National Integrated Services

Transcription

1 National Integrated Services The Foundation for Future e-health Connectivity Peter Connolly HSE March 2014

2 The Integrated Services Framework (ISF) A standards based single framework for the HSE ICT 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

3 The Integrated Services Framework (ISF) Vision Work-stream-1: The Framework Model...5 Technical Infrastructure WS:11-12 GOVERNANCE STRATEGIC ROADMAP WS:1 INTEGRATED SERVICES FRAMEWORK (ISF) ACCESS WS:9-10 TECHNICAL ARCHITECTURE WS:2-4 INFORMATION ARCHITECTURE WS:5-8 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 Information Architecture Work-stream-5: High Level Business Process Specification...15 Work-stream-6: Information Architecture Model. 18 Work-stream-7: & Information Repository Work-stream-8: Transformation, Interfacing & Sourcing...23 Access Work-stream-9: Identity, Access & Consent Management...25

4 Stakeholder Requirements Integration and connectivity of disparate applications and data Horizontal integration of legacy systems Leverage information from heterogeneous systems Integration that is scalable A component based architecture Loose coupling Fast & efficient deployment

5 Courtesy of NEHTA The Problem

6 Example of an Information Challenge The NICIS will be used to capture all immunisation events including national childhood immunisation programmes (including schools), outbreaks, campaigns, late entrants, adult vaccinations and pandemic response. In addition the system should allow for the recording of client information relating to neonatal and metabolic screening, breast feeding and developmentals. The NICIS system will require data sharing with a broad range of systems including- The Maternal and Newborn Clinical Management System (MN-CMS) (and prior to that being in place to the Dublin Maternity Hospitals The National Client Identity Services Health Service Provider GP practice management systems National Cold Chain Delivery System Primary Care Reimbursement Services (PCRS) National Cancer Service The National Childcare System

7 Tender Deliverables 1. Determination of the Information Model 2. Specification for the Dictionary 3. Terminology Assurance 4. Support Processes & Services

8 Proof-of-Concept (SAM) Disease, DF Metabolic Disease, D Disorder of carbohydrate metabolism, D Disorder of glucose metabolism, D Diabetes Mellitus, DB SAM Repository Neonatal, DB75110 Type 1, DB Insulin dependant type IA, DB Carpenter Syndrome, DB Clinical Applications Value Dictionary Portal Integrate Validate & Publish Proof-of-Concept

9 Directive 2011/24/EU

10 Stakeholder Engagement Workshops Interviews Questionnaires Feedback Sessions Demonstrations

11 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

12 National Information Architecture (IA-RM) EU NCP EHR Public Health

13 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 set 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

14 National Utility Platform N-DUP Core HL7 2.4 CDA Definitions Mapping Terminologies SAM ISO Payload in Messages

15 National Utility Platform Home Care Clinic Emergency Services Community Care Centers Clients Pharmacy EHR Public Health EU NCP Laboratory Specialist Clinic Hospital Emergency Diagnostic Center N-DUP Core HL7 2.4 CDA Definitions Mapping Terminologies SAM ISO Payload in Messages

16 Deployment Standards Guidance Public Health Primary Others Procurement Stakeholders Requirements Business Case Technical & Information Architecture Vendor Selection Delivery Maintenance Standards Structure Types Dictionary Terminology Binding Registry/ Repository Delivery Platform ICT Delivery Implementation & Integration Services Application Services

17 Standards & Information Architecture Project (HSE ISF LOT4) Gerard Freriks René M. Schippers HISI - Dublin ERS 2014

18 A common path to a future for all 18 ERS 2014

19 Agenda 1. Introduction 2. Recommendations - Outline (IA-RM, SAM, Coding,) 3. Recommendations - Deployment 4. Q&A session (Validation, suggestions for improvements) 19 ERS 2014

20 HSE ISF Reasons Patient Safety Creation of Jobs Value for Money 20 ERS 2014

21 HSE ISF Reasons Patient Safety: quality Systems quality National EHR Creation of Jobs: ehealth ecosystem for all Value for Money: Less Integration cost Less Maintenance cost More Flexibility, Adaptability 21 ERS 2014

