Healthcare Services Specification Project The Business Case and Importance of Services

1. June 2005 Healthcare Services Specification Project The Business Case and Importance of Services HL7 Services Specification Project Workgroup OMG Healthcare Domain Task Force

2. Background • This presentation represents the collective input and thinking from the collective participants involved in the Healthcare Services Specification Project. • Represented were members from • Object Management Group (OMG) • Health Level Seven (HL7) • Integrating the Healthcare Enterprise (IHE) • This presentation is intended to describe the purpose, role, and importance of industry-standard service interface specifications

3. Why “common services” and not just “messages”?* • A common practice in healthcare, just not yet in healthcare IT • Many key products use them but do not expose interfaces • Ensures functional consistency across applications • Accepted industry best practice • Furthers authoritative sources of data • Minimizes duplication across applications, reuse • Messages can be either payloads in or infrastructure beneath services • Service-oriented architecture is just automation of common services *slide adapted from a Veterans Health Administration Presentation, used with permission

4. What is the Healthcare Service Specification Project? • An effort to create common “service interface specifications” tractable within Health IT • A joint standards development project involving Health Level 7 (HL7) and the Object Management Group (OMG) • Its objectives are: • To create useful, usable healthcare standards that address functions, semantics and technologies • To complement existing work and leverage existing standards • To focus on practical needs and not perfection • To capitalize on industry talent through open community participation

5. Where would these specifications be used • Inter-Enterprise (such as RHIOs) • By functionally specifying behavior, roles between applications and products are clarified, and the technologies supporting them can be profiled and sharpened • Intra-Enterprise • Standardization on functionality allows for better integration of off-the-shelf and custom development environments, and promotes more of a “plug and play” environment • Intra-Product • Facilitates vendors ability to integrate third-party value-add components and speed design phase with higher confidence • Custom-Implementation • Affords organizations wishing to custom-develop the opportunity to later integrate off-the-shelf

6. The Approach • HL7 to lead in service selection, functional elaboration, and conformance criteria • OMG to lead in technical specification • Both organizations jointly participate in all activities • Work products will be “owned” by only one organization but used collaboratively • “Operate as one project” as a principle • Actively seek vendor participation • Engage IHE community

7. The Value of Collaboration • HL7 brings… • Healthcare semantic interoperability expertise • Rich, extensive international community perspective • Diverse membership base • OMG brings • distributed systems architecture and modeling excellence • Effective, efficient, rapid process • Premise that standards must be implemented • Resulting in… • Services will be identified by the community needing them • Improved methodology resultant from functional and architectural merging of the two groups • Facilitation of multi-platform implementation and broader implementation community

8. Context of HSSP Specifications High Ability to Interoperate Low Information Design and Technology & Semantics Interoperability Platform Bindings Model-based Platform-independent component Specifications Model Fragment Computationally- Independent Specification Reference Information Model HL7 Application Roles Data Types and Terminology Bindings Middleware Frameworks Standard Terminologies and Vocabularies Messaging Specifications (HL7, others) HL7 Community and Open Participation Physical/Software Infrastructure

9. Functional Organization OMG Service INFRASTRUCTURE Service Service API API TOOLS HL7 HL7 HL7 HL7 OMG Service

10. HSSP Stakeholder Benefits and Impacts

11. Promotes deployment ease and flexibility Consistency at the interface level assures asset protection Multiple vendor product use/ interoperability Increased buyer/product offerings Facilitates integration Time to market Requirements definition – influence vendors in a direct way Lower cost = wider deployment = higher quality service Specifications will support multiple topologies Standard interfaces means that conformant components are substitutable Using compliant products means side-by-side interoperation of multiple product offerings Consumer demand will create increased marketplace competition Unity in purpose and consistency in interface eases integration burden Availability of an industry-accepted component interface eases product development burden Participation by provider and payer community is direct expression of business need For Product Consumers and Users…The Impacts and Rationale of HSSP Specifications Impacts Rationale

12. Market opportunity – ability to grow business / “Grow the pie” Conformance adds legitimacy to product offering Reduced time and cost to market Use of 3rd party components Simplify / reuse of design Participation provides the ability to influence the standard Standardization of interfaces eases cost-of-entry to markets Consumers view conformance as a confidence metric Ability to reuse design ideas, incorporate off-the-shelf components into value-add offerings You can shape the standard to be supportive of your product architecture Product Vendor …The Impacts and Rationale of HSSP Specifications Impacts Rationale

13. Establishing objective assessment criteria Measurement criteria for regulatory compliance Allows for technology change within the regulation Offering an easy/easier solution that is complete and actionable / ease the path to adoption How do we “Pick the winning horse” “Opportunity cost” of using the wrong standard has big implications Solution that complements existing standards Inclusion of rigorous conformance assertions benefits compliance and verification Concurrent support of multiple technologies allows for technology evolution HSSP integrates function/ behavior, data, and protocol promoting an integrated solution set HSSP is using HL7 semantics, OMG processes, IHE testing, and established technology protocols Regulatory/Policy/Legislative …The Impacts and Rationale of HSSP Specifications Impacts Rationale

14. Promotes accessibility to “raw” information Enabler for collaborative studies, e.g. de-identification, retrieval, etc. Enlarges cell and sample sizes based on interoperability Facilitates responsiveness to bio-surveillance requirements Enables construction of higher-order service stacks with less investment Strong emphasis on semantically rigorous data and query/retrieval Leveraged use of identity service enables de-identification Standard interfaces accommodate dynamic and emerging strategies and tools Composable nature of services promotes construction Research …The Impacts and Rationale of HSSP Specifications Impacts Rationale

