Norwegian Perspective

1. Norwegian Perspective The Patient and Family Journey

2. Forum 9000 Quality Systems for Quality Care Electronic PRocess for Home Healthcare Dan Pattyn Chief Technical Officer The Patient and Family Journey

3. The Electronic PRocess (EPR)Pilots • Extending the ebXML Model to eGovernment Service Solutions • e-Healthcare for the Home • e-Government in local communities • e-Building • Deliverables • Templates and Specifications for eprXML based implementations of semantic interoperability in different Communities of Interest • Open Implementation Framework • Legacy System Migration and/or Integration The Patient and Family Journey

4. EPR Pilot 1: Hjemmebasert Pleie&OmsorgIntegrert tjenesteplanlegging og rapportering.(Oppgavebeskrivelse/Rapportering med PDA-phone.SIM-kort = Digital signatur ) The Patient and Family Journey

5. EPR Pilot 2:Digitalt ByggesakskontorElektronisk samarbeidsarena(Oppgavebeskrivelse/Rapportering/Inspeksjon med PDA-phone. SIM-kort = Digital signatur ) The Patient and Family Journey

6. EPR Uses Workcards as a GUI Metaphor Participant and ContextBased Architecture • Participant can be: • Traditional User • Machine or Device acting as a Proxy for a User • Environmental Context dynamically modifies Declarative Display Metaphor The Patient and Family Journey

7. Business CentricMethodology TC eGOV TC eGOVNorway USA Forum 9000 BCM-EPR SC NorwayEPR Forum Norway SINTEF CUNY OMG Semantic ContentMgmt. SC Home HealthcarePilot METU W3C SemanticRegistry TC Content AssemblyMechanism TC Informatics Stds. OpenEHR, HL7, etc. e-Healthcare Pilot Participants The Patient and Family Journey

8. Perspective Perspective Tools The eGovernment Challenge Experience EnablersMiniaturizationEnvironmental SensingEmbedded IntelligenceAdaptive LearningNetworked Communication Experience Innovation LeversGranularityExtensibilityLinkageEvolvabilityEventsEvent Context • Need Structured Specifications • Medical EcoSystem Centric • Collaborative Services Centric • Dynamic Contextual Information • Context Control Mechanisms • Shift from “System” to “Workspace” Focus • Occasionally Connected Workspaces The Patient and Family Journey

9. Primary Doctor Patients with Similar Condition Medical Specialists Patient Scan and Diagnostics Clinic Pacemaker Manufacturer Doctor on Call at Out-of-Town Hospital Emergency Services Source: The Future of Competition, Figure 1-1, Page 9 Medtronic CareLink Patient Co-Creation Experience The Patient and Family Journey

10. Step 2 : Build Templates with Familiar Business Tools Step 3 : Deploy with Declarative Component Operations Step 1 : Use Layers to Define Business Needs While Referencing the Information Architecture The Patient and Family Journey

11. Digital Bag Collaboration Partner Agreements- CPA Contract BP Specification Process Collaboration Partner Profiles - CPP Content Assembly Mechanism - CAM Workflow XForms Messages Artifact relationships Specifications Schema Presentation Rules Events Roles MotivationTime People Directory Services Nouns Verbs Transport Routing, Packaging Data/CodesServices/Functions Network Core Components WSDL MSHSOAP Source: BCM Lubash Pyramid Semantic Interoperability Standards Stack The Patient and Family Journey

12. Commitment Pattern Template • SendAgentPrimary Care Physician • RecieveAgentDialysis Clinic Alter Accept • Contract Patterns - Agreement Patterns - Commitment Patterns Accept Request Dialysis Alter Dialysis Treatment Task Dialysis Treatment When How When How Action Event Action Event Accepted Schedule Friday 4 Apr 04 2 pm Rule Information Rule Information Why What Proposed New Schedule Priority: Urgent What Why Request Dialysis Treatment Accept Dialysis Treatment Task Dialysis Treatment Task Dialysis Treatment Provisional Schedule Friday 4 Apr 04 2 pm Accepted Schedule Friday 4 Apr 04 2 pm Priority Priority: Urgent Priority: Urgent ResponseByDate Two Hours from Receipt of Request The Patient and Family Journey

