Transcript Presentation_ - Open Health Tools

Integrating Standards for the EHR
Workshop
Helsingor, Denmark
28th 29th October 2008
nehta
Summary for OHT
Note:
• Day 1 of this workshop was for national initiatives and
large eHealth programs only
– Included representation from:
Australia, Canada, Denmark, European Union, Lithuania,
Netherlands, New Zealand, Singapore, Sweden, UK
• Day 2 attendees:
– Included all Day 1 attendees plus:
– Representatives of Standards Development Organisations:
HL7, IHTSDO, OpenEHR
– Representatives of Suppliers:
Cerner, iSoft, BT, EMIS, Microsoft, Oracle, IBM
Why are we here?
• There are gaps in the existing standards and
undeveloped aspects that tend to be patched by the
various initiatives in ad hoc ways in order to achieve a
working deployment
• There can be confusing and sometimes heated debate
around the technicalities of different standards which can
inhibit adoption and polarise the market
• Tooling and infrastructure to support development, local
customisation and implementation of the standards is
generally poor, of limited scope, and not integrated
• Implementation support is limited and often ineffective
• There is a lack of coordination in setting direction and
priorities among national eHealth initiatives which then
effect the SDO’s work plans and budgets
Day 1 observations / issues
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Directions of entry into the problem
space vary
Large uptake of standards, with varied
success
Cost and complexity of engagement
with SDOs high
Small countries are particularly
disadvantaged
Requirements are not adequately or
collaborately expressed to SDOs
We are not sharing successes and
failures
The “volunteer” model is not free –
many stakeholders spend a lot on this.
SDOs are not adequately funded for
their assumed remit
National standards investment models
excede SDOs considerably, but best
value not being achieved
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Standardising clinical concepts a
developing theme (e.g. archetypes)
Agree that tooling and infrastructure is
weak
Version control a key concern
More holistic, generic approach
needed (e.g. Put, List, Get paradigm)
No SDO provides all of:
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Controlled medical vocabularies
Clinical concepts and business rules
Documents
Messaging
Transactions, interactions, higher level
service interaction
Need clarity on what is / is not an SDO
Need clarity on ISO / CEN role
Need to build on European
collaboration models in a global way
SDOs need clearer scope and remit
General conclusions from Day 1
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Issues and end goals of national initiatives very similar
Architectures differ, but
– Can reuse common processes, interchanges, data
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Commonality needed from processes for
– Definition of Requirements
– Ensuring standards meet needs
– Configurability
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Commonality of clinical focus areas
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Medication
Patient Summary (inc allergies)
Discharge
Laboratory
International standards needed for supplier engagement / commitment
No nation, no matter how large, can drive the standards agenda
Retrieval and usage needs to be more prominent in consideration of
standards
What do we need to do?
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Shape the market to enable nations
and large initiatives to
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To be successful within and across
national boundaries
To engage with and drive the
development and use of standards
Lower costs of interoperability
Improve timeliness
Prevent regional splits
Shape the market to enable SDOs:
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To have effective standards that are
widely adopted
To understand their stakeholder
community
To set strategy and prioritise activity
To achieve better funding flows,
directed towards business needs
Create a forum for national and other
large inititiatives to enable
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Shape the market to enable
international vendors:
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Meet their business needs
Achieve value for money for their
stakeholders
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Collaborate on requirements definition
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Collaboration
Sharing
Harmonised perspective from national
initiatives on the development of
standards
What level do we standardise?
Improve tooling and infrastructure
Establish lightweight governance to
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Identify and agree priorities
Realise accountability through the
membership
Strengthen membership and reduce
conflict and confusion in standards
development
Establish conformance criteria for
functionality against requirements
Establish conformance criteria for
implementation
Arbitrate where overlaps and gaps
occur
Country
Communities
Country
Communities
Country
Communities
Implementers
Initiative
Members
Initiative
Members
Initiative
Members
International Initiative
Requirements
& Priorities
Common Requirements
Functional Conformance Criteria
Vendor Community
SDO’s
Align Customer
Providers
Next steps
reflecting aims from Day 1, and responses at end of Day 2
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Agree whether an initiative is needed and whether there is a credible buy-in?
Day 2 Response:
Those present agreed it had been a valuable exercise, and collaboration should continue
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Form a steering group
Day 2 Response:
Existing steering group agreed to continue
(Ken, Karen, Dennis)
Agreed to distribute presentations and outcomes of this workshop
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Develop and agree remit
Day 2 Response:
Develop options for a tightly scoped Use case which could be used to focus future discussion
Facilitate on-line collaboration and teleconference
Consider a second workshop – technically focussed – which will explore chosen Use case
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Develop the governance and behaviour
Day 2 Response:
Project focussed – must deliver an outcome
Light governance
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Options for a use case (Medications?)
Day 2 Response:
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Current medications list an option (prescribing too tied to regional legislation)
Allergies is high value, and tightly scoped
Diagnosis – may be simpler, and ubiquitous
Critical success factors
• Forum progresses requirements, and
shares them freely
• Has buy-in from national initiatives, SDOs
and suppliers
• Can bring together an early consolidated
list of key requirements
• Is inclusive, open and transparent
• Has early successes
• Is authoritative