15. Reduced integration time and cost resulting from the use of standard tooling Risk mitigation (skill portability/ training advantage, vendor independence, substitutability) Creates a value offering opportunity based on the ability to deliver using these service standards Improved ability to deliver and support interfaces that have been implemented Use of standard in off-the-shelf tools facilitates their use By training staff in the standard, skills are portable across tools Allows staff and solutions to build upon the use of the standard and not technologies Using services speeds project design phases and promotes reuse Implementer/Integrator …The Impacts and Rationale of HSSP Specifications Impacts Rationale

16. Useable standards Market-focused standards based on commercial implementations Promotes harmonization, cooperation, cohesion among standards communities More members/involvement = more revenue & better specs Emphasis on practicality Shortens time required to develop specifications and encourages collaboration Integration of function, data, and technology promotes leveraged reuse Practical, market-focus and iterative timeline promotes participation and results SDOs …The Impacts and Rationale of HSSP Specifications Impacts Rationale

17. Reference Examples • Mass Clinical Data Exchange (CDX) • RHIO • Merger/acquisition • Public health / disease reporting

18. What Participants are Saying… • “Kaiser Permanente I.T. is currently transitioning to an SOA-based approach to business and systems integration. Availability of industry standard services will bring many benefits towards this goal in terms of speed of implementation, flexibility and reduced cost. I am very pleased that both HL7 and OMG are committed to this timely effort.”, Alan Honey, Enterprise Architect (Principal), Kaiser-Permanente • “The creation of a health Informatics infrastructure based upon a service-based architecture grounded in comparable data has the potential to improve healthcare delivery and greatly enhance patient safety.”, Peter L. Elkin, MD, FACP, Professor of Medicine, Mayo Clinic College of Medicine • “The MedicAlert mission – to protect and save lives – requires a repository of comprehensive medical information that comes from multiple sources for our members. Our SOA-based infrastructure demands the rich and flexible capabilities that are provided by these standard interoperable services.”, David Harrington, CTO, MedicAlert Foundation • “The Eclipse Foundation is pleased to support an open source project dedicated to building frameworks, components, and exemplary tools to make it easy and cost-effective to build and deploy healthcare software solutions. This Eclipse Open Healthcare Framework project will leverage the Eclipse Platform developed by IBM, Intel, Wind River, Actuate, Borland, BEA, Computer Associates and others.” Mike Milinkovich, Executive Director, Eclipse Foundation • “The time is now and the place is here in this joint OMG/HL7 project. Never before has the industry been closer to cogent, clear healthcare IT data model and service standards that can provide true interoperability in a short timeframe, with open-source implementations making availability abundant.”, Richard Mark Soley, Ph.D., Chairman and CEO, OMG

19. Project Timeline and Roadmap 1996: First OMG Healthcare Service Spec Adopted (PIDS?) 2003: HL7 ServicesBOF formed 2005 September: HL7, OMG Collaboration MOU 2005 January: Joint Project Chartered 2005 April: Project Kickoff 2005 September: Methodology and MetaSpecs Baselined (planned) 2005 October: Interoperability Services Workshop & Conference 2006 January: Functional Specs Ballot (planned) 2006 Q4: Technical Specs RFP (planned)

20. How is this project “different”? • Active participation from three continents and 15+ organizations • Significant cross-cutting community involvement • Providers (Kaiser, VHA, Intermountain Health, Mayo) • Vendors (IBM, PatientKeeper, Universata) • Value-added Providers (MedicAlert, Ocean Informatics, Eclipse Foundation, etc.) • Integrators (IBM, EDS) • Governments (Veterans Health Administration, Canada Health Infoway, HealthConnect (Australia), SerAPI (Finland)) • Managing differences between SDOs in terms of membership, intellectual property, and cost models

21. Why should I participate? [One] • This effort is focused on and driven by business-need • It is not an “academic exercise” striving for perfection • Acknowledgement that for standards to be useful they must be used • Focused on the practical and achievable • Short timelines • Based upon business value and ROI • Leveraging talent from two standards communities • Up-front commitment ensures community engagement • Being run like a “project” and not a committee • Recognize participation as an investment and not an expense

22. Why should I participate? [Two] • This is happening—the only way to influence the outcome is to engage • Significant “networking” opportunities—you will gain access to the best and brightest in the industry and the world • Prime opportunity to directly engage with complementing stakeholder groups (provider-to-vendor, vendor-to-payer, SDO-to-SDO, etc) • Benefit from “lessons learned” from others • Reduce design burden • Establish market presence and mindshare as industry leader

23. How do I Participate? • Join appropriate standards organizations • HL7 for functional work • OMG for technical specification work • Join both • Allocate resources to actively engage in the project • Engage existing, knowledgeable resources in the areas they are working already. • Subgroups form based on industry need and priority • Teleconferences are weekly; meetings approximately bimonthly

24. Who should I involve? • Involve the staff that can best address your business needs: • The benefits you receive will depend upon your investment • Organizations that commit resources garner more influence and more mindshare • Your business interests are being represented by your attendees

25. References • HL7 Website: • http://www.hl7.org • OMG Website: • http://www.omg.org/hssp • Services Project Homepage • http://groups.yahoo.com/group/ServicesSpec