Transcript What did Continua do with CDA? Interface to EHR and PHR systems

What did Continua do with CDA?
Interface to EHR and PHR systems
Keith Naylor
December 2009
Agenda
• Background
– Who are Continua?
– The ‘Continua Technology Stack’
– The ‘HRN-IF’ (previously known as xHR)
• CDA, CCD and PHM within the HRN-IF
• Example and demo (if we have a live web connection)
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Continua – who are they?
• The Continua Health Alliance’s mission:
– to establish an ecosystem of interoperable personal health
systems that empower people and organizations to better
manage their health and wellness.
• The charter of Continua’s Technical Working Group (TWG):
– is to select the standards and specifications necessary to
meet this vision and to define Design Guidelines that further
clarify the standards and specifications that guarantee
seamless interoperability is achieved.
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The Continua Technology Stack
PAN Device
Health
Record
Device
Tele-Health WAN
Device
HRN-Interface
LAN-Interface
WAN-Interface
PAN-Interface
LAN Device
Application
Hosting Device
X
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Heath Record Network - IF
• The purpose of the HRN interface:
– is to transfer patient information from a Continua WAN
device (HRN Sender) to either another WAN device or
an electronic health record device (HRN Receiver)
• The HRN Sender can be:
– A Remote Patient Monitoring (RPM) server of a Disease
Management service provider
– An Application Server of an Aging Independently or
Health & Fitness service provider
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Heath Record Network - IF
• The patient information for transfer may include:
–
–
–
–
report summarizing the patient’s current status,
a detailed listing of specific patient results,
readings from one or more personal health devices,
or a combination of these.
• The electronic health record device may contain:
– hospital’s Enterprise Health Record (EHR),
– physician’s Electronic Medical Record (EMR)
– Personal Health Record service (PHR) used by the
patient.
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HRN-IF Standards Selection
• Data: To facilitate the accurate transfer of
both coded patient results from personal
health devices and textual summary results
from patient care-givers, the HL7 Personal
Healthcare Monitoring Report document
format standard was chosen.
• NOTE:
The Data Guidelines are based on the HL7 CDA R2
standard, profiled by the HL7 Personal Healthcare Monitoring (PHM)
Implementation Guide.
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HRN-IF Standards Selection
• Messaging: A future is envisioned where patient information is sent
between providers by various methods. These methods include: secure
direct connection over the Internet, secure email, delivery on portable
media (data stick, etc.), through a messaging hub, and through a data
repository or RHIO / NHIN.
• To facilitate this, a messaging standard capable of supporting all five
transport methods with a minimal amount of re-work was chosen. That
is, once the first transport method was accomplished, incorporating
additional transport methods require less work.
• In addition, because this interface is used to communicate with nonContinua certified electronic health records, a messaging standard
supported by others that certify electronic health record systems was
chosen.
• For these reasons, Integrating the Healthcare Enterprise’s (IHE)
Cross-Enterprise Document Sharing (XDS) profile was chosen.
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HRN-IF Standards Selection
• Transport Protocol: To accomplish secure direct
communication of pertinent patient information
between care-givers, the IHE XDR (CrossEnterprise Document Reliable interchange)
profile utilizes current standards such as SOAP 1.2
and MTOM.
• To accomplish secure indirect communication of
pertinent patient information between caregivers, the IHE Cross-Enterprise Document Media
Interchange (XDM) profile utilizes current
standards such as Zip and S-MIME.
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CDA,CCD and PHMR
• The data transmitted from the HRN Sender can be either
summary, raw data or both. The summarization may be a
result of analysis by an authentic disease management
service provider. The data has multiple characteristics that
include:
– Representation of measurements captured by devices
– Representation of notes, summary, and other kinds of
narrative information that are added by care givers or by the
user themselves
– Representation of graphs that are added by intermediary
devices that represent trends of user’s health
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CDA,CCD and PHMR
• To accommodate the wide variety of data characteristics, the HL7
Clinical Document Architecture (CDA) based format is chosen.
• The guidelines specify constraints on the CDA in accordance with
requirements set forward by the HRN interface.
• These constraints are laid out in the Personal Healthcare Monitoring
Report (PHMR) Implementation Guide**.
• Wherever possible, the PHM report reuses the templates already set
forth by an HL7 specification called Continuity of Care Document
(CCD).
• Note: **HL7 PHM Report Implementation Guide will have an independent
lifecycle under a project called “Personal Health Monitoring Report” under
the HL7.org Structured Documents Workgroup (SDWG).
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PHMR
Implementation Guide for CDA Release 2.0
Personal Healthcare Monitoring Report (PHMR)
(International Realm)
Draft Standard for Trial Use
Release 1
First Release
November 2008
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PHMR Data Model
HL7 v3 - RIM
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PHMR Data Model
PHM Report
Header
Creation Date/Time - when the
report was generated
Actors and
identification
Describes and identifies all
individuals, organizations, locations
and systems with data in this
document (Patient name, Patient
ID, Patient demographics,
Document author ID, Author name,
Author demographics, Doctor
name, Doctor ID)
Purpose
Purpose of the document (e.g.,
“diabetes care progress note)
Remote
Monitoring Notes
Update/Notes/summary information
by a remote monitoring service
provide (e.g., narrative information
that may include graphs, pictures,
trends)
Functional
status
This is a place holder for free form
text written by RPM care givers,
may include interpretation of care
givers perspective of RPM
information
Device
Information
Information of the devices that are used
to collect observations (e.g., BP cuff,
glucometer)
 System Type
 System Model
 System ID
 Device Configuration ID
 Production Spec (Serial Number, Part
number, hardware revision, firmware
revision, protocol revision)
 Regulatory information
Vital sign data
Measurement observations of vital signs
 Unified Code for Units of Measure
(UCUM)
 Nomenclature mapped primarily to
SNOMED CT (with IEEE 11073 and
LOINC as necessary)
Medication
compliance
data
Describes current medications and
patient adherence
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Example PHMR
• The following slides illustrate the following:
– A series of readings taken by a patient using a Roche
Glucose Meter
– Transmitted to a Device Monitoring System, which
creates the CDA/PHMR
– Which is then transmitted to an IBM HRN gateway
– Viewed using the NHS CfH Workbench utilising a
standard XSLT transformation into HTML
–
If we have a live web connection I can demonstrate the retrieval and display of a
PHMR from an online IBM data repository
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Continua Connectivity Demo
Continua Connectivity
Demo
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ACCU-CHEK® 360˚
Diabetes Management Software
HRN Gateway
Continua HRN
(xHR)
Continua – USB Devices
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Example PHMR – CfH Workbench
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NHS CfH Workbench
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Google Health
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Questions ?
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