nehta

Integrating Standards for the EHRWorkshop

Helsingor, Denmark28th 29th October 2008

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• 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

• 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:

– 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• Issues and end goals of national initiatives very similar• Architectures differ, but

– Can reuse common processes, interchanges, data• Commonality needed from processes for

– Definition of Requirements– Ensuring standards meet needs– Configurability

• Commonality of clinical focus areas– 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?• Shape the market to enable nations

and large initiatives to– Meet their business needs– Achieve value for money for their

stakeholders• Shape the market to enable

international vendors:– 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:– 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

– Collaboration– Sharing

• Collaborate on requirements definition– Harmonised perspective from national

initiatives on the development of standards

– What level do we standardise?• Improve tooling and infrastructure• Establish lightweight governance to

– 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

International Initiative

Vendor Community

SDO’s

Requirements & Priