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Reliable Infrastructures for eHealth

Reliable Infrastructures for eHealth. Welcome and Introduction.

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Reliable Infrastructures for eHealth

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  1. Reliable Infrastructures for eHealth

  2. Welcome and Introduction • The reality of a reliable infrastructure for the exchange of healthcare information across the Internet can only be achieved when, international standards organizations agree to coordinate efforts and extend foundational standards to the healthcare domain in a way that is relevant to the entire community.

  3. Workshop Agenda Module Time Provider and HL7 Perspective 9:15 – 9:45 NHS Insight 9:45 – 10:15 10:30 – 11:00 HIPAA and Finance Norwegian Perspective 11:00 – 11:30 Medical Business Process Map 11:30 – 12:00 Epidemiology History and Introduction 1:00 – 1:15 Epidemiology Panel 1:15 – 3:00 Epidemiology Pilot 3:15 – 4:00 Applying Standards to the Business Process Map 4:00 – 4:45 OASIS eHealth Technical Committee 4:45 – 5:00 3 Innovation Process

  4. Business CentricMethodology TC eGOV TC eGOVNorway Digital Bag Collaboration Partner Agreements- CPA Contract BP Specification USA Forum 9000 Process Collaboration Partner Profiles - CPP Content Assembly Mechanism - CAM Workflow XForms Messages Artifact relationships Specifications Schema BCM-EPR SC NorwayEPR Forum Presentation Events Roles Rules Directory Services MotivationTime People Norway SINTEF Nouns Verbs Transport Routing, Packaging Data/CodesServices/FunctionsNetwork Core Components WSDL MSHSOAP Source: BCM Lubash Pyramid CUNY OMG Semantic ContentMgmt. SC Home HealthcarePilot METU W3C SemanticRegistry TC Content AssemblyMechanism TC Informatics Stds. OpenEHR, HL7, etc. Norwegian Perspective

  5. Forum 9000 Quality Systems for Quality Care Electronic PRocess for Home Healthcare Dan Pattyn Chief Technical Officer

  6. The Electronic PRocess (EPR)Pilots • Extending the ebXML Model to eGovernment Service Solutions • e-Healthcare for the Home • e-Government in local communities • e-Building • Deliverables • Templates and Specifications for eprXML based implementations of semantic interoperability in different • Communities of Interest • Open Implementation Framework • Legacy System Migration and/or Integration

  7. EPR Pilot 1: Hjemmebasert Pleie&OmsorgIntegrert tjenesteplanlegging og rapportering.(Oppgavebeskrivelse/Rapportering med PDA-phone.SIM-kort = Digital signatur )

  8. EPR Pilot 2:Digitalt ByggesakskontorElektronisk samarbeidsarena(Oppgavebeskrivelse/Rapportering/Inspeksjon med PDA-phone. SIM-kort = Digital signatur )

  9. EPR Uses Workcards as a GUI Metaphor Participant and ContextBased Architecture • Participant can be: • Traditional User • Machine or Device acting as a Proxy for a User • Environmental Context dynamically modifies Declarative Display Metaphor

  10. Business CentricMethodology TC eGOV TC eGOVNorway USA Forum 9000 BCM-EPR SC NorwayEPR Forum Norway SINTEF CUNY OMG Semantic ContentMgmt. SC Home HealthcarePilot METU W3C SemanticRegistry TC Content AssemblyMechanism TC Informatics Stds. OpenEHR, HL7, etc. e-Healthcare Pilot Participants

  11. Perspective Perspective Tools The eGovernment Challenge Experience EnablersMiniaturizationEnvironmental SensingEmbedded IntelligenceAdaptive LearningNetworked Communication Experience Innovation LeversGranularityExtensibilityLinkageEvolvabilityEventsEvent Context • Need Structured Specifications • Medical EcoSystem Centric • Collaborative Services Centric • Dynamic Contextual Information • Context Control Mechanisms • Shift from “System” to “Workspace” Focus • Occasionally Connected Workspaces

