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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

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

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

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.


Weaving interoperability combining local regional and national solutions on hospital level

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

Beyond the hospital – seamless care

Rehabilitation

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


Health information infrastructure developments finland

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


Weaving interoperability combining local regional and national solutions on hospital level

Hospital level

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

HUS,Sinikka Ripatti 2004


Example of a major vendor s architecture

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


Migration situation in a major hospital

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 view common core services starting point for his

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

“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

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

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

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

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

Patient’s / citizen’s front-end

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

  • add:

    • opposite direction

    • patient-provider communications


His challenges for interoperability

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

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

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

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

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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