National Integrated Services

(1)

National Integrated Services

Peter Connolly

HSE

March 2014

(2)

• A Technical Architecture

• An Applications Architecture

• An Information Model and Architecture

• An Communications / Network Architecture

• A Technical Architecture

• An Applications Architecture

• An Information Model and Architecture

• An Communications / Network Architecture

A ‘standards based’

single framework for the

HSE ICT

• Deliver the ICT Strategy work streams

• Strategic National Business Initiatives

• Develop, implement & support

• local & regional initiatives

• Develop the EHR Information Framework

• Develop & improve ICT Infrastructure

• Deliver the ICT Strategy work streams

• Strategic National Business Initiatives

• Develop, implement & support

• local & regional initiatives

• Develop the EHR Information Framework

• Develop & improve ICT Infrastructure

A Single Information

Systems Framework to

provide for integration

and sharing of data

and information

Foundation for the

Electronic Health

Record (EHR) and

a National Patient/

Client Portal

Foundation for the

Electronic Health

Record (EHR) and

a National Patient/

Client Portal

Secondary

Deliverable

Secondary

Deliverable

(3)

Vision

Work-stream-1: The Framework Model………...5

Technical Infrastructure

Work-stream-2: Technical Infrastructure Work Stream………7

(ICT Platforms, Technologies & Asset Base)

Work-stream-3: Applications Reference Base………....10

(Applications Portfolio, Standards & Toolsets)

Work-stream-4: Integrated Systems Management Framework…13

Information Architecture

Work-stream-5: High Level Business Process Specification…...15

Work-stream-6: Information Architecture Model……….…18

Work-stream-7: Data & Information Repository…………..…..….. 21

Work-stream-8: Transformation, Interfacing & Sourcing………....23

Access

Work-stream-9: Identity, Access & Consent Management……...25

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IN

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TEC

HN

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INTEGRATED

SERVICES

FRAMEWORK

(ISF)

W

S:1

W

S:2

-4

W

S:5

-8

WS:9-10

W

S:1

1-1

2

(4)

–

Integration and connectivity of disparate applications

and data

–

Horizontal integration of legacy systems

–

Leverage information from heterogeneous systems

–

Integration that is scalable

–

A component based architecture

–

Loose coupling

–

Fast & efficient deployment

(5)

The Problem

(6)

The NICIS will be used to capture all immunisation events including national childhood

immunisation programmes (including schools), outbreaks, campaigns, late entrants, adult

vaccinations and pandemic response. In addition the system should allow for the recording

of client information relating to neonatal and metabolic screening, breast feeding and

developmentals.

The NICIS system will require data sharing with a broad range of systems including-

•

The Maternal and Newborn Clinical Management System (MN-CMS) (and prior to that being in place to the Dublin

Maternity Hospitals

•

The National Client Identity Services

•

Health Service Provider

•

GP practice management systems

•

National Cold Chain Delivery System

•

Primary Care Reimbursement Services (PCRS)

•

National Cancer Service

•

The National Childcare System

(7)

1. Determination of the

Information Model

2. Specification for the Data

Dictionary

3. Terminology Assurance

4. Support Processes &

Services

(8)

SAM Repository

Data Dictionary

Portal

Clinical

Applications

Value

Disease, DF-00000 Metabolic Disease, D6-00000

Disorder of glucose metabolism, D6-50100

Diabetes Mellitus, DB-61000 Type 1, DB-61010

Insulin dependant type IA, DB-61020

Neonatal, DB75110

Carpenter Syndrome, DB-02324

Disorder of carbohydrate metabolism, D6-50000

Integrate

Validate &

Publish

Proof-of-Concept

Proof-of-Concept (SAM)

(9)

(10)

• Workshops

• Interviews

• Questionnaires

• Feedback Sessions

• Demonstrations

Stakeholder Engagement

(11)

MedDRA; HL7 E2B; ISO IDMP

WHO ATC/DDD;

WHO INN (International Nonproprietary Names)

LOINC (Lab) and ICPC2

Healthlink messaging - HL7v2, XML

ICD10 and Health One dictionary

PICNIC; loosely based on HL7v1 (not a standard)

Edifact (ebXML)

IPU codes/ATC/GMS -IPU product file

GS1

Snomed CT

Contsys

HISA

ISO 13606

HL7

-Functional Model

IS0 21090

System 1

System 2

System 3

System 4

System 6

System 7

System 8

Information Architecture Reference Model (IA-RM)

