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Weaving interoperability: combining local, regional and national solutions on hospital level. IMIA HIS Conference, Oeiras, July 3, 2006 Juha Mykkänen, Mikko Korpela HIS R&D Unit, University of Kuopio, Finland. In this presentation. HIS, sub-systems and interoperability

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Weaving interoperability:combining local, regional and national solutions on hospital level

IMIA HIS Conference, Oeiras, July 3, 2006

Juha Mykkänen, Mikko Korpela

HIS R&D Unit, University of Kuopio, Finland


In this presentation

  • HIS, sub-systems and interoperability

  • Local, regional and national health information infrastructure initiatives in Finland

  • HIS architectural components: hospital view

  • Some challenges for advanced interoperability

  • Emerging interoperability best practices

  • Summary + discussion


IMIA HIS, Heidelberg, April 2002:

  • "need a common description for components in health information systems" - still a valid need

  • components = units of composition, reuse and interoperability:

    • scope, availability, granularity, physical and conceptual nature

    • healthcare-specific scope: infrastructure, administration, care support, direct care, diagnostics, communication, simulation

    • information and semantics, instance / type / context / meta levels

    • functionality and interactions - capabilities + collaboration

    • relation to reference architectures and specific application architecture

    • technical aspects - data communication, interfaces, technical infrastructure, integration platforms etc.

    • cross-cutting aspects: security, management, flexibility, extensibility

    • relationship to systems lifecycle - development paradigm, migration

Mykkänen, Tuomainen 2006, Information and Software Technology, submitted.


Role of information systems in hospitals

Process model of a hospital – systems are for processes

Auxiliary processes:

Management, …

Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou

Core process:

Direct care

Input: illness

Output: wellness?

Support

processes:

Laboratory Radiology


Beyond the hospital – seamless care

Rehabilitation

Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou


Kuopio

Helsinki

Health information infrastructure developments / Finland

  • Hospitals and health centres

    • primary care = health centres: ~100 % use EPR systems

    • hospitals: replacing legacy core applications > 10 years

    • continuous heterogeneity in processes, applications, infrastructures

    • managerial and clinical process developments - e.g. DRG, decision support

  • Regional

    • new organisational models of health services (e.g. laboratories, regional clusters)

    • regional information systems, references to back-end HIS data

    • shared electronic services (e.g. prescriptions, electronic booking)

    • disease-specific specialised systems

  • National

    • national services: EHR for professionals, code sets/vocabularies etc.

    • migration from regional to national services

  • Citizen

    • e-services emerging first for professionals, then patients

    • PHR: little real integration to professional-oriented EPRs


Hospital level

Sample high-end composition of the hospital-wide information system today:Helsinki-Uusimaa hospital district

HUS,Sinikka Ripatti 2004


Hospital level

Example of a major vendor’s architecture

Loosely connected systems

Launching

Common context & services

Medici Data Oy, Juha Sorri 7.10.2004

HMIS core

EPR system

Common user

  • inner circles: optimised usability, reduced maintenance and redundancy, tightly integrated application families and components

  • outer circles: flexibility, cross-organisational processes


Hospital level

Migration situation in a major hospital

New HIS systems

Health center systems

KYS, Pekka Sipilä, 2006

Old HIS systems


Elements of a HIS architecture: hospital viewCommon core services: Starting point for HIS

  • presumptions:

    • heterogeneous specialised applications, existing (legacy) systems

    • practicality, feasible implementation threshold in multi-vendor environment

    • extensibility

    • service-orientation supported by generic middleware

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing


“Pluggable” specialized clinical subsystems

  • alternatives:

    • non-pluggable clinical subsystems

    • no clinical subsystems

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing


Standard structured EPR/EHR data storage

  • alternatives:

    • system-specific data views

    • point-to-point queries

    • (personal / virtual health record - outside organization)

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing


Front-end viewer for health professionals (EHR-S)

  • alternatives:

    • context management

    • no point-of-decision integration

    • (additional) workflow management systems

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing


Information exchange by messages across facilities

Potentiallysame data structure

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

  • alternatives:

    • central repository (for some scenarios - see next slide)

    • peer-to-peer negotiations / mediation


Clinical on-line access across facilities

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

  • alternatives:

    • peer-to-peer negotiations / mediation


Patient’s / citizen’s front-end

Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

  • add:

    • opposite direction

    • patient-provider communications


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?


Interoperability apex 2006

  • 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)


Summary and discussion topics

  • hospitals will long remain one central point for health services provision, but will not remain "the centre"

    • challenges for advanced interoperability remain on local, regional, national and international level: common frameworks needed

    • regional and national initiatives demand local acceptance and user benefits

  • described elements are based on Finnish practical experience, international standardization, China, Africa

  • one basis for generic framework architecture adjustable to the specific contexts in Portugal, Germany, UK, USA, … Mozambique?

  • how can the service interfaces and semantics be developed for global reusability & local adaptability? gradually?

    • understanding of and support for healthcare processes

    • semantic and functional views addressed

      → International standardization of relevant aspects with users and industry

      → ’IT for Health’ at IFIP World IT Forum 2007 www.witfor.org

      → IMIA recommendations, Health Informatics in Africa HELINA 2007 www.helina.org


Acknowledgements and more information

Healthcare application integration: PlugIT, 2001­2004: www.plugit.fi,Finnish Agency for Technology and Innovation Tekes grants no. 40664/01, 40246/02 and 90/03

Service-oriented architecture and web services in healthcare application production and integration: SerAPI, 2004­2007:www.centek.fi/serapi, Tekes grants no. 40437/04, 40353/05

Healthcare work and information systems development in parallel: ZipIT2004-2007 Tekes grants no. 40436/04 and 790/04, and ActAD­HIS, 2004-2005 Finnish WorkEnvironment Fund grant no. 104151 :www.centek.fi/zipit

Packaging Finnish e-health expertise for international use: ExportHIS, 2004­2006 www.centek.fi/exporthis(Tekes grant no. 70062/04,), e-Health Partners Finland, 2006-2007 www.uku.fi/ehp (Tekes grants no. 40140/06, 70030/06)

Informatics development for health in Africa: INDEHELA­Methods(Academy of Finland grants no. 39187,1998­2001), INDEHELA­Context(201397 and 104776, 2003, 2004­2007):www.uku.fi/indehela

Open Integration Testing Environment: Avointa, 2004­2006:www.centek.fi/avointaTekes grant no. 40449/04


Assets to support benefits of electronic health information interoperability

  • separation of care management from patient-specific health information

  • increasingly documented and formalised requirements, processes and practices in healthcare

  • common concept models, vocabularies and terminologies, extended to ontological languages and tools

  • component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments

  • guidelines, methods and reference models for acquisition, integration and systems development projects

Mykkänen, Specification of Reusable Integration Solutions in Health Information Systems, forthcoming.


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