Transcript Resurssin ajanvaraus

Weaving interoperability:
combining local, regional and
national solutions on hospital level
Web services-soveltamistavat arviointi
Semantiikan tarkkuus
Kehitysvälinetuki
Sisällöllinen
joustavuus
XML/http
Open CDA /SOAP
WSDL/SOAP
HL7 v3 + WS-transport
Opittavuus
Kehityksen
suoraviivaisuus
Tekninen
laajennettavuus
SerAPI
41
Miten tärkeinä pidätte seuraavia
palveluiden ja rajapintojen
tavoitteita?
TH-organisaatiot
TH-ohjelmistotoimittajat
Infrayritykset
Kaikki
Terveydenhuollon ammattilaisia
palvelevien toimintojen yhtenäiset
ohjelmistorajapinnat
2,8
3,0
2,5
2,8
Sovellusten tuottajille valmiina
saatavien ohjelmistopalvelujen
tarjoaminen
2,7
2,2
1,5
2,2
Terveydenhuollon asiakkaille
suunnattujen palveluiden ja
sovellusten tukeminen
ohjelmistopalveluilla
2,0
2,5
2,0
2,2
Päällekkäisten tietojen ja toimintojen
vähentäminen sovelluksissa
2,8
2,2
2,7
2,5
Useiden järjestelmien tarvitsemien
tietojen keskitetty ylläpito
2,8
2,2
2,3
2,4
Sovellusten helppo mukautettavuus
eri organisaatioiden vaatimuksiin
(konfiguroimalla)
2,5
1,7
2,0
2,0
Sovellustuotannon nopea reagointi
muuttuneisiin toimintatapoihin
2,8
1,8
2,0
2,2
IMIA HIS Conference, Oeiras, July 3, 2006
Juha Mykkänen, Mikko Korpela
HIS R&D Unit, University of Kuopio, Finland
1
In this presentation
• HIS, sub-systems and interoperability
• Local, regional and national health information
infrastructure initiatives in Finland
• HIS architectural components: hospital view
• Some challenges for advanced interoperability
• Emerging interoperability best practices
• Summary + discussion
2
2
• "need a common description for components in health
information systems" - still a valid need
• components = units of composition, reuse and
interoperability:
– scope, availability, granularity, physical and conceptual nature
– healthcare-specific scope: infrastructure, administration, care support,
direct care, diagnostics, communication, simulation
– information and semantics, instance / type / context / meta levels
– functionality and interactions - capabilities + collaboration
– relation to reference architectures and specific application architecture
– technical aspects - data communication, interfaces, technical
infrastructure, integration platforms etc.
– cross-cutting aspects: security, management, flexibility, extensibility
– relationship to systems lifecycle - development paradigm, migration
3
Mykkänen, Tuomainen 2006, Information and Software Technology, submitted.
IMIA HIS, Heidelberg, April 2002:
3
Process model of a hospital – systems are for processes
Auxiliary processes:
Management, …
4
…
Laboratory
Radiology
Core process:
Direct care
Support
processes:
Input:
illness
Output:
wellness?
Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou
Role of information systems in
hospitals
4
Home
5
GP
Hospital care
Rehabilitation
Korpela 2005, presentattion at Sun Yat-sen University Cancer Center, Guangzhou
Beyond the hospital – seamless care
5
Health information infrastructure
developments / Finland
•
Hospitals and health centres
–
–
–
–
•
primary care = health centres: ~100 % use EPR systems
hospitals: replacing legacy core applications > 10 years
continuous heterogeneity in processes, applications, infrastructures
managerial and clinical process developments - e.g. DRG, decision support
Regional
–
–
–
–
•
Kuopio
Helsinki
new organisational models of health services (e.g. laboratories, regional clusters)
regional information systems, references to back-end HIS data
shared electronic services (e.g. prescriptions, electronic booking)
disease-specific specialised systems
National
– national services: EHR for professionals, code sets/vocabularies etc.
– migration from regional to national services
•
6
Citizen
– e-services emerging first for professionals, then patients
– PHR: little real integration to professional-oriented EPRs
6
24.
25.
MYNLA
myyntilaskutus
HUS DW
tietovarasto
21.
22.
