Upload
percival-norton
View
219
Download
0
Tags:
Embed Size (px)
Citation preview
HL7 Version 3:Driving Interoperability & Transforming
Healthcare Information Management
Charles Mead, MD, MSc
Director, Healthcare Information Architecture
Oracle Healthcare
BCIG Seminar
National Institutes of Health
October 14, 2004
“The great thing about standards is that there are
so many to choose from.” --- anonymous
Slide 2BCIG Seminar October 14, 2004
A Framework for Change:Bits vs Atoms
(“Being Digital,” Nicholas Negroponte)
• Atoms– Occupy proportional physical space– Cost money to move or replicate– Take time to move or replicate– Atom processing today vs 2000BC is order-of-magnitude unchanged
• Bits– Occupy disproportionately small physical space– Cost of replication not related to number of replications– Transport times virtually identical regardless of distance
• Healthcare has traditionally used atoms (paper) to move bits (information)
Slide 3BCIG Seminar October 14, 2004
A Second Framework:Process vs Implementation
• Process Description: “An implementation-independent description of an activity or sequence of activities focused on accomplishing a specific goal.”
– e.g. ‘Communicate a message from Party A to Party B’
• Implementation Solution: “An implementation-specific mechanism whereby a given process is realized and achieves its stated goal. Every implementation is a set of compromises on the original Problem statement”
– e.g. Face-to-face conversation vs email vs voicemail vs US Mail
• Healthcare personnel (clinical, administrative, and financial) often confuse the (historical) paper implementation as the essential care delivery / management process.
Slide 4BCIG Seminar October 14, 2004
A Third Framework:Complex Systems
• Complex System: A system composed of multiple vertical organizational levels engaged in horizontal processes that cross vertical organizational boundaries
– Problems occur at the interchange boundaries/interfaces• Duplication/redundancy of effort• Inefficiency/variability of process
Slide 5BCIG Seminar October 14, 2004
The Computer-Based Patient Record• Described by 1991 IOM report: “The Computer-Based Patient Record: An Essential
Technology for Health Care”– 180 features in 12 categories. “The CPR should support…”
• direct data entry by all persons caring for a patient• measurement of health status and function (outcomes of care)• support for co-managing cost and quality of care• documentation of clinical reasoning and rationale• clinical problem solving/decision support• Problem/Condition Lists• relevant and timely linkage with all relevant patient information• layered confidentiality and audit trails• continuous (ad hoc) (authorized) user access• simultaneous user views• local and remote information access to relevant resources• existing and evolving specialty needs
Slide 6BCIG Seminar October 14, 2004
What Makes the CPR so Difficult?
• Complexity of purpose
• Requirement for (computable semantic) interoperability
• Historic lack of standards facilitating (computable semantic) interoperability
– ‘Best of Breed’
• E.g. Medication allergy– Initial text capture in an anesthetic setting– Need for machine processing and decision
support in an ER setting
Slide 7BCIG Seminar October 14, 2004
The National Health Information Infrastructure (NHII)
• 2004 Announcement: “An initiative set forth to improve the effectiveness, efficiency, and overall quality of healthcare in the US through the development of a comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information that will improve decision-making by making the information available when and where it is needed. The NHII includes the set of technologies, standards, applications, systems, values, and laws that currently or will be needed to support all facets of individual health, personal healthcare, and public health.”
Slide 8BCIG Seminar October 14, 2004
The Continuity of Care Record (CCR)
• 2003 initiative: “developed in response to the need to organize and make transportable a sete of basic information about a patient’s healthcare accessible to all clinicians and patients. The CCR is intended to foster and improve the continuity of care, reduce medical errors, and ensure a minimum standard of secure health information transportabiliity. Adoption of the CCR by the medical community and IT vendors will be the first step in achieving interoperability of medical records.”
• CCR is being developed by the AAFP, the Massachusetts Medical Society, the AMA, the AAP, HIMSS, American Health Care Association, and ASTM Committee E31.
