EN 13606 Product & Services Suite an elevator pitch 1-9-2008
Authors Gerard Freriks, director René Schippers, director Iʼm very proud to be able to present to you a product based on the European EHR-standard EN13606. 2 For many years I was the chairman of CEN/tc251 wg1 responsible for this exciting standard.
ERC B.V. Electronic Record Company: Distributor for Ocean Informatics in Europe and the Middle East of the Software Suite for Persistence Logic with regional partners based on the openehr implementable specification of the European (ISO) EHR-standard EN13606 3
B.V. : World wide Distributor for Unusual Visions with local product delivery Partners: - Automatic EHR Generator the Software for Presentation Logic (viewing data and images for data-entry and ordering purposes in 1 webbrowser) - Business Logic (Application and Clinical Pathways) - Integration Platform (Legacy seamlessly Integrated by web-services orchestration) using the Ocean Software. 4
More partners will be added: planning, Pacs, RIS, e-prescribing, GPʼs, Workflow, Implementors,... EN 13606 partners IC-EHR-Systems EHR-Components Licenses Licenses ERC Software Ocean Informatics Unusual Visions... Implementable Specification openehr Standards CEN/ISO EHR standard EN13606 The relationships of 13606 and our main partners. 5 The EN13606 is an European CEN EHR-standard that is a standard in all European Member States. It is becoming a full ISO standard soon. openehr is the implementable specification and is a superset of the EN13606. WIth EHR-systems based on this specification it is possible to document, exchange, archive and re-use information in any data base in a standardised way. It does not prescribe how the EHR looks like or what the structure its content is. It places the user in the drivers seat. Ocean Informatics is a software company that sells software based on openehr and EN13606 ERC is the distributor in Europe and the Middle East for Ocean. sells state-of-the-art applications that make use of Ocean Informatics since it is conformant to openehr/en13606. Unusual Visions is a Dutch/Rumanian company that build interesting software that is implemented in a Dutch Hospital: GUI-generator, Nursing record, (Lab) Order management,
Philosophy State-of-the-art IT-systems means - IT should not dictate, but really facilitate users - The customer needs extremely flexible agile systems development - The customer needs model driven, high quality, highly performant and highly scalable, IT-systems - The customer needs plug-and-play IT-functionality, managed storage and archiving as a service Our philosophy 1- IT facilitates and does not dictate 2- agile developement 3- model driven, sclable, flexible, maintainable 4- managed storage and plug-and-play Software as a service 6
Philosophy State-of-the-art IC-EHR-systems must facilitate flexibly: - documentation, exchange, archiving and re-use based on standards - healthcare providers, health organisations, regions and countries. - healthcare work processes - innovation and reporting Integrated Care EHR-systems = IC-EHR 7
Vision Finally The cutting edge European/ISO EHR-standards will play one of the enabling roles in and outside healthcare European standard play a regulated role in legislation and procurement in Europe and its Member States. 8 But more importantly Healthcare organisations, healthcare providers and National project will use this exciting technology. This technology will produce very flexible State-of-the-Art EHR-systems that really facilitate Healthcare with healthcare in the drivers seat.
