Resurssin ajanvaraus - UEF

Resurssin ajanvaraus - UEF

Weaving interoperability: combining local, regional and national solutions on hospital level Web services-soveltamistavat arviointi Context of HSSP Specifications High K e h it y s v li n e tu k i Ability to Interoperate S e m a n t iik a n ta r k k u u s S is ll llin e n jo u s ta v u u s X M L /h t t p O p e n C D A /S O A P W S D L /S O A P H L 7 v 3 + W S -tra n s p o rt Low O p itta v u u s K e h ity k s e n s u o r a v iiv a is u u s T e k n in e n la a je n n e t ta v u u s SerAPI 41 Page 8 Miten trkein pidtte seuraavia palveluiden ja rajapintojen tavoitteita? TH-organisaatiot TH-ohjelmistotoimittajat Infrayritykset Kaikki Terveydenhuollon ammattilaisia palvelevien toimintojen yhteniset ohjelmistorajapinnat 2,8 3,0 2,5

2,8 Sovellusten tuottajille valmiina saatavien ohjelmistopalvelujen tarjoaminen 2,7 2,2 1,5 2,2 Terveydenhuollon asiakkaille suunnattujen palveluiden ja sovellusten tukeminen ohjelmistopalveluilla 2,0 2,5 2,0 2,2 Pllekkisten tietojen ja toimintojen vhentminen sovelluksissa 2,8 2,2 2,7 2,5 Useiden jrjestelmien tarvitsemien tietojen keskitetty yllpito 2,8 2,2 2,3 2,4 Sovellusten helppo mukautettavuus eri organisaatioiden vaatimuksiin (konfiguroimalla) 2,5 1,7

2,0 2,0 Sovellustuotannon nopea reagointi muuttuneisiin toimintatapoihin 2,8 1,8 2,0 2,2 IMIA HIS Conference, Oeiras, July 3, 2006 Juha Mykknen, Mikko Korpela HIS R&D Unit, University of Kuopio, Finland 1 In this presentation HIS, sub-systems and interoperability Local, regional and national health information infrastructure initiatives in Finland HIS architectural components: hospital view Some challenges for advanced interoperability Emerging interoperability best practices Summary + discussion 2 2 "need a common description for components in health information systems" - still a valid need components = units of composition, reuse and interoperability: scope, availability, granularity, physical and conceptual nature healthcare-specific scope: infrastructure, administration, care support, direct care, diagnostics, communication, simulation information and semantics, instance / type / context / meta levels functionality and interactions - capabilities + collaboration relation to reference architectures and specific application architecture technical aspects - data communication, interfaces, technical infrastructure, integration platforms etc. cross-cutting aspects: security, management, flexibility, extensibility relationship to systems lifecycle - development paradigm, migration 3 Mykknen, Tuomainen 2006, Information and Software Technology, submitted. IMIA HIS, Heidelberg, April 2002: 3

Process model of a hospital systems are for processes Auxiliary processes: Management, 4 Laboratory Radiology Core process: Direct care Support processes: Input: illness Output: wellness? Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou Role of information systems in hospitals 4 Home 5 GP Hospital care Rehabilitation Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou Beyond the hospital seamless care 5 Health information infrastructure developments / Finland Hospitals and health centres primary care = health centres: ~100 % use EPR systems

hospitals: replacing legacy core applications > 10 years continuous heterogeneity in processes, applications, infrastructures managerial and clinical process developments - e.g. DRG, decision support Regional Kuopio Helsinki new organisational models of health services (e.g. laboratories, regional clusters) regional information systems, references to back-end HIS data shared electronic services (e.g. prescriptions, electronic booking) disease-specific specialised systems National national services: EHR for professionals, code sets/vocabularies etc. migration from regional to national services 6 Citizen e-services emerging first for professionals, then patients PHR: little real integration to professional-oriented EPRs 6 24. 25. MYNLA myyntilaskutus HUS DW tietovarasto 21. 22. 3. 17. T i l a u k s

e t, h e n k i l s t MUSTI Potilasrekisteri MAKSULI TOTI RADU AHA SAIR. SENIORI MD-OBERON lhete-, ajanvaraus-, avo- ja vuodeos. toiminnot, tilaukset, vestrekisteri 2. 3. 12. WebLab MULTILAB II (sis. SAMBA QPATI) VERTTI 4. 14. 51. 1. MD-MIRANDA potilaskertomus hoitopalautteet lkitystietokanta, Digi-sanelu 7 Agfa RIS

PACS kuva-arkisto 6. 5. 15. Ulkoiset yhteydet MARELA apteeki Helsinki-Uusimaa hospital district 8. SAI Sairaalainfektioiden rek. PICIS Anestesiatj. ja tehotj. TITANIA, PRIMA, ym hh,koulutus,kulunv. DYNASTY asianhallinta, AMS 7 11. 9. Sample high-end composition of the hospital-wide information system today: 16. OPERA Leikkaustoiminnan ohjausjrjestelm OBSTETRIX synnytysosastojen tj. ENDOBASE gastroenterologia Kardiologia, muut osastojrjestelmt 18. TIETU

