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(1)

Online Public Health

@ Health Level Seven

Alean Kirnak

Co-chair, HL7 Public Health and

Emergency Response Workgroup

(2)

Health Level Seven (HL7)

„

American National Standards Institute-accredited

Standards Development Organization (SDO)

„

Highly successful in healthcare

„

International organization

„

Other SDOs adopt and build upon HL7 standards

„

Public Health and Emergency Response (PHER)

Workgroup works to address the requirements of

public health

(3)

PHER Areas of Interest

„

Public health registries

¾

Immunizations

¾

Cancer …

„

Tuberculosis

„

Vital records

„

Public health reporting

„

Public health case management

„

Outbreak management

(4)
(5)

National Person Id in Sweden

gratis!Logga in

Förnamn:

Fredrik

Efternamn:

Strom

Födelsedatum:

[ ]

Adress:

[ ]

Postnummer:

[ ]

Postort:

[ ]

Fonetisk sökning:

[X] Träfflista Antal träffar: 0 Ansvarig utgivare

Example checksum

812228-987xgives

The sum 48 has the last digit of 8. That is then subtracted from ten to give the value: x= 10 −8 = 2; the checksum is the last digit (in this example, the only digit) of this: 2 If the sum had been 50, then subtraction of the last digit 0 from 10 would give the value x= 10 −0 = 10. The last digit of this is 0 which would be the resulting checksum.

(6)

Source: Public Health Data Standards Consortium (PHDSC). Pediatric Electronic Health

Record Public Health Perspectives. Report to Health Resources and Services Administration

(HRSA), 2004, Baltimore, MD

(7)

Domain Analysis Model

„

Describes use cases in domain expert terms

„

Immunization DAM

„

Vital Records DAM

„

TB DAM

¾

Moved to Clinical Interoperability Council

„

Public Health Reporting DAM

(8)

EHR-S Functional Activities

„

Vital Records Functional Profiles

„

Add public health functional profile to EHR

Functional Model?

„

Public health functional profile or functional

(9)

HL7 Paradigms

¾

HL7 Version 2 (V2)

„

Large installed base especially in the U.S.

¾

HL7 Version 3 (V3)

„

Messages, documents, services

„

National commitment internationally

¾

Structured Documents

„

V3-based

„

Clinical Document Architecture

Continuity of Care Document

„

Fast growing

¾

Service-Oriented Architecture (SOA)

(10)

Version 2

„

Point-to-point communication

„

Delimited text strings

„

Field semantics is implied by its position in

the string

(11)

V2 Application Architecture

Application

 

Functions:

Identity

 

Resolution

Retrieval/Update

 

of

 

Data

Decision

 

Support

HL7

 

Version

 

2

Hospital

 

#2

User

Hospital

 

#1

 

user

User

user

user

Application

 

Functions:

Identity

 

Resolution

Retrieval/Update

 

of

 

Data

Decision

 

Support

HL7

 

Version

 

2

Clinic

 

#2

Clinic

 

#1

 

Other

 

user

HL7

 

Version

 

2

Other

 

provider

(12)

PHER V2 Projects

„

No actual Version 2 standards development

„

“Implementation Guides”

¾

Immunizations V2.5 Guide

¾

Electronic Lab Reporting (ELR) V2.5 Guide

¾

Cancer Registries V2.5 Guide

„

“housed” in Anatomical Pathology Workgroup

¾

Newborn Screening 2.3 Implementation Guide

(13)

Version 3

„

Uses Internet family of protocols

„

XML: Semantics of strings is given by “tags”

<Tag1> value1

<Tag2> value2…

„

Object-Oriented technology

¾

Reference Information Model (RIM)

¾

Universal Modeling Language (UML)

¾

“Common information model”

(14)

Version 3 Paradigms

„

Messages

¾

Point-to-point orientation

¾

Not architecturally different from V2

„

Documents

¾

Meant to persist

¾

Similar data payloads but different wrappers

¾

Architecturally different from messages (V2/V3)

„

Services

¾

Bus orientation – like Internet

¾

Service provider - like web site

¾

Service consumer - like browser

(15)

PHER V3 Messaging Projects

„

Version 3 Immunization Standard

¾

Canada Health Infoway

„

Outbreak Management

„

Common Product Model

¾

With Pharmacy Workgroup

„

Clinical Decision Support (CDS)

¾

With CDS Workgroup

(16)

Structured Documents

„

Human-readable part

¾

.xslt

„

Structured data part

„

Clinical authentication

„

Wholeness

(17)

Document Examples

„

Continuity of Care Document (CCD)

¾

Particular type of medical summary doc

¾

CDA and Continuity of Care Record

¾

Based upon V3 Care Provision standard

¾

Increasing adoption of CCD and other Care

Record variants

„

IHE Cross-Document Sharing (XDS)

(18)

Document Fragment

<templateId root="2.16.840.1.113883.10.20.1.53" />

<manufacturedMaterial classCode="MMAT">

<code code="110" codeSystem="2.16.840.1.113883.6.59" codeSystemName="CVX"

displayName="DTaP-Hep B-IPV">

<originalText>

<reference value="#ImmCode-1" />

</originalText>

<originalText>

<reference value="#ImmName-1" />

</originalText>

</code>

<lotNumberText>ABC12345M

<originalText>

<reference value="#ImmLotNumber-1" />

</originalText>

</lotNumberText>

<expirationTime value='20080305'/>

<!-- Manufacturer of Vaccine -->

<manufacturerOrganization classCode='MANU'>

<manufacturer classCode='ORG'>

<code code="SKB" codeSystem="2.16.840.1.113883.6.60" codeSystemName="MVX"

displayName="Glaxo Smith Kline Beacham“>

(19)
(20)

Services

„

Can pass or subsume messages and

(21)

Computing in the Cloud

(Service-Oriented Architecture)

Service

Interfaces

Identity

Resolution

Decision

Support

Retrieve and

Update

Hospital #2

Clinic #2

Hospital #1

EMR

Clinic #1

EMR

Internet

Browser

interface

Other

Database

Master

Person Index

Document

Repository

Data Stores

Document

Registry

Services

Other

Service

Security

Data

Transform

(22)

Economies of SOA

„

Unifying

¾

Common abstract service definition

¾

Multiple concrete renditions

¾

V2, V3, Messages and documents as payloads

„

Workflow optimization (“agility”)

„

Economies of bus architecture

„

Reuse of components

„

Ability to create security layers

„

Standardization of services makes them

(23)

Bus Architecture Economies

„

Approximately 75 U.S. Immunization Registries

(Immunization Information Systems - IIS)

„

Completely connected point-to-point message

network: 74 * 75 / 2 = 2775 connections

„

Each connection costs $10K-$30K per side

„

Approx $40K each * $111,000,000 total

Just to put connections in place

„

Bus Architecture: each site connects once

„

$40K * 75 = $3,000,000

(24)

SOA, HL7, PHER

„

HL7 Service-Aware Enterprise Architecture

Framework

„

SOA-PHER-EHR Reference Architecture

¾

Public health use case

„

Healthcare Service Specification Project

¾

Service Functional Models (HL7)

¾

Technical Specifications (OMG)

¾

Collaboration with IHE

(25)
(26)

Contacts for PHER

„

Alean Kirnak, American Immunization

Registry Association (AIRA)

akirnak@swpartners.com

„

Joginder Madra, Gordon Pt Ltd Canada

joginder.madra@gpinformatics.com

„

Rita Altamore, Washington State

Rita.Altamore@DOH.WA.GOV

References

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