Ontario EHRi Enterprise Architecture Project Terms of Reference Presentation to OHIMA

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Ontario EHRi Enterprise Architecture
ProjectTerms of ReferencePresentation to OHIMA

• Bill Gilliam, Project Lead Architect
• SSHA Standards Management Business Integration
• May 2004

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PROJECT TEAM

• Danna Dobson, Executive Director (SMBI)
• Ilia Ladouceur, Project Lead (ePP)
• Bill Gilliam, Project Lead Architect (SMBI)
• Richard Liu, Solution Architect (ePP)

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Todays Objectives

• Communicate project rationale, goals and
  objectives and approach
• Next steps

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Ontario's eHealth Strategy Vision is broad in
scope

• Includes all health information jurisdictional
  and point of service systems
• Includes interoperability between all
  participants
• Includes functionality beyond clinical systems
  (e.g. financial, claims, adjudication, billing,
  health card validation, business initiatives,
  etc.)
• Priorities set by eHealth Council

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Ontarios eHealth Strategy Overview
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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Ontario's eHealth Strategy Government Program
Alignment
Federal Provincial Government Programs
Infoway EHRS Blueprint
Infoway EHRi Architecture
Ontario EHRi Enterprise Architecture
Ontario eHealth Strategy
Ontario Health System Environment
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What is Infoways definition of an Electronic
Health Record?
An Electronic Health Record (EHR) provides each
individual in Canada with a secure and private
lifetime record of their key health history and
care within the health system. The record is
available electronically to authorized health
care providers and the individual anywhere,
anytime in support of high quality care.
EHR

• Infoways goal have the elements of
  interoperable EHR solutions in place within 5-7
  years

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Infoways definition of the Electronic Health
Record Solution

• Organizational entities, business processes,
  technology and standards of best practices and
  electronic solutions for high quality and
  effective healthcare.

EHRS
EHRi (Infostructure) Mechanisms to find
uniquely identify people, providers
locations Patient centric EHR Domain
Repositories Common services and standards to
enable integration and interoperability Services
to ensure privacy and security Physical
infrastructure to support reliable and highly
available communications across Canada EHRS
(Solution) includes all of above
and Presentation solutions and intelligent
agents Workflow case management Decision
support services Services to support health
surveillance and research
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What is Infoways definition of an an Enterprise
Architecture?

• Formal description of the business, infostructure
  and infrastructure services and technology
  options a reference model
• Provides standards and guidelines for systems
• Organization of structural and functional
  properties
• Describes the components or building blocks of
  the information system
• Defines interrelationships between service
  components
• Detailed plan from which a system can be rapidly
  implemented and incorporate new functionality or
  technology

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Infoway EHRS / EHRi Blueprint Terminology
Electronic Health Record Solution (EHRS)
Electronic Health Record Infostructure (EHRi)
Jurisdictional Systems
Health InformationAccess Layer
Point of Service Systems
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Ontario EHRi Enterprise Architecture
ProjectBenefits

• Infoway EHRS Blueprint outlines the plan for
  expanding and making the EHRi operational for
  Ontario
• The Ontario EHRi Enterprise Architecture defines
  the infostructure kernel for provincial
  interoperability
• Geographic / Program / Health Sector Business
  Initiatives in Ontario can use the Ontario EHRi
  Enterprise Architecture for
• Architectural review / compliance with Infoway
  EHRi strategies
• Analysis for Infoway funding opportunities
• Potential reuse of EHRi components (both
  infostructure and infrastructure)
• Interoperability message standardization between
  peer to peer systems
• Interoperability message standardization with
  Province-wide EHR and other jurisdictional
  systems
• Future extension of the Ontario EHRi Enterprise
  Architecture -- the To Be Architecture -- will
  guide the coordinated implementation of
  jurisdictional Ontario Health System Environment
  within the Ontario eHealth Strategy

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EHR Strategic Direction Ontario