System 5

SAM 2

SAM 1

SAM 3 SAM 4 SAM 5

SAM 7

SAM 6

(12)

National Information Architecture (IA-RM)

EU

NCP

EHR

Public

Health

EU

NCP

EHR

Public

Health

(13)

MedDRA; HL7 E2B; ISO IDMP

WHO ATC/DDD;

WHO INN (International Nonproprietary Names)

LOINC (Lab) and ICPC2

Healthlink messaging - HL7v2, XML

ICD10 and Health One dictionary

PICNIC; loosely based on HL7v1 (not a standard)

Edifact (ebXML)

IPU codes/ATC/GMS -IPU product file

GS1

Snomed CT

Contsys

HISA

ISO 13606

HL7

-Functional Model

IS0 21090

System 1

System 2

System 3

System 4

System 6

System 7

System 8

Information Architecture Reference Model (IA-RM)

System 5

SAM 1

Patient

Summary /

Demographics

Dataset

(14)

National Data Utility Platform

Definitions

Mapping

Payload in

Messages

SA

M

Terminologies

N-DUP Core

HL7 2.4

ISO 13606

CDA

(15)

National Data Utility Platform

Definitions Mapping Payload in Messages

SA

M

Terminologies N-DUP Core

HL7 2.4

ISO 13606

CDA

Clients Clients Clinic Clinic Community Care CentersCommunity Care Centers Specialist Clinic Specialist Clinic Hospital Emergency Hospital Emergency Diagnostic Center Laboratory Pharmacy Emergency Services Emergency Services Home Care

EU

NCP

EHR

Public

Health

(16)

Public Health

Data Dictionary

Terminology Binding

Data Registry/

Repository

Procurement

Stakeholders

ICT Delivery

Business Case

Technical &

Vendor Selection

Delivery

Maintenance

Delivery Platform

Standards

Data Structure

Data Types

Implementation &

Integration Services

Others

Primary

Deployment

Application

Services

Data

Requirements

Standards

Guidance

(17)

Standards & Information Architecture

Project

(HSE ISF LOT4)

Gerard Freriks

René M. Schippers

25-03-2014

HISI - Dublin

(18)

(19)

Agenda

1. Introduction

2. Recommendations - Outline

(IA-RM, SAM, Coding,)

3. Recommendations - Deployment

4. Q&A session

(Validation, suggestions for improvements)

(20)

HSE ISF

Reasons

Patient Safety

Creation of Jobs

Value for Money

(21)

HSE ISF

Reasons

Patient Safety:

Data quality

Systems quality

National EHR

Creation of Jobs:

eHealth ecosystem for all

Value for Money:

Less Integration cost

Less Maintenance cost

More Flexibility, Adaptability

(22)

Project

Introduction

From a collection of disconnected systems

to connected systems

One single communication domain

D … Y Z A B C A B C

Situation:

Present

Situation:

To be

(23)

Project

Introduction

EHR-systems

Silo’s

23

Recipe

Ingredients

Screen

Kitchenware

Oven

Pastry

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

(24)

Project

Introduction

EHR-systems

Minimal condition:

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

(25)

Project

Introduction

EHR-systems

Maximal condition

Share: Normalised data, logic and presentation

25

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

(26)

Project

Introduction

EHR-systems

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

Business

Logic

Data

Presentation

Software

Hardware

EMR/EHR

System

(27)

Methods for sharing data

Data Exchange standard

27

System a

Data

System b

Connector

Neutral

Data

Exchange format

Connector

System a

Data

System b

Connector

Neutral

Data

Exchange format

Neutral

Data

Exchange format

System a

Data

System b

Evolution

Project

Introduction

Methods

- Data Set

- Data Dictionary

- Data Message standard

- Data Document standard

- Data Object standard

- Coding Systems standard

- Ontologies

(28)

Project

Introduction

Methods for sharing data

Evolution - Revolution

System a

Data

System b

Connector

Neutral

Data

Exchange format

Connector

System a

Data

System b

Connector

Neutral

Data

Exchange format

Neutral

Data

Exchange format

System a

Data

System b

System M

Data

System M

Proprietary

Data

Exchange format

Evolution

Revolution

viable Ecosystem

(29)

Project

Introduction

Connector Deployment

29

Data

System

Data

System

Data

System

Neutral

Normalised

Data

Exchange format

Data

System

Connector

(30)