Integrated Care Electronic Health Record Definition (ISO/tc215 20514: EHR - Definition, Scope and Context) a repository of information, regarding the health of a subject of care, in computer processable form, stored and transmitted securely, and accessible, by multiple authorised users. EHR Shareable EHR Non-shareable EHR Integrated Care EHR 9
Integrated Care Electronic Health Record Definition (ISO/tc215 20514: EHR - Definition, Scope and Context) The ICEHR has a standardised information model, which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated healthcare and it contains information which is retrospective, concurrent and prospective. EHR Shareable EHR Non-shareable EHR Integrated Care EHR 10
Modus operandi Healthcare providers 1. Select and download the relevant Archetypes provided by openehr or NHS or EuroRec to be used by Product Suite 2. Produce Templates for National, regional, local use 3. Produce flexibly and instantly forms for: Input-, Output screens and EhrExtracts (messages) 4. Generate Applications and Message formats instantly 5. Use Archetype and Template generated forms for documentation, exchange, archiving and re-use (reporting and research) How do these new exciting technologies work in real life? Based on models state-of-the art EHR-systems make possible: - complete freedom of healthcare - to decide what they want to document, exchange, archive and re-use - without: reprogramming, database conversions - generate application that implement changes imediately 11
Modus operandi Archetypes define what can be documented maximally Templates define what will be documented, exchanged, archived and re-used in a specific (local) context Archetype Repository Archetype Archetype Archetype Archetype Archetype Archetype Archetype Archetype Archetype Archetype ArchetypeArchetype Template Generated and Implemented instantly Generated Program Code Archetype 1 Archetype 2 Archetype 3 Generated Program Code - Code - Forms - Exchange formats HL7 v3 HL7 v3 CDA Ehr Extract HL7 v2 Edifact PDF Again but now in pictures. 12
History European EHR standard 20 Years of European Commission funded research for EHR-projects Two pre-standards for the European EHR Since 2006 one European EHR-standard (5 parts in the end) At this moment 4 out of 5 parts are a full CEN EHR-standard and almost an ISO standard 13
Why a European EHR standard 25 European countries Many cultures, many languages One united European Community Free movement of goods, people, money and services One big competitive European economic space It is for all these reasons that European standard play a regulated role in Legislation and Procurement 14
Why a European EHR standard European competitive advantages - Keep 100% of the citizens insured at the cost of 8-9% of GNP - European standards to foster world wide health-it winners (like the Nokia GSM example) - Strengthen European pharmaceuticals, facilitating research by re-use of data Potentially this European can become as influencial as several other European standards like the one for Mobile Telephony. 15
The EN13606 features - Standardised semantic exchange format - not only between EHR-systems but inside EHR-systems - thereby creating an Information Bus in and between EHR-systems Observe the HL7 message standard can not be compared - analogous to the GSM-standard in mobile telephony Two important concepts (ideas) are introduced in this slide. 16-1- Scope This EHR_standard deals not only with communication between systems but also inside EHR-systems. Therefor this EHR-standard can not be compared with any message standard like Edifact or HL7. -2- Information Bus The next slides explain more about this.
The EN13606 features The only available Integrated Care EHR-standard based on a firm foundation: - ISO 18308: Requirements for an Electronic Health Record Reference Architecture - ISO 22600: Privilege management and access control - 20 years of European funded R&D This European standard does not come out of the blue. 17 It has firm foundation in an ISO standard that defines quality criteria for EHR-systems. It is linked with an important ISO standard for Privilege Management and Access Control thereby implementing European Privacy laws. And it is based on the results of many European projects.
The EN13606 features Full separation of responsibilities Domain content and IT-technology Domain content concern: Healthcare in the drivers-seat because they can define their information needs themselves and use the date anytime Technology concern: Use of the complete state-of-the-art technology stack (web services, etc) With Message standards concerns from the health domain are firmly linked with technological choices. Any change in the requirements from health will result in a complete new message specification. 18 Present day EHR-systems need reprogramming, data base conversions all the time. In the case of State-of-the-Art systems based on the European EHR-standard and openehr there is a big divide between concern of healthcare and the technology domains. Any change in technology does not impact healthcare and vice versa. This brings healthcare in the drivers seat,
The EN13606 features No-proprietary data information models Plug-and-play interoperability in and between EHR-systems Connectivity with legacy systems Edifact, HL7v2, HL7v3 (CDA) Zero resource (time and money) implementation of data exchange Focus on semantic and health knowledge Interesting and useful features for State-of-the-Art EHR-systems based on EN13606/openEHR. 19
The EN13606 consequences IC-EHR Cross border, cross culture, cross language exchange of health information Supporting innovation and collaboration Documentation, exchange, archiving and re-use respecting the European Privacy Directive Any real successful European standard MUST take these things in account. 20
EHR-systems EN13606 and HL7 generation Enterprise viewpoint Information viewpoint Computation viewpoint Engineering viewpoint Technical viewpoint Government Organisations Work processes People EHR-systems using EN13606 Information Bus Information Communication Technology EHRsystems using HL7 All viewpoints programmed in one system or message Depicted here is that in the case of messages - work processes are standardised, - translated in an Information Model - the exchange between databases is choreographed - and implemented in IT-systems, by programming and - that have to rolled out. 21 State-of-the-Art EHR-systems that are based on EN13606/openEHR behave differently. They only define what has to be Documented, Exchanged, Archived and Re-Used. They do NOT standardise Workflow or the way information is exchanged. They define define Engineering and Technology choices. They ceate EHR-systems that facilitate healthcare maximally.
