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Healthcare software Healthcare software servicesservices

- open interfaces and - open interfaces and standards in Finlandstandards in Finland

HL7/OMG Healthcare Services Specification Project

London, 31 Jan 2006

Juha Mykkänen, University of Kuopio, HIS R&D unit

SerAPI project, HL7 Finland CS SIG

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Overview

healthcare & health information systems in Finland open service-oriented interfaces: efforts and

specifications in Finland HL7 Finland Common Services SIG PlugIT project SerAPI project

comparison of three services experiences

national efforts HSSP

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KuopioHelsinki

Healthcare in Finland Population 5.3 million Life expectancy 74.6 / 81.5 years GDP per capita 28,646 EUR (2004) Growth competitiveness index score (World Economic Forum

2005) 5,94 (1st) Healthcare 7.6% of GDP Public healthcare funded by taxation Basis: 278 primary health centres by 444 municipalities 5 university + 32 central/district hospitals in 20 districts =

associations of municipalities Private care 14% Occupational health by private organisations

Information systems in healthcare in Finland In primary health care, EPR used by 98% of GPs In hospitals, HIS used since 1980s Now: EPR to hospitals, integration, migration, web-based systems

– National interoperable EHR by 2007?

Healthcare & HIS in Finland

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Background: HL7 Finland Common Services SIG

HL7 Finland held its 10th anniversary in October 2005 HL7 v2.3 messaging widely used in some domains active in national work for EHR

CDA r2 used as a basis for the structure and archiving

HL7 Finland Common Services SIG (2002-) initial focus on clinical context integration (CCOW) work on service specifications from the background

projects - national comments, balloting 3 available specification areas + implementation guides

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Needs

Softw. devel.

Sales & support

R & D

Applied research

Basic research

Teach-ing

Software companies

Healthcare / welfare service providers

IS-enabled

care

IS project

IT support

Educational and research institutions

Health/welfare services

Better life

Needs

Products, consultation

Needs

Actors, methods

Intl. links

Government

Guidance, resources

Communities, citizens

Background: PlugIT project

National R&D project to develop integration solutions for healthcare Results: Service specifications, integration methods, centre of expertise Oct 2001–Aug 2004, about 15 full-time + 15 part-time researcher/developers Budget € 2 million, 84% by National Technology Agency TEKES

3 univ. depts, 1 polytechnic

12 applications vendors, 3 technology vendors

6 hospital districts, 2 municipalities

Natl. healthcare programme / National EHR project

www.plugit.fi

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Background: SerAPI

SerAPI project (2004-2007) national R&D project service-oriented architecture and web services 14 software companies, 4 public healtcare organisations,

3 research units process / application / platform viewpoints service specifications, methods and tools participation in standards development (national /

international) Healthcare Services Specification Project

participation through both OMG and HL7 infrastructure work / individual services

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Open service specifications

HL7 Finland accepted Context Management (context repository) ~ CCOW Core services: User & Person information access +

Access control ~ EIS, OMG PIDS Core services: CodeAPI ~ Common Terminology Services

Vocabulary API, OMG TQS other publicly available

DRG classification OID generation

other in progress and related scheduling ~ e-booking decision support patient lists, care relationship, etc.

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Service implementations

several context service applications context services available in core applications in hospitals

and health centres low effort implementation for single sign-on + patient

synchronisation recent additions for security in regional information

systems core service implementations in university hospitals

implementations in new core hospital systems also legacy applications wrapped with interfaces -

migration several proprietary services, some specifications available in

public DRG classification, care relationship, decision support

service pilot etc.

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Approach + interface technologies

incremental specification: from functional interface specification to technology-specific interfaces

simple http communication (context management) http + XML (user, person, etc. HL7 specifications) WSDL/SOAP with WS-I, "API style" (versions of user,

person etc. core services, DRG, OID)

in addition to CDA documents (national EHR core technology) -

national "services" HL7 messaging (v2.3 v3 + Web services transport) others (EDI, custom solutions..)

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Different types of services: three cases

DRG (Diagnosis Related Groups) classifier interface resource utilisation groups (NordDRG) to support e.g.

invoicing and benchmarking EPR (Electronic Patient Record) archive interfaces

variety of clinical documents stored in archives on organisational, regional and national level - note: national solution not yet specified

Context repository single sign-on, synchronisation of several applications

(used by one user) to one patient at a time etc.

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Scenario DRG classifier interfaces

EPR archive interfaces

Context repository interfaces

Requirement Produce information based on diagnosis and other information for the assessment and comparison of resource consumption

Provide a common interface for archiving and retrieving different types of clinical documents related to a patient (e.g. referrals, prescriptions)

Maintain user-specific context information for several applications (user, patient, encounter etc.)

Integration model

service information user

Adaptability static, parameters well-known

dynamic, different types of documents, support for local variation

static interface, extensible subject definitions

Unified or federated

unified model (common service)

unified model (common archive) and federated model (content translations, cascading archives)

unified model (common service)

Comparison of service scenarios 1

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Scenario DRG classifier interfaces

EPR archive interfaces

Context repository interfaces

Granularity fine-grained operations and parameters

large-grained documents

fine-grained operations and parameters

Tight/loose tight, common service must be available

loose, archive may be queued, national messaging service

tight, but applications work also without the service

Consumers / providers

many consumers use one provider (one organization)

many consumers use one logical provider (national, regional)

many consumers use one provider (organization / region)

Message exchange pattern

immediate response needed, find and invoke

guaranteed delivery needed, send and retrieve

immediate response, find and invoke

State stateless stateless stateful

Additional conside-rations

can be used in interactive and/or batch-oriented way

clinical documents, functionally simple, informationally complex interface, digital signatures

low implementation threshold for participating applications, no bi-directional invocation

Comparison of service scenarios 2

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Emphasis in Finnish efforts

increased plug and play, reduced local tailoring simplicity and genericity: start from minimal but sufficient

implementability low introduction threshold compatibility with existing systems defined path from requirements to implementations

services as one part of the big picture CDA (moving from regional to national level) messaging (v2 v3 transition is beginning) emerging architectures on local, regional and national

levels three-partite collaboration (vendors, hospital districts,

research)

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Lessons & observations

important: pragmatic approach and right timing acknowledge different types of services clear usability improvement, low introduction threshold and

little invasiveness have fostered the most uptake start where there is most repeated point-to-point integration nail down both functionality and information (does not mean

sacrificing flexibility) a unifying architecture would help

differences in organisations, in regions and nationally "where to put the mandate.."

HSSP: practical, community-driven, multi-platform... SOA main benefits: flexibility and interconnectivity moving from closed consortia to open standards community but quite bad conference call times for Europeans (EET) .. :)

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Thank you

SerAPI project participants: National Technology Agency TEKES (grants no 40437/04, 40353/05), Medici Data Oy, Datawell Oy, Fujitsu Services Oy, Hospital district of Northern Savo, WM-data Oy, Commit; Oy, Intersystems B.V. Finland, Mediconsult Oy, Microsoft Oy, Oracle Finland Oy, Hospital District of Satakunta, Bea Systems Oy, Hospital District of Helsinki and Uusimaa, City of Kuopio, Kustannus Oy Duodecim, Mawell Oy

Juha.Mykkanen@uku.fi

www.centek.fi/serapi/english.html www.plugit.fi/