13. When When How How Service OrientedOpen Implementation Framework (Autonomous Portal Agent) Action Action Event Event Rule Rule Information Information What What Why Why Where / Who Where / Who Digital Bag Digital Bag CollaborationServices ProcessServices Digital Bag Metadata Services Open Implementation Framework Services for Occasionally Connected Applications The Patient and Family Journey

14. Social Worker Primary Care Physician Collaboration Services Collaboration Services ProcessServices Digital Bag Metadata Services Social Network Home Dialysis Equipment Digital Bag Digital Bag Collaboration Services Collaboration Services Digital Bag Collaboration Services ProcessServices Digital Bag ProcessServices Digital Bag Metadata Services Metadata Services Social Network Aspects of Digital Bags The Patient and Family Journey

15. Business Collaboration Specification Business Agreement Languages (RINs) Collaboration Profile Agreement (CPA) Choreography & Coordination Lang. (BPSS) Context Driven Information Exchanges (CAM) Semantic Registry The Patient and Family Journey

16. Perspective Perspective Tools The eGovernment Challenge • Federated Registry Services • Informational and Terminological Model Integration • e-ID Services • e-Authentication Services • Declarative Access Rights The Patient and Family Journey

17. CredentialServiceProvider AccessPoint Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services E-Authentication Service hands off Authenticated User ProcessServices ProcessServices ProcessServices ProcessServices Digital Bag Digital Bag Digital Bag Digital Bag Metadata Services Metadata Services Metadata Services Metadata Services eGOVNorwayRegistry Digital Bag Digital Bag Digital Bag Digital Bag eGOV SuperStructure Portal The Patient and Family Journey

18. Issues • Secure Authenticated Delivery and Tracking: • Messaging system, envelope format and payload with exchange source profile controls • PKI Adoption Challenges (from PKI Action Plan) • Software Applications Don’t Support It • Costs Too High • PKI Poorly Understood • Too Much Focus on Technology, Not Enough On Need • Poor Interoperability PKI Challenges Source: http://www.oasis-open.org/committees/pki/pkiactionplan.pdf The Patient and Family Journey

19. BCM-EPR Tasks • Integration of BCM Choice Point technology to provide flow control and linking and switching for EPR. • Create BPSS of discrete workflow components – especially intra-enterprise exchanges. • Create BCM contract and CPA templates for EPR participant roles and agreements. • Look at applicability of CAM templates for formalizing information quality control and context rules. The Patient and Family Journey

20. Additonal Information and Contacts • OASIS ebXML Business Centric Methodology TC • http://www.oasis-open.org/committees/tc_home.php?wg_abbrev=bcm • http://www.oasis-open.org/ committees/download.php/5931/BCM%20Executive%20Brochure.pdf • http://www.businesscentricmethodology.com • OASIS ebXML Registry Semantic Content SC • http://www.oasis-open.org/ committees/sc_home.php?wg_abbrev=regrep-semantic • OASIS Content Assembly Mechanism TC • http://oasis-open.org/committees/cam/ • EPR Forum • http://www.eprForum.org The Patient and Family Journey

21. Additional Information and Contacts OASIS Business Centric Methodology Technical Committee(TC)Chairs: Mike Lubash – mike.lubash@dfas.milCarl Mattocks - carlmattocks@checkmi.com OASIS Business Centric Methodology EPR Subcommittee (SC) Chairs: Hans A. Aanesen – hans@iti.as ; eprXML System ArchitectDan Pattyn – danpattyn@austin.rr.com ; BCM MethodologistDavid Webber – david@drrw.info ; XML Specialist OASIS ebXML Registry Semantic Content Management Subcommittee (SC) Chairs: Carl Mattocks - carlmattocks@checkmi.com Norway EPR Forum Hans A. Aanesen – hans@iti.as The Patient and Family Journey

22. Value Co-Creation via Customer Centric Collaboration (Feb 2004) • Customer relationships based on experiences rather than products • The product is no longer the basis of value • Real-time customer experiences on-the-fly, shaped by the customer "context" is the value proposition • Real-time insights required to deliver on-demand customer value and service that's meaningful to individuals within the context of their day and location The Patient and Family Journey

