Standards and their role in Healthcare ICT Strategy. 10th Annual Public Sector IT Conference

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1 Standards and their role in Healthcare ICT Strategy 10th Annual Public Sector IT Conference Peter Connolly Oct 2014

2 What is the Direction of Travel? 1

3 Understanding the Why- The Data Context 2

4 Stakeholder Expectations are changing Patient Centric Integrated View Access Anywhere 3

5 Standards- a critical part of the solution!

6 Why Standards in Healthcare ICT (ehealth) Reduced implementation costs and timeframes Minimum data sets for patient summaries and clinical programmes Facilitating semantic and syntactical operability Ensure functional requirements and specifications are understood Removal of technical barriers Transfer of technology Unambiguous testing methods and certification Data- entered once but used many times with consistent meaning Europe 2020: Digital Agenda and Directive EU 2011/24 Record portability across member states Sharing information exchange for better patient care Laying a foundation for a national EHR. Sharing becomes possible only if interoperability exists Interoperability occurs only if a full set of standards in health care exist

7 What are we doing about it? (ICT National Integrated Services Framework)

8 (ISF)-The Integrated Services Framework A standards based single framework for the public health system A Technical Architecture An Applications Architecture An Information Model and Architecture An Communications / Network Architecture Secondary Deliverable A Single Information Systems Framework to provide for integration and sharing of data and information Deliver the ICT Strategy work streams Strategic National Business Initiatives Develop, implement & support local & regional initiatives Develop the EHR Information Framework Develop & improve ICT Infrastructure Foundation for the Electronic Health Record (EHR) and a National Patient/ Client Portal

9 Integrated Services Framework Components Applications, Information, Communications & Technical Architecture Information & Communications Architecture Applications Architecture Applications Access Business Processes Electronic Health Record (EHR) National/Patient/Client Portal Consolidated Business Process Services Common Applications Identity, Access & System Services Data/Information Repository Patient Identity Services Patient Consent Access & Privacy Rules Provider ID Services Service Management Auditing & Configuration Services Aggregated & Consolidated Data / Information Repository Individual Applications & Systems Data Validation & Transformation Systems/Data Integration HSE Health Data Model Interface Engines Source data Extraction, Transformation & Loading Validation rules Web Services Interfaces Common Services Communication & Technical Infrastructure New Systems Existing Hospital Systems Existing HSE Systems G.P. Systems National Registers

10 (ISF)-The Integrated Services Framework Vision Work-stream-1: The Framework Model...5 Technical Infrastructure > Work-stream-2: Technical Infrastructure Work Stream 7 (ICT Platforms, Technologies & Asset Base) > Work-stream-3: Applications Reference Base...10 (Applications Portfolio, Standards & Toolsets) > Work-stream-4: Integrated Systems Management Framework 13 INTEGRATED SERVICES FRAMEWORK (ISF) ACCESS WS:9-10 Information Architecture > Work-stream-5: High Level Business Process Specification...15 > Work-stream-6: Information Architecture Model. 18 > Work-stream-7: Data & Information Repository > Work-stream-8: Transformation, Interfacing & Sourcing...23 Access > Work-stream-9: Identity, Access & Consent Management...25 Work-stream-10: Portal & Presentation..28 Governance > Work-stream-11: Architecture Documentation 30 > Work-stream-12: Governance Model..33 Appendix Blueprint of the Integrated Services Framework...34

11 Strategic Global Insights Denmark The Netherlands England Wales Scotland Northern Ireland Hong Kong Taiwan Canada USA Germany France Nordics Estonia Slovenia NZ/Australia Singapore Hong Kong Taiwan What was your approach to the development of a national standards based platform? Who are your key stakeholders and how were they engaged? What standards did you review and which did you adopt? What was your allocated budget and what timelines are you working towards? How effective was the adopted approach, were there any lessons learnt? What resources did this require and what is the allocated budget? What approach did you adopt and why? Where were the big road blocks and how did you overcome these? There was a broad sharing of knowledge and material We assimilated the findings and identified best practices The way forward moved from obscurity to clarity

12 Key Findings The approach should include all key stakeholders and facilitate broad participation in order to achieve appropriate consensus and support. The fostering of mature partnerships with pioneering peer organisations will provide for effective collaboration and broaden the collective resource pool. An incremental approach should be considered, and in so far as practical adopt a build on rather than a rip and replace approach to existing infrastructure. Focussing solely on an accelerated implementation of an EHR platform is likely to extend the existing legacy and add an unnecessary degree of cost. No one single standard in likely to address all requirements. Significant value can be achieved by focussing on implementing a ready-set of data standards that are mature and proven. Value can also be achieved through leveraging internal standards and aligning them with the Framework.