Project

Introduction

Scope of this project

RM-ODP: Information Viewpoint

Ethical, legal, health, process Requirements

Static Domain specific Data Sets - Exchange formats

Active Data Interfaces - Services

Software - Data bases, networks, applications

Hardware: Computers, disks, wires

Enterprise Viewpoint

Information Viewpoint

Computational Viewpoint

Engineering Viewpoint

(31)

Agenda

1. Introduction

2. Recommendations -

IA-RM, SAM, Coding systems

4. Q&A session

(Validation, suggestions for improvements)

(32)

Reference Model

Project

•

6 Months

•

Desktop research

•

8 Workshops

•

1 questionnaire

(33)

Objectives - Project Outline

Introduction

Requirements

-

Cost effective

-

NO revolution

-

Stepwise evolution

-

Respect investments in existing working solutions

(e.g. HealthLink)

-

Exchange data with HSE registries in a normalised

format

-

Impose data requirements plus Connector via

procurement

(34)

Reference Model

LinkEHR Archetype Editor

HSE

‘Virtual Normalised Data Bus’

EHR

Normalised

Data

Clinical Repositories

Connector

Vendor / Data repository EHR

Normalised

Data

Vendor / Data repository EHR

Normalised

Data

Vendor / Data repository EHR Normalised Data Clinical Audits EHR Normalised Data EHR Data

Vendor / Data repository

EHR Data

HisLINK

EHR Data

EHR Data MedLis Data Require-ments HcP Autho rities SAM Library Archetype Knowledge Manager © ERS B.V. EHR Data SME’s EHR Data SME’s EHR Data SME’s EHR Data SME’s EHR Data SME’s EHR Data SME’s EHR Data SME’s EHR Data Personal Health Records

EHR Data Personal Health Records

EHR Data Personal Health Records EHR Data Disease specific Portals EHR Data Research Data Set SAM Output Formats

MeDRA

WHO ATC/ D DD

WHO INN

WHO ICPC

WHO ICD10

HealthLink (messaging)

Edifact (ebXML)

HL7 Functional Model

HL7v2, CDA

CEN/ISO ContSys

CEN/ISO HISA

CEN/ISO EHR

Commmunication

Loinc

IPU

GS1

SNOMED-CT

(35)

Reference Model

(36)

Information Architecture

Reference Model

Creation of one ecosystem for applications

(federated) Data repositories

big and smaller IT-systems

many Apps

Procurement based on shared:

Standards

Functional requirements

Data requirements

(37)

Subject Area Model

SAM

Data Sets -> Subject Area Models

Subject Area Models -> Outputs

Outputs -> Users

(human readable, computer processable)

(38)

Subject Area Model

SAM

IA-RM

SAM’s

IT-Domain

Health

Domain

HSE

Data Utility

Platform

Data

Require-ments

Autho

Component Library SAM/ Document Server

Data Set

Semantic

Interoperability

Artefacts

SIA

HSE

‘Virtual Normalised

Data Bus’

Computer processable

Human processable

Services

(39)

Subject Area Model

SAM

ERS has modeled one Subject Area Model:

epSOS Patient Summary

and demonstrated tooling

Next step e-Prescribing?

(40)

Subject Area Model

SAM

Open

International

Standard

Pure

ISO RM/ODP

Information

Viewpoint

Spec

Scope = EHR

Low

Implementation

maintenance

cost

HL7 v2

messages

+

-

-HL7 v3 RIM

messages

+

-

-HL7 v3 CDA

documents

+

-

±

-CEN/ISO

13606

EHR-Extracts

+

(41)

Subject Area Model

SAM

CEN/ISO EN13606

•

>20 years R&D

•

Based on ISO 18308 Requirements for EHR architecture

•

Harmonised with:

System of Concepts for Continuity of Care

Health Information Service Architecture

•

Two Level Modeling Paradigm

•

Agile, efficient, implementations

•

5 Part standard

-

Reference Model

-

Archetype Object Model

-

Termlists

-

Patient mandate

-

Deployment support

(42)

Subject Area Model

SAM

CEN/ISO EN13606 is used for

these purposes in:

•

England: NHS HSCIC

•

Spain

•

Clinical Information Modeling Initiative

(43)

(44)

(45)

(46)

The DD4C Process ..(2)

Phase 1

Exis4ng Content

•

SNOMED CT Subsets

•

Data Collec4ons

•

NHS Messaging Specs

•

Royal Colleges Headings

Catalogue

•

Deﬁne metadata of all content

•

Metadata model based on ISO 13119

Harmonise

•

ISO13606-‐based logical models for

Royal Colleges headings

•

ISO13606-‐based logical models for

clinical record keeping

Pu

blis

h

(47)