28. INFO puhelinkeskus INTRA, INTERNET ORACLE MAN. materiaalikeskus Lomakepankki (suunnitteilla) EVS ateriatilaus VIRVE, ym. TUKIPALVELUJRJESTELMT HALLINNON JRJESTELMT HUS,Sinikka Ripatti 2004 ATJ Gentia, HILMO Ecomed PowerPlay LASKUTUS-, SEURANTA- JA RAPORTOINTIJRJESTELMT ASLA asiakaslaskutus 13. 50. Pivittisraportointi 23. 10. 52.. RONDO, OFA, ym. ORACLE FINANCIALS SAUKKO Vistyvt

jrjestelmt, migraatioalusta Hospital level 27. 26. 7 Hospital level Example of a major vendors architecture Esim. palveluyksikiden kyttjt Liitnnisjrjestelm A A (esim. Lab) Liitnnisjrjestelm B (esim. RIS) Loosely connected systems Liitnnisjrjestelm Liitnnisjrjestelm D (Esim. Diabetes) Launching C (esim. toimenpidejrjestelm) Liitnnisjrjestelm E (Esim. kuvaarkisto) HMIS MD-OBERON core EPR MD-MIRANDA system Potilaskertomuksen ydin Toiminnanohjauksen ydin

Common user MD-ARIEL & MD-UMBRIEL Kyttoikeuksien mritys MD-ARIEL Kontekstin hallinta ja yhteiset tietovarastot sek palvelut MD-ARIEL kynnistykset ja parametrinvlitykset sek psynvalvonta 8 "Peruskyttjt" inner circles: optimised usability, reduced maintenance and redundancy, tightly integrated application families and components outer circles: flexibility, cross-organisational processes Medici Data Oy, Juha Sorri 7.10.2004 Common context & services 8 Hospital level Migration situation in a major hospital MD-ymprist MD-Oberon MD-Miranda VAJAT Ajan- ja hoidonvaraukset Lhete Hoitopalaute AVOS avo- ja osastohoidot Kyntien ja hoitojaksojen kirjaus Kytt KPK Hoidonvarau sjonojen hallinta Potilaskertomus Hoitopalaute ASLA Laskutus Ajanvaraus CRIS/PACS Rtg:n tuotannonohjausjrjestelm Lhete

UPO poliklinikkajrjestelm Ajanvaraukset Lhetteet MPOTI potilashallinto Kyntien ja hoitojaksojen kirjaus Laskutus Henkiltiedot RADU Rtg-lhetteet Rtg-lausuntojen katselu UJO Hoidonvarausjonojen hallinta TOTI Toimenpideyksi kiden tietojrjestelm Musti-ymprist Merkinnt: 9 Kytss Health center systems Lhete ja hoitopalaute Kuopion tk Old HIS systems Rtg-tylistat Rtg-lhetteet Rtg-lausunnot Rtg-kuvat Shkiset lhetteet ja hoitopalautteet sek shkiset laboratoriopyynn t ja vastaukset laajenevat koko shp:n alueelle vuoden 2006 aikana

Otetaan kyttn tulevaisuudessa MULTILAB Laboratorion tietojrjestel m YKERT Sairauskerto musten hallintajrj. Laboratoriopyy nt ja vas-taus (HL7) Kuopio tk SiilinjrviMaaninka tk Varkaus tk KYS, Pekka Sipil, 2006 New HIS systems Henkiltiedot Terveyskeskusjrjestelmt 9 presumptions: heterogeneous specialised applications, existing (legacy) systems practicality, feasible implementation threshold in multi-vendor environment extensibility serviceorientation supported by generic middleware 10 Healthcare organization in charge Patient administration core: master patient data, code sets, APIs

Core database Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Elements of a HIS architecture: hospital view Common core services: Starting point for HIS 10 Healthcare organization in charge Patient administration core: master patient data, code sets, APIs Spezialized clinical systems: outpatient, laboratory, ophthalmol DBMS Core database 11 Application databases alternatives: non-pluggable clinical subsystems no clinical subsystems Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Pluggable specialized clinical subsystems 11 Healthcare organization in charge EHR data (CDA/XML) Patient administration

core: master patient data, code sets, APIs Spezialized clinical systems: outpatient, laboratory, ophthalmol DBMS Core database 12 Application databases alternatives: system-specific data views point-to-point queries (personal / virtual health record - outside organization) Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Standard structured EPR/EHR data storage 12 Healthcare organization in charge Front-end for clinicians in charge: EHR viewer, professional portal EHR data (CDA/XML) Patient administration core: master patient data, code sets, APIs Invocation by context passing