• Ontario has developed a high level EHR Strategy
• Arrived at through consultation with stakeholders
• Identified key components of a comprehensive
  electronic health record
• Leveraging government investments and pilot
  opportunities
• Work is underway (policy, legal, procurement,
  etc.) to seek government approval to introduce a
  province-wide EHR
• Built upon standards, privacy and security
  frameworks
• The Province-wide EHR
• Is a cornerstone of Ontarios eHealth Strategy
• Supports and aligns with Infoways pan-Canadian
  EHRi initiative
• Ontarios health service provider community is
  paving the way for the creation of a
  province-wide EHR Solution
• Consists of enabling SSHA infrastructure, a
  secure data repository, province-wide registries,
  unique identifiers for providers, clients,
  locations, and interfaces to domain repositories

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Ontario High Level EHR Strategy (Target)
Provincial (Operational)
Local (Operational)
Collaborative Groups(Operational)
Provincial (Sharing)
EHR(Thin )
Medical Practices
EMR
Health Profile (CDS)
EMR
EMR
Hospitals
EPR
Selected Hospital Encounters
CDR
EPR
EPR
CCACs
ECR
ECR
Domain Repositories
Rx (HNS)
Selected CCAC Encounters
PHUs
For future consideration, currently not
proposed/planned
ECR
ECR
DI
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)
eCHN
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
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Ontario Alignment with EHRi Architecture
EHR - Province-wide EHR - eCHN
Client Registry -RPDB -UPI -Identity Management
Lab -OLIS
Provider Registry -CPDB -RMS
Drug -HNS / ODB

• Location Registry
• RMS

• DI
• NORrad
• Southwest, etc.

Service Components Infrastructure
(e.g.) -Directory Svcs -HL7 Interfaces -Messaging
Svcs -Security Privacy -etc ...

• EHRi
• OHISC (Stds.)
• -eCHN, CHA
• CCO/UHN
• DII (CCO)

• NOTE
• Diagram illustrates examples of Ontario
  initiatives that map to Infoways architecture
  and is not intended to be an all inclusive list
• In addition, Ontario has a number of Program and
  Geographic-Based eHealth initiatives throughout
  the Province

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Ontario EHRi Enterprise Architecture
ProjecteHealth Initiative Governance
Participation

• The ability to progress the Ontario alignment
  with Infoways EHRi vision priorities requires
  MOHLTC, Ontario eHealth Council and SSHA, eHealth
  / Business Initiatives to participate in this
  project
• These initiatives are on the critical path to
  create an interoperable foundation of
  Province-wide EHR and other jurisdictional
  systems, for example
• Drug (HNS / ODB)
• Lab (OLIS)
• Client Registry (RPDB, CRIMS)
• Provider registry (CPDB, RMS)
• Public Health (IPHIS)
• CCAC
• Others

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Ontario EHRi Enterprise ArchitectureProject Goal

• The goal of the Ontario EHRi Enterprise
  Architecture initiative is to articulate the
  Ontario EHR vision and strategy and to identify
  the alignment / gaps between Ontarios and
  Infoways pan-Canadian strategies.

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Ontario EHRi Enterprise ArchitectureProject
Objectives

• Document the Infoway EHRi Architecture based on
  Ontarios understanding of the Infoway EHRS
  Blueprint (architecture, concepts and principles)
• Use the Infoway EHRi Architecture to create an
  Ontario EHRi Enterprise Architecture instance
  based on the Ontario EHR High Level Strategy
• Identify and document alignment and gaps between
  the Ontario EHRi Enterprise Architecture and the
  Infoway EHRi Architecture

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Ontario EHRi Enterprise ArchitectureProject
Objectives (continued)

• Produce recommendations to address gaps
• Create architecture management recommendations,
  which include
• A process by which current and new initiatives
  (e.g. ePP Architecture, ePP Interface
  Architecture, Province-wide EHR, etc.) can be
  aligned with the Ontario EHRi Enterprise
  Architecture
• A process to maintain the Ontario EHRi Enterprise
  Architecture

