospital


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HIS challenges for interoperability● healthcare process specifics

○ balance between customer, provider and organisational objectives○ complexity, legality, communication, multi-professionality, exceptions○ externalisation of healthcare processes from HISs○ requires flexibility of architectures, definition of migration paths

● explosion of potential interoperability solutions○ architectures, evaluation of standards, development and

maintenance costs

● evidence○ identification of real needs, requirements traceability○ collection of application experience of domain-neutral best practices

in HIS

● generic innovation vs. local introduction○ reduced local tailoring, increased reuse on many levels○ gaps: product development - healthcare process development -

academia?


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Interoperability apex 2007● Semantic and process integration

○ structured and coded information, shared terminologies, ontology-based semantics

○ clinical decision support, integration and adaptation of HIS into defined or even evidence-based workflows

● Service-oriented architectures○ paradigm for open, flexible and business-aligned systems, cohesive &

reusable services○ process management and automation (vs. exceptional healthcare workflows)○ infrastructure services (e.g. EHR access, codes and terminolofies, access

control) and added value services (e.g. decision support)○ e.g. Healthcare Services Specification Project / HL7+OMG

● Profiles = constraints on application of generic mechanisms○ technical: e.g. Web services interoperability (WS-I)○ functional: e.g. HL7 EHR-S Functional Model○ semantic: e.g. CEN/OpenEHR archectypes, HL7 templates○ standardisation: e.g. Integrating Healthcare Enterprise (IHE)

ehealth partners finland finnish agency for technology and innovation tekes grants no. 40140/06 and...

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