Slide 9BCIG Seminar October 14, 2004
The Continuity of Care Record (CCR)
• Contexts of application include– Referral– Transfer– Discharge
• Proposed components of the CCR include– Dx, Problems, and Conditions– Adverse Reactions/Alerts– Current Medications and Immunizations– VS– Lab results– Procedures and Assessments– “Extensions”
Slide 10BCIG Seminar October 14, 2004
The Cancer Bioinformatics Grid (caBIG)
• 2003-04 initiative: “…An informatics infrastructure that will connect teams of cancer and biomedical researchers together to enable them to better develop and share tools and data. Standards for common vocabularies and data elements will be an integral part of the caBIG infrastructure.”
Slide 11BCIG Seminar October 14, 2004
A caBIG Example(from Covitz et al, Bioinformatics, V19, N18, P2404)
• Patient presents with headache, focal weakness, history of seizures• Workup reveals glioblastoma multiforma subtype astrocytoma
• Is this tumor histology is associated with gene expression abnormalities?– Yes, in the p53 signaling pathway including BCL2, TIMP3, GADD45A, CCND1
• Is there documented evidence of aberrant expression of (e.g.) CCND1?– Yes, SAGE tags for cyclin D1 appear with 3x greater frequency in cancerous vs normal
brain tissue• Are any gene products of the p53 signaling pathway known targets for therapeutic agents?
– Yes, TP53, RB1, BCL2, CDK4, MDM2, CCNE1• Are any of the agents known to target these genes being specifically tested in glioblastoma
patients?– Yes, trials xxx and yyy are currently underway
• Research data at the point of care, Clinical data at the point of research
Slide 12BCIG Seminar October 14, 2004
“Interoperability”
• Everyone in healthcare seems to want it (at least in some sense)
• What does it mean?
• Is it obtainable?
• If so, at what cost ($$, effort, etc.)?
Slide 13BCIG Seminar October 14, 2004
Clinical Data Interchange Standards Consortium (CDISC)
• CDISC is an open, multidisciplinary, non-profit organization committed to the development of worldwide industry standards to support the electronic acquisition, exchange, submission and archiving of clinical trials data and metadata for medical and biopharmaceutical product development.
• CDISC’s mission is to lead the development of global, vendor-neutral, platform-independent standards to improve data quality and accelerate product development in our industry.
Protocol Std
ClinicalDocument
Architecture
DICOM
The “World of Clinical Trial Standards” (circa 2004)
International Conference on Harmonization (ICH)
U.S. Dept. of Health and Human Services(HHS)
Health Level 7 (HL7)
U.S. FDA
CDISC
TC:RCRIM
NIH/NCI NLM
EFPIA
EMEA MHLWKIKO
PhRMAJPMA
CDC
Reference Information Model
RIM
LAB
eCTD
LOINC
ISO/ANSI
SNOMED
MedDRA ODMSDS
= Organization= Dictionary, Codelist = Standard = Model = Document Standard,
or Architecture
ADaM
Slide 15BCIG Seminar October 14, 2004
Health Level Seven (HL7)
• “HL7 develops specifications that enable the semantically interoperable exchange of healthcare data. ‘Data’ refers to any subject, patient, or population data required to facilitate the management or integration of any aspect healthcare including the management, delivery, evaluation of and reimbursement for healthcare services, as well as data necessary to conduct or support healthcare-related research. HL7 Specifications are created to enable the semantically interoperable interchange of data between healthcare information systems across the entire healthcare continuum.”
(C Mead paraphrase of HL7 Mission Statement)
Slide 16BCIG Seminar October 14, 2004
HL7: A Brief History(www.hl7.org)
• Founded in 1987• Produced Version 1.0 and 2.0
in ‘87 and ‘88• Approved HL7 message
standards - –2.1, 2.2, 2.3, 2.3.1 and 2.4 in ‘90, ‘94, ‘97, ‘99 and ‘00
• Approved CCOW standards–1.0, 1.1, 1.2, 1.3 in ’99, ’00 and ‘01
• Approved Arden Syntax standard in ’99
• Approved XML-based Clinical Document Architecture standard in ‘00
• Accredited as an SDO by ANSI in 1994–All HL7 approvals since ‘94 are “American National Standards”
• Published implementation recommendations for:–Object broker interfacing ‘98–Secure messaging via e-mail ‘99
–HIPAA Claims attachments ‘99–XML encoding of Version 2 ’00
Slide 18BCIG Seminar October 14, 2004
Syntax vs Semantics
• The dog eats red meat.• The dog eats blue trees.
