David Hay Chair, HL7 New Zealand (Wednesday, Interoperability Reference Architecture Workshop)

1. HealthBase
enterprise architecture
Introduction to the Interoperability Reference
Architecture
November 2011

2. HealthBase
enterprise architecture About us
• Dr David Hay – Chair, HL7 New Zealand
• Alastair Kenworthy – Information Strategy, MoH
• Alan Le Maitre – HIQ
• Dr Koray Atalag – NIHI

3. HealthBase
enterprise architecture Agenda
• Development of the reference architecture
• Content of the reference architecture
• Architecture building blocks
• HISO public comment process
• Further development
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4. HealthBase
enterprise architecture
Development of the Interoperability
Reference Architecture

5. HealthBase
enterprise architecture Setting the scene
• Vision: a patient-
focused, integrated
healthcare model,
based on shared care
• Scope: an architecture
for inter-system
exchange of health
information
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6. HealthBase
enterprise architecture Our activity
• TWG commenced February 2011
• Presentation to SAG April 2011 (also June and
September)
• 1st draft published on hive.org.nz/ May 2011
• Standards proposal to HISO June 2011 (also
presented March and August)
• Presentation to PCIM Group August 2011
• Vendor consultations September 2011
• Public comment October 2011
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7. HealthBase
enterprise architecture
Content of the Interoperability
Reference Architecture

8. HealthBase
enterprise architecture Design principles
1. Align to national strategy
2. Be business needs focussed
3. Work with sector
4. Use proven standards
5. Invest in information
6. Adopt services approach
7. Develop single content model for exchange
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9. HealthBase
enterprise architecture
Key components
Working Interoperability Components Model Driven Design
Use Case Exchange
Content Model
Extensions text
Core
Extended
Workflow
Detailed Clinical Models
HIE Fabric
Data Service
Data
Taxonomy
Service Using HSSP
CDA Template Library
Registry - Repository Model
Patient Identity Source
(Distributed Data Management)
Document Registry Document Consumer Provides Data Services
CDA
Document
Document Source Document
Repository
Provides CDA Document
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10. HealthBase
enterprise architecture Health Information Exchange
National Services Regional Services Regional Enabling Regional CDR
Services
Sector Indices
Laboratory IS Record Locator
NHI, HPI etc..
HIE Adapter
Health Information Exchange (HIE)
Data Data Data Data
Service Service Service Service
HIE Adapter
HIE Adapter
Integrated Family Pharmacy Dispensing Maternity Shared Care
Health System System System
HIE Adapter
GP PMS Hospital PAS Immunization Register
Provider Services
and Personal Services
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11. HealthBase
enterprise architecture
Interoperability Reference Architecture
Building Blocks

12. HealthBase
enterprise architecture HISO 10040
• HISO 10040 Health Information Exchange
• 10040.1 HIE Clinical Data Repository Utility Services
– Service based access to shared repositories using
IHE XDS
• 10040.2 HIE Content Model
– Based on Continuity of Care Record (CCR)
– Expressed using archetypes (ISO 13606, openEHR)
and ISO/IEC 11179 dataset definitions
• 10040.3 HIE Structured Documents
– HL7 CDA
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13. HealthBase
enterprise architecture 10041.1 Utility Services
National Services
Document Registry
Patient Identity
Source
NHI and HPI Document National
Repositories Specialty
Regional Document PoC Document
Registry Consumer
PoC Document
Source or Image Orders & Continuity
Source Results of Care Regional Gateway
Regional Document
Repositories
Imaging
Medicines & Other
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14. HealthBase
10041.2 HIE Content Model
enterprise architecture
(CCR, DCMs)
CORE Model
(Based on ASTM Continuity of Care (CCR)) Extensions:
???
Extended Model (e.g. Maternity)
(Based on Core Model)
Core
text
Information
Core Extension: Extension:
Core
Static Model
Detailed Clinical Model Maternity Palliative
(DCM) Care Care
Extension:
Extended Cancer
Extended
Detailed Clinical Model
Static Model Registry
(DCM)
Core Meta-Data
Extended Meta-Data
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15. HealthBase
enterprise architecture Continuity of Care Record
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16. HealthBase
enterprise architecture Detailed Clinical Models
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17. HealthBase
10041.3 Structured Documents
enterprise architecture
(HL7 CDA)
Document • Document template has specific set of
sections
Header
Author • Document identified by a templateId
Demographics
…
Body
Section
Clinical Information
Section
Clinical Information
Section
Clinical Information
• Entries map reference the
Exchange Content Model
• Each section has specific contents
• Specific characteristics, e.g. context, wholeness,
identified by a template Id
persistence
• Incremental Interoperability
• Not workflow
• Templates for sections, documents
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18. HealthBase
enterprise architecture
HISO Public Comment Process

