Anatomy of a Regional EHR Infostructure A Canadian

Anatomy of a Regional EHR Infostructure A Canadian Experience June 28, 2005 José Mussi, Group Director, Clinical Programs Canada Health Infoway

Infoway’s Mandate Mission To foster and accelerate the development and adoption of electronic health information systems with compatible standards and communications technologies on a pan-Canadian basis, with tangible benefits to Canadians. To build on existing initiatives and pursue collaborative relationships in pursuit of its mission. Goal Infoway’s plan is to have an interoperable EHR in place across 50 percent of Canada by the end of 2009. Core Business We invest with public sector partners to develop, replicate and re-use compatible electronic health systems, thereby leveraging public funds, knowledge and results across Canada, to build a safer, more efficient healthcare system.

Summary of Key EHRS Architecture Concepts • Data and Data Services – EHR and domain repositories are patient-centric, lifetime, federated databases EHR Solution (EHRS) – All clinically relevant data that needs to be shared – Encounter information – Structured, integrated and semantically consistent EHR Data & Services – Public Health repositories to support outbreaks – Registries to identify people, providers and locations of care • Health Information Access Layer (HIAL) – Standards, common and communications services to integrate applications across the continuum of care and healthcare delivery jurisdictions Public Health Services Registry Services Continuity of Care Data Domain Repository Services – Creates data and application abstraction layers – Most cost effective approach to integration HIAL – Enables integrated access and view Common Services Communication Bus • Applications – Clinical data to share is “pushed” from source systems into EHR in near real time – EHR data is “pulled” into the provider’s application for one integrated view Applications Appl

Context: EHR Solution (Infoway Blueprint) Distributed, Message-based, Peer-to-Peer Network of EHRS Systems EHR Solution (EHRS) EHRS EHR Solution (EHRS) EHR Infostructure (EHRi) Locator EHR Infostructure (EHRi) EHR Data & Services EHR Repository & Services Domain Repository Services EHR Repository & Services Registry Services Common Services Communication Bus Communication. Bus HIAL Registry Services EHR Data & Services Common Services Communication Bus Communication. Bus Applications Appl EHRS Domain Repository Services Applications Appl EHRS Appl EHRS Appl

EHR Infostructure Component Layout HIAL Location Registry Terminology Registry Outbreak Services PHS Reporting Services EHR Services Drug Information Diagnostic Imaging Laboratory HIAL HIAL Provider Registry EHR Data & Services PHS Data & Services EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Consent Security Common Services HIAL POINT OF SERVICE Configuration Communication Bus HL 7 EHR IP HL 7 EHR IP Public Health Services Pharmacy System Radiology Center PACS/RIS Lab System (LIS) Public Health Agent Pharmacist Radiologist Lab Technician EHR IP HL 7 EHR IP Hospital, Community, etc. , EPR Physician/ Provider EHR IP Physician Office EMR Physician/ Provider EHR IP Clinical Portal Physician/ Provider

EHR Infostructure Component Layout HIAL Location Registry Terminology Registry Outbreak Services EHR Services PHS Reporting Services Drug Information Diagnostic Imaging Laboratory HIAL HIAL Provider Registry EHR Data & Services PHS Data & Services EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Communication Bus Consent Security MESSAGING Common Services HIAL POINT OF SERVICE Configuration Transformation Routing Services Communication Bus HL 7 EHR IP Public Health Services HL 7 EHR IP Pharmacy System Encrypt / Decrypt Services HL 7 EHR IP Parser Services Radiology Center PACS/RIS Pharmacist Radiologist HL 7 Lab Services System (LIS) HL 7 EHR IP Serialization PROTOCOL App Protocol Services Public Health Agent HL 7 En / Decoding Services Hospital, Community, etc. , EPR EHR IP Physician Office EMR EHR IP Clinical Portal Network Protocol Services Lab Technician Physician/ Provider