22 Project Introduction Situation: Present Situation: To be One single communication domain D A A B B Y C C Z From a collection of disconnected systems to connected systems 22 ERS 2014

23 Project Introduction Business Logic Presentation Software Hardware EMR/EHR System Recipe Ingredients Screen Kitchenware Oven Pastry Business Logic Presentation Software Hardware EMR/EHR System EHR-systems Silo s 23 ERS 2014

24 Project Introduction Business Logic Presentation Software Hardware EMR/EHR System Business Logic Presentation Software Hardware EMR/EHR System EHR-systems Minimal condition: Share normalised data 24 ERS 2014

25 Project Introduction Business Logic Presentation Software Hardware EMR/EHR System Business Logic Presentation Software Hardware EMR/EHR System EHR-systems Maximal condition Share: Normalised data, logic and presentation 25 ERS 2014

26 Project Introduction Business Logic Presentation Software Hardware EMR/EHR System Business Logic Presentation Software Hardware EMR/EHR System EHR-systems One big system 26 ERS 2014

27 Project Introduction viable Ecosystem Evolution System a Connector System a System a Methods Neutral Exchange format Connector Neutral Exchange format Connector Neutral Exchange format - Set - Dictionary - Message standard - Document standard - Object standard - Coding Systems standard - Ontologies System b System b System b Methods for sharing data Exchange standard 27 ERS 2014

28 Project Introduction viable Ecosystem Evolution Revolution System a Connector System a System a System M Neutral Exchange format Neutral Exchange format Neutral Exchange format Proprietary Exchange format Connector Connector System b System b System b System M Methods for sharing data Evolution - Revolution 28 ERS 2014

29 Project Introduction Neutral Normalised Exchange format Connector Connector Connector System System System System Connector Deployment 29 ERS 2014

30 Project Introduction Enterprise Viewpoint Ethical, legal, health, process Requirements Information Viewpoint Static Domain specific Sets - Exchange formats Computational Viewpoint Active Interfaces - Services Engineering Viewpoint Software - bases, networks, applications Technology Viewpoint Hardware: Computers, disks, wires Scope of this project RM-ODP: Information Viewpoint 30 ERS 2014

31 Agenda 1. Introduction 2. Recommendations - IA-RM, SAM, Coding systems 3. Recommendations - Deployment 4. Q&A session (Validation, suggestions for improvements) 31 ERS 2014

32 Information Architecture Reference Model Project 6 Months Desktop research 8 Workshops 1 questionnaire face to face meetings 32 ERS 2014

33 Objectives - Project Outline Introduction Requirements - Cost effective - NO revolution - Stepwise evolution - Respect investments in existing working solutions (e.g. HealthLink) - Exchange data with HSE registries in a normalised format - Impose data requirements plus Connector via procurement 33 ERS 2014

34 Information Architecture Reference Model Vendor / repository MedLis EHR MeDRA WHO ATC/ D DD WHO INN WHO ICPC WHO ICD10 Vendor / repository HisLINK EHR Loinc IPU GS1 SNOMED-CT Health One Termlist SME s EHR Disease specific Portals EHR HealthLink (messaging) Edifact (ebxml) HL7 Functional Model HL7v2, CDA Requirements Set LinkEHR Archetype Editor SAM Library Archetype Knowledge Manager SAM Output Formats Connector HSE Virtual Normalised Bus CEN/ISO ContSys CEN/ISO HISA CEN/ISO EHR Commmunication Autho rities HcP ERS B.V. Clinical Repositories EHR Normalised Vendor / repository Clinical Audits EHR Normalised Personal Health Records Personal Health Records EHR Research EHR 34 ERS 2014

35 Information Architecture Reference Model 35 ERS 2014

36 Information Architecture Reference Model Creation of one ecosystem for applications (federated) repositories big and smaller IT-systems many Apps Procurement based on shared: Standards Functional requirements requirements Coding Systems 36 ERS 2014

