Otsikko - uef.fi
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Transcript Otsikko - uef.fi
Healthcare software
services
- open interfaces and
standards in Finland
f
HL7/OMG Healthcare Services Specification Project
London, 31 Jan 2006
Juha Mykkänen, University of Kuopio, HIS R&D unit
SerAPI project, HL7 Finland CS SIG
Overview
healthcare & health information systems in Finland
open service-oriented interfaces: efforts and
specifications in Finland
HL7 Finland Common Services SIG
PlugIT project
SerAPI project
f
comparison of three services
experiences
national efforts
HSSP
Healthcare & HIS in Finland
Kuopio
Helsinki
Healthcare in Finland
Population 5.3 million
Life expectancy 74.6 / 81.5 years
GDP per capita 28,646 EUR (2004)
Growth competitiveness index score (World Economic Forum
2005) 5,94 (1st)
Healthcare 7.6% of GDP
Public healthcare funded by taxation
Basis: 278 primary health centres
f by 444 municipalities
5 university + 32 central/district hospitals in 20 districts =
associations of municipalities
Private care 14%
Occupational health by private organisations
Information systems in healthcare in Finland
In primary health care, EPR used by 98% of GPs
In hospitals, HIS used since 1980s
Now: EPR to hospitals, integration, migration, web-based systems
– National interoperable EHR by 2007?
Background: HL7 Finland Common
Services SIG
HL7 Finland
held its 10th anniversary in October 2005
HL7 v2.3 messaging widely used in some domains
active in national work for EHR
CDA r2 used as a basis for the structure and archiving
HL7 Finland Common Services SIG (2002-)
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initial focus on clinical context
integration (CCOW)
work on service specifications from the background
projects - national comments, balloting
3 available specification areas + implementation guides
Background: PlugIT project
www.plugit.fi
Government
Guidance,
resources
Educational and
research institutions
Software
companies
Teaching
Intl.
links
Basic
research
Applied
research
Healthcare / welfare
service providers
R&D
Actors,
methods
Needs
3 univ. depts,
1 polytechnic
Natl. healthcare programme /
National EHR project
Softw.
devel.
IT
support
f
Sales &
support
Products,
consultation
Needs
12 applications
vendors, 3 technology
vendors
IS
project
ISenabled
care
Communities,
citizens
Health/welfare
services
Better
life
Needs
6 hospital districts,
2 municipalities
National R&D project to develop integration solutions for healthcare
Results: Service specifications, integration methods, centre of expertise
Oct 2001–Aug 2004, about 15 full-time + 15 part-time researcher/developers
Budget € 2 million, 84% by National Technology Agency TEKES
Background: SerAPI
SerAPI project (2004-2007)
national R&D project
service-oriented architecture and web services
14 software companies, 4 public healtcare organisations,
3 research units
process / application / platform viewpoints
service specifications, methods
and tools
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participation in standards development (national /
international)
Healthcare Services Specification Project
participation through both OMG and HL7
infrastructure work / individual services
Open service specifications
HL7 Finland accepted
Context Management (context repository) ~ CCOW
Core services: User & Person information access +
Access control ~ EIS, OMG PIDS
Core services: CodeAPI ~ Common Terminology
Services Vocabulary API, OMG TQS
other publicly available
f
DRG classification
OID generation
other in progress and related
scheduling ~ e-booking
decision support
patient lists, care relationship, etc.
Service implementations
several context service applications
context services available in core applications in hospitals
and health centres
low effort implementation for single sign-on + patient
synchronisation
recent additions for security in regional information
systems
core service implementations fin university hospitals
implementations in new core hospital systems
also legacy applications wrapped with interfaces migration
several proprietary services, some specifications available in
public
DRG classification, care relationship, decision support
service pilot etc.