(48)

Logical Models for Care ..(1)

The aim

Provide

clinically assured, quality assessed, process-‐driven

logical representa4ons of

health care records

Single reference point

for all product-‐dependent modelling work such as NHS Data

Dic4onary and NHS Messaging Speciﬁca4ons

Provide

metadata

for our logical models to provide valuable informa4on about the

models as well as to allow associa4ons with other content such as SNOMED CT subsets,

message templates etc

Allow

mul4ple format download

of our logical models as a

free public resource

: ADL,

UML, HTML, XML, JSON, Mindmap, Word etc.

(49)

ISO 13606 Extract Reference Model adopted

Revision proposed to ISO 13606 Demographics Model (awai4ng adop4on)

SNOMED CT used as the reference terminology for binding to clinical content

Demographic and par4cipant-‐related vocabulary for other content (to be decided)

LinkEHR Editor used for logical modelling (pending approval)

Logical Modelling Guideline document to help with consistent modelling and

terminology binding (dra_ status)

(50)

•

Two level modelling processHigh level models (for ini4al

discussion with healthinforma4cians and clinicians)

•

Logical models (technical models for discussion with

health informa4cians and technical modellers)

•

Transforma4on process (ini4ally manual but possible

automated transforma4on in future?)

•

NHS Data Dic4onary models

•

NHS Messaging Speciﬁca4ons (CDA, FHIR?)

(51)

Logical Models for Care ..(4)

•

ISO13606-‐based models for

Royal College headings

•

ISO13606-‐based models for

record keeping

External Reference Resources

•

Discharge Summary

• Outpa4ent

•

Referrals

• Diagnosis

•

Blood Pressure

• Medica4ons ....

CIMI Models

Seman4cHealthNet

pacerns

CONTSys

SNOMED CT

Interna4onal

Internal Reference Resources

SNOMED CT UK

Extensions

Logical Record

(52)

(53)

©ERS 2014

Clinical Information Modeling

Initiative (CIMI)

(54)

Clinical Information Modeling

Initiative (CIMI)

(55)

Electronic Record Services BV

ERS

©ERS 2014

SAM’s

SAM Editor

Structure

Human readable

labels

Control over

structure vis

occurrences,

cardinatities, etc.

Location for

inspection of

Internal Codes

Labels in all needed

languages

Human Labels

coded with as many

codes asn needed

from a defined

coding system

(56)

ERS

HSE Toolset

SAM Editor

Allowed data points

can be specified

(57)

ERS

©ERS 2014

DEMO: SAM Editor

Structure:

RM-Class Names

Internal atCodes

Human labels

Cardinalities

(58)

ERS

DEMO: SAM Editor

Data Type PQ

Units of

Measurement

Data Type PQ

Control over

allowed data fields

content

Data Type PQ

Define Lists of

allowed data

Data Type PQ

Name/label of the

datum

Data Type PQ

Description as text

Data Type PQ

(59)

ERS

©ERS 2014

(60)

ERS

Demo:

Mind Map

(61)

ERS

©ERS 2014

epSOS

PatientDemographics

Mind Map

(62)

ERS

DEMO

(63)

ERS

©ERS 2014

epSOS Patient Summary

Generated mock-up screen

(64)

ERS

DEMO

Excel

(65)

ERS

©ERS 2014

(66)

ERS

Demo:

Schematron

<schema xmlns="http://purl.oclc.org/dsdl/schematron" queryBinding='xslt2'> <ns prefix="EN13606" uri="urn:hl7-org:v3"/> <title>DEMOtwoDatapoints</title> <pattern id="ENTRY"> <rule context="EN13606:ENTRY"> <assert test="count(EN13606:items)=1"/> </rule>

(67)

ERS

©ERS 2014

(68)

Agenda

1. Introduction

2. Recommendations -

IA-RM, SAM, Coding systems

(69)

Reference Model

(70)

D

…

Y

Z

A

B

C

A

B

C

Project

Introduction

Policies

Country

Laws, regulations

Standards

INFO structur

e

INFRA structur

e

Services

Governance / Quality Assurance

Procurement

EU

DIRECTIVES

Standards

CEN

ISO

HL7

…

Payload

Transport

Storage

(71)

A common path to a future for all

Q/A

Discussion

http://purl.oclc.org/dsdl/schematron"