International HL7 Interoperability Conference - IHIC 2010

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1 International HL7 Interoperability Conference - IHIC 2010 National ehealth Initiatives: Global Health Information Technology Standards Serving Local Needs Building Interoperability across many localities Don Newsham May 14, 2010

2 Three localities Canadian Standards Direction Global Standards Direction Low Income / Low Resource Country Standards Direction

3 Connecting Standards in Canada Health Informatics standards community in Canada has completed a major governance transformation Now a single cohesive, coordinated collaborative With integrated organizations, process and services across numerous standards SDOs and domains resulting in a 50% reduction in committees Providing a single point of contact for coordination of Pan-Canadian standards throughout the standards life cycle. SCC CSA Technical Sub-Committee pcsg SCWG #1 - Population Health (Delivery of Care) Infoway Standards Collaborative Strategic Committee Standards Collaborative Coordinating Committee SCWG #4 - Medication Management SCWG #7 - Non- Clinical Registries CIHI Clinical Sub-Committee pcsg SCWG #2 - Individual Care (Delivery of Care) SCWG # - Labs & Diagnostics SCWG #8 - IT Privacy & Security Services SCWG #3 - Managing the Health System SCWG #6 - Infostructure & Architecture SCWG #9 - Terminology Representation & Services

4 Standards Collaborative Governance Model

5 Infoway Investment on Standards to date Total Infoway investments in standards including source of other funds Change Management $33 Million Tools and Templates Investments in the development of standards through Infoway Programs Licenses Needs Identification & Business Definition Options Research and Analysis Maintenance Standards Development Standards Knowledge Management Pan-Canadian Standards Evaluation Conformance Test Pilot $30.0 Million Actual and planned investments in the deployment and maintenance of standards through the Standards Collaborative FY Adoption Strategies Implementation Support Training Education Promotion & Communication Liaison

6 Standards to support the Infoway EHR mandate SNOMED CT National e-claims Standards Client Registry Standards Provider Registry Standards Diagnostic Imaging Standards Drug Standards Laboratory Messaging and Nomenclature Standards Public Health Surveillance Standards iehr Clinical Messaging Standards Physician Office Systems Requirements iehr Technical Standards Security and Consent Standards Patient Access to Quality Care Standards

7 Standards Used in the EHRS JURISDICTIONAL INFOSTRUCTURE Registries Data & Services Client Registry Provider Registry Location Registry Immunization Management Ancillary Data & Services Business Rules PHS Reporting EHR Index Shared Health Record Message Structures Normalization Rules Drug Information EHR Data & Services Terminology Repository Diagnostic Imaging Laboratory Data Warehouse Health Information HIAL Public Health Services Pharmacy System Radiology Center PACS/RIS Longitudinal Record Services Common Services Communication Bus Lab System (LIS) Security Mgmt Data Hospital, LTC, CCC, EPR Privacy Data Physician Office EMR Configuration EHR Viewer POINT OF SERVICE Public Health Provider Pharmacist Radiologist Lab Clinician Physician/ Provider Physician/ Provider Physician/ Provider Standards Legend Client Registry Provider Registry Location Registry CeRx/Drugs SNOMED / Clinical Terminology Laboratory LOINC, PCLOD iehr Clinical Messaging Public Health Surveillance National e-claims Diagnostic Imaging

8 Global HI Standards Direction Underway for 10+ years Launched under different authorities, with different or overlapping mandates Global, European, US, WHO, Individual Country Targeting segments of the interoperability problem Imaging, Messaging, Laboratory Results, Terminologies, Medicinal Products, EHR, Technical Transport, Devices, Research Through multiple SDO s Often volunteer based, varying infrastructure / proposal / development / balloting / publication processes All with best intentions, all contributing to duplicate, overlapping, differing approaches to interoperability With no coordinated answer to: 1. What is the one standard (or package of standards) to solve my health business problem, with 100 s of standards to choose? 2. What can be done to support local needs, to support countries at varying stages of HIS development?

9 Joint Initiative Joint Initiative on SDO Global Health Informatics Standardization CEN, HL7, ISO Initial Charter Signatories CDISC, IHTSDO and GS1 also now signatories International Health Terminology

10 Joint Initiative Work Program Work Program includes: Biomedical Research Information Domain Group (Bridg) Model Data Types (in final FDIS ballot) Pharmacovigilance / Identification of Medicinal Products (ICSR and IDMP) Clinical Trial Registration and Results SKMT (GLOSSARY and DOCUMENT Registry) EHR Functional Model (R2) Patient Identifiers for automatic identification data capture Preliminary / Potential Quality requirements and methodology for detailed clinical models Generic Model for Dose Syntax Tracking Medical Device Software regulation and Privacy standards across SDO s

11 Some Emerging Country Directions Collaborating with countries at varying stages Developed countries using national mandates / national funded initiatives Low Income / Low Resource countries Becoming very active Finding ways to address health information technology needs Are challenged to access standards and engage with the standards community

12 Local needs in many countries Need to support country wide Health Information Systems (HIS) At population and public health levels Nationally and for communities (of diseases and of people) Moving also to EHR s A surge of interest in ehealth infostructures Starting often with architectures

13 Local needs in many countries Support for standards based ehealth architecture decisions that are non-proprietary robust and future proof locally-driven and open reference implemented based And that use commonly shared standards to carry out monitoring and evaluation For govt bodies, international organizations, donors and others

14 Local (HI standards) needs supported by Global Action Players Countries at early stages of health information systems Global players (being there, doing that) WHO / Health Metrics Network Standards Development Organizations Donors (Rockefeller, Gates, IDRC,.) Country governments / associations / experts Technology associations (mhealth, )

15 Local (HI standards) needs supported by Global Action Actions Collaborative, capacity building, design & standards development workshops Increasing scope and momentum Geneva, Kigali, Bangkok, Bellagio, Vancouver WHO / HMN global coordination / strength Expertise, focal point, leadership Donors engaged and also leading Targeting initiatives with momentum and broad participation, real impact on health, Targeting / leading collaborative initiatives

16 Local (HI standards) needs supported by Global Action Actions Country Governments Assigning government / academic leaders to develop their own ehealth plans, strategies & architectures Signing bi or multi-lateral mutual development agreements or assigning expert support Often starting with telehealth or public health Technology companies / associations Increasing awareness of market potential Still find balance between providing their solution versus supporting local needs

17 Local (HI standards) needs supported by Global Action Actions SDO s Bellagio workshop on ISO / ehealth architecture standard for low income / low resource countries & declaration for standards access and participation Joint Initiative Task group underway to determine joint actions needed for standards access and participation for low income / low resource countries HMN leading Framework For National Health Information Systems standard in ISO/TC215 Developing list of standards now available

18 Getting Started for Local Needs Get involved and engaged with standards of priority to you / your country / your context Participate in standards meetings, standards discussions where ever such take place Connect your experts / academics to other nearby countries to address ehealth, architecture and standards issues Track Joint Initiative actions Build local capacity and awareness through education, workshops, support from SDO leaders for in-country conferences / meetings, donor engagement Promote use of standards that are important to your local initiatives

19 International HL7 Interoperability Conference - IHIC 2010 Building Interoperability across many localities THANK YOU Don Newsham

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