Approach + interface technologies
incremental specification: from functional interface
specification to technology-specific interfaces
simple http communication (context management)
http + XML (user, person, etc. HL7 specifications)
WSDL/SOAP with WS-I, "API style" (versions of user,
person etc. core services, fDRG, OID)
in addition to
CDA documents (national EHR core technology) national "services"
HL7 messaging (v2.3 v3 + Web services transport)
others (EDI, custom solutions..)
Different types of services: three cases
DRG (Diagnosis Related Groups) classifier interface
resource utilisation groups (NordDRG) to support e.g.
invoicing and benchmarking
EPR (Electronic Patient Record) archive interfaces
variety of clinical documents stored in archives on
organisational, regionalf and national level - note:
national solution not yet specified
Context repository
single sign-on, synchronisation of several applications
(used by one user) to one patient at a time etc.
Comparison of service scenarios 1
Scenario
DRG classifier
interfaces
Requirement Produce information
based on diagnosis
and other
information for the
assessment and
comparison of
resource
consumption
Integration
service
model
Adaptability static, parameters
well-known
Unified or
federated
unified model
(common service)
EPR archive
interfaces
Provide a common
interface for archiving
and retrieving
different types of
clinical documents
related to a patient
(e.g. referrals,
prescriptions)
information
f
Context repository
interfaces
Maintain user-specific
context information for
several applications
(user, patient,
encounter etc.)
dynamic, different
types of documents,
support for local
variation
unified model
(common archive)
and federated model
(content translations,
cascading archives)
static interface,
extensible subject
definitions
user
unified model
(common service)
Comparison of service scenarios 2
Scenario
DRG classifier
interfaces
fine-grained
operations and
parameters
EPR archive
interfaces
large-grained
documents
Context repository
interfaces
fine-grained operations
and parameters
Tight/loose
tight, common
service must be
available
loose, archive may be
queued, national
messaging service
tight, but applications
work also without the
service
Consumers
/ providers
many consumers use
one provider (one
organization)
many consumers use
one logical provider
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(national,
regional)
many consumers use
one provider
(organization / region)
Message
exchange
pattern
immediate response
needed, find and
invoke
guaranteed delivery
needed, send and
retrieve
immediate response,
find and invoke
State
Additional
considerations
stateless
can be used in
interactive and/or
batch-oriented way
stateless
clinical documents,
functionally simple,
informationally
complex interface,
digital signatures
stateful
low implementation
threshold for
participating
applications, no bidirectional invocation
Granularity
Emphasis in Finnish efforts
increased plug and play, reduced local tailoring
simplicity and genericity: start from minimal but sufficient
implementability
low introduction threshold
compatibility with existing systems
defined path from requirements to implementations
services as one part of thef big picture
CDA (moving from regional to national level)
messaging (v2 v3 transition is beginning)
emerging architectures on local, regional and national
levels
three-partite collaboration (vendors, hospital districts,
research)
Lessons & observations
important: pragmatic approach and right timing
acknowledge different types of services
clear usability improvement, low introduction threshold and
little invasiveness have fostered the most uptake
start where there is most repeated point-to-point integration
nail down both functionality and information (does not mean
sacrificing flexibility)
f
a unifying architecture would help
differences in organisations, in regions and nationally
"where to put the mandate.."
HSSP: practical, community-driven, multi-platform...
SOA main benefits: flexibility and interconnectivity
moving from closed consortia to open standards community
but quite bad conference call times for Europeans (EET) .. :)
Thank you
www.centek.fi/serapi/english.html
www.plugit.fi/
SerAPI project participants: National
Technology Agency TEKES (grants no
40437/04, 40353/05), Medici Data Oy,
Datawell Oy, Fujitsu Services Oy,
Hospital district of Northern Savo,
WM-data Oy, Commit; Oy,
f
Intersystems B.V. Finland, Mediconsult
Oy, Microsoft Oy, Oracle Finland Oy,
Hospital District of Satakunta, Bea
Systems Oy, Hospital District of
Helsinki and Uusimaa, City of Kuopio,
Kustannus Oy Duodecim, Mawell Oy
[email protected]