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Ontario EHRi Enterprise Architecture Project
Scope

• Is based on information included in
• Infoway EHRS Blueprint Version 1.0
• Infoway Infostructure Investment Program Strategy
  RFI
• Infoway Generation 3 Drug Information System RFI
• Infoway Data Definitions and Standards Project
  Update Webcast
• Reflects the priorities for Ontario within the
  Infoway pan-Canadian vision
• Includes the business transactional layer and
  standards alignment of programs / initiatives
  identified by the Ontario EHR High Level Strategy

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Ontario EHRi Enterprise Architecture Project
Scope (continued)

• Provides a context for keeping the Ontario EHR
  High-Level Strategy current and up-to-date
• Is limited to the business, information and
  technical architectures related to jurisdictional
  (province-wide) systems versus point of service
  applications
• Is created to provide a reference architecture
  that can be used by all Ontario healthcare sector
  stakeholders to assist in the alignment of
  initiatives and projects with the Infoway
  pan-Canadian vision starting with the Ontario EHR
  High Level Strategy.

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Ontario EHRi Enterprise Architecture ProjectOut
of Scope

• Operational Domains detailed descriptions of
  operational domains / point of service systems
  such as CMS, LIS etc will not be included in this
  architecture.
• The Financial data domain (e.g. Claims, Global
  Funding) and other domains that are not directly
  related to provision of clinical care e.g.
  Knowledge Management, etc.) are currently
  excluded from the Conceptual Domain Diagram
  except for synchronization purposes.

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Ontario EHRi Enterprise ArchitectureProject
Approach
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Ontario EHRi Enterprise Architecture Project
Approach (continued)
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Ontario EHRi Enterprise Architecture
ProjectDeliverables (Stage 1 and Stage 2)
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Infoway EHRi Business ArchitectureBusiness
Domains
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Infoway EHRi Information ArchitectureData Domains
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Infoway EHRi Technology ArchitectureService
Components
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Project Steering Committee Summary Decisions
(February 2004)

• Steering committee endorsed
• The goals and objectives of this initiative
• The governance model is correctly structured to
  achieve these goals objectives
• The sector stakeholder representatives ready and
  able to participate

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Ontario EHRi Enterprise Architecture ProjectNext
Steps

• Steering Committee committed to
• Identify additional members
• Endorse business initiative teams to participate
  with this project
• Provide project status to their eHealth Council
  representatives
• Endorse SMBI / ePP to lead and manage this
  project

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Ontario EHRi Enterprise Architecture
ProjectStage 2 Update
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ELECTRONIC HEALTH RECORD PROJECT
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Province-wide EHR Information Sharing
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ELECTRONIC HEALTH RECORD SYSTEM CONCEPTUAL
PROTOTYPE
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EHR Conceptual Prototype

• Objectives
• The conceptual prototype will serve as a
• EHR Project business analysis tool
• Stakeholder communications tool
• Disclaimers please note!
• The prototype is an evolving conceptual model (a
  work in progress) and therefore subject to
  change
• In the future, the full system will not appear or
  operate exactly as shown
• As this is a conceptual model, it is not intended
  that every feature or user interface style shown
  will be included in the final design

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Stakeholder communications tool

• Shows a concrete representation of one way in
  which proposed system concepts could be
  implemented
• Allows us to determine how well stakeholders
  grasp the concepts i.e., understand how real
  clinical data would be handled in real situations
• Facilitates consultation provides opportunity
  for stakeholder feedback
• Helps confirm the scope of the desired
  functionality
• Shows examples of intended system functionality,
  including planned and future interfaces