• Give the patient pain medication.• Give the patient medication for pain.
• Time flies like an arrow• Fruit flies like a banana.
• Syntax Structure• Semantics Meaning• ….and then there’s Context
– ‘he threw his hat into the ring….’– ‘he’s got a chip on his shoulder…’
Slide 19BCIG Seminar October 14, 2004
The Semiotic Triangle:How Humans Communicate
ThingSymbol“Shark”
(Concept)
Symbol“Shark”
Thing
Concept
“Delicious with cabernet.”
Symbol“Shark”
Thing 1
Concept 1
“A predator.”
“A guy who hustled me.”Concept 2
Thing 2
Slide 20BCIG Seminar October 14, 2004
Interchange vs Interoperability
• Main Entry: in·ter·op·er·a·bil·i·ty: ability of a system ... to use the parts or equipment of another system
Source: Merriam-Webster web site
• interoperability : ability of two or more systems or components toexchange information and to predictably use the information that has been exchanged.
Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]
Semanticinteroperability
Syntacticinteroperability
(interchange)
Syntax Structure
Semantics Meaning
Slide 21BCIG Seminar October 14, 2004
The Pillars of(Semantic) Interoperability
Necessary but not Sufficient
• Common model across all domains-of-interest– Information model vs Data model
• Model grounded on robust data type specification
• Methodology for binding terms from concept-based terminologies
• A formally defined process for defining specific structures to be exchanged between machines, i.e. a “messaging standard”
The Version 3 Tool Kit
Slide 22BCIG Seminar October 14, 2004
Pillar #1: A Common Model
• The HL7 Reference Information Model (RIM) (ANSI)
• RIM203.pdf
Slide 23BCIG Seminar October 14, 2004
Pillar #2: A Data Type Specification
• The HL7 Version 3 Data Type Specification (ANSI)
Slide 24BCIG Seminar October 14, 2004
Data Types
• Design Goals for HL7 Data Type Specification– Coherence– Parsimony– Stability– Completeness– Simplicity
• HL7 Data Type Specification as an interoperability standard– ANSI approved– Currently in ISO process– Endorsed by CEN
Slide 25BCIG Seminar October 14, 2004
Pillar #3: A Methodology for Binding to Concept-Based Terminologies
• The HL7 Version 3 Vocabulary Technical Committee
• Concept-based terminologies are essential for capturing the complexity of healthcare delivery in the context of the CPR and its derivative products
Taxonomy of Terminologies(from Ingenerf, MEDINFO Proceedings, 1995)
Dictionaries and Thesauri
Collections of terms, definitions, associations, synonyms, etc.
Classification Systems
Exhaustive concept identification
Hierarchical structure
Disjunctive
Derived from / serve a particular perspective
ICD-9
CPT
NANDA
Taxonomy of Terminologies(from Ingenerf, MEDINFO Proceedings, 1995)
Nomenclatures
Multi-axial
Combinations of atomic terms used to build complex terms
No formal grammar
C/C fx of L femur
C/C/fx of R eye
Formal Terminologies
Nomenclature + associated formal grammar
Requires tool support to enforce grammar rules during both construction and interpretation
SNOMED-CT
Grail (Galen Project, Rector et al)
Slide 28BCIG Seminar October 14, 2004
Pillar #4: A Messaging Model
• The HL7 Version 3 Messaging Specifications (including Clinical Document Architecture, Release 2)
• HL7 is an ANSI Standards Development Organization
• HL7 v3 ‘Early Adopters’ Program
Slide 29BCIG Seminar October 14, 2004
The HL7 V3 Messaging Standard
• Focused on information exchange that enables semantic interoperability
• All “message structures” are derived from the RIM
• Message structures defined using HL7-defined process
• Message content defined using HL7-supplied tools
• Message implementation to multiple technologies– XML– Java
Slide 30BCIG Seminar October 14, 2004
Pillar #1: A Common Model
• The HL7 Reference Information Model (RIM) (ANSI)
• RIM203.pdf
Slide 31BCIG Seminar October 14, 2004
What’s the RIM ‘About?’
