international hl7 interoperability conference - ihic 2010

International HL7 Interoperability Conference - IHIC 2010

National eHealth Initiatives: Global Health Information Technology Standards Serving Local Needs

“Building Interoperability…across many localities”

Don Newsham – May 14, 2010

Three “localities”

Canadian Standards Direction

Global Standards Direction

Low Income / Low Resource Country Standards Direction

Connecting Standardsin Canada

Health Informatics standards community in Canada has completed a major governance transformation

Now a single cohesive, coordinated collaborative

With integrated organizations, process and services across numerous standards SDOs and domains

• resulting in a 50% reduction in committees

Providing a single point of contact for coordination of Pan-Canadian standards throughout the standards life cycle.

Infoway CIHISCC

Standards CollaborativeStrategic Committee

Standards CollaborativeCoordinating Committee

CSA

Technical Sub-Committee Clinical Sub-Committee

SCWG #1 -

Population Health

(Delivery of Care)

SCWG #2 -

Individual Care

(Delivery of Care)

SCWG #3 -

Managing the Health

System

pCSGSCWG #4 -

Medication

Management

SCWG # - Labs &

Diagnostics

SCWG #6 -

Infostructure &

Architecture

SCWG #7 - Non-

Clinical Registries

SCWG #8 - IT

Privacy & Security

Services

SCWG #9 -

Terminology

Representation &

Services

pCSG

Standards Collaborative Governance Model

Options Research

and Analysis

StandardsDevelopment

NeedsIdentification

&Business Definition

Maintenance

TrainingEducation

Conformance

ImplementationSupport

Test Pilot

Pan-Canadian Standards

Options Research

and Analysis

StandardsDevelopment

NeedsIdentification

&Business Definition

Maintenance

TrainingEducation

Conformance

ImplementationSupport

Test Pilot

Pan-Canadian Standards

Evaluation

AdoptionStrategies

Tools andTemplates

StandardsKnowledge

Management

Liaison

Promotion & Communication

Licenses

Change Management

Infoway Investment on Standards to date

Total Infoway investments in standards including source of other funds

$33 Million Investments in the development of standards through Infoway Programs

$30.0 Million Actual and planned investments in the deployment and maintenance of standards through the Standards Collaborative FY 06-10.

Standards to support the Infoway EHR mandate

SNOMED CT

National e-Claims Standards

Client Registry Standards

Provider Registry Standards

Diagnostic Imaging Standards

Drug Standards

Laboratory Messaging and Nomenclature Standards

Public Health Surveillance Standards

iEHR Clinical Messaging Standards

Physician Office Systems Requirements

iEHR Technical Standards

Security and Consent Standards

Patient Access to Quality Care Standards

JURISDICTIONAL INFOSTRUCTURE

POINT OF SERVICE

TerminologyRepository

Ancillary Data& Services

Registries Data& Services

EHR Data& Services

DataWarehouse

ImmunizationManagement

PHSReporting

SharedHealth Record

DrugInformation

DiagnosticImaging

Laboratory HealthInformation

Hospital, LTC,CCC, EPR

PhysicianOffice EMR

EHRViewer

Physician/Provider

BusinessRules

EHRIndex

MessageStructures

NormalizationRules

Security MgmtData

Privacy Data Configuration

Physician/Provider

Physician/Provider

Lab System(LIS)

Lab Clinician

RadiologyCenter

PACS/RIS

Radiologist

PharmacySystem

Pharmacist

Public HealthServices

Public Health Provider

Longitudinal Record Services

HIALCommunication Bus

Common Services

ClientRegistry

ProviderRegistry

LocationRegistry

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Standards Used in the EHRS

Standards Legend �� Client Registry �� Provider Registry �� Location Registry �� CeRx/Drugs

�� SNOMED / Clinical Terminology �� Laboratory LOINC, PCLOD �� iEHR Clinical Messaging �� Public Health Surveillance ��National e-Claims

�� Diagnostic Imaging

Global HI Standards Direction

Underway for 10+ years

Launched under different “authorities”, with different or overlapping “mandates”

Global, European, US, WHO, Individual Country

Targeting segments of the interoperability problemImaging, Messaging, Laboratory Results, Terminologies, MedicinalProducts, EHR, Technical Transport, Devices, Research

Through multiple SDO’s Often volunteer based, varying infrastructure / proposal / development / balloting / publication processes

All with best intentions, all contributing to duplicate, overlapping, differing approaches to interoperability

With no coordinated answer to:1. What is the one standard (or package of standards) to solve my

health business problem, with 100’s of standards to choose?