13 Key Findings Pursuit of a Summary Care Record based on an incremental build approach An incremental approach involving the adoption (and tailoring) of international standards Commence with defining a minimum suite of standards for data exchange Close coordination of data model development via a Logical Information Model (LIM) Minimal compliance burdens to encourage migration of existing data silos to the new standards based models A test and certification programme to ensure interoperability at each stage-gate of information architecture development An approach based on a secure portal or internet type access and data transport Ensure reliable authorisation and legislative support

14 EHR Enablement STANDARDS BASED EHR CAPABILITY Information Architecture Technical Architecture Strategy & Governance EHR TECHNOLOGY Local Exchange National Exchange WIP WIP TBC TBC HSE Data Dictionary European Exchange WIP TBC Full Standards Based EHR Implementation

15 EHR System Concept End User Adoption & Governance Deployment, Adoption & Governance The National Electronic Health Record Interoperable EHR Domain Repositories & Healthcare Feeder Applications Drug Information Systems eprescribing Laboratory Information Systems MedLIS Diagnostic Imaging Systems Nimis Public Health Information Systems Clinical Programmes / Speciality Systems Cross Program Foundational Components Identifier & Location Services Architecture & Standards Standards based Infostructure & Infrastructure

16 Information Architecture

17 Technical Architecture

18 Technical Architecture EHR: The Patient Information Viewpoint

19 Information Architecture Reference Model (IA-RM) MedDRA; HL7 E2B; ISO IDMP WHO ATC/DDD; WHO INN (International Nonproprietary Names) LOINC (Lab) and ICPC2 Healthlink messaging - HL7v2, XML ICD10 and Health One dictionary PICNIC; loosely based on HL7v1 (not a standard) Edifact (ebxml) IPU codes/atc/gms -IPU product file Standardised & Common Information Architecture System 1 System 2 System 3 System 4 GS1 Snomed CT Contsys HISA ISO HL7 - Functional Model IS System 5 System 6 System 7 System 8

20 Information Architecture Reference Model (IA-RM) MedDRA; HL7 E2B; ISO IDMP WHO ATC/DDD; WHO INN (International Nonproprietary Names) LOINC (Lab) and ICPC2 Healthlink messaging - HL7v2, XML ICD10 and Health One dictionary PICNIC; loosely based on HL7v1 (not a standard) Edifact (ebxml) IPU codes/atc/gms -IPU product file Standardised & Common Information Architecture System 1 System 2 System 3 System 4 GS1 Snomed CT Contsys HISA ISO HL7 - Functional Model IS System 5 System 6 System 7 System 8

21 Information Architecture Reference Model (IA-RM) MedDRA; HL7 E2B; ISO IDMP WHO ATC/DDD; WHO INN (International Nonproprietary Names) LOINC (Lab) and ICPC2 Healthlink messaging - HL7v2, XML ICD10 and Health One dictionary PICNIC; loosely based on HL7v1 (not a standard) Edifact (ebxml) IPU codes/atc/gms -IPU product file SAM 1 SAM 2 System 1 System 2 System 3 System 4 GS1 Snomed CT Contsys HISA ISO HL7 - Functional Model IS SAM 3 SAM 4 SAM 5 SAM 6 SAM 7 System 5 System 6 System 7 System 8

22 Information Architecture Reference Model (IA-RM) MedDRA; HL7 E2B; ISO IDMP WHO ATC/DDD; WHO INN (International Nonproprietary Names) LOINC (Lab) and ICPC2 Healthlink messaging - HL7v2, XML ICD10 and Health One dictionary PICNIC; loosely based on HL7v1 (not a standard) Edifact (ebxml) IPU codes/atc/gms -IPU product file SAM 1 Patient Summary / Demographics Dataset System 1 System 2 System 3 System 4 GS1 Snomed CT Contsys HISA ISO HL7 - Functional Model IS System 5 System 6 System 7 System 8

23 Facilitating Quality Assured & Integrated Data 22 ERS 2014

24 New Skills & Toolsets

25 The European Dimension The National Contact Point (NCP) is the fulcrum of cross border interoperability, exploiting the role of connecting the national system to the European Level environment Primary Mental Health Social IRELAND Health and Wellbeing Acute Care

26 Directive 2011/24/EU

27 Strategy Meets Complexity

28 Standardisation & Harmonisation EU NCP EHR Public Health

29 Reference Model ISO ISO EN SNOMED CT LOINC HL7 System Functional Model Core National Systems & Applications Standards Based High Level Logical Reference Model (LRM) Logical (XSD) Schema Data Exchange Requirements Model Logical Information Model (LIM) Template Repository EHR Message (XML) HL7 SOA Service Definitions Archetype Repository Messaging Platform ESB HL7 v2.x/3 Message National EHR Records & Longitudinal Services

30 Closing Thoughts

31 ISF Programme Further Information

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