• The set of concepts, attributes, and relationships needed to describe any aspect of healthcare
– Clinical• Patient Care• Aggregated Populations• Non-person domains-of-interest
• Veterinary• Genomics
Slide 32BCIG Seminar October 14, 2004
What’s the RIM ‘About?’
• The set of concepts, attributes, and relationships needed to describe any aspect of healthcare
– Administrative• Scheduling• Materials Management• Personnel Management
• Credentialing and Privileging
Slide 33BCIG Seminar October 14, 2004
What’s the RIM ‘About?’
• The set of concepts, attributes, and relationships needed to describe any aspect of healthcare
– Financial• Reimbursement model neutral• Supports ‘supply-chain’ approaches to patient care
(‘inventory-to-bedside’)
Slide 34BCIG Seminar October 14, 2004
How Can the RIM be All Things to All Parties?
• Constructs– High-level abstract structures– Well-defined set of data types– Well-defined interfaces to terminologies
• Healthcare Domains (clinical, administrative, financial) are defined by the combination of common structures and unique terminologies
Slide 35BCIG Seminar October 14, 2004
The HL7 Reference Information Model
• Motivated by need for standard to facilitate semantic interoperability
– HL7 2.x is an interchange standard
– “Too technical and abstract for domain experts (‘I can’t find the things I need to describe my domain’)”
– “Too abstract and not detailed enough for the technology cognoscenti (‘No methods, no foreign keys…worthless as a data model.’)”
Slide 36BCIG Seminar October 14, 2004
The RIM BackboneEssential Structures of Healthcare
Party 1..*
0.. *Healthcare
Action
Is involved inIs involved in
involvesinvolves
• A Party (Person or Organization) is involved in zero-to-many Healthcare Actions
• A Party (Person or Organization) is involved in zero-to-many Healthcare Actions
• A Healthcare Action involves one-to-many Parties (Persons or Organizations)
• A Healthcare Action involves one-to-many Parties (Persons or Organizations)
• How do we represent a Person as both a Patient and a Clinician?
• How do we represent a Person as both a Patient and a Clinician?
Slide 37BCIG Seminar October 14, 2004
The RIM BackboneEssential Structures of Healthcare
Party1..* 0..* Healthcare
Actionplaysplays involvesinvolves
• A Party (Person or Organization) plays zero-to-many Roles
• A Party (Person or Organization) plays zero-to-many Roles
• How do we represent a Clinician who is a Consultant in one Healthcare Action and a Supervisor in another?
• How do we represent a Clinician who is a Consultant in one Healthcare Action and a Supervisor in another?
Role
• A Party (Person or Organization) in Role is involved in zero-to-many Healthcare Actions
• A Party (Person or Organization) in Role is involved in zero-to-many Healthcare Actions
1 0..*
Slide 38BCIG Seminar October 14, 2004
Party0..*
1Role
1..*
10..*
1Participation
HealthcareAction
The RIM BackboneEssential Structures of Healthcare
• A Party (Person or Organization) plays zero-to-many Roles
• A Party (Person or Organization) plays zero-to-many Roles
• A Party (Person or Organization) in a Role may assume zero-to-many Participations
• A Party (Person or Organization) in a Role may assume zero-to-many Participations
• A Party (Person or Organization) in Role assuming a Participation is involved in zero-or-one Healthcare Action
• A Party (Person or Organization) in Role assuming a Participation is involved in zero-or-one Healthcare Action
Slide 39BCIG Seminar October 14, 2004
‘Collections’ using RIM Structures
• A Healthcare Action can be the source of zero-to-many Healthcare Relationships, each of which relate the source Healthcare Action to one-and-only one other Healthcare Action (the target action).
