HEALTH INFORMATICS STANDARDS Showcase 2004 Ontario Panel Presentation

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HEALTH INFORMATICS STANDARDSShowcase 2004
Ontario Panel Presentation

• Presented by Danna Dobson, Executive Director
• Standards Management Business Integration
  Ontarios Electronic Health Record Project
• Smart Systems for Health Agency

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Healthcare Information Sharing Challenges

• Delivering evidence-based care wherever the
  patient may becoupled with a variety of vendor
  systems
• A shift in care from specialist providers to
  community locales e.g. eCHN and MY CARE portal
• An increasingly distributed and mobile clinical
  and client workforces
• A high growth of consumerism and patient
  participation in healthcare e.g. MY CARE
  (patient-focused)
• A critical reliance on comprehensive patient
  records
• Consumers expectations to reduce the redundancy
  of data collection and more efficient sharing of
  appropriate data to appropriate providers
• Increasing concerns regarding the confidentiality
  of patient records

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Complexity of Ontarios eHealth Landscape
MOHLTC, Ontario eHealth Council and SSHA
Integration thru Geographic-Based Initiatives
Integration thru Program Initiatives
Integration thru Province-wide EHR
EHR, Network, PKI/security, Data Centres, Secure
messaging, Portal
Authoritative registries and unique identifiers
for providers, patients and location (sites,
facilities, organizations, applications)
Enterprise Master Person Indices, directory
services
Ontario Health Informatics Standards Council
(OHISC)
Align Legislative Policy Frameworks and Program
Incentives
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Connecting the Dots.

• Question
• What does My Care Source Portal and eCHN have in
  common?
• Answer
• They both
• Allow for the sharing and exchange of health
  information
• Enable interoperability among information systems
• Have adopted standards or a standards-based
  approach within the scope of their own projects

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Connecting the Dots..Sharing the Information

• Interoperability is one of the key ingredients to
  this success
• Broader Cross- Sectoral Solutions
• Standards to ensure interoperability among health
  information systems
• Standards Governance to manage the priorities of
  need, development and adoption of provincial
  standards

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Why Health Informatics Standards?

• Health informatics standards are
• Accepted rules or formats used to share and
  exchange information in a consistent way and
  maintain meaning
• The link in establishing and maintaining
  application interoperability amongst and across
  healthcare systems
• Health informatics standards set some business
  and content rules that let information systems
  talk to one another.

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Ontarios Vision for a Province-wide EHR

• A 'thin EHR' that is intended to be shared
  cross-sectorally and include
• An Health Profile (cumulative patient profile)
• Selected hospital encounters (e.g. ADT related
  info)
• Links to clinical domain repositories (e.g. Lab,
  Drug)
• Interfaces to provincial infostructure ( e.g.
  registries)
• Not intended to function or substitute for a
  comprehensive local/regional point of service EHR

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Ontario High Level EHR Strategy (Target)
Provincial (Operational)
Local (Operational)
Collaborative Groups(Operational)
Provincial (Sharing)
EHR (Thin)
Health Profile (CDS)
Medical Practices
EMR
EMR
EMR
Selected Hospital Encounters
Hospitals
EPR
CDR
EPR
EPR
CCACs
Domain Repositories
ECR
ECR
Selected CCAC Encounters
Rx (HNS)
PHUs
DI
For future consideration, currently not
proposed/planned
ECR
ECR
Shared ECR
Labs (OLIS)
Others
?
Further consultation required with other sectors
(e.g. Mental Health, Rehab, Long Term Care, and
Private Diagnostic Facilities) and with proposed
new regional and program initiatives (i.e.
disease-specific e.g. cancer, diabetes)
?
Enabling Infrastructure
Network, Hosting, Messaging and Directories,
Privacy and Security, Standards Health
Information Access Layer (HIAL includes
gateways) is used to facilitate information
exchange among all repositories and applications
Registries Client (E M P I / UPI/IdM), Provider,
Location, Consent
Business Rules and Workflow (Operational Systems)
Shared Repositories
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Ontario Alignment with Infoways EHRS Architecture
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Sharing Information is Fundamental to an EHR
Province-wide EHR

• Registries
• Client (CRIMS)
• Provider (RMS)
• Domain Repositories

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Application Interoperability using HL7

• HL7 is a recognized standard for exchanging
  clinical data
• "Level Seven" refers to the highest level of
  ISOs communications model for Open Systems
  Interconnection (OSI) the application level
• HL7 focuses on interface requirements of entire
  healthcare organizations (most other SDOs create
  standards for particular domain e.g. pharmacy,
  medical devices, imaging or insurance
  transactions)

American National Standards Institute
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Why HL7?