  12. Primary Doctor Patients with Similar Condition Medical Specialists Patient Scan and Diagnostics Clinic Pacemaker Manufacturer Doctor on Call at Out-of-Town Hospital Emergency Services Source: The Future of Competition, Figure 1-1, Page 9 Medtronic CareLink Patient Co-Creation Experience

  13. While Referencing the Information Architecture Step 2 : Build Templates with Familiar Business Tools Step 3 : Deploy with Declarative Component Operations Step 1 : Use Layers to Define Business Needs

  14. Digital Bag Collaboration Partner Agreements- CPA Contract BP Specification Process Collaboration Partner Profiles - CPP Content Assembly Mechanism - CAM Workflow XForms Messages Artifact relationships Specifications Schema Presentation Rules Events Roles MotivationTime People Directory Services Nouns Verbs Transport Routing, Packaging Data/CodesServices/Functions Network Core Components WSDL MSHSOAP Source: BCM Lubash Pyramid Semantic Interoperability Standards Stack

  15. SendAgentPrimary Care Physician • RecieveAgentDialysis Clinic Alter Accept Accept Request Dialysis Alter Dialysis Treatment Task Dialysis Treatment When How When How Action Event Action Event Accepted Schedule Friday 4 Apr 04 2 pm Rule Information Rule Information Why What Proposed New Schedule Priority: Urgent What Why Request Dialysis Treatment Accept Dialysis Treatment Task Dialysis Treatment Task Dialysis Treatment Provisional Schedule Friday 4 Apr 04 2 pm Accepted Schedule Friday 4 Apr 04 2 pm Priority Priority: Urgent Priority: Urgent ResponseByDate Two Hours from Receipt of Request Commitment Pattern Template • Contract Patterns - Agreement Patterns - Commitment Patterns

  16. When When How How Action Action Event Event Rule Rule Information Information What What Why Why Service OrientedOpen Implementation Framework (Autonomous Portal Agent) Digital Bag Digital Bag CollaborationServices ProcessServices Digital Bag Where / Who Where / Who Metadata Services Open Implementation Framework Services for Occasionally Connected Applications

  17. Social Worker Primary Care Physician Collaboration Services Collaboration Services ProcessServices Digital Bag Metadata Services Social Network Home Dialysis Equipment Digital Bag Digital Bag Collaboration Services Collaboration Services Digital Bag Collaboration Services ProcessServices Digital Bag ProcessServices Digital Bag Metadata Services Metadata Services Social Network Aspects of Digital Bags

  18. Business Collaboration Specification Business Agreement Languages (RINs) Collaboration Profile Agreement (CPA) Choreography & Coordination Lang. (BPSS) Context Driven Information Exchanges (CAM) Semantic Registry

  19. Perspective Perspective Tools The eGovernment Challenge • Federated Registry Services • Informational and Terminological Model Integration • e-ID Services • e-Authentication Services • Declarative Access Rights

  20. CredentialServiceProvider AccessPoint Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services Collaboration Services E-Authentication Service hands off Authenticated User ProcessServices ProcessServices ProcessServices ProcessServices Digital Bag Digital Bag Digital Bag Digital Bag Metadata Services Metadata Services Metadata Services Metadata Services eGOVNorwayRegistry Digital Bag Digital Bag Digital Bag Digital Bag eGOV SuperStructure Portal

  21. Issues • Secure Authenticated Delivery and Tracking: • Messaging system, envelope format and payload with exchange source profile controls • PKI Adoption Challenges (from PKI Action Plan) • Software Applications Don’t Support It • Costs Too High • PKI Poorly Understood • Too Much Focus on Technology, Not Enough On Need • Poor Interoperability • PKI Challenges Source: • http://www.oasis-open.org/committees/pki/pkiactionplan.pdf

  22. BCM-EPR Tasks • Integration of BCM Choice Point technology to provide flow control and linking and switching for EPR. • Create BPSS of discrete workflow components – especially intra-enterprise exchanges. • Create BCM contract and CPA templates for EPR participant roles and agreements. • Look at applicability of CAM templates for formalizing information quality control and context rules.

  23. Additonal Information and Contacts • OASIS ebXML Business Centric Methodology TC • http://www.oasis-open.org/committees/tc_home.php?wg_abbrev=bcm • http://www.oasis-open.org/ committees/download.php/5931/BCM%20Executive%20Brochure.pdf • http://www.businesscentricmethodology.com • OASIS ebXML Registry Semantic Content SC • http://www.oasis-open.org/ committees/sc_home.php?wg_abbrev=regrep-semantic • OASIS Content Assembly Mechanism TC • http://oasis-open.org/committees/cam/ • EPR Forum • http://www.eprForum.org

  24. Additonal Information and Contacts OASIS Business Centric Methodology Technical Committee(TC)Chairs: Mike Lubash – mike.lubash@dfas.milCarl Mattocks - carlmattocks@checkmi.com OASIS Business Centric Methodology EPR Subcommittee (SC) Chairs: Hans A. Aanesen – hans@iti.as ; eprXML System ArchitectDan Pattyn – danpattyn@austin.rr.com ; BCM MethodologistDavid Webber – david@drrw.info ; XML Specialist OASIS ebXML Registry Semantic Content Management Subcommittee (SC) Chairs: Carl Mattocks - carlmattocks@checkmi.com Norway EPR Forum Hans A. Aanesen – hans@iti.as

  25. Perspective Tools Perspective Value Co-Creation via Customer Centric Collaboration • Customer relationships based on experiences rather than products • The product is no longer the basis of value • Real-time customer experiences on-the-fly, shaped by the customer "context" is the value proposition • Real-time insights required to deliver on-demand customer value and service that's meaningful to individuals within the context of their day and location

  26. Norwegian Perspective Backup Slides

  27. ArchitecturalFramework Metaprocess 1988-1992 Role Interaction Networks (RINs) 1994 World Wide Web 1999 W3C XML, RDF 1990-1992 Agility Forum 1996 Foundation for Intelligent Physical Agents (FIPA) 1994 Cooperative Clinical Information Systems 2000-2003 FIPA AgentCities Project 1997 SINTEF WORKWARE Interactive Process Modeling 2000 ebXML, Semantic Registry and OASIS Stds. 2001 IOM Crossing the Chasm Report 2002 Open Source Commodity Portals 2003 OASIS Business Centric Methodology (BCM)

  28. Patients are Users-Plug & Play Web Forms for portable medical records- Plug & Play Workflows, Medical Protocols, Clinical Guidelines- User-Defined Patient Lists and PopulationsCustomizable Workflows- Hierarchical Modeling: Question ItemsFormsWorkflowsComplex Workflows- Automatic Creation of Web Forms Automatic Generation of DBMS Schema Automatic Linking of Code Between Forms and Data- Five Minutes to LearnPreview / Test forms during editing Forms RepositoryCare Team Collaboration Services • Workflow Form Debugger / Stepper- Execution Workflow Tracking and Workflow Resumption after interruption- Reactive ECA Rule Engine integrated with Schedule and Workflow (Sharable Schedules among users who are patients) Simple-to-Use Development Tools ZOPE Web Management Interface, DTML/SQL/Python Process Services Digital Bag Process Virtual Machine- jCAM, Blackboard, ruleCore RuleEngine, etc. Metadata Services MetaData Engineering Architecture- Meta Meta Model Support- Deployment Metadata for Introspection- Web Browser Metadata Creation Tools- Systematic Method of Metadata Management for Interactive Process Models (SINTEF)- Portable via Simple XML upload / download- Separation of patient identifiers from other data Traditional Architecture- Mozilla Web Browser- Apache with SSL Web Server- ZOPE Application Server- PostgreSQL RDBMS- Linux, Windows OS-Skinnable User Interface Open Implementation Framework Prototype

  29. $ Semantic Interoperability Barrier Data Exchange Costs Data Quality Costs $ Structuring Barrier $ Time OASIS Business Case

  30. Value Stream Management in a Co-Creation Environment • “Artifacts with Durable Business Value” can be re-sequenced for more value extraction • If Value is created by Context, how much infrastructure investment is needed for definition, capture, and movement of Context • Distributed Context Management with Persistent State Information • Distributed Decision Support based on Environmental Context • Currently need Standards Effort focused on a Collaboration Environment with ebXML business primitives that add value to Service Oriented Architecture (SOA)

  31. Specification Value Stream Management • Current Practice • Monolithic “blob” of linear text in proprietary word processor format - “ignorance wrapper” • Little focus on Business Protocols • Little emphasis on sequence and interactions • Roles and Responsibilities • Exception Handling • Focus on Documents • No common and controlled vocabularies • No fine granularity configuration management • No Structured Documentation • Product Planning by looking in the “Rear View Mirror” • Value Barriers • No common understanding • No packaging of business operational procedures (services) • No accountability based on roles and responsibilities • Artifacts have no Durable Business Value because of the lack of re-composable document fragments • No Reuse • No Reconfiguration • Scaleability Problems • Data Scale Barriers • Structuring Barriers • Integration Barriers • Precludes Automation & Outsourcing • IT / Business Alignment Issues

  32. Business Process Evolution Value Co-Creation via Customer Centric Collaboration Extreme Mobility Infrastructure Occasionally Connected Application Cross-Enterprise Service Centric Digitization Transaction Centric Digitization of Simple Task & Processes Process Re-Engineering Process Improvement Wearable Computing

  33. The Digital Bag- A Universal Nomadic Work Object - • A Digital Bag is an architectural model for a universal nomadic work object that maintains data, process and work contextindependently from any one system. • In technical terms, a Digital Bag is a compound XML document that exists independently from all applications, persistent data stores and processing technologies.

  34. Digital Bag Architectural Model • • directory services information • data in appropriate format and structure for the collective intent of participants • • work flow processes• work process metadata, which determine what work steps are intended for the current instance of the digital bag, the genealogy of the instance as created, and the recent history of interactions executed between the current digital bag instance and any participant.

  35. Epidemiology and Introduction

  36. Epidemiology and Introduction Feeling feverish, tired, or achy? When we think of plagues, we think of AIDS, Ebola, anthrax spores, and, of course, the Black Death. Influenza never makes the list. But in 1918 the Great Flu Epidemic felled the young and healthy virtually overnight. An estimated forty million people died as the pandemic raged. More American soldiers were killed by the 1918 flu than were killed in battle during World War I. And no area of the globe was safe. Eskimos living in remote outposts in the frozen tundra succumbed to the flu in such numbers that entire villages were wiped out. If such a plague returned today, taking a comparable percentage of the U.S. population with it, 1.5 million Americans would die, which is more than the number killed in a single year by heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer's combined.

  37. Plague Ring around the rosies, A pocket full of posies, Ashes, ashes! We all fall down.

  38. Interesting Point • Napoleon lost thousands of his men to typhus in Russia - as did the Russians who caught it from the enemy. Many historians believe that Napoleon would have won were it not for the might of his opponents "General Winter, General Famine and General Typhus."

  39. In May 2002, the World Health Assembly passed a resolution, Global public health response to natural occurrence, accidental release or deliberate use of biological and chemical agents or radionuclear material that affect health. http://www.who.int/csr/delibepidemics/en/ http://www.who.int/emc/pdfs/WHA55.16.pdf Deliberate Epidemics

  40. Economic Consequences According to the February 6, 2004 Taipei Times Not stated in the WHO recommendations and demands is the economic consequences of a major outbreak of an infectious disease. It is estimated that economic losses suffered in the SARS outbreak of 2002/2003 was in the tens of billions of dollars. In the case of the Avian Flu, Thailand alone shuttered its poultry industry (estimated to be worth $1 billion per year)

  41. Perspective Tools World Health Organization EB 107.R13 The WHO: 3. Demands Member States report cases promptly and transparently and to provide requested information to WHO; 4. Calls upon Member States to enhance collaboration with WHO and other international and regional organizations in order to support epidemiological and laboratory surveillance systems, and to foster effective and rapid responses to contain the disease; 6. Requests Member States to exchange information and experience on epidemics and the prevention and control of emerging and re-emerging infectious diseases in a timely manner, including among countries sharing land borders. World Health Organization EB107.R13 Global health security: epidemic alert and response

  42. WHO Communicable Disease Surveillance & Response (CSR)

  43. Thank You and Conclusions

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