37 Subject Area Model SAM Sets -> Subject Area Models Subject Area Models -> Outputs Outputs -> Users (human readable, computer processable) 37 ERS 2014

38 Subject Area Model SAM Health Domain IA-RM SAM s IT-Domain HSE Utility Platform Human processable Requirements Component Library SAM/ Document Server Semantic Interoperability Artefacts SIA HSE Virtual Normalised Bus Set Services Computer processable Autho rities HcP ERS B.V. ERS 2014

39 Subject Area Model SAM ERS has modeled one Subject Area Model: epsos Patient Summary and demonstrated tooling Next step e-prescribing? 39 ERS 2014

40 Subject Area Model SAM Open International Standard Pure ISO RM/ODP Information Viewpoint Spec Scope = EHR Low Implementation maintenance cost HL7 v2 messages HL7 v3 RIM messages HL7 v3 CDA documents + - ± - CEN/ISO EHR-Extracts ERS 2014

41 CEN/ISO EN13606 >20 years R&D Subject Area Model SAM Based on ISO Requirements for EHR architecture Harmonised with: System of Concepts for Continuity of Care Health Information Service Architecture Two Level Modeling Paradigm Agile, efficient, implementations 5 Part standard - Reference Model - Archetype Object Model - Termlists - Patient mandate - Deployment support 41 ERS 2014

42 Subject Area Model SAM CEN/ISO EN13606 is used for these purposes in: England: NHS HSCIC Spain Clinical Information Modeling Initiative Ireland becomes the fast follower 42 ERS 2014

43 HSCIC.GOV.UK - > Informa4on Standards

44 HSCIC.GOV.UK.. With DD4C

45 The DD4C Process..(1)

46 The DD4C Process..(2) Phase 1 Exis4ng Content Catalogue SNOMED CT Subsets Collec4ons NHS Messaging Specs Royal Colleges Headings Define metadata of all content Metadata model based on ISO Publish Harmonise ISO based logical models for Royal Colleges headings ISO based logical models for clinical record keeping Publish

47 Catalogue Metadata

48 Logical Models for Care..(1) The aim Provide clinically assured, quality assessed, process- driven logical representa4ons of health care records Single reference point for all product- dependent modelling work such as NHS Dic4onary and NHS Messaging Specifica4ons Provide metadata for our logical models to provide valuable informa4on about the models as well as to allow associa4ons with other content such as SNOMED CT subsets, message templates etc Allow mul4ple format download of our logical models as a free public resource: ADL, UML, HTML, XML, JSON, Mindmap, Word etc.

49 Logical Models for Care..(2) ISO Extract Reference Model adopted Revision proposed to ISO Demographics Model (awai4ng adop4on) SNOMED CT used as the reference terminology for binding to clinical content Demographic and par4cipant- related vocabulary for other content (to be decided) LinkEHR Editor used for logical modelling (pending approval) Logical Modelling Guideline document to help with consistent modelling and terminology binding (dra_ status)

50 Logical Models for Care..(3) Two level modelling processhigh level models (for ini4al discussion with healthinforma4cians and clinicians) Logical models (technical models for discussion with health informa4cians and technical modellers) Transforma4on process (ini4ally manual but possible automated transforma4on in future?) NHS Dic4onary models NHS Messaging Specifica4ons (CDA, FHIR?) Other consumers (NHS as well as external) that require informa4on models

51 Logical Models for Care..(4) ISO based models for Royal College headings ISO based models for record keeping Discharge Summary Outpa4ent Referrals Diagnosis Blood Pressure Medica4ons... SNOMED CT Interna4onal CIMI Models External Reference Resources Seman4cHealthNet pacerns CONTSys Logical Record Architecture (LRA) Internal Reference Resources SNOMED CT UK Extensions