Spezialized clinical systems: outpatient, laboratory, ophthalmol DBMS Core database 13 Application databases alternatives: context management no point-ofdecision integration (additional) workflow management systems Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Front-end viewer for health professionals (EHR-S) 13 Healthcare organization in charge Potentially same data structure Front-end for clinicians in charge: EHR viewer, professional portal EHR data (CDA/XML) alternatives: central repository (for some scenarios see next slide) peer-to-peer negotiations / mediation Patient

administration core: master patient data, code sets, APIs Spezialized clinical systems: outpatient, laboratory, ophthalmol DBMS Core database 14 Invocation by context passing Application databases XML Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Information exchange by messages across facilities 14 Healthcare organization in charge Other healthcare or welfare organizations Regional / national / EU-wide / global front-end EHR data or indices Front-end for clinicians in charge: EHR viewer, professional portal Adaptor EHR data (CDA/XML) Invocation by context

passing Indexing alternatives: peer-to-peer negotiations / mediation Patient administration core: master patient data, code sets, APIs DBMS Core database 15 Spezialized clinical systems: outpatient, laboratory, ophthalmol Application databases XML Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Clinical on-line access across facilities 15 Healthcare organization in charge Other healthcare or welfare organizations Regional / national / EU-wide / global front-end EHR data or indices Front-end for clinicians in charge: EHR viewer, professional portal

Adapter EHR data (CDA/XML) Invocation by context passing Citizen EHR data or indices Citizens front-end Indexing Patient administration core: master patient data, code sets, APIs Spezialized clinical systems: outpatient, laboratory, ophthalmol add: DBMS Core database 16 XML Application databases opposite direction patient-provider communications Korpela, Mykknen, Porrasmaa, Sipil 2005, CHINC conference, Beijing Patients / citizens front-end 16

HIS challenges for interoperability healthcare process specifics balance between customer, provider and organisational objectives complexity, legality, communication, multi-professionality, exceptions externalisation of healthcare processes from HISs requires flexibility of architectures, definition of migration paths explosion of potential interoperability solutions architectures, evaluation of standards, development and maintenance costs evidence identification of real needs, requirements traceability collection of application experience of domain-neutral best practices in HIS generic innovation vs. local introduction reduced local tailoring, increased reuse on many levels gaps: product development - healthcare process development - academia? 17 17 Interoperability apex 2006 Semantic and process integration structured and coded information, shared terminologies, ontology-based semantics clinical decision support, integration and adaptation of HIS into defined or even evidence-based workflows Service-oriented architectures paradigm for open, flexible and business-aligned systems, cohesive & reusable services process management and automation (vs. exceptional healthcare workflows) infrastructure services (e.g. EHR access, codes and terminolofies, access control) and added value services (e.g. decision support) e.g. Healthcare Services Specification Project / HL7+OMG Profiles = constraints on application of generic mechanisms

18 technical: e.g. Web services interoperability (WS-I) functional: e.g. HL7 EHR-S Functional Model semantic: e.g. CEN/OpenEHR archectypes, HL7 templates standardisation: e.g. Integrating Healthcare Enterprise (IHE) 18 Summary and discussion topics hospitals will long remain one central point for health services provision, but will not remain "the centre" challenges for advanced interoperability remain on local, regional, national and international level: common frameworks needed regional and national initiatives demand local acceptance and user benefits described elements are based on Finnish practical experience, international standardization, China, Africa one basis for generic framework architecture adjustable to the specific contexts in Portugal, Germany, UK, USA, Mozambique? how can the service interfaces and semantics be developed for global reusability & local adaptability? gradually? understanding of and support for healthcare processes semantic and functional views addressed International standardization of relevant aspects with users and industry IT for Health at IFIP World IT Forum 2007 www.witfor.org IMIA recommendations, Health Informatics in Africa HELINA 2007 www.helina.org 19 19 Acknowledgements and more information Healthcare application integration: PlugIT, 20012004: www.plugit.fi, Finnish Agency for Technology and Innovation Tekes grants no. 40664/01, 40246/02 and 90/03 Service-oriented architecture and web services in healthcare application production and integration: SerAPI, 20042007: www.centek.fi/serapi, Tekes grants no. 40437/04, 40353/05 Healthcare work and information systems development in parallel: ZipIT 2004-2007 Tekes grants no. 40436/04 and 790/04, and ActADHIS, 2004-2005 Finnish Work Environment Fund grant no. 104151 : www.centek.fi/zipit Packaging Finnish e-health expertise for international use: Export HIS, 20042006 www.centek.fi/exporthis (Tekes grant no. 70062/04,), e-Health Partners Finland, 2006-2007 www.uku.fi/ehp (Tekes grants no. 40140/06, 70030/06) Informatics development for health in Africa: INDEHELAMethods (Academy of Finland grants no. 39187,19982001), INDEHELAContext (201397 and 104776, 2003,

20042007): www.uku.fi/indehela Open Integration Testing Environment: Avointa, 20042006: www.centek.fi/avointa Tekes grant no. 40449/04 20 20 21 separation of care management from patient-specific health information increasingly documented and formalised requirements, processes and practices in healthcare common concept models, vocabularies and terminologies, extended to ontological languages and tools component- and service-based systems development and management approaches to support changing requirements and heterogeneous environments guidelines, methods and reference models for acquisition, integration and systems development projects Mykknen, Specification of Reusable Integration Solutions in Health Information Systems, forthcoming. Assets to support benefits of electronic health information interoperability 21

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