2. What can be done to support local needs, to support countries atvarying stages of HIS development?

Joint Initiative

Joint Initiative on SDO Global Health Informatics Standardization

�CEN, HL7, ISO Initial Charter Signatories

� CDISC, IHTSDO and GS1 also now signatories

International Health Terminology

Joint Initiative Work Program

Work Program includes:Biomedical Research Information Domain Group (Bridg) Model

Data Types (in final FDIS ballot)

Pharmacovigilance / Identification of Medicinal Products (ICSR and IDMP)

Clinical Trial Registration and Results

SKMT (GLOSSARY and DOCUMENT Registry)

EHR Functional Model (R2)

Patient Identifiers for automatic identification data capture

Preliminary / PotentialQuality requirements and methodology for detailed clinical models

Generic Model for Dose Syntax

Tracking Medical Device Software regulation and Privacy standards across SDO’s

Collaborating with countries at varying stages

Developed countries using national mandates / national funded initiatives

Low Income / Low Resource countries

Becoming very active

Finding ways to address health information technology needs

Are challenged to access standards and engage with the standards community

Some Emerging Country Directions

Local needs in many countries

Need to support country wide Health Information Systems (HIS)

At population and public health levels

Nationally and for communities (of diseases and of people)

Moving also to EHR’s

A surge of interest in ehealth infostructures

Starting often with architectures

Local needs in many countries

Support for standards based ehealth architecture decisions that are

non-proprietary

robust and future proof

locally-driven and open

reference implemented based

And that use commonly shared standards to carry out monitoring and evaluation

• For govt bodies, international organizations, donors and others

Local (HI standards) needs supported by Global Action

Players

Countries at early stages of health information systems

Global players (being there, doing that)

• WHO / Health Metrics Network

• Standards Development Organizations

• Donors (Rockefeller, Gates, IDRC, ….)

• Country governments / associations / experts

• Technology associations (mhealth, …)


Actions

Collaborative, capacity building, design & standards development workshops

• Increasing scope and momentum

– Geneva, Kigali, Bangkok, Bellagio, Vancouver

WHO / HMN global coordination / strength

• Expertise, focal point, leadership

Donors engaged and also leading

• Targeting initiatives with momentum and broad participation, real impact on health,

• Targeting / leading collaborative initiatives


Actions

Country Governments

• Assigning government / academic leaders to develop their own ehealth plans, strategies & architectures

• Signing bi or multi-lateral mutual development agreements or assigning expert support

• Often starting with telehealth or public health

Technology companies / associations

• Increasing awareness of market potential

• Still find balance between providing their solution versus supporting local needs


Actions

SDO’s

• Bellagio workshop on ISO / ehealth architecture standard for low income / low resource countries & “declaration” for standards access and participation

• Joint Initiative

– Task group underway to determine joint actions needed for standards access and participation for low income / low resource countries

• HMN leading Framework For National Health Information Systems standard in ISO/TC215

• Developing list of standards now available

• …

Getting Started for Local NeedsGet involved and engaged with standards of priority to you / your country / your context

Participate in standards meetings, standards discussions where ever such take place

Connect your experts / academics to other nearby countries to address ehealth, architecture and standards issues

Track Joint Initiative actions

Build local capacity and awareness through education, workshops, support from SDO leaders for in-country conferences / meetings, donor engagement

Promote use of standards that are important to your local initiatives

International HL7 Interoperability Conference - IHIC 2010

“Building Interoperability…across many localities”

THANK YOU

Don Newsham

international hl7 interoperability conference - ihic 2010

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