Interoperability Robin Breslin

Transcription

1 Interoperability Robin Breslin

2 Where to start?

3 Where to start?

4 Where to start? Increasing populations Aging populations Reducing numbers of healthcare workers Certainly per capita Have to be more smart about healthcare Have to be more efficient this means money Therefore, any technology approach must be money efficient

5 Where to start? Using a single system and a single system provider is one approach But it is expensive; M 10 s or even M 100 s Can we re-use our existing systems? Can we make a cheaper alternative? Interoperability?

6 Quick Forcare Background Interoperability Different Interoperability Approaches Discussion

7 Forcare Background

8 Facts and Figures Established in 2006 Locations Zeist, The Netherlands Toronto, Canada Northampton, UK Germany Focus on Quality ISO 13485, CE, MDD, FA Global Interoperability Experts 90+ People Installed Base 12 Countries World Wide Partners 12+ Global Companies

9 Vision We foresee a seamlessly integrated suite of information systems that create, share and manage the (clinical) data about patients, improving quality of patient care and driving efficiency in care processes.

10 Mission To provide smart solutions that enable patientempowered collaborative care among healthcare professionals and patients, by leveraging open, standards-based interoperability.

11 Our Solutions HIE Platform Radiology Ordering Referral Management Radiation Therapy Referral

12 Our Building Blocks Modular suite of IHE compliant software Scalable Interoperability building blocks Reliable infrastructure components Safe and Secure exchange of Personal Health Information

13 Projects and References Frisian Cardiology HIE Dutch National Mammography Exchange NI-PACS Radiology Exchange NIMIS National Image Exchange Ireland Radboud University Hospital Copenhagen Radiology Exchange Rijnmondnet/UPZuid Exchange Flemish health information exchange NHS Sussex and Surrey Network Alberta Health Services XDS network University of Miami Radiotherapy HIE Rotterdam ereferral Hôpital du Valais Cardiology HIE Groningen University of Wisconsin (Wonix) Moscow City XDS infrastructure Hospital District of Helsinki and Uusimaa (HUS) NHS Hampshire Network Care network East Netherlands ehealth Ontario NHS Gloucestershire Piedmont

14 Interoperability & Open Standards

15 Interoperability Very much in the foreground for NHS England Many driving forces, and organisations XDS Many approaches and contributing technologies

16 Interoperability XDS

17 Interoperability Interoperability Integration Data/Information Sharing Terms used Interchangeably

18 Interoperability Interoperability Integration Data/Information Sharing Terms used Interchangeably This is messy thinking

19 Interoperability in Healthcare Means being able to send information from one healthcare system to another and For the information to be meaningful in both places Useful in multiple contexts

20 Hospitals, labs, clinics GP practices, care homes.. and people s homes In healthcare, Patients travel between different institutions People transit into and out of healthcare Having relevant data for people available to support their Health and Social Care is essential

21 Hospitals, labs, clinics GP practices, care homes.. and people s homes Imagine one single computer system that could encompass all of these settings Is it even possible? Even in a hospital there are multiple systems (let alone in a region, with Primary, Acute and Social Care Information Sharing - monolithic

22 Hospitals, labs, clinics GP practices, care homes.. and people s homes Hospitals alone are too complex 1000 s of specialist applications All with legacy data Non-explicit Privacy/Consent/Access controls

23 Single Solution Healthcare too complex for one provider to provide all Multi-system environment will require sharing information in a meaningful way, between systems Monolithic cannot work, and it is the most expensive route An interoperability eco-system is the only viable alternative Typical costs of a Healthcare Interoperability Network (HIE) are M 0.5 to M 5 10x smaller than the monolithic approach

24 Consider by example, a Hospital Radiology Multiple systems Multiple data formats Structured / unstructured approaches Integration can bring some success EPR RIS Voice PACS VNA Portal

25 Consider by example, a Hospital Radiology Multiple systems Multiple data formats Structured / unstructured approaches Integration can bring some success EPR HL7 DICOM RIS Voice PACS HL7 and Desktop Call HL7 interoperability is a mindset DICOM DICOM VNA Portal WADO

26 Many Integrations Even in one facility Many integrations Each with two ends of the communication to maintain Complex and expensive Further standardisation is the right mindset Harmonisation of the messaging This is the IHE approach

27 Hospitals, labs, clinics GP practices, care homes.. and people s homes For information to flow between care settings, it needs an information highway For information to flow freely and safely it needs organised rules

28 Hospitals, labs, clinics GP practices, care homes.. and people s homes Open Standards Interoperability

29 Different interoperability approaches IHE XDS XDS FHIR openehr

30 XDS Stands for Cross(x) Document Sharing Provides meta-data to reference document or other information blobs Can mange structured data (like CDAs) Or unstructured data like pdf s Mature technology

31 Some Key Aspects of XDS A central registry publish subscribe model Knows where all information is stored Information filed correctly (patient id and clinical context) Data sources can confidently store information (it will be linked) And consumers can trust the information Source Source Source Source Patient Source Source Source Identity Source Registry Repository Repository Repository Source Source Consumer Source

32 Some Key Aspects of XDS An entity to track who is accessing what (ATNA) Has Patient Privacy and Consent Management Audit Record Repository Patient Source Source Source Identity Source XCA Publish subscribe model. Subscription module for workflow. Source Source Source Source Registry Repository Repository Repository DSUB Source Source Consumer Source Link to other domains XCA = Cross Community Access

33 Consumer Consumer Consumer Consumer Consumer Hospitals, labs, clinics GP practices, care homes.. and people s homes Audit Record Repository Registry Repository Repository Repository Repository Source Source Source Source Source

34 Fast Healthcare Interoperability Resources (need to understand history to understand fast ) Has heritage in HL7 v3 Designed for implementors (easy to read) Great for making connectors to EHR / EMR / PAS Still early in development cycle Meta-data management not explicit Privacy and consent not explicit

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36 FHIR Connectors Forcare IHE MDH, PDQm, PIXm

37 openehr data driven modelling for Healthcare Structured data Model built up on Archetypes Grouped together in Templates

38 Standards and their evolution 2004 TIME EDIFACT MD9 INTERFILE HL7 DICOM XDS FHIR EDIFACT GEHR-> openehr WADO RAD69 openehr COM/DCOM Active X CCOW (web services) HTTP(S) SOAP REST XML JSON Technological Evolution

39 Summary interoperability approaches IHE XDS mature technology Allows implementation today with openehr structured and unstructured objects If you want to buildyour-own Separate index and Patient Privacy/Consent Have a strong data Enables an interoperability highway modelling requirement Includes FHIR connects for fast integration Direct platform for Apps FHIR essential tool Still needs IHE for down south focus for integration Privacy/Consent Easy for Healthcare Systems Providers to adopt Helpful for portals / apps

40 Summary interoperability is a mindset No one solution or provider can do everything Monolithic solutions are too expensive (10x) and cannot work Re-using existing systems and developing an open systems ecosystem is the alternative Different Interoperability tools to choose from Interoperability is a mindset to set a forward strategy (over and beyond simple integration) The Interoperability forward evolution is inclusive, Do not let evangelists fool you