OHT Charter Project Submission

1. OHT Charter Project Submission • Canada Health Infoway Inc. Mohawk Applied Research Centre in Health Informatics (MARC HI)

2. Canada Health Infoway • Created in 2001 • $1.6 billion in federal funding • Independent, not-for-profit corporation • Accountable to 14 federal/provincial/territorial governments • Goal by 2010 • Every Canadian will benefit from modern health information systems; and, 50 per cent of Canadians will have an electronic health record accessible by authorized health care providers.

3. Infoway business strategies • Participate in health care renewal • Collaborate with our partners • Target the investments • Support solution deployment • Promote solution adoption and benefits realization

4. HealthInformationDataWarehouse Point OfServiceApplications Point OfServiceApplications Focus on standards and interoperability EHR Solution • Common architecture accepted and in use by jurisdictions • Updated architecture includes privacy and security requirements • Extensive standards development and implementation underway • Pan-Canadian EHR standards governed by the Infoway Standards Collaborative • Architecture and standards are freely available EHR Infostructure Longitudinal Record Services Ancillary Data and Services EHR Data& Services RegistriesData &Services EHRLocator HIAL EHR Viewer

5. What is MARC HI?

6. Mohawk Applied Research Centre for Health Informatics ecGroup Inc. Inaugural Private Sector Partners

7. Who is Mohawk College? • Large Ontario college with specific strengths in healthcare and IT • 10,000 full time postsecondary students across 4 campuses • 1400 enrolled in the Mohawk-McMaster Institute for Applied Health Sciences • 42,000 Continuing Education registrants • NSERC (Natural Sciences and Engineering Research Council of Canada) accredited Applied Research program (pending) • Joint degree programs with McMaster University • Mohawk-McMaster-Conestoga BScN Nursing • Mohawk-McMaster collaborative degree/diploma in Medical Radiation Sciences • Mohawk-McMaster Bachelor of Technology (Engineering) • Committed to Co-op Education • 33 co-op programs • 2000 co-op students placed with over 300 companies • Mohawk is a charter member of the Open Healthcare Tools (OHT) consortium

8. Overview of MARC HI • Mohawk Applied Research Centre in Health Informatics • 2 FT faculty | 3 FT developers | 3 Students | 10 FTE “offshore dev team” • Applied research vs. academic research • Focus on real world solutions to real world problems • Private/public sector partnerships essential to success • Furthering the goals of Canada’s EHR: • Demonstrate interoperability between federated systems • Develop, adopt and deploy re-usable solutions across Canada • “Evidence-based” standards development • Mitigate implementation project risk • EHR Reference Implementation Project • Build a working EHRS based on the Infoway Blueprint and the pan-Canadian messaging standards

9. EHR Architecture

10. EHR Project Governance • MARC HI Advisory Council • Mohawk College – Cheryl Jensen, VP Technology • Canada Health Infoway – Ron Parker • Clinician Rep – Dr. Marion Lyver, Healthy Futures • Jurisdiction/Customer Rep – Roger Girard, CIO Manitoba eHealth • Jurisdictional Steering Committee • Vendor Rep – Gary Teelucksingh, Satyam • Vendor Steering Committee

11. EHR Project’s Guiding Principles • Abide the pan-Canadian standards and the EHRS Blueprint • Open source project-developed software through OHT • Employ a loosely-coupled, product-agnostic design • Undertake the project as Applied Research • Manage the project under the college’s governance structure • Leverage private and public sector partners to sustain the project • Be INCLUSIVE; seek the participation of a broad base of stakeholders

12. Who are the Participants in MARC HI? ecGroup Inc.

13. Takeaway This is a credible, well-governed project that has successfully established strong private and public sector partnerships.

14. What is the project’s status?

15. EHR Project Scope and Current Status • Phase 1 • Discharge Summary • Phase 2a (eHealth 2008 – EHR Interoperability Showcase) • Referrals • Retrieve Lab Reports • Phase 2b • Rest of iEHR domain • Rest of Lab domain IN PROGRESS • Drugs domain • Diagnostic Imaging domain • Public Health Surveillance • NeCST Completed

16. EHR Project Scope and Status cont… • R&D Phase (overlaps the other phases) • Health System Management • EHR Load/stress testing • PKI/Security/Privacy • Chronic Disease Management • Mobile eHealth technologies • PHRs • Pervasive secure email