• HL7 standards widely implemented, especially in
  the hospital sector, including eCHN
• Helps focus users on the data as well
• Ontarios EHR strategy will require HL7 messaging
  standards for transfer of information to and from
  current and future infostructure
• Client - provider - location registries
• Clinical data Domain repositories (e.g. Rx, Lab
  and DI)
• Local instances of EHRs

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Patient-focused Benefits of HL7

• Increased access to patient data can increase
  rate of care delivery
• The right information, in the right place, at the
  right time aids decision support
• Improved confidentiality by reducing exchanges of
  paper-based data
• Elimination of repeated data entry improves data
  quality and reduces errors
• Information sharing between provider systems and
  repositories can reduce redundant service
  delivery
• Elimination of repeated data entry permits
  re-allocation of human resources

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Administrative Benefits of HL7

• Open, platform-independent standard, widely
  accepted in health information system community
• Reduces custom programming for interoperability
  (required in absence of standards)
• Enables information exchange between applications
  developed by different vendors
• Standardized approach permits cost-effective
  system interoperability and coordinated
  maintenance
• Implementation flexibility (HL7 message can be
  implemented using different technical
  implementation designs)

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Who Are We and How Do We Fit In?

• Standards Management and Business Integration,
  SSHA has the standards management mandate on
  behalf of the Ontario Minister of Health and
  Long-Term Care, which includes recommending
  standards for approval and use within the
  province
• Secretariat to the Ontario Health Informatics
  Council (OHISC)
• Link to pan-Canadian and international standards
  development organizations (SDOs)

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SMBI Who are we, how do we fit in?

• eHealth Project integration support
• Standards needs analysis, development and
  adoption strategies
• Stakeholder Engagement to support standards
  development
• Information and Business Architectures to ensure
  the interoperability success of the eHealth
  strategy for Ontario

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Governance and Accountability Framework
SSHA
Minister of Health and Long-Term Care
OHISC
Ontario Deputy Minister of Health Long Term Care
Proposed e-Health Councils
Continuing Care e-Health Council
Ontario e-Health Council
Pharmacy e-Health Council
Laboratory e-Health Council
e-Health Office
Public Health e-Health Council
Physician e-Health Council
Shared Vision Strategy
Regional Integration e-Health Council
Ontario Hospital e-Health Council
Program Integration e-Health Council
MOHLTC-centric Common Applications
A collaborative approach is key to the successful
implementation of e-Health in Ontario
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OHISC

• The Ontario Health Informatics Standards Council
  is the authority for recommending health
  informatics standards to the Minister of Health
  and Long-Term Care of Ontario
• Ensures national and international alignment with
  existing standards or those under development
• The Councils vision is one of enabling the
  secure, consistent sharing of information amongst
  authorized providers across the healthcare
  system.

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OHISCs Guiding Principles

• Employs an adopt where possible, adapt where
  necessary, develop if required philosophy when
  considering standards needs of clients
• Encourages and utilizes a broad stakeholder
  engagement strategy to make use of a wide range
  of subject matter expertise
• Early focus is on standards that will ensure
• The secure exchange of information
• Comparability and consistency of shared
  information without the loss of semantical
  meaning
• Access to informational needs that support
  service delivery

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OHISC Membership

• A 17-member organization established in January
  2002 with multi-disciplinary and cross-sectoral
  representation

• Members
• Canada Health Infoway
• Canadian Council on Health Services Accreditation
• Canadian Institute for Health Information
• Information Technology Association of Ontario
• Management Board Secretariat
• Ministry of Health and Long-Term Care
• Ontario Public Health Association/Association of
  Local Public Health Agencies
• Ontario Association of Community Care Access
  Centres

• Ontario Chiropractors Association
• Ontario Health Information Management Association
  (formerly Ontario Health Records Association)
• Ontario Home Health Care Providers Association
• Ontario Hospital Association
• Ontario Medical Association
• Ontario Pharmacists Association
• Registered Nurses Association of Ontario
• Ontario Association of Medical Laboratories
• Smart Systems for Health Agency

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OHISC Update - Past

• The Minister of Health and Long-Term Care has
  approved the inaugural set of health informatics
  standards submitted by OHISC
• 7 technology standards DNS, HTML, LDAP, NTP,
  SMTP, SSL, TCP/IP
• 3 content (data) standards CCI, HL7 and
  ICD-10-CA
• Sectors have unanimously agreed that these
  standards will be adopted when clinical
  information is exchanged across Ontarios
  healthcare system

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OHISC Update - Current

• OHISC is currently working with the broader
  health sector to consider
• National e-Claims Standard (NeCST)
• Security Standard ISO/IEC 17799
• Country Sub-region codes ISO 3166-1 and 3166-2
  (also related to ISO 17120)
• Language codes ISO 639-2

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OHISC Update- Future

• SMBI and OHISC will soon engage the stakeholders
  in a review of several new ISO Standards of
  interest to Canada
• SMBI and the provincial Client Registry Identity
  Management Project will soon engage OHISC to
  officially recommend the adoption of core data
  attributes

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How You Can Help Make eHealth Standards a Reality?

• Participate in stakeholder subject matter expert
  working groups
• Participate in your sectoral consultation
  activities
• Contact SMBI about your current and upcoming
  health information system projects.
• Think broader sector and cross-sector when
  developing solutions
• Spread the wordSMBI and OHISC are here to help
  make eHealth a reality.

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How to Reach Us

• Contact Danna.dobson_at_ssha.on.ca
• Fraser Ratchford, Program Director,
• Standards Management and Co-Chair, OHISC
• Fraser.Ratchford_at_ssha.on.ca
• Email standards_at_ssha.on.ca