23. Backup Slides The Patient and Family Journey

24. ArchitecturalFramework Metaprocess 1988-1992 Role Interaction Networks (RINs) 1994 World Wide Web 1999 W3C XML, RDF 1990-1992 Agility Forum 1996 Foundation for Intelligent Physical Agents (FIPA) 1994 Cooperative Clinical Information Systems 2000-2003 FIPA AgentCities Project 1997 SINTEF WORKWARE Interactive Process Modeling 2000 ebXML, Semantic Registry and OASIS Stds. 2001 IOM Crossing the Chasm Report 2002 Open Source Commodity Portals 2003 OASIS Business Centric Methodology (BCM) The Patient and Family Journey

25. Patients are Users-Plug & Play Web Forms for portable medical records- Plug & Play Workflows, Medical Protocols, Clinical Guidelines- User-Defined Patient Lists and PopulationsCustomizable Workflows- Hierarchical Modeling: Question ItemsFormsWorkflowsComplex Workflows- Automatic Creation of Web Forms Automatic Generation of DBMS Schema Automatic Linking of Code Between Forms and Data- Five Minutes to LearnPreview / Test forms during editing Forms RepositoryCare Team Collaboration Services • Workflow Form Debugger / Stepper- Execution Workflow Tracking and Workflow Resumption after interruption- Reactive ECA Rule Engine integrated with Schedule and Workflow (Sharable Schedules among users who are patients) Simple-to-Use Development Tools ZOPE Web Management Interface, DTML/SQL/Python Process Services Digital Bag Process Virtual Machine- jCAM, Blackboard, ruleCore RuleEngine, etc. Metadata Services MetaData Engineering Architecture- Meta Meta Model Support- Deployment Metadata for Introspection- Web Browser Metadata Creation Tools- Systematic Method of Metadata Management for Interactive Process Models (SINTEF)- Portable via Simple XML upload / download- Separation of patient identifiers from other data Traditional Architecture- Mozilla Web Browser- Apache with SSL Web Server- ZOPE Application Server- PostgreSQL RDBMS- Linux, Windows OS-Skinnable User Interface Open Implementation Framework Prototype The Patient and Family Journey

26. $ Semantic Interoperability Barrier Data Exchange Costs Data Quality Costs $ Structuring Barrier $ Time OASIS Business Case The Patient and Family Journey

27. Value Stream Management in a Co-Creation Environment • “Artifacts with Durable Business Value” can be re-sequenced for more value extraction • If Value is created by Context, how much infrastructure investment is needed for definition, capture, and movement of Context • Distributed Context Management with Persistent State Information • Distributed Decision Support based on Environmental Context • Currently need Standards Effort focused on a Collaboration Environment with ebXML business primitives that add value to Service Oriented Architecture (SOA) The Patient and Family Journey

28. Specification Value Stream Management • Current Practice • Monolithic “blob” of linear text in proprietary word processor format - “ignorance wrapper” • Little focus on Business Protocols • Little emphasis on sequence and interactions • Roles and Responsibilities • Exception Handling • Focus on Documents • No common and controlled vocabularies • No fine granularity configuration management • No Structured Documentation • Product Planning by looking in the “Rear View Mirror” • Value Barriers • No common understanding • No packaging of business operational procedures (services) • No accountability based on roles and responsibilities • Artifacts have no Durable Business Value because of the lack of re-composable document fragments • No Reuse • No Reconfiguration • Scaleability Problems • Data Scale Barriers • Structuring Barriers • Integration Barriers • Precludes Automation & Outsourcing • IT / Business Alignment Issues The Patient and Family Journey

29. Business Process Evolution Value Co-Creation via Customer Centric Collaboration Extreme Mobility Infrastructure Occasionally Connected Application Cross-Enterprise Service Centric Digitization Transaction Centric Digitization of Simple Task & Processes Process Re-Engineering Process Improvement Wearable Computing The Patient and Family Journey

30. The Digital Bag- A Universal Nomadic Work Object - • A Digital Bag is an architectural model for a universal nomadic work object that maintains data, process and work contextindependently from any one system. • In technical terms, a Digital Bag is a compound XML document that exists independently from all applications, persistent data stores and processing technologies. The Patient and Family Journey

31. Digital Bag Architectural Model • • directory services information • data in appropriate format and structure for the collective intent of participants • • work flow processes• work process metadata, which determine what work steps are intended for the current instance of the digital bag, the genealogy of the instance as created, and the recent history of interactions executed between the current digital bag instance and any participant. The Patient and Family Journey