• A Healthcare Action can be the source of zero-to-many Healthcare Relationships, each of which relate the source Healthcare Action to one-and-only one other Healthcare Action (the target action).
OBS:Temp 101F
OBS:Abnormal
CXR
OBS:Elevated
WBC
AR:“is supported
by”
AR:“is supported
by”
AR:“is supported
by”
has target has target
has targethas target
has targethas target
OBS:Dx Pneumonia
is source foris source for
is source for
is source for
is source for
is source for
•NOTE: Each Observation is ‘Attributed’
Slide 40BCIG Seminar October 14, 2004
The HL7 Reference Information Model
• Referral• Transportation• Supply• Procedure• Consent• Observation• Medication• Administrative act• Financial act
• Organization• Place• Person• Living Subject• Material
• Patient• Member• Healthcare facility• Practitioner• Practitioner assignment• Specimen• Location
Entity
1
0..*
1
0..*
Role Link
0..*
1Role
1
0..*
1
0..*
ActRelationship
1..*
10..*
1Participation Act
• Author• Reviewer• Verifier• Subject• Target• Tracker
• Has component• Is supported by
•ReducedShakespeare.ppt
State
– Definition: “A named stage in the lifecycle of an instance of a concept”
• Washing Machine• Stopped, Running (Filling, Spinning, Emptying)
• Lab order• New, Active, Suspended
– The lifecycle of a concept (i.e. valid states and transitions) is shown in a State Diagram (a visual representation of a State Machine)
• A single instance of a concept may take on one-to-many states over its ‘lifetime’
• An instance does not have to pass through all possible states in its lifetime
The State Diagram for the Act Class
Mood
– Definition: “A named description – from the perspective of a single concept – of one stage of a business cycle”
• e.g. Order/Request vs Event• In order to completely describe a business cycle (from the
perspective of a single concept), multiple instances of that concept – each with their own mood designation – must be instantiated
– The term ‘mood’ is used based on its meaning in formal grammar, where it is used to describe certain characteristics of verbs relative to time
– A concept instance can have many state (aka status) values in its life; it can have one and only one mood
Mood in HL7 V3
– Specified by the value of the ‘moodCode’ attribute in the Act class
– All instances of Act (or its subtypes) must have a value for moodCode attribute
• Once assigned (at creation time), the value of moodCode never changes
– moodCode value set is controlled by HL7
– Examples include…• Define• Order/Request• Event• Goal
Mood: Example 1– The Concept: Penicillin VK 500mg IV
– In Master Service Catalogue (orderable) DEFINE– Ordered or patients ORDER/REQUEST
• Mr. Brown TID x 10 days• Mrs. Smith QID x 7 days• Mr. Jones 2 doses STAT
– Given to patients based on order EVENT• Mr. Brown 3 x 10 = 30 events• Mrs. Smith 4 x 7 = 28 events• Mr. Jones 1 (or 2) events
– State describes single instance; mood describes multiple instances in a business process
Mood: Example 2– The Concept: Observation (Ambulatory Assessment)
– 03.06.03: “Pt will walk 20 ft without assistance in 3 weeks.”
– 03.27.03: “Pt walked 15 ft with assistance.”– 03.27.03: “Pt did not meet ambulatory goal.”
AR:“has outcome”
AR:“has explanation”
Is source for Is source for
has targethas target
OBS:Date: 03.27.03Goal Assmt.
moodCode: EVTValue: DNM
is source for
is source for
Is target for
Is target for
OBS:Date: 03.27.03
Amb Asmt.moodCode: EVT
Value: 15 w
OBS:Date1: 03.06.03Date2: 03.27.03
Amb. Asmt.moodCode: GOAL
Value: 20 w/o
Mood: A Final Implication
– Because an instance in ORDER mood is different from an instance in EVENT mood, it follows that the ORDER mood instance will not have any ‘value’ associated with it, while the instance in the EVENT (or GOAL) mood will have a ‘value’ associated with it.