EHR Infostructure Component Layout HIAL Location Registry Terminology Registry Outbreak Services PHS Reporting Services EHR Services Drug Information Diagnostic Imaging Laboratory HIAL HIAL Provider Registry EHR Data & Services PHS Data & Services EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Consent Security Common Services HIAL POINT OF SERVICE Configuration Communication Bus HL 7 EHR IP HL 7 EHR IP Public Health Services Pharmacy System Radiology Center PACS/RIS Lab System (LIS) Public Health Agent Pharmacist Radiologist Lab Technician EHR IP HL 7 EHR IP Hospital, Community, etc. , EPR Physician/ Provider EHR IP Physician Office EMR Physician/ Provider EHR IP Clinical Portal Physician/ Provider

EHR Infostructure Component Layout JURISDICTIONAL INFOSTRUCTURE HIAL Client Registry INTEROP HIAL Provider Registry Interoperability Services Terminology Registry PHS Identity Outbreak Protection Reporting Services Search / Resolution Services HIAL Location Registry Common Services PHS Data & Services EHR Data & Services PRIVACY INTEGRATION Diagnostic Imaging Laboratory HIAL Identity Mgmt Services User Authentication Services Encryption Services Privilege Mgmt Services Secure Auditing Services Digital Signature Services Consent Security Configuration Common Services Broker Services POINT OF SERVICE Drug Information Consent Mgmt Services SECURITY HIAL Service Catalogue Services EHR Anonymisation Services EHR Data & Services General Security Communication Services Bus Mapping Services HL 7 EHR IP Queuing Services Public Health Services CONTEXT Caching Services Session Mgmt Services. Public Health Agent HL 7 MANAGEMENT EHR IP GENERAL EHR IP Pharmacy Lab Alert / Notification Radiology. Management Center System Services PACS/RIS (LIS) Hospital, Auditing Community, Services etc. , EPR SUBSCRIPTION EHR IP Pub / Sub Services Pharmacist EHR IP Configuration Services HL 7 EHR IP Physician Office EMR EHR IP Clinical Portal Log Mgmt Services Exception / Error Policy Handling Management Physician/ Services Radiologist Services Technician Lab Provider Physician/ Provider

EHR Infostructure Component Layout HIAL Location Registry Terminology Registry Outbreak Services PHS Reporting Services EHR Services Drug Information Diagnostic Imaging Laboratory HIAL HIAL Provider Registry EHR Data & Services PHS Data & Services EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Consent Security Common Services HIAL POINT OF SERVICE Configuration Communication Bus HL 7 EHR IP HL 7 EHR IP Public Health Services Pharmacy System Radiology Center PACS/RIS Lab System (LIS) Public Health Agent Pharmacist Radiologist Lab Technician EHR IP HL 7 EHR IP Hospital, Community, etc. , EPR Physician/ Provider EHR IP Physician Office EMR Physician/ Provider EHR IP Clinical Portal Physician/ Provider

EHR Infostructure Component Layout HIAL Provider Registry POINT OF SERVICE EHR Services PHS Reporting Services Drug Information Diagnostic Imaging Laboratory HIAL EHR Services DATA Key Management Services Data Services Consent Security Configuration Replication ETL Services Common Services HIAL Terminology Registry Outbreak Services HIAL Location Registry EHR Data & Services PHS Data & Services EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Communication Bus BUSINESS HL 7 EHR IP Public Health Services Public Health Agent HL 7 EHR IP Pharmacy System Pharmacist Data Quality HL 7 Services EHR IP Normalization Services HL 7 EHR IP Radiology Lab Domain Business Components Center (Registries, EHR, Domains, User, Context) System PACS/RIS (LIS) Business Rules EHR Index Services Orchestration Services Radiologist Assembly Services Lab Technician HL 7 EHR IP Hospital, Community, etc. , EPR Physician/ Provider EHR IP Physician Office EMR Physician/ Provider EHR IP Clinical Portal Physician/ Provider