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EHR
OLIS
ODB
CCAC Encounters
Hospital Encounters
Health Profile
Patient FRED THOMPSON, AGE 53, MALE HN
4563 456 842 AG Primary Care Physician Dr.
Brian McGee, Oshawa [phone]
The EHR contains the Health Profile, along with
Hospital encounter data. The Health Profile is
maintained by the patients Primary Care
Physician (PCP). Dr. Lyver reviews this data to
determine if any past medical history is relevant
to the patients presenting complaint.
For Discussion Purposes Only
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Dr. Lyver opens the hospital section of the EHR
to check for recent hospital encounters (the blue
tabs only appear if the patient has information
of that type). She notes that the patient visited
the ED in Oshawa the previous night with the same
problem. The same tests she would have done, were
performed last night, so she might not have to
repeat them.
For Discussion
Purposes Only
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EHR System TORONTO EAST
GENERAL HOSPITAL INC. EMERGENCY
DEPT
EHR
OLIS
ODB
Hospital Encounters
Health Profile
CCAC Encounters
ADT
Encounter Summary
Medications
Discharge Summaries
Lab Results
Diagnostic Reports
Operative Reports
Patient FRED THOMPSON, AGE 53, MALE HN 4563
456 842 AG Address 45 Any Street, Oshawa, ON
L6V 2S4 Home [phone] PCPhysician Dr.
Brian McGee, Oshawa [phone]
Jan 25, 2004 1930 LR Health, Oshawa DI
Dr. Susan Crowe Abdominal Series Oct 23, 2003
1145 LR Health, Oshawa DI Dr. Brian
McGee Abdominal Series
Date Time Location Dept
Ordering Physician Test(s) Ordered
Dr. Lyver decides to check the Diagnostic
Reports. She selects the appropriate tab and
then clicks to highlight the X-ray report she
wishes to see.
For Discussion
Purposes Only
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Dr. Lyver reviews the report on the abdominal
X-Ray series from the previous evening. She notes
there are no abnormalities on the X-Rays.