MUSTI
Potilasrekisteri
MD-OBERON
lähete-,
ajanvaraus-,
avo- ja vuodeos.
toiminnot, tilaukset,
väestörekisteri
2.
3.
T
i
l
a
u
k
s
e
t,
h
e
n
k
i
l
ö
s
t
ö
MAKSULI
TOTI
RADU
AHA
SAIR. SENIORI
WebLab
MULTILAB II
(sis. SAMBA
QPATI)
VERTTI
4.
14.
51.
MD-MIRANDA
potilaskertomus
hoitopalautteet
lääkitystietokanta,
Digi-sanelu
7
Agfa RIS
PACS
kuva-arkisto
6.
5.
15.
Ulkoiset
yhteydet
MARELA
apteeki
Helsinki-Uusimaa
hospital district
8.
16.
SAI Sairaalainfektioiden rek.
PICIS
Anestesiatj.
ja tehotj.
TITANIA, PRIMA, ym
hh,koulutus,kulunv.
DYNASTY
asianhallinta, AMS
7
12.
1.
3.
17.
11.
9.
Sample high-end
composition of the
hospital-wide
information system
today:
OPERA Leikkaustoiminnan ohjausjärjestelmä
OBSTETRIX
synnytysosastojen tj.
ENDOBASE
gastroenterologia
Kardiologia,
muut osastojärjestelmät
18.
TIETU
28.
INFO
puhelinkeskus
INTRA, INTERNET
ORACLE MAN.
materiaalikeskus
Lomakepankki
(suunnitteilla)
EVÄS
ateriatilaus
VIRVE, ym.
TUKIPALVELUJÄRJESTELMÄT
HALLINNON
JÄRJESTELMÄT
HUS,Sinikka Ripatti 2004
ATJ
Gentia, HILMO
Ecomed
PowerPlay
LASKUTUS-, SEURANTA- JA
RAPORTOINTIJÄRJESTELMÄT
ASLA
asiakaslaskutus
13.
50.
Päivittäisraportointi
23.
10.
52..
RONDO,
OFA, ym.
ORACLE
FINANCIALS
SAUKKO
Väistyvät
järjestelmät,
migraatioalusta
Hospital level
27.
26.
7
Hospital level
Example of a major vendor’s architecture
Esim. palveluyksiköiden käyttäjät
Liitännäisjärjestelmä
A
A
(esim. Lab)
Liitännäisjärjestelmä
B
(esim. RIS)
Loosely connected
systems
Liitännäisjärjestelmä
Liitännäisjärjestelmä
D
(Esim. Diabetes)
Launching
C
(esim.
toimenpidejärjestelmä)
Liitännäisjärjestelmä
E
(Esim. kuvaarkisto)
HMIS
MD-OBERON
core
Potilaskertomuksen
ydin
Toiminnanohjauksen
ydin
Common user
EPR
MD-MIRANDA
system
MD-ARIEL & MD-UMBRIEL Käyttöoikeuksien määritys
MD-ARIEL Kontekstin hallinta ja yhteiset tietovarastot sekä palvelut
MD-ARIEL käynnistykset ja parametrinvälitykset sekä pääsynvalvonta
•
8
•
"Peruskäyttäjät"
inner circles: optimised usability, reduced maintenance and
redundancy, tightly integrated application families and components
outer circles: flexibility, cross-organisational processes
Medici Data Oy, Juha Sorri 7.10.2004
Common context & services
8
Hospital level
Migration situation in a major hospital
MD-ympäristö
MD-Oberon
MD-Miranda
VAJAT
Ajan- ja hoidonvaraukset
New HIS
systems
Henkilötiedot
Lähete
Hoitopalaute
AVOS avo- ja
osastohoidot
Käyntien ja
hoitojaksojen kirjaus
Käyttö KPK
Hoidonvarau
sjonojen
hallinta
Potilaskertomus
Hoitopalaute
ASLA
Laskutus
Terveyskeskusjärjestelmät
Sähköiset
lähetteet ja
hoitopalautteet
sekä sähköiset
laboratoriopyynn
öt ja vastaukset
laajenevat koko
shp:n alueelle
vuoden 2006
aikana
Health
center
systems
Lähete ja
hoitopalaute
Kuopion tk
CRIS/PACS
Rtg:n tuotannonohjausjärjestelmä
Lähete
UPO poliklinikkajärjestelmä
Ajanvaraukset
Lähetteet
MPOTI potilashallinto
Käyntien ja hoitojaksojen kirjaus
Laskutus
Henkilötiedot
RADU
Rtg-lähetteet
Rtg-lausuntojen katselu
UJO
Hoidonvarausjonojen
hallinta
TOTI
Toimenpideyksi
köiden
tietojärjestelmä
Old HIS
systems
Rtg-työlistat
Rtg-lähetteet
Rtg-lausunnot
Rtg-kuvat
Musti-ympäristö
Merkinnät:
9
Käytössä
Otetaan käyttöön tulevaisuudessa
MULTILAB
Laboratorion
tietojärjestel
mä
YKERT
Sairauskerto
musten
hallintajärj.