EHR Infostructure Component Layout JURISDICTIONAL INFOSTRUCTURE EHR Data & Services Index maintains a. PHS Data &all events that affect the clinical picture of a client. It sequential list of Services EHR also provides the location where the data relevant to each event is kept in the EHRi. It can be used to retrieve the history of events for a client or to trace the information about a specific event. Provider Diagnostic Drug Location Registry Outbreak Services HIAL Registry HIAL Client The EHR Registry PHS Reporting Services EHR Services Information Imaging Laboratory HIAL EHR Services HIAL DATA Terminology Registry Key Management Data Services POINT OF SERVICE HIAL ETL Services EHR IP Communication Bus Normalization HL 7 Services EHR IP Pharmacy Domain. Public Business Components Health System (Registries, EHR, Domains, User, Context) Services EHR Index Services Orchestration Services Public Health Agent Configuration Common Services BUSINESS Data Quality HL 7 Services Consent Security Replication Services HL 7 EHR IP Radiology Center PACS/RIS Lab System (LIS) Radiologist Lab Technician HL 7 EHR IP Hospital, Community, etc. , EPR EHR IP Physician Office EMR EHR IP Clinical Portal Business Rules Services Assembly Services Pharmacist Physician/ Provider

EHR Infostructure Component Layout HIAL Location Registry HIAL Provider Registry Terminology Registry EHR Data & Services PHS Data & Services EHR Data & Services Outbreak Locator Services PHS maintains information Reporting Services EHRS Locator EHR about the Services Drug Information Diagnostic Imaging Laboratory The EHRS EHR Infostructures where clinical data is stored for a given individual. It allows HIALtrace and retrieve which specific EHR HIAL to HIAL Infostructures should be queried in the context of a transaction retrieving data. HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Consent Security Common Services HIAL POINT OF SERVICE Configuration Communication Bus HL 7 EHR IP HL 7 EHR IP Public Health Services Pharmacy System Radiology Center PACS/RIS Lab System (LIS) Public Health Agent Pharmacist Radiologist Lab Technician EHR IP HL 7 EHR IP Hospital, Community, etc. , EPR Physician/ Provider EHR IP Physician Office EMR Physician/ Provider EHR IP Clinical Portal Physician/ Provider

EHR Infostructure - EHR Services EHR Transaction Processing Defined Location Registry Terminology Registry HIAL Clinical Data Repository Data Access Services Domain Components Client Provider Location Encounter Health Event Blood Allergy Immunization Summary Note Drug EHRS Locator EHR Data & Services EHR Services HIAL Provider Registry EHR Data & Services HIAL Client Registry HIAL JURISDICTIONAL INFOSTRUCTURE Domain Systems Normalization Lab DI Alert Etc… Business Rules Service EHR Index Repository EHR Index Service Workflow Service Messaging Registry Assembly Service Security HIAL POINT OF SERVICE Common Services Communication Bus HL 7 EHR IP Physician CIS EHR IP Clinical Portal HIAL IIP Workflow Registry Template Registry Consent Configuration

P&S Conceptual Architecture – User Authentication Services EHR Data & Services EHRi HL 7 Identity Protection Services User Authentication Services Encryption Services Secure Auditing Services Digital Signature Services UAS Domain Repository 1 Consent Mgmt Services Identity Mgmt Services HL 7 Anonymisation Services Access Control Services HL 7 EHR Data Repository General Security Services Organisational HL 7 Trusted User Management EHRi Trusted User UAS Management UAS Domain Repository 2 HIAL HL 7 Common Services HIAL User Registry HIAL Provider Registry HIAL Client Registry HIAL PRIVACY AND SECURITY Communication Bus HL 7 EHR API POS Clinical Portal UAS Organizational Trusted User Auth Service UAS EHR API EHRi Trusted User Auth Service UAS Provider UAS Domain Repository Trusted User Auth Service (Where applicable)