17. Longitudinal Record Services Common Services Communication Bus Info/Infra-structure Design A – authenticate B – submit transmission payload to queue C – establish authorization D – apply business rules E – write content to repository F – exception handling Lab Repository SharedHealth Record ClientRegistry D Registry Servers Shared Health Record Servers E E ProviderRegistry C EHR Index BusinessRules MessageStructures MSMQ F LRS Servers D C E B Security MgmtData Privacy Data CDMS / ACS Servers HIAL Audit Logging C D A B A Web Services B PKI CAs (2) EHR Viewer Test client A F

18. An EHRS “Framework” is Emerging HIAL WSDL Vocab. Service Audit Log EHR Index PoS LRS ACS CDMS PRS PR CRS CR SHRS SHR Native HL7v3 messages Customizable “black boxes” LRS Meta data model based on HL7v3 Non-native “mapped” messages A consistent above-the-HIAL interaction “framework”

19. eHealth 2008 Interoperability Showcase Longitudinal Record Services Common Services Communication Bus SharedHealth Record LabRepository HSM Data WH ClientRegistry ProviderRegistry MARC HI EHR Index BusinessRules MSMQ Audit Log Privacy Policies CDMS / ACS Servers HIAL Web Services PKI CAs (2) EHR Viewer

20. Takeaway MARC HI has yielded demonstrable results. The EHR Reference Implementation project is a working example of Canada’s national EHRS Blueprint.

21. OHT Charter Project Proposal

22. Overview • This charter was developed in accordance with the OHT Development Process and is jointly submitted by Mohawk College and Canada Health Infoway – both OHT members. It outlines the mission, scope and expected contributions of the Canadian EHRS Reference Implementation project. • The project charter is a living document that will be updated to reflect the evolution of the mission, scope and development processes.

23. Mission • The Canadian EHRS Reference Implementation project aims to build, with public and private sector partners, a working EHR system based on the Infoway EHRS blueprint and utilizing the pan-Canadian health information messaging standards

24. Scope • The scope of the project is to build a working version of the Canadian EHRS blueprint covering all interactions in all domains: • Labs • Drugs • Diagnostic Imaging • interoperable EHR • Public Health Surveillance • The EHRS reference implementation will be leveraged to support applied research into areas important to the Canadian EHR initiative.

25. Expected Contributions • A Working EHRS • Software developed and source code contributed under the auspices of the Canadian EHRS Reference Implementation Project will be open sourced through OHT • Test Harnesses • Tooling to programmatically develop HL7v3 test messages based on the pan-Canadian standards will be developed • SOAP-based test message “transmitters” based on the Canadian TLI (transport layer interoperability) specification will be developed • New ITS • Applied research, engineering, and prototype tooling development will be undertaken regarding the development of a new, simplified Implementable Technology Specification (ITS) for HL7v3 messages • The impact of these new message formats will be objectively measured using the EHRS reference implementation as the test bed

26. IP Issues • None anticipated • Note: we will be providing open-source components that may require consumers of the work to have their own licensing… • (for example, as open-source the Biztalk scripts, it is presumed that anyone using those has a licensed copy of Biztalk) • For this reason, we propose that as part of every “package” we provide an implementation guide that outlines the assumptions and pre-requisites for use of the materials

27. Deviations • None anticipated

28. Canadian EHRS Reference Implementation 3Q2008 Content Pressures Added • learning curve regarding HL7v3 • learning curve regarding pan-Canadian standards • ambiguity of elements of the pan-Canadian EHRS blueprint • engineering constraints around providing a secure, high-availability, high-traffic SOA environment • inherent complexities of service orchestration • immaturity of some of the standards and vendor products • discharge summaries (iEHR domain) • referrals (iEHR domain) • lab report list/get (lab domain) • full support for Lab domain • full support for DI domain • full support for Drug domain • full support for Public Health Surveillance (PHS domain) • investigation of PHR support (Applied Research) • investigation of CDM (Applied Research) Deleted & Changed Dependencies Packaging Editions • pan-Canadian standards development processes • resource availability • HL7/ISO harmonization activities • eHealth 2008 Interoperability Demo Milestones • 2008/05 – EHR Interoperability Demo Statistics • 4 profiles supported • 9 HL7v3 interactions supported

29. Canadian EHRS Reference Implementation 3Q2008 3Q09 iEHR (7), Lab (3), PIX/PDQv3 (native), Drug? (3) * PHR, Consent Management, CDM EHR Interoperability Showcase 2Q09 1Q09 iEHR (7), Lab (3), PIX/PDQv3 (native) * EHR index, ExID, Orchestration, TLI, New ITS, HSM 4Q08 HL7 IHIC Conference presentation EHR Interoperability Showcase iEHR (2), Lab (1), PIX/PDQv3 (facade), HSM (1) 3Q08 * Applied Research topics investigated