Integration of hospitals and other medical specialists through international standards, technologies and best practices

Christian Ohr

ICW Germany, Feb 13th 2008, Sofia

NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORDUnder the aegis of Ministry of Health

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Agenda

• Standards and Interoperability– Examples

– Barriers to Adoption and Acceptance

• IHE Initiative– Leverage instead of reinvent

– Profiles

– Showcases

• Strategies to introduce standard-compliance

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Standards and Interoperability

• Medical IT Standards– HL7 v2– HL7 v3– CDA, CCOW, CCR– DICOM– ISO 11073, 13606, … , CEN …

• Medical IT Terminologies and Vocabularies– SNOMED CT– LOINC– ICD

• Industry IT Standards– XML, ebXML– SOAP, WSDL, WS-*– BPM, BPEL

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Standards – Barriers to Adoption and Acceptance

• … there are so many to choose from …– Competing standards

– Complementing standards

• … each of them covers only part of the story …– Real-world use cases and scenarios span over:

• Health domains • Technical layers

• … they are too generic and add extra overhead …– Even using a small part of it requires you to use the whole stack

• … they are interpretable …– Using the standard and still don’t understand each other (“plug-and-

play”)

– Constraining the standard by defining profiles

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Standards – Barriers to Adoption and Acceptance

• … none of them cover your special needs …– Project-, region- or country-specific requirements

– Process to generalize these features and propose them for the official standard is often troublesome and time-consuming

• … consciously ignored …– “not invented here”-principle

– recognition, funding, significance

• … unconsciously ignored …– Missing knowledge about existence

– Limited accessibility of standard documents

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IHE Initiative

• IHE– Driven by users and industry

– Workflows in Frameworks

– Goal: “enable health information systems to share and exchange medical data more easily”

– www.ihe.net

• Leverage standards instead of reinvent standards

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IHE Initiative

• Profiles– define how a particular system can

exchange its information with another, to meet specific (clinical) needs

– Use-case driven– Clear distinction between use-case and technical implementation– Leverage existing standards for information exchange

(at times, the chosen ones seem arbitrary and heterogeneous)

– Detailed, also covers boundary conditions– Dependencies between profiles

• Domains– Groups of profiles– cardiology, eye care, IT infrastructure, lab, pathology, patient care

coordination, patient care devices, quality, radiation oncology and radiology

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IHE Connectathons

• Largest interoperability testing event in health care– vendors refine and test their products for conformance with IHE

integration profiles and interoperability with corresponding healthcare IT systems.

– Chicago, Jan/Feb 2008: 70 companies, ~ 400 participants– Results are published

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Strategies how to introduce standard compliance

• Adding another interface to an existing product is a non-trivial task– Doesn‘t match existing interfaces

– Uses different technology

– Bloats the core product with integration issues

– …

• "Any [software] problem can be solved by adding another layer of indirection.” (Steven M. Bellovin)

• Exceptions– the problem of too much indirection (complexity)

– improve performance

– minimize usage of [computing] resources

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ICW - General portfolioPATIENT / CITIZEN

PHYSICANS / -NETWORKS /PHARMACIES

HOSPITALS / -ASSOCIATIONS

HEALTH INSURANCE COMPANIES

- Patient Information- HomeCare Integration- Fitness and Prevention- Rehabilitation

- Patient Information- HomeCare Integration- Fitness and Prevention- Rehabilitation

Chronically ill patients

Young mothers

Elderly

Health conscious

Athletes

- Teleconsultation- Patient Integration- eHealth Integration- Networking of Physician‘s

Electronic Medical Record

- Hospital Networking- Referrer- Patient Integration- Telemedicine

Virtual Medical Record

- DMP Management- Card Management- Kiosksystems- Teleconsulting- Telemonitoring

Care Management

Insurance Companies

Call Center

Pharmacies

Radiology

Physician‘s offices

Physician networks

Patient Integration

Patient Information

CaseRecord

Tele-monitoring

Hospitals

Hospital Associations

Healthcare Professionals

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Example: introduce messaging middleware

ICW Professional Suite (PXS)ICW Professional Suite (PXS)

Health care provider – primary systems, hospitalsHealth care provider – primary systems, hospitals

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Example: introduce messaging middleware

ICW Professional Suite (PXS)ICW Professional Suite (PXS)

Health care provider – primary systems, hospitalsHealth care provider – primary systems, hospitals

Messaging MiddlewareMessaging Middleware

Passed IHE PIX profile tests

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Example: introduce messaging middleware

ICW Professional Suite (PXS)ICW Professional Suite (PXS)

Health care provider – primary systemsHealth care provider – primary systems

Messaging Middleware

Integration Process Management

Messaging Middleware

Integration Process Management

Passed IHE PIX profile tests

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ICW e-card Project – (ePrescription)

Health Professional Card Patient Card

Pharmacist Card Patient Card

CardTerminal

ICW BoxConnector

GPSoftware

CardTerminal

PharmacySoftware

VPNTunnel

ICW BoxConnector

ePrescriptionService

Contract DataService

CertificateAuthority

NHIF

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8. Dispense ePrescription

1. Patient authentication1. Successful authorization

2. Requests patient ePrescription

3./ 9. Transfers Request for ePrescription/ dispensing

Primary System

Connector

4. Reads ePrescription Info from card

5. ePrescription is transferred together with ePrescription ID

6. Visualize ePrescription

7. Cross check print out and deliver drugs

10. Delete ePrescription Info on card

Patient CardPharmacist

ePrescriptionServer

X.509

ICW e-Card project – pharmacy processes

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8. Dispense ePrescription

1. Patient authentication1. Successful authorization

2. Requests patient ePrescription

3./ 9. Transfers Request for ePrescription/ dispensing

Primary System

Connector

4. Reads ePrescription Info from card

5. ePrescription is transferred together with ePrescription ID

6. Visualize ePrescription

7. Cross check print out and deliver drugs

10. Delete ePrescription Info on card.

Patient CardPharmacist

ePrescriptionServer

X.509

ICW e-Card project – pharmacy processes

SICCT

ISO 7816-1,2,3,…15

ISO 7816-1,2,3,…15

X.509, CVCIPSec, TLS, L2TP

gematik

X.509, CVCX.509, CVC

gematik

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ICW project – Building of eHealth portal and Personal Health Record

Primary System

ICW e-Government Health Record (MSAAR)ICW e-Government Health Record (MSAAR)

PortalPortal

Authorization

Physician Patient‘sHome

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Summary

• Adoption of standards is often troublesome– Choice, complexity, abstractness, applicability, support

• IHE puts standards in context with real-world health care integration scenarios

– Description of use cases, required standards and boundary conditions– offers an exciting compliance test platform

• ICW actively supports standardization activities– Member in many standardization boards (national + international)– Coordination of standard activities by own department– Standards compliance in core products

• ICW products and projects started in Bulgaria– Relevant to the standards accepted by eHealth industry– Relevant to European plans and initiatives– Oriented to the integration of legacy (existing) systems and not to the rejection

of these systems.

• The message of ICW is „Connect, don‘t reject!“

Thank you

christian.ohr@icw.de

NATIONAL DISCUSSION FORUM „E-HEALTH” REGIONAL HEALTH NETWORKS. PUBLIC ELECTRONIC SERVICES. ELECTRONIC HEALTH RECORDUnder the aegis of Ministry of Health