• Larger size Jurisdictions Provider Registry Laboratory Repository Region 2 Region 1 DI Repository EHR EMR EHR Viewer • Medium size Jurisdictions – Provincial Client and Provider and Location Registries – Provincial Lab, Drug, DI, EHR Services, HIAL and EHR Viewer – Provincial EHRS Locator across Provinces – Local EMR, CIS and EHR viewer applications Client Registry Laboratory Repository Provider Registry EHR Drug Repository DI Repository Common Services Communication Bus CIS LOCAL EHR Viewer REGIONALJURISDICTIONAL Common Services Communication Bus CIS – Provincial Client and Provider and Location Registries – Provincial Lab, Drug Repositories, HIAL and EHR Viewer – Supra-regional EHR Services and DI Repositories – EHRS Locator across regions – Local EMR, CIS applications Drug Repository HIAL Client Registry HIAL LOCAL/REGIONALJURISDICTIONAL Large and Medium Interoperability Models EMR EHR Viewer CIS EMR EHR Viewer

Small jurisdictions § Provincial Client, Provider and Location Registry § An integrated hospital CIS solution fulfilling the roles of the Provincial EHR Services, Laboratory and Drug services § A Provincial DI Service Client Registry Location Registry Provider Registry Hospital CIS as EHR DI Repository HIAL Small Jurisdictions REGIONAL / JURISDICTIONAL Example Common Services Communication Bus § Local physician office systems and other CIS connect as POS Systems LOCAL § A Provincial HIAL and EHR Viewer Community Care Centers Long Term Care Centers EHR Viewer Clinic EMR Other CIS

Investing in Standards • Why Standards – Standards facilitate information exchange and are a critical foundation for the EHR. – They create the opportunity for future cost reduction as systems converge on pan-Canadian and international standards. – In addition, standards can ease the effort required for replication. Infoway’s role is to set standards and requirements for • Mandatory Investment Eligibility Requirementsrobust, interoperable products and outcomes – Compliance to standards (infostructure and architecture) – Initiatives will comply with existing guidelines or standards that have been adopted by Infoway. Where standards or guidelines do not exist, projects must support longer-term interoperability and congruence of solutions.

Principles for Establishing pan-Canadian EHRS Standards • Infoway has created Principles for Establishing pan-Canadian EHRS Standards to provide guidance in the adoption of standard based solutions – – 11 Principles – can be found on Infoway Knowledge Way Business Driven Adoption of existing standards where ever possible http: //knowledge. infoway-inforoute. ca

Role of the SCP • Consultation and partnership are key components of the EHR Standards Collaboration Process. The process consists of: – The EHR Standards Steering Committee which leads and approves pan -Canadian EHR information standards within the context of Infoway investment programs – The EHR Standards Advisory Committee which recommends information standards for approval by the EHR Standards Steering Committee and coordinates and guides the activities of pan-Canadian Standards Groups in accordance with direction from the EHR Standards Steering Committee – A number of pan-Canadian Standards Groups that focus on the standards requirements of individual Infoway programs – An expert group of resources available to provide cross-program technical and subject matter expertise in standards

Standards at Infoway Pan-Canadian Standards Groups Standards Projects • • • • • Drugs Client and Provider Registry DI/Teleradiology Laboratory Clinical Terminology EHR Data Definition & Standards Collaboration Process Standards Tactical Plan Artefacts Repository Telehealth ISO Interoperability Telehealth CCHSA Accreditation Ce. Rx (formerly Rx 5) HL 7 V 3 Messaging Client and Provider Registry IRIS (Infoway Reference Implement. Suite) Laboratory Nomenclature & Messaging Ne. CST – electronic claims messaging EHR Clinical Terminology Integration EHR Profiles for Interoperability (XDS-I) EHR Blueprint Evolution Project Privacy & Security Architecture Project 20

Thank You! jmussi@infoway-inforoute. ca www. infoway-inforoute. ca