Healthcare software services open interfaces and standards in Finland

1
Healthcare software services- open interfaces
and standards in Finland

• HL7/OMG Healthcare Services Specification Project
  
• London, 31 Jan 2006
• Juha Mykkänen, University of Kuopio, HIS RD unit
• SerAPI project, HL7 Finland CS SIG

2
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
• comparison of three services
• experiences
• national efforts
• HSSP

3
Healthcare HIS in Finland

• 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 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?

4
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-)
• initial focus on clinical context integration
  (CCOW)
• work on service specifications from the
  background projects - national comments,
  balloting
• 3 available specification areas implementation
  guides

5
Background PlugIT project
www.plugit.fi
Natl. healthcare programme / National EHR project
3 univ. depts, 1 polytechnic
12 applications vendors, 3 technology vendors
6 hospital districts, 2 municipalities

• National RD project to develop integration
  solutions for healthcare
• Results Service specifications, integration
  methods, centre of expertise
• Oct 2001Aug 2004, about 15 full-time 15
  part-time researcher/developers
• Budget 2 million, 84 by National Technology
  Agency TEKES

6
Background SerAPI

• SerAPI project (2004-2007)
• national RD 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
• participation in standards development (national
  / international)
• Healthcare Services Specification Project
• participation through both OMG and HL7
• infrastructure work / individual services

7
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
• DRG classification
• OID generation
• other in progress and related
• scheduling e-booking
• decision support
• patient lists, care relationship, etc.

8
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 in 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.

9
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, DRG, OID)
• in addition to
• CDA documents (national EHR core technology) -
  national "services"
• HL7 messaging (v2.3 ? v3 Web services
  transport)
• others (EDI, custom solutions..)

10
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, regional 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.

11
Comparison of service scenarios 1
12
Comparison of service scenarios 2
13
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 the 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)

14
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)
• 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) .. )

15
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, 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

Juha.Mykkanen_at_uku.fi