– It follows (after a bit of thought) that Documents are collections of values which can be represented as instances of Acts in the EVENT mood
• A document instance may have a complex structure which requires consider use of ActRelationship instances
• Documents have additional semantics (discussed later)
RMIM – Specifications vs Constraints
Slide 49BCIG Seminar October 14, 2004
`
The Communication Pyramid
Communication
Free-text Documents
Structured Documents
ad hoc Drawings
Non-standard Graphics
Discussions
Standardized Models (UML)Pro
blem
Probl
em
Space
Space
Solution
Solution
Space
SpaceIm
plem
enta
tion-
Inde
pend
ent
Implem
entation-Specific
Source: Charlie Mead, MD, HL7
Slide 50BCIG Seminar October 14, 2004
Standards Development
XML message spec
Specification Development
HL7Documentation
Domain Experts
ICH
Requirements
CDISCSEND
FDA
Other..
HL7 RCRIM
R. Levin, EuroInterchange, May 2004 (modified by Med, Oct 2004
Implementation
FDAVendors
SROs
other
Slide 51BCIG Seminar October 14, 2004
Requirements Documentation:The Problem Space Model
The “Problem Space” is defined using a combination of visual models and a rigorously-defined and linked Glossary
RequirementsDocumentation
Requirements Specification
1. Document Domain Process Flow: UML Activity Diagram
2. Capture Domain Structure: UML Class Diagram and Glossary
3. Capture Business Rules: Relationships, Triggers, and Constraints
4. Harmonize the resulting Problem Space Model with HL7 RIM etc.
Mission StatementAnd
Goals
Slide 52BCIG Seminar October 14, 2004
Healthcare information management technology that supports:• Comprehensive view across entire community • Data reuse and portability• Analysis and control of patient care processes• Management of healthcare transactions
Healthcare information management technology that supports:• Comprehensive view across entire community • Data reuse and portability• Analysis and control of patient care processes• Management of healthcare transactions
Healthcare information management technology that supports:• Comprehensive view across entire community • Data reuse and portability• Analysis and control of patient care processes• Management of healthcare transactions
Healthcare information management technology that supports:• Comprehensive view across entire community • Data reuse and portability• Analysis and control of patient care processes• Management of healthcare transactions
Standards-based (including HL7 v3 and RIM) application development platform to enable:
Healthcare information management technology supporting:• Comprehensive view across entire community • Data reuse and portability• Analysis and control of patient care processes• Management of healthcare transactions
HTB is a platform/framework
HTB is not an application
HTB Product Vision
Slide 53BCIG Seminar October 14, 2004
Healthcare Transactions
RIM-basedEnterprise Object
Model
Check EquipmentAvailability
PerformProcedure
I need aChest X-ray
for Mr. Smith
OrderChest X-ray
ReportResult
Place Image in
RadiologistQueue
InterpretStudy
Check TechnicianAvailability
ScheduleChest X-ray
Slide 54BCIG Seminar October 14, 2004
Oracle E-Business Platform
Mar
keti
ng
Ord
er M
anag
emen
t
Co
ntr
acts
Sal
es
Ser
vice
Su
pp
ly C
hai
n
Inte
rnet
Pro
cure
men
t
Fin
anci
als
Hu
man
Res
ou
rces
Pro
ject
s
Mar
keti
ng
Ord
er M
anag
emen
t
Co
ntr
acts
Sal
es
Ser
vice
Su
pp
ly C
hai
n
Inte
rnet
Pro
cure
men
t
Fin
anci
als
Hu
man
Res
ou
rces
Pro
ject
s
Oracle E-Business PlatformOracle E-Business Platform
Hea
lth
care
Fin
anci
al A
pp
s
Hea
lth
care
Clin
ical
Ap
ps
Hea
lth
care
Ad
min
istr
ativ
e A
pp
s
HTB
