Agenda

2. Agenda • Introduction and Acknowledgements • EMRLD Approach • Pilot Details • Q&A

3. What is EMRLD • EMRLD is a proposed data integration approach for RIM implementation connecting organization specifics to RIM. • EMRLD (pronounced as “emerald”) encompasses: • Extract: source data extraction • Merge: merge and prepare data for RIM • RIM standardization: standardization including terminology binding • Load: loading and persisting • Deliver: delivering integrated data from RIM data for consumption by multiple use cases

4. Key Drivers for EMRLD • Clinical data Integration across regions and subject areas • Integration of EMR data with data from ancillary systems (Labs, Rx) • Attribution and integration of external data with KP data • Standardization using terminology services

5. Alternatives to RIM • Build a home-grown integration model according to business needs • Purchase and deploy industry available models • OR • Adopt a reference information model (model of meaning): HL7 V3 RIM

6. Needs & Suggestions Needs Suggestions • Lack of a standard-based model is driving towards creation of many point-to-point solutions. • Downstream applications, datamarts and analytics are forced to do their own data integration. • External agencies are favoring use of standard-based data interchange approach (e.g., HL7 RIM V3). • More needs for standard-based data integration are being driven from Meaningful Use cases implementation, BIOMED devices integration, and data interchange with CDC, VA , etc. • Adopt appropriate standards to support meaningful information integration, representation and exchange between disparate systems. • Validate and adopt the HL7 Reference Information Model as a standard, explicitly targeted to enable “consistent sharing and usage of data across multiple contexts (both internal and external).”

7. Model Of Meaning and EMRLD • RIM implementation needs support for data extraction, persistence and delivery • EMRLD: suggested approach to adopt and implement RIM • Bridges model-of-use to model-of-meaning • Modular approach to implement RIMBAA • Scalability on addition and expansion of data sources • Helps in achievement of semantic interoperability • Helps in standardization, including terminology binding • Helps in adoption of HDF ( HL7 Development Framework)

8. EMRLD - Logical Approach Data Sources Integration & Staging Layer Potential Use Cases • Implement a information model that enables “data integration” or “staging” that provides: • Future scalability and extensibility and leverages industry standards • Replaces point–to–point linkages and de-couples consumption from access • Honors unique characteristics of healthcare data: including sparseness, constantly changing attributes, non-additive facts, and too many references (dimensions) • Tie in with architectural tenets • Standardization including Terminology Services • Support multiple use cases • Support clinical domain and additional (financial, administrative) and research • Security and access layer is built-in using access policies that can be governance HL7 v3 RIM Subject Data Marts EMR NHINHIE Labs, Rxs Data Exchanges Program Warehouse External Regional Data Store Research Others BIOMED

9. EMRLD Implementation View Data Sources Data Integration & Staging Layer Data DeliveryLayer Use Case Examples EMR Standard Docs (CDA, Hl7) Datamarts NHIN HIE Extract& Convert to CDA RIM (Integrated Data layer) HQL Queries Lab, Rx Data Exchanges Merge On Demand Others Research Bulk Data Extract Bulk Load CDA Terminology Services BIOMED External CDAs (CDC, VA,DOD, etc.)

10. EMRLD - Pilot Details • Imported KP EMR data via CDEF into RIM • Imported clinical data from external sources (as CDA documents) into RIM • Created interfaces to query/view data stored in RIM • Exported data stored in RIM as CDA documents Note: Open Source Software including JSIG, Hibernate (Object to Relational DB mapper) and MySQL ( Database Layer) were used for the pilot at no cost to KP

11. Screenshots from Pilot

12. EMRLD Pilot - Observations • Pilot was successful to demonstrate that the KP EMR clinical data can be imported and persisted in a HL7 RIM environment. • In addition the pilot demonstrated capability to import external CDA documents (bulk data import), export clinical data as CDA, and views the imported data using HQL queries. • This pilot was done using Open source platform created by the JavaSIG.** KP System Integration team’s developed CDEF framework engine was used to extract information from KP EMR. • CDEF is Custom Data Extract Framework which extracts KP EMR real-time transaction data. The extraction is based on pre-defined events and rules. The data is available from CDEF in table format. • JSIG is an open source HL7 RIM implementation. It maps all RIM classes to SQL tables using hibernate. Provides helper classes to create CDA document and persist in RIM data model. • Any database can be used to support RIM and for demonstration purposes, MySQL was used. • KP-JSIG is a web application built on top of JSIG to incorporate a way to import KP EMR data, external CDA documents, export CDA documents, and execute HQL queries on RIM classes. • **Note that the HL7 Java SIG (JSIG) has been renamed to the RIM Based Application Architecture Work Group (the RIMBAA WG).

13. EMRLD- RIM Data IntegrationPotential Implementation Use Cases NHIN - HIE Downstream Applications, Analytics and Datamarts • The NHIN specifications states that clinical data should be exchanged via CDA release-2 documents (one of the HL7 v3 standards), and that all inter-NHIE (inter National Health Information Exchange) messages (gateway to gateway communication) in the NHIN will use HL7 v 3.0 RIM based messages. • KP context will need an integration layer of data collected via DOD, VA and internal KP. • KP HIE initiative is evaluating a standard based approach like RIM for information exchange. • Many applications, analytics and datamarts using KP EMR data need additional information and need to integrate via a manually/semi automated way or using a point solution at their end. • This not only increases cost but also has time to market and data quality issues. • An integrated staging layer will not only provide a consistent layer of information, it will reduce cost and improve information latency. Real Time Standards-based Interfaces Others • KP EMR needs to interchange information with other ancillary systems (e.g. Lab, Rx etc) in Real Time. • These interfaces are today built point to point • Can be applied to situations like point-point interfaces currently being used between EMR, Labs, Rx • Can be a good foundation layer for integration while we are approaching new Lab and Pharmacy systems • BIOMED Devices: Information storage and retrieval of biomedical device information is supported by an HL7 v3 RIM-mapable integrated staging approach. Device messages, documents and services are also supported. • External information from agencies like CDC, VA can be made efficient and easy to implement • PHR (Personal Health Record): Support for Patient controlled EHR is being developed by HL7 RIM HER Working Group • Foundation for upcoming integration needs for upcoming Insurance Exchanges

14. Questions? • pradeep.k.chowdhury@kp.org