Weaving interoperability: combining local, regional and national solutions on hospital level

1. Weaving interoperability:combining local, regional and national solutions on hospital level IMIA HIS Conference, Oeiras, July 3, 2006 Juha Mykkänen, Mikko Korpela HIS R&D Unit, University of Kuopio, Finland

2. In this presentation • HIS, sub-systems and interoperability • Local, regional and national health information infrastructure initiatives in Finland • HIS architectural components: hospital view • Some challenges for advanced interoperability • Emerging interoperability best practices • Summary + discussion

3. IMIA HIS, Heidelberg, April 2002: • "need a common description for components in health information systems" - still a valid need • components = units of composition, reuse and interoperability: • scope, availability, granularity, physical and conceptual nature • healthcare-specific scope: infrastructure, administration, care support, direct care, diagnostics, communication, simulation • information and semantics, instance / type / context / meta levels • functionality and interactions - capabilities + collaboration • relation to reference architectures and specific application architecture • technical aspects - data communication, interfaces, technical infrastructure, integration platforms etc. • cross-cutting aspects: security, management, flexibility, extensibility • relationship to systems lifecycle - development paradigm, migration Mykkänen, Tuomainen 2006, Information and Software Technology, submitted.

4. Role of information systems in hospitals Process model of a hospital – systems are for processes Auxiliary processes: Management, … Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou Core process: Direct care Input: illness Output: wellness? Support processes: … Laboratory Radiology

5. Beyond the hospital – seamless care Rehabilitation Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou

6. Kuopio Helsinki Health information infrastructure developments / Finland • Hospitals and health centres • primary care = health centres: ~100 % use EPR systems • hospitals: replacing legacy core applications > 10 years • continuous heterogeneity in processes, applications, infrastructures • managerial and clinical process developments - e.g. DRG, decision support • Regional • new organisational models of health services (e.g. laboratories, regional clusters) • regional information systems, references to back-end HIS data • shared electronic services (e.g. prescriptions, electronic booking) • disease-specific specialised systems • National • national services: EHR for professionals, code sets/vocabularies etc. • migration from regional to national services • Citizen • e-services emerging first for professionals, then patients • PHR: little real integration to professional-oriented EPRs

7. Hospital level Sample high-end composition of the hospital-wide information system today:Helsinki-Uusimaa hospital district HUS,Sinikka Ripatti 2004

8. Hospital level Example of a major vendor’s architecture Loosely connected systems Launching Common context & services Medici Data Oy, Juha Sorri 7.10.2004 HMIS core EPR system Common user • inner circles: optimised usability, reduced maintenance and redundancy, tightly integrated application families and components • outer circles: flexibility, cross-organisational processes

9. Hospital level Migration situation in a major hospital New HIS systems Health center systems KYS, Pekka Sipilä, 2006 Old HIS systems

10. Elements of a HIS architecture: hospital viewCommon core services: Starting point for HIS • presumptions: • heterogeneous specialised applications, existing (legacy) systems • practicality, feasible implementation threshold in multi-vendor environment • extensibility • service-orientation supported by generic middleware Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

11. “Pluggable” specialized clinical subsystems • alternatives: • non-pluggable clinical subsystems • no clinical subsystems Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

12. Standard structured EPR/EHR data storage • alternatives: • system-specific data views • point-to-point queries • (personal / virtual health record - outside organization) Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

13. Front-end viewer for health professionals (EHR-S) • alternatives: • context management • no point-of-decision integration • (additional) workflow management systems Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing

14. Information exchange by messages across facilities Potentiallysame data structure Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing • alternatives: • central repository (for some scenarios - see next slide) • peer-to-peer negotiations / mediation

15. Clinical on-line access across facilities Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing • alternatives: • peer-to-peer negotiations / mediation

16. Patient’s / citizen’s front-end Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing • add: • opposite direction • patient-provider communications

17. 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?

18. Interoperability apex 2006 • 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)

19. Summary and discussion topics • hospitals will long remain one central point for health services provision, but will not remain "the centre" • challenges for advanced interoperability remain on local, regional, national and international level: common frameworks needed • regional and national initiatives demand local acceptance and user benefits • described elements are based on Finnish practical experience, international standardization, China, Africa • one basis for generic framework architecture adjustable to the specific contexts in Portugal, Germany, UK, USA, … Mozambique? • how can the service interfaces and semantics be developed for global reusability & local adaptability? gradually? • understanding of and support for healthcare processes • semantic and functional views addressed → International standardization of relevant aspects with users and industry → ’IT for Health’ at IFIP World IT Forum 2007 www.witfor.org → IMIA recommendations, Health Informatics in Africa HELINA 2007 www.helina.org

20. Acknowledgements and more information Healthcare application integration: PlugIT, 2001­2004: www.plugit.fi,Finnish Agency for Technology and Innovation Tekes grants no. 40664/01, 40246/02 and 90/03 Service-oriented architecture and web services in healthcare application production and integration: SerAPI, 2004­2007:www.centek.fi/serapi, Tekes grants no. 40437/04, 40353/05 Healthcare work and information systems development in parallel: ZipIT2004-2007 Tekes grants no. 40436/04 and 790/04, and ActAD­HIS, 2004-2005 Finnish WorkEnvironment Fund grant no. 104151 :www.centek.fi/zipit Packaging Finnish e-health expertise for international use: ExportHIS, 2004­2006 www.centek.fi/exporthis(Tekes grant no. 70062/04,), e-Health Partners Finland, 2006-2007 www.uku.fi/ehp (Tekes grants no. 40140/06, 70030/06) Informatics development for health in Africa: INDEHELA­Methods(Academy of Finland grants no. 39187,1998­2001), INDEHELA­Context(201397 and 104776, 2003, 2004­2007):www.uku.fi/indehela Open Integration Testing Environment: Avointa, 2004­2006:www.centek.fi/avointaTekes grant no. 40449/04

21. Assets to support benefits of electronic health information interoperability • separation of care management from patient-specific health information • increasingly documented and formalised requirements, processes and practices in healthcare • common concept models, vocabularies and terminologies, extended to ontological languages and tools • component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments • guidelines, methods and reference models for acquisition, integration and systems development projects Mykkänen, Specification of Reusable Integration Solutions in Health Information Systems, forthcoming.