The EN13606 EHR-systems architecture EHR-systems with the European Information Bus enable: Persistence layer with flexible patient records, as a managed resource, as a standardised service Best of breed plug-and-play interchangeable EHR-modules Any database will be supported: Oracle, SQL, Sybase, Matisse,... Any technology will be supported: Java, PHP,.Net, Eifel,... 22 Because of all this the Information Bus as defined by EN13606/openEHR will enable interchangeable modules that can be exchanged plug-andplay.
EHR-systems HL7-messages - EN13606 Presentation Engine Business Engine Communication Engine HL7 Messages Nonstandardised Persistance Presentation Engine Business Engine 13606 Information Bus EN13606 Extract Standardised Persistance Communication Engine HL7 Messages In purple present day EHR-systems. All components in the architecture talk with the database. 23 In EN13606/openEHR conformant systems all components talk with the Information Bus. Via Web-Services. The EN13606/openEHR creates a new layer in the EHR-architecture: the Information Bus
EHR-systems 13606 Information Bus - Managed Services Presentation Engine Business Engine 13606 Information Bus EN13606 Extract Standardised Persistance Communication Engine HL7 Messages Presentation Engine Business Engine 13606 Information Bus Standardised Managed Storage Active Records Archived Records Module A Module B Module C Software as a Standardised Service Module Module 1Module 1Module 1 1 1 Because of this Information Bus EHR-system modules will become hot swappable. Each module has access to its information via the standardised Information Bus. 24 Software as a Service is supported. SaaS Remote managed storage of EHR patient information is possible. The EHR as a managed infrastructural resource available via Ethernet and an IP-address. Enabling Pay as you go. And observe that integration using messages and proprietary exchange models and database models is always possible.
The EN13606 business model IT-market developments: EHR persistence as an infrastructural standarised service (managed storage, archiving) Hospital Information Systems with EHR-functionality as Best-of-both Worlds (Software as a Service) Developments of EHR-systems Phase 1: Healthcare started with Monolithic IT-systems 30-40 years ago. 25 Phase 2: Because these monoliths never provided a complete solution Best of Breed became popular. Hospitals with hundreds of applications that have to be maintained and interfaced suing messages are normal. Phase 3: Monoliths again. WIth more functionality, limited workflow, and windows based. Phase 4: State-of-the-Art or Best of both Worlds EHR-systems that are based on the EN13606/openEHR Information Bus
The EN13606 business model Developments and Trends IT-market developments: A new innovative IT-market with cheaper flexible services delivered by System Integrators using centralised infrastructures with applications produced by SME s All these exciting new developments will lead to a new market orientation of the Health IT-Industry. 26 SMEʼs get new chances to produce innovative applications supporting healthcare.
The EN13606 Scope This European standard is developed for healthcare with the scope: - documentation, - exchange, - archiving, - re-use But this is not all The Scope of the EN13606/openEHR is clear. It was developed for healthcare. BUT... 27
The EN13606 Scope The European EN13606 EHR-standard originally developed for healthcare can equally be deployed in: - e-government - e-business This European/ISO standard is so generic that it equally can be applied outside of healthcare. 28 Its effect will stretch to e-government and e-business. The potential if huge. Because it will change the way society is flexibly supported by IT-systems using the Information Bus based on the EN13606/openEHR.
Experiences implementing the EN13606 Information Bus in EHRsystems - Medical Center Alkmaar (MCA) 800 bed teaching hospital and - Via Unusual Visions: Lab ordering management Nursing record Now it is time to look at the next part of our program. 29 The Demonstration by our first partner and our first launching customer in the Netherlands.
Experiences implementing the EN13606 Information Bus in EHRsystems In addition building partnerships: - Workflow/Case Management - GP Information Systems Enterprise Dicom images - - - Radiology Information System Managed storage / digital archiving -... is actively working on its portfolio of supporting applications 30
31