A National Study of eHealth Standardization in Finland - Goals and Recommendations

1. Medinfo 2007 Brisbane Wed 22 Aug, Session S126, 4 PM A National Study of eHealth Standardization in Finland- Goals and Recommendations Juha Mykkänena, Maritta Korhonenb, Jari Porrasmaaa, Tuula Tuomainenb , Antero Ensioc a Health Information Systems (HIS) R&D Unit, University of Kuopio, Finland b Business and Administration, Savonia Univ. of Applied Sciences, Kuopio, Finland c Ensitieto Oy, Varkaus, Finland

2. in this presentation • background and basis of the study • materials and methods • results • recommendations + conclusions • brief update (latest news)

3. background of the study • in Nov 2004 various stakeholdes in Finland: • Ministry of Social affairs and Health • Ministry of Trade and Industry • the Association of Finnish Local and Regional Authorities • the Technical Research Centre of Finland / HL7 Finland • the National Research and Development Centre for Welfare and Health Stake • the Finnish Agency for Technology and Innovation TEKES • the University of Kuopio and the Savonia University of Applied Sciences • "standardization: an important enabler of the health service provision, the development of the economy, and the growth of the enterprises" • but "lack of sustained solutions for the development and utilization of standards and participation in standardization activities" • study form December 2004 to March 2005 by two national R&D projects (SerAPI, ZipIT-ojo), tasks: • review the previous studies and recommendations and combine them with a wider view of standardization • make recommendations for the improvements in the development of activities related to standardization on a national level

4. standards and standardization • standard: a document approved by and accepted body which contains rules, guidelines or features for generic and repeated use in products, processes or services[Project management institute] • goals and motivations of standardization: • uniformity (quality, efficiency) • compatibility (services, applications, technologies) • objectivity (measurement, neutrality, multilaterality) • justice (control, equality) • hegemony (competitive advantage, market protection)

5. areas of standardization in the study(classified by the required types of expertise)

6. materials, methods & activities of the study • perform a literature survey including national and international recommendations • update an evaluation and selection framework of standards (Mykkänen, Tuomainen, An evaluation and selection framework for interoperability standards, Information and Software Technology 2007, in press) • conduct surveys to probe current and target status • previous web-based survey • targeted e-mail survey to named experts • survey questions discussed in meetings with named experts • total response rate of surveys and meetings 66,7% (23/36) • conduct interviews and project board reviews • construct recommendations based on the results and authors' experience and views • result: a report in Finnish, a basis for further actions

7. Finnish eHealth standards landscape 2005 [based on Pekka Ruotsalainen, 2005]

8. results: general • applicability and quality assurance key factors in relation to the goals and policies • also usability, fast introduction, consistency across domains • no uniform view on the importance of international compatibility, existing systems, fine-grained vs. framework standardization • the most central areas: specification and support of healthcare processes, information structures, data types, semantic consistency, EPR (archive) • followed by unified information models, desktop integration, terminologies, knowledge, shared IT services, workflow support • different opinions: architectures, security solutions, technical and cross-domain aspects • many types of participation and utilization of generic technology standards was emphasized

9. results: goals and challenges • target: a coordinated and compatible set of standards for factual needs of the market, utilizing experts in various areas, clear relationship between national and international levels • main challenges • "Who is navigating?" - coordination and ownership, selection of standards, production of recommendations, balanced participation in standards-related work • "Random patch on top of patch" - quality assurance and evolution of goals, pressures for fast introduction, difficulty of finding right level of flexibility, accuracy needed for conformance and certification • "Pile of paper standards" - relationship between de facto and de jure standardization, standards uptake, availability of specifications, local requirements are not easily traced to international work • "Sticks and carrots" - commitment and business drivers, market demand instead of official enforcement • learning

10. recommendations based on the study • 8 main recommendations • 51 detailed goals, 127 recommended actions on: • policies: organization, steering, funding • relationship management: improve international and cross-domain linkages • quality assurance: linkage to demand, expertise, models for selection and evaluation • improved know-how in system acquisitions • establishment of education and support related to standards • balanced participation in standards activities • detailed recommendations for many standards areas, most urgent in relation to the national EHR: core information sets, clinical documents, architecture and security

11. main recommendations 1-4 • intensify the the standardization relationship between the healthcare IT and the domain-neutral IT: shared national goals, policies and procedures, steering groups for overall coordination and the healthcare-specific standards • assure the continuity of domain-neutral and healthcare-specific IT standardization using permanent funding • give primary preference to cross-domain and generic standards; develop and introduce healthcare-specific standards only on areas where they are essential • intensify and resource participation to the international standardization work and observation of international developments in standardization: identify mature standards for current local needs and avoid local overlaps with the international development

12. main recommendations 5-8 • support the participation (and balance) of healthcare application vendors and health service providers in the development, localization and introduction of standards; standards compliance as a project funding criteria • support primarily the goals of the national health project, especially interoperable electronic health records: requires quick decisions • define the status, normativeness and mutual relationships of healthcare IT standards, guidelines and recommendations unambiguously and accurately • create a support and education network to ensure interoperability, to support introductions, to support the steering groups and to promote the recommendations

13. conclusions and brief update • many successful standards already used and providing everyday benefits • to achieve the evident benefits of eHealth standardization, coordination, selection, expertise on many areas, collaboration, are required • success is only measured through utilization on the market and the benefits to the users • update late 2007: • several working and coordination groups in place to support the national EHR (connections to standardization and to some extent recommendations 5-7) • the national association for standardization SFS (de jure) has formed a unit for overall coordination of IT standardization, is creating healthcare-specific standardization steering group together with other key stakeholders (recommendations 1-4 on the agenda!)

14. other results from the SerAPI project in Medinfo'07 • Model-Centric Approaches for the Development of Health Information Systems (Tuomainen et al.) • Conformance Testing of Interoperability in Health Information Systems in Finland (Toroi et al.)

15. THANK YOU juha.mykkanen@uku.fi, University of Kuopio, HIS R&D Unit Maritta Korhonen Jari Porrasmaa Tuula Tuomainen Antero Ensio This work is part of SerAPI and ZipIT-ojo projects: www.serapi.fi/ www.centek.fi/zipit/ Projects are funded by the Finnish funding agency for Technology and Innovation TEKES together with 5 hospital districts / cities / joint municipal boards for healthcare and 17 companies.