52 Spain development ERS 2014

53 Clinical Information Modeling Initiative (CIMI) ERS 2014

54 Clinical Information Modeling Initiative (CIMI) ERS 2014

55 Structure Human readable labels SAM s SAM Editor ERS Electronic Record Services BV Control over structure vis occurrences, cardinatities, etc. Human Labels coded with as many codes asn needed from a defined coding system Labels in all needed languages Location for inspection of Internal Codes ERS 2014

56 HSE Toolset SAM Editor ERS Electronic Record Services BV Allowed data points can be specified ERS 2014

57 DEMO: SAM Editor ERS Electronic Record Services BV Structure: RM-Class Names Internal atcodes Human labels Cardinalities ERS 2014

58 DEMO: SAM Editor ERS Electronic Record Services BV Type PQ Type PQ Control over allowed data fields content Type PQ Units of Measurement Type PQ Define Lists of allowed data Type PQ Name/label of the datum Type PQ Description as text Type PQ Meaning; Codes ERS 2014

59 DEMO: SAM Editor: ERS Electronic Record Services BV ERS 2014

60 Demo: Mind Map ERS Electronic Record Services BV ERS 2014

61 epsos PatientDemographics ERS Electronic Record Services BV Mind Map ERS 2014

62 DEMO ERS Electronic Record Services BV Generated mock-up screen ERS 2014

63 epsos Patient Summary ERS Electronic Record Services BV Generated mock-up screen ERS 2014

64 DEMO ERS Electronic Record Services BV Excel ERS 2014

65 DEMO: XML Instantiation ERS Electronic Record Services BV ERS 2014

66 Demo: ERS Electronic Record Services BV Schematron <schema xmlns=" querybinding='xslt2'> <ns prefix="en13606" uri="urn:hl7-org:v3"/> <title>demotwopoints</title> <pattern id="entry"> <rule context="en13606:entry"> </rule> <assert test="count(en13606:items)=1"/> <rule <!-- Rule for archetype path /items[resultvalues] --> </rule> <assert test="count(en13606:parts)=0 or count(en13606:parts)=1"/> <assert test="count(en13606:structure_type)=1"/> <assert <rule <!-- Rule for archetype path / items[resultvalues]/parts[resultcomments] --> </rule> <assert test="count(en13606:value)=0 or count(en13606:value)=1"/> <assert test="en13606:items[@node_id='at0432']/en13606:parts[@node_id='at0434' <rule context="en13606:entry/en13606:items[@node_id='at0432']/en13606:parts[@node_id='at0434']/en13606:value"> <!-- Rule for archetype path /items[resultvalues]/parts[resultcomments]/value[resultcomments] --> </rule> <assert test="count(en13606:originaltext)=0 or count(en13606:originaltext)=1"/> <assert test="matches(originaltext, '.*')"/> <assert test="en13606:items[@node_id='at0432']/en13606:parts[@node_id='at0434']/en13606:value[@xsi:type='simple_text']"/> <rule context="en13606:entry/en13606:items[@node_id='at0432']/en13606:parts[@node_id='at0435']"> <!-- Rule for archetype path / items[resultvalues]/parts[resultnumeric] --> <assert test="count(en13606:parts)=1"/> <assert test="count(en13606:structure_type)=1"/> <assert test="en13606:items[@node_id='at0432']/en13606:parts[@node_id='at0435' 66 ERS 2014

67 DEMO: ADL 1.4 ERS Electronic Record Services BV ERS 2014

68 Agenda 1. Introduction 2. Recommendations - IA-RM, SAM, Coding systems 3. Recommendations - Deployment 4. Q&A session (Validation, suggestions for improvements) 68 ERS 2014

69 Information Architecture Reference Model 69 ERS 2014

70 EU DIRECTIVES Project Introduction Country Laws, regulations Standards D Standards CEN ISO HL7 A B C Policies A B C Procurement Y Z Services INFO structure INFRA structure Payload Transport Storage Governance / Quality Assurance Large scale deployment 70 ERS 2014

71 A common path to a future for all Q/A Discussion 71 ERS 2014