For
Discussion Purposes Only
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EHR System TOR0NTO EAST GENERAL
HOSPITAL INC.
EHR
OLIS
ODB
CCAC Encounters
Hospital Encounters
Health Profile
ADT
Encounter Summary
Medications
Discharge Summaries
Lab Results
Diagnostic Reports
Operative Reports
Patient FRED THOMPSON, AGE 53, MALE HN 1234
567 890 Address 21 Any Street, Oshawa, ON L6V
2S4 Home [phone] PCPhysician Dr.
Brian McGee, Oshawa [phone]
Oct 30, 2003 1930 LR Health, Oshawa Dr.
Paul Stewart 1. Colonoscopy 2. Upper
Endoscopy
Date Time Location Physician
Procedure(s)
Dr. Lyver decides to check for any Operative
Reports. She clicks to select the colonoscopy
from October in order to pull up the
corresponding report. For Discussion
Purposes Only
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EHR System TOR0NTO EAST GENERAL
HOSPITAL INC.
EHR
OLIS
ODB
CCAC Encounters
Hospital Encounters
Health Profile
ADT
Encounter Summary
Medications
Discharge Summaries
Lab Results
Diagnostic Reports
Operative Reports
Patient FRED THOMPSON, AGE 53, MALE HN 1234
567 890 Address 21 Any Street, Oshawa, ON L6V
2S4 Home [phone] PCPhysician Dr.
Brian McGee, Oshawa [phone]
LAKERIDGE HEALTH OSHAWA 1 Hospital Court,
Oshawa, ON L1G 2B9 Adm Date 30/10/03
Hospital Number H000304578 DOB 01/01/50 Name
Thompson, Fred Doctor Stewwart, Paul Account
Number DS 0083445/0_ OPERATIVE REPORT Job ID
409100 INPATIENT LOCATION GS-ENC-DS DATE OF
OR 30/10/03 SURGEON Paul Stewart
POST-OPERATIVE DIAGNOSIS 1. Multiple sigmoid
and descending colon diverticula. 2. A few tiny
polyps in the distal sigmoid and rectum,
measuring approximately 1-2 mm in diameter and
looked hyperplastic. Some were biopsied for
sampling. No other abnormalities were seen and
random biopsies were taken. 3. Upper endoscopy
revealed a Schatzki Ring that was not obstructing
and a 2 cm hiatal hernia. 4. Small polyp in the
fundus of the stomach, likely a fundic polyp no
significance. This was biopsied. 5. Multiple
white spots/patches in the duodenum, ? etiology.
Biopsies were taken. Biopsies were taken from
small bowel as well. OPERATION PERFORMED 1.
Colonoscopy to Terminal Ileum. c 2. Upper
Endoscopy. PREOPERATIVE MEDICATIONS
Intravenous Versed and Fentanyl. PROCEDURE 1.
Colonoscopy to terminal ileum.
Dr. Lyver reviews the operative report from the
colonoscopy. It suggests that the patients
current symptoms might be caused by diverticular
disease. For Discussion Purposes
Only
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Primary Care Physician - Clinical Management
System (example)
Appointments
Notifications
Charts
Print
EHR System
EHR
ODB
OLIS
Hospital Encounters
Health Profile
CCAC Encounters
Patient FRED THOMPSON, AGE 53, MALE HN 4563
456 842 AG Address 21 Any Street, Oshawa, ON
L6V 2S4 Home [phone] PCPhysician
Dr. Brian McGee, Oshawa [phone]
Dr. McGee clicks on the EHR System tab, then the
EHR tab, and then the CCAC tab to open the
document. It confirms that Wilma Anderson was
discharged from hospital 26/01/2004 and the CCAC
has set up Professional and Personal Support
Services, with Dr. McGee to provide medical
management. For Discussion
Purposes Only
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Primary Care Physician - Clinical Management
System (example)
Notifications
Charts
Appointments
Print
EHR System
EHR
OLIS
ODB
Hospital Encounters
Health Profile
CCAC Encounters
ADT
Encounter Summary
Medications
Discharge Summaries
Lab Results
Diagnostic Reports
Operative Reports
HOSPITAL CLINICAL DATA Dr. Brian McGee Patient
List
Name Hospital
Hospital Age/Sex Status Date
Location
Thompson, Fred Toronto East General
2009874 53M Discharged 26 Jan 04 ED Wilson,
Harold Lakeridge Oshawa G000254 73M Discharged 26
Jan 04 Medicine Raas, Jennifer Lakeridge
Oshawa B000212 6F Admitted 27 Jan
04 Pediatrics Thompson, Fred Lakeridge
Oshawa F000436 53M Discharged 25 Jan
04 ED Wilson, Harold Lakeridge Oshawa G000254 73
M Admitted 26 Jan 04 Medicine Booth, William
Lakeridge Oshawa B000116 65M Discharged 23 Jan
04 ECG Clinic
While in the EHR System, Dr. McGee clicks on the
EHR tab, then the Hospital tab and brings up the
display of Admit, Discharge, Transfer data for
his patients. He selects William Booth to see if
his ECG Report is available, and looks under
Diagnostic Reports. For
Discussion Purposes Only
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Primary Care Physician - Clinical Management
System (example)
Notifications
Charts
Appointments
Print
EHR System
EHR
OLIS
ODB
CCAC Encounters
Hospital Encounters
Health Profile
Encounter Summary
Medications
Discharge Summaries
Lab Results
Diagnostic Reports
Operative Reports
ADT
Patient WILLIAM BOOTH, AGE 65, MALE HN 1211
562 888 Address 213 Some Street, Oshawa, ON L6V
2S8 Home [phone] PCPhysician Dr.
Brian McGee, Oshawa [phone]
LAKERIDGE HEALTH OSHAWA 1 Hospital Court
Oshawa, ON L1G 2B9 Adm Date 23/01/04
Hospital Number H000414580 DOB 05/05/37 Name
Booth, William Out Patient Stress
Test
Dr. McGee reviews the ECG of William Booth, which
confirms his diagnosis of atrial fibrillation.
For Discussion Purposes Only
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OHIMA Involvement

• Provide input via OHISC
• Clinical data content
• Clinical data coding
• Current projects of interest to OHISC
• Client Registry
• EHR Health Profile

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END OF PRESENTATION