Hea
lth
care
Fin
anci
al A
pp
s
Hea
lth
care
Clin
ical
Ap
ps
Hea
lth
care
Ad
min
istr
ativ
e A
pp
s
Healthcare Transaction BaseAn interoperability framework
Slide 55BCIG Seminar October 14, 2004
• Terminology Mediation• Person Services• Auditing and Security• Configuration• Workflow Integration• Message Management
• Terminology Mediation• Message Management• Security and Auditing• Person Services• Configuration• Workflow Integration
Core Services
Slide 56BCIG Seminar October 14, 2004
• All terminologies managed by HTB are Concept-based – Unique internal ID– ‘Standard’ and ‘homegrown’ terminologies
managed identically
• Intra-terminology version management
• Inter-terminology cross mapping– Equivalence– Other semantic relationships (e.g. SNOMED-CT set)
Terminology Services
Slide 57BCIG Seminar October 14, 2004
Message ServicesInbound
v2.x v3.0
Repository(RIM)
ApplicationProgramming
Interface
LegacySystem
InboundMessage
Processing
HL7 IFEngine
Oracle
Customer
Responsibilities
App. Dev.
HTB Applications
HL7 IFEngine
Slide 58BCIG Seminar October 14, 2004
Messaging Services DetailsInbound Message Processor
AncillarySystem
v2.X
pipe&bar
InterfaceEngine(iHub)
API Based HTB Services
Configuration
Inbound Message Processor • Cross referencing external Ids• Mapping and domain validation via
Enterprise Terminology Services• Extracting data from v3XML to Value
Objects using mapping routines• Message Acknowledgement
Repository
Bu
sin
es
s A
PIs
DatabaseEntry Vehicle
PostUpdate
Workflow
CustomAcknowledge
OutboundMessageProcessor
Kickoff
V3.0
XML
Slide 59BCIG Seminar October 14, 2004
Services
Mechanisms E-Signature
• Digital Signature• Message integrity• Non-repudiation• User authentication
• Integrity control• Message authentication• Access control• Encryption• Alarm• Audit control• Entity authentication• Event reporting
Services
• Emergency access• User/role/context-based access• Audit control• Consent/authorization control• Data authentication• Automatic logoff• Unique user identification
Security and AuditingHIPAA Requirements
Slide 60BCIG Seminar October 14, 2004
Security and Auditing Authorization policy engine
2. HTB compiles policy rules into DB constraints
3. DB constraints associated with tables
1. Security Administrator defines policy
4. Application invokes security services
5. DB constraints attached to application queries
6. DBMS executes extended queriesData Model
HTB Applications
Security MgmtApplication
Management API Service API
Enterprise Object Model
Slide 61BCIG Seminar October 14, 2004
Internet
BusinessIntelligence
DataMining
Healthcare Transaction BaseA healthcare Interoperability platform
ExternalWarehouse
DataAccess
Registries
Clinical TrialSystem (OC)
ClinicalInformation
Systems
LaboratoryInformation
Systems
HL7 IFEngine
Data Warehouse
Providers Patients Administrators Researchers
Healthcare Transaction Base
ClinicalData
Repository
• Messaging Services• Person Services• Terminology Management• Security and Auditing
NewApplications
Point of CareAppliances
Slide 62BCIG Seminar October 14, 2004
• Semantic interoperability is essential if we are to solve the myriad of problems facing the healthcare delivery system
• Semantic interoperability is difficult
• Semantic interoperability is possible if the ‘Four Pillars’ are addressed
• HL7 Version 3 and the associated RIM provide a framework satisfying the ‘Four Pillars’
• Oracle is building HTB, a standards-based interoperability platform based on HL7 v3, the RIM, and the ‘Four Pillars’
Summary
Slide 63BCIG Seminar October 14, 2004
AQ&Q U E S T I O N SQ U E S T I O N S
A N S W E R SA N S W E R S