Laboratoriopyy
ntö ja vas-taus
(HL7)
Kuopio tk
SiilinjärviMaaninka tk
Varkaus tk
KYS, Pekka Sipilä, 2006
Ajanvaraus
9
• presumptions:
– heterogeneous
specialised
applications,
existing (legacy)
systems
– practicality,
feasible
implementation
threshold in
multi-vendor
environment
– extensibility
– serviceorientation
supported by
generic
middleware
10
Healthcare organization in charge
Patient
administration
core: master
patient data,
code sets, …
APIs
Core
database
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Elements of a HIS architecture: hospital view
Common core services: Starting point for HIS
10
Healthcare organization in charge
• alternatives:
Patient
administration
core: master
patient data,
code sets, …
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
APIs
DBMS
Core
database
11
Application
databases
– non-pluggable
clinical
subsystems
– no clinical
subsystems
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
“Pluggable” specialized clinical subsystems
11
Healthcare organization in charge
• alternatives:
EHR data
(CDA/XML)
Patient
administration
core: master
patient data,
code sets, …
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
APIs
DBMS
Core
database
12
Application
databases
– system-specific
data views
– point-to-point
queries
– (personal /
virtual health
record - outside
organization)
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Standard structured EPR/EHR data storage
12
Healthcare organization in charge
Front-end for clinicians in charge:
EHR viewer, professional portal
Invocation
by context
passing
EHR data
(CDA/XML)
Patient
administration
core: master
patient data,
code sets, …
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
APIs
DBMS
Core
database
13
Application
databases
• alternatives:
– context
management
– no point-ofdecision
integration
– (additional)
workflow
management
systems
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Front-end viewer for health professionals (EHR-S)
13
Healthcare organization in charge
Potentially
same data
structure
Front-end for clinicians in charge:
EHR viewer, professional portal
Invocation
by context
passing
EHR data
(CDA/XML)
• alternatives:
– central
repository (for
some scenarios see next slide)
– peer-to-peer
negotiations /
mediation
Patient
administration
core: master
patient data,
code sets, …
APIs
DBMS
Core
database
14
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
Application
databases
XML
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Information exchange by messages across facilities
14
Healthcare organization in charge
Other healthcare or
welfare organizations
Regional /
national /
EU-wide /
global
front-end
Front-end for clinicians in charge:
EHR viewer, professional portal
Invocation
by context
passing
EHR data
or indices
Adaptor
EHR data
(CDA/XML)
Indexing
• alternatives:
– peer-to-peer
negotiations /
mediation
Patient
administration
core: master
patient data,
code sets, …
APIs
DBMS
Core
database
15
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
Application
databases
XML
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Clinical on-line access across facilities
15
Healthcare organization in charge
Other healthcare or
welfare organizations
Regional /
national /
EU-wide /
global
front-end
Front-end for clinicians in charge:
EHR viewer, professional portal
Citizen
Invocation
by context
passing
EHR data
or indices
Adapter
EHR data
(CDA/XML)
EHR data
or indices
Citizen’s
front-end
Indexing
Patient
administration
core: master
patient data,
code sets, …
Spezialized
clinical
systems:
outpatient,
laboratory,
ophthalmol…
APIs
• add:
DBMS
Core
database
16
XML
Application
databases
– opposite
direction
– patient-provider
communications
Korpela, Mykkänen, Porrasmaa, Sipilä 2005, CHINC conference, Beijing
Patient’s / citizen’s front-end
16
HIS challenges for interoperability
•
healthcare process specifics
–
–
–
–
•
balance between customer, provider and organisational objectives
complexity, legality, communication, multi-professionality, exceptions
externalisation of healthcare processes from HISs
requires flexibility of architectures, definition of migration paths
explosion of potential interoperability solutions
– architectures, evaluation of standards, development and maintenance costs
•
evidence
– identification of real needs, requirements traceability
– collection of application experience of domain-neutral best practices in HIS
•
generic innovation vs. local introduction
– reduced local tailoring, increased reuse on many levels
– gaps: product development - healthcare process development - academia?
