Architecture, Interoperability, Standards - recent research in eHP Finland network

1. Architecture, Interoperability, Standards -recent research in eHP Finland network China-Finland eHealth Partnership meeting, Helsinki, 6 Sep 2007 Dr. Juha Mykkänen 穆 佑 赫 University of Kuopio, Health Information Systems R&D Unit

2. outline • recent work items and related projects • recent results, including examples • relation to China-Finland eHP project guidelines and

3. background • applied research responding to challenges related to systems development and interoperability in healthcare • point-to-point integration solutions, expensive tailoring, heterogeneity in technologies, requirements, and standards • central elements of solutions • guidelines, methods and reference models for acquisition, integration and systems development projects • component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments • separation of care management from health information • formalised requirements, processes and practices • common concept models, vocabularies and terminologies • validation in practice in hospitals and products

4. recent related work • SerAPI project, results available in September, examples: • regional scheduling (HL7 v3), clinical decision support interfaces, specification of core services (e.g. code sets, context management), patient groupings (for billing/statistics, e.g. DRG), patient lists • Service-oriented architecture and development guidelines: service identification, process modeling, architecture specification • education related to SOA and HL7 version 3 • Healthcare Services Specification Project and HL7 (international) • joint HL7/OMG effort for standardizing services and SOA approaches for healthcare: EIS, RLUS, DSS, CTS2 • SOA for HL7, dynamic model enhancements to HL7 version 3 • Electronic + Personal Health records, Scheduling, Infrastructure etc. • participation in national initiatives in Finland • specification of core data sets and speciality data sets • specification and certification related to national health IT services • national standards work: HL7 version 3, CDA r2, social services • IHE (integrating healthcare enterprise) initiative in Finland

5. examples of recent results • Evaluation and selection framework for interoperability standards • e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) • Comparison of model-centric approaches for development of health information systems • Methods for service-oriented development of systems and integration solutions • interface and service definitions for • clinical decision support • regional scheduling (HL7 version 3) • patient groupings for billing, benchmarking etc. (e.g. DRG) • code sets,

6. eHealth standardization areas(used in the evaluation framework and national recommendations in Finland)

7. examples of recent results • Evaluation and selection framework for interoperability standards • e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) • Comparison of model-centric approaches for development of health information systems • Methods for service-oriented development of systems and integration solutions • interface and service definitions for • clinical decision support • regional scheduling (HL7 version 3) • patient groupings for billing, benchmarking etc. (e.g. DRG) • code sets,

8. medium-term integration architecture guidelines for hospitals (Finnish setting)

9. examples of recent results • Evaluation and selection framework for interoperability standards • e-hospital architectural guidelines development - applying SOA locally for enterprise architecture (continues via further projects in Finland and IMIA) • Comparison of model-centric approaches for development of health information systems • Methods for integration solutions and service-oriented development of health information systems • interface and service specifications • >20 related open specifications nationally and internationally • related testing, certification and conformance research

10. model-centric approaches in relation to the phases of information systems development

11. discussion: China/Finland guidelines • health information sharing (regional, national) • practical large-scale approach (good example in Finland): agreed data sets, shared services, open standards • clear separation of patient and professional needs • combination of international and local standards • architectures and interoperability • up-front investment in architecture will provide significant long-term benefits (bad examples in Finland) • several solution models need to be combined • hospital / health centre-specific starting points must be acknowledged • all work must be based on accurate requirements specification and supported by evaluation

12. 谢谢 Thank you presenter: Dr. Juha Mykkänen University of Kuopio HIS R&D Unit Juha.Mykkanen@uku.fi

13. Architectures and standards in healthcare ‘Architecture’ defines how elements and relations between them make up a whole – e.g., an e-hospital architecture • Organizational view: Who uses, who stores, who maintains; workflows, processes, service chains –IHE(Integratingthe Healthcare Enterprise) workflows, etc. • Functional view: What the system elements should provide; – HL7 EHR-S Functional Model, HL7-OMG HSSP, etc. • Technological view: How system should be implemented – HL7-OMG Services Spec. Project HSSP, Eclipse, etc. • Information view: Data elements, coding, structures, stores – HL7 RIM (Reference Information Model), HL7 CDA (Clinical Document Architecture), OpenEHR, etc. Adapted from RM-ODP model, ISO/IEC 1995

14. SerAPI:Service-based architecture and web services in healthcare Application Production and Integration • Theme: flexibility, integration and interoperability in healthcare applications • project in the FinnWell programme of Tekes, Sep 04 – Aug 07 • 14 software companies, 4 public health service provider organizations, 3 research units (University of Kuopio) • Healthcare processes and services  software products • Service-oriented architectures (SOA) • flexibility and connectivity: support for different processes, transition towards component- and service-based information systems • Web services • open Internet technologies, service interfaces in software products, support for multiple implementation technologies and tools • Application interfaces, application integration and service-oriented application design • based on integration results (interfaces, methods) from the PlugIT project

15. Research groups (University of Kuopio) HIS (Health Information Systems) R&D Unit Shiftec Unit (Dept. of Health Policy and Management) Software engineering (Dept. of Computer Science) Healh care organizations Hospital district of Helsinki and Uusimaa Hospital district of Northern Savo Hospital district of Satakunta City of Kuopio Companies (healthcare application / content development) Commit; Oy Datawell Oy Fujitsu Services Oy Finnish Medical Society Duodecim Mawell Oy Medici Data Oy Mediconsult Oy Prowellness Oy Softera Oy WM-data Oy Companies (infrastructure) Bea Systems Oy Intersystems B.V. Finland Microsoft Oy Oracle Finland Oy SerAPI - participants

16. SerAPI approach: standpoints of processes, applications and technologies

17. SerAPI: main activity areas • Application domains • three-party collaboration: healthcare provider organizations, companies, research group • interfaces and application services responding to the needs of health professionals, information management and application development • e.g. clinical context integration, scheduling, OID identifiers, DRG grouping, patient record location and access, clinical decision support etc. • Service interfaces and standardization • Healthcare Services Specification Project / HL7 and OMG – international healthcare service interface standardization • HL7 Finland Common Services SIG background project • National recommendations for the development and organization of standardization to support health information systems • Collaboration • national (e.g. AVOINTA, ZipIT, Export HIS, FinnWell interoperability group, national and regional projects related to electronic health records • international (e.g. HL7, OMG, Eclipse, research collaboration) • Juha.Mykkanen@uku.fi, University of Kuopio, HIS R&D Unit • www.centek.fi/serapi/english.html

18. Integration specification process(overview) Mykkänen et al., in MEDINFO 2004

19. 4. Conclusion • E-hospital is not “turn-key shopping” but a process • Collaborative process between stakeholders • Functionality, data standards and software interfaces • The main steps for one hospital: • Evaluate your current state from activity/service viewpoint • Identify target: How activities/services to be supported by ICT • Identify your migration path with phases, specify Phase 1 • Select an initial portfolio of products with a shared architecture • Select your trustworthy key solution provider with a consortium • eHealth Partners Finland is a consortium of international-level research groups and companies willing to contribute along your path to e-hospital

20. 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?

21. Interoperability apex 2007 • 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)