19. HealthBase
enterprise architecture Public comment
• Public comment closed 17 Oct 2011
• Review panel held 27 Oct 2011
• 14 respondents
• 100+ comments
• HISO 10040.1: 28 comments, 26 agreed
• HISO 10040.2: 46 comments, 14 agreed
• HISO 10040.3: 37 comments, 20 agreed
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20. HealthBase
enterprise architecture Bouquets and brickbats
• ‘In our view, use of XDS is not a good approach to
information sharing for the New Zealand environment’
• ‘The ISO/IEC 11179 metadata standard may itself be
vapourware’
• ‘The HISO 10040 standard is based on an inadequate
underlying model of clinical medicine’
• ‘The current chimerical HIE Content Model offering looks
more like a standards soup’
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21. HealthBase
enterprise architecture Bouquets and brickbats
• ‘A very readable document, easy to follow – well
done to the authors’
• ‘We applaud the IT Health Board and HISO for their
efforts to create and adopt industry standards for
interoperability’
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22. HealthBase
enterprise architecture Comments on 10040.1 (XDS)
• What is a Regional CDR in XDS terms?
• What is an affinity domain?
• How many regions are we talking about and what’s the
purpose of repositories at national level?
• Shouldn’t this standard for interoperability include
eForms?
• What place is there for HL7 v2 transport?
• Do we use NHI or PAS as the patient identity source?
• Where in the world is XDS actually used?
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23. HealthBase
enterprise architecture Where in the world is XDS?
23

24. HealthBase
enterprise architecture Dossier Médical Personnel
24

25. HealthBase
enterprise architecture Dossier Médical Personnel
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26. HealthBase
enterprise architecture PCEHR in Australia
• ‘IHE has developed a number of integration profiles
which have been adopted internationally to provide
services consistent with the Australian PCEHR vision.
These profile components are called Cross Enterprise
Document Sharing (IHE - XDS)’
[http://ihe-australia.wikispaces.com/PCEHR]
• PCEHR Concept of Operations requires repositories
to support either XDS or RLUS
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27. HealthBase
Comments on 10040.2
enterprise architecture
(HIE Content Model)
• What is ‘core health information’?
• Which approach to Detailed Clinical Models?
• Extension versus specialisation
• Suitability of CCR
• Importance of the problem list
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28. HealthBase
enterprise architecture Content model development
• ‘Revision should involve creation of a simple (but not
simplistic) continuity of care model that (a) is
problem centred, (b) allows representation of
problems as they evolve over time, and (c) facilitates
clear representation of clinical meta-information
(linking hypotheses to observations)’
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29. HealthBase
enterprise architecture Content model development
– CCR supports a problem list, – Whether the subject is aware of
which may be any length, of the the problem – and if not, why not
patient’s current and resolved – can be recorded
problems – There’s a link to medications –
– A problem may be classified as when a listed problem is an
either a condition, diagnosis, indication for certain medication
symptom, finding, complaint or – Clinical documents may be
functional limitation associated with problems
– Problems can be described using – Problems may be recorded as the
SNOMED CT and/or in narrative cause of allergies or adverse
– Problems have a status of either reactions
active, inactive, chronic, – The existence of a problem may
intermittent, recurrent, or be flagged as an alert
resolved – Orders and results may be linked
– Problem episodes are recorded to problems
– The problem list can be ranked or – A problem may be an indication
filtered by date of onset or order for a procedure
of importance, e.g. for a referral – A problem may be a reason for an
– The source of problem encounter
information may be recorded,
including who and when

30. HealthBase
enterprise architecture Comments on 10040.3 (CDA)
• Questions about the value of document orientation
• Questions about the HL7 v3 RIM
• Salutary lessons related to the NHS
• Document lifecycles
• Document stewardship and custodianship
• How do we manage ‘state’ and workflow?
• Virtual / on-demand documents
• Document security
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31. HealthBase
enterprise architecture Ratification of HISO 10040
• HISO 10040 ballot round after public comment
• Expected to become interim standard in December
2011
• Proof-of-concept work to follow
• Becomes full standard once there is a successful
implementation
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32. HealthBase
enterprise architecture
Further development

33. HealthBase
enterprise architecture Further development
33

34. HealthBase
enterprise architecture Conclusion
• SAG has created an Interoperability Reference
Architecture in support of the Health IT Plan
• The three essentials – CCR-based content model,
CDA structured documents and XDS transport – have
been formulated as architecture building blocks
• These building blocks have been put through the
HISO process towards becoming sector standards
• Proof of concept work will be undertaken in support
of future regional implementations

35. HealthBase
enterprise architecture
Thank you