17
17
Interoperability apex 2006
•
Semantic and process integration
– structured and coded information, shared terminologies, ontology-based
semantics
– clinical decision support, integration and adaptation of HIS into defined or
even evidence-based workflows
•
Service-oriented architectures
– paradigm for open, flexible and business-aligned systems, cohesive &
reusable services
– process management and automation (vs. exceptional healthcare workflows)
– infrastructure services (e.g. EHR access, codes and terminolofies, access
control) and added value services (e.g. decision support)
– e.g. Healthcare Services Specification Project / HL7+OMG
•
18
Profiles = constraints on application of generic mechanisms
–
–
–
–
technical: e.g. Web services interoperability (WS-I)
functional: e.g. HL7 EHR-S Functional Model
semantic: e.g. CEN/OpenEHR archectypes, HL7 templates
standardisation: e.g. Integrating Healthcare Enterprise (IHE)
18
Summary and discussion topics
•
hospitals will long remain one central point for health services
provision, but will not remain "the centre"
– challenges for advanced interoperability remain on local, regional,
national and international level: common frameworks needed
– regional and national initiatives demand local acceptance and user
benefits
•
•
•
19
described elements are based on Finnish practical experience,
international standardization, China, Africa
one basis for generic framework architecture adjustable to the specific
contexts in Portugal, Germany, UK, USA, … Mozambique?
how can the service interfaces and semantics be developed for global
reusability & local adaptability? gradually?
– understanding of and support for healthcare processes
– semantic and functional views addressed
→ International standardization of relevant aspects with users and industry
→ ’IT for Health’ at IFIP World IT Forum 2007 www.witfor.org
→ IMIA recommendations, Health Informatics in Africa HELINA 2007
www.helina.org
19
Acknowledgements and more information
Healthcare application integration: PlugIT, 20012004: www.plugit.fi, Finnish
Agency for Technology and Innovation Tekes grants no. 40664/01, 40246/02 and 90/03
Service-oriented architecture and web services in healthcare
application production and integration: SerAPI, 20042007:
www.centek.fi/serapi, Tekes grants no. 40437/04, 40353/05
Healthcare work and information systems development in parallel:
ZipIT 2004-2007 Tekes grants no. 40436/04 and 790/04, and ActADHIS, 2004-2005
Finnish Work Environment Fund grant no. 104151 : www.centek.fi/zipit
Packaging Finnish e-health expertise for international use: Export HIS,
20042006 www.centek.fi/exporthis (Tekes grant no. 70062/04,), e-Health Partners
Finland, 2006-2007 www.uku.fi/ehp (Tekes grants no. 40140/06, 70030/06)
Informatics development for health in Africa: INDEHELAMethods
(Academy of Finland grants no. 39187,19982001), INDEHELAContext (201397 and 104776, 2003,
20042007): www.uku.fi/indehela
Open Integration Testing Environment: Avointa, 20042006:
www.centek.fi/avointa Tekes grant no. 40449/04
20
20
•
•
•
•
•
21
separation of care management from patient-specific health
information
increasingly documented and formalised requirements,
processes and practices in healthcare
common concept models, vocabularies and terminologies,
extended to ontological languages and tools
component- and service-based systems development and
management approaches to support changing requirements and
heterogeneous environments
guidelines, methods and reference models for acquisition,
integration and systems development projects
Mykkänen, Specification of Reusable Integration Solutions in Health Information
Systems, forthcoming.
Assets to support benefits of electronic
health information interoperability
21