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Christian Ohr ICW Germany, Feb 13th 2008, Sofia

Integration of hospitals and other medical specialists through international standards, technologies and best practices. Christian Ohr ICW Germany, Feb 13th 2008, Sofia.

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Christian Ohr ICW Germany, Feb 13th 2008, Sofia

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  1. Integration of hospitals and other medical specialists through international standards, technologies and best practices Christian Ohr ICW Germany, Feb 13th 2008, Sofia NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORD Under the aegis of Ministry of Health

  2. Agenda • Standards and Interoperability • Examples • Barriers to Adoption and Acceptance • IHE Initiative • Leverage instead of reinvent • Profiles • Showcases • Strategies to introduce standard-compliance

  3. Standards and Interoperability • Medical IT Standards • HL7 v2 • HL7 v3 • CDA, CCOW, CCR • DICOM • ISO 11073, 13606, … , CEN … • Medical IT Terminologies and Vocabularies • SNOMED CT • LOINC • ICD • Industry IT Standards • XML, ebXML • SOAP, WSDL, WS-* • BPM, BPEL

  4. Standards – Barriers to Adoption and Acceptance • … there are so many to choose from … • Competing standards • Complementing standards • … each of them covers only part of the story … • Real-world use cases and scenarios span over: • Health domains • Technical layers • … they are too generic and add extra overhead … • Even using a small part of it requires you to use the whole stack • … they are interpretable … • Using the standard and still don’t understand each other (“plug-and-play”) • Constraining the standard by defining profiles

  5. Standards – Barriers to Adoption and Acceptance • … none of them cover your special needs … • Project-, region- or country-specific requirements • Process to generalize these features and propose them for the official standard is often troublesome and time-consuming • … consciously ignored … • “not invented here”-principle • recognition, funding, significance • … unconsciously ignored … • Missing knowledge about existence • Limited accessibility of standard documents

  6. IHE Initiative • IHE • Driven by users and industry • Workflows in Frameworks • Goal: “enable health information systems to share and exchange medical data more easily” • www.ihe.net • Leverage standards instead of reinvent standards

  7. IHE Initiative • Profiles • define how a particular system can exchange its information with another, to meet specific (clinical) needs • Use-case driven • Clear distinction between use-case and technical implementation • Leverage existing standards for information exchange (at times, the chosen ones seem arbitrary and heterogeneous) • Detailed, also covers boundary conditions • Dependencies between profiles • Domains • Groups of profiles • cardiology, eye care, IT infrastructure, lab, pathology, patient care coordination, patient care devices, quality, radiation oncology and radiology

  8. IHE Connectathons • Largest interoperability testing event in health care • vendors refine and test their products for conformance with IHE integration profiles and interoperability with corresponding healthcare IT systems. • Chicago, Jan/Feb 2008: 70 companies, ~ 400 participants • Results are published

  9. Strategies how to introduce standard compliance • Adding another interface to an existing product is a non-trivial task • Doesn‘t match existing interfaces • Uses different technology • Bloats the core product with integration issues • … • "Any [software] problem can be solved by adding another layer of indirection.” (Steven M. Bellovin) • Exceptions • the problem of too much indirection (complexity) • improve performance • minimize usage of [computing] resources

  10. ICW - General portfolio PATIENT / CITIZEN HEALTH INSURANCE COMPANIES Care Management Health conscious Insurance Companies Athletes Call Center Patient Information • Patient Information • HomeCare Integration • Fitness and Prevention • Rehabilitation • DMP Management • Card Management • Kiosksystems • Teleconsulting • Telemonitoring Chronically ill patients Young mothers Elderly Patient Integration Tele- monitoring Electronic Medical Record Virtual Medical Record Physician‘s offices Case Record • Teleconsultation • Patient Integration • eHealth Integration • Networking of Physician‘s • Hospital Networking • Referrer • Patient Integration • Telemedicine Physician networks Hospitals Pharmacies Radiology Hospital Associations PHYSICANS / -NETWORKS /PHARMACIES HOSPITALS / -ASSOCIATIONS Healthcare Professionals

  11. Example: introduce messaging middleware ICW Professional Suite (PXS) Health care provider – primary systems, hospitals

  12. Example: introduce messaging middleware ICW Professional Suite (PXS) Messaging Middleware Passed IHE PIX profile tests Health care provider – primary systems, hospitals

  13. Example: introduce messaging middleware ICW Professional Suite (PXS) Messaging Middleware Integration Process Management Passed IHE PIX profile tests Health care provider – primary systems

  14. ICW e-card Project – (ePrescription) Card Terminal ePrescription Service GPSoftware ICW Box Connector NHIF Contract Data Service VPN Tunnel Card Terminal ICW Box Connector PharmacySoftware Certificate Authority

  15. Connector X.509 ICW e-Card project – pharmacy processes 1. Successful authorization 1. Patient authentication 2. Requests patient ePrescription 3./ 9. Transfers Request for ePrescription/ dispensing 8. Dispense ePrescription 6. Visualize ePrescription 4. Reads ePrescription Info from card 7. Cross check print out and deliver drugs 10. Delete ePrescription Info on card 5. ePrescription is transferred together with ePrescription ID

  16. Connector X.509 ICW e-Card project – pharmacy processes ISO 7816-1,2,3,…15 1. Successful authorization 1. Patient authentication ISO 7816-1,2,3,…15 X.509, CVC X.509, CVC 2. Requests patient ePrescription 3./ 9. Transfers Request for ePrescription/ dispensing gematik 8. Dispense ePrescription 6. Visualize ePrescription 4. Reads ePrescription Info from card 7. Cross check print out and deliver drugs SICCT gematik 10. Delete ePrescription Info on card. 5. ePrescription is transferred together with ePrescription ID IPSec, TLS, L2TP X.509, CVC

  17. ICW project – Building of eHealth portal and Personal Health Record Physician Patient‘s Home Authorization Portal ICW e-Government Health Record (MSAAR)

  18. Summary • Adoption of standards is often troublesome • Choice, complexity, abstractness, applicability, support • IHE puts standards in context with real-world health care integration scenarios • Description of use cases, required standards and boundary conditions • offers an exciting compliance test platform • ICW actively supports standardization activities • Member in many standardization boards (national + international) • Coordination of standard activities by own department • Standards compliance in core products • ICW products and projects started in Bulgaria • Relevant to the standards accepted by eHealth industry • Relevant to European plans and initiatives • Oriented to the integration of legacy (existing) systems and not to the rejection of these systems. • The message of ICW is „Connect, don‘t reject!“

  19. Thank you christian.ohr@icw.de NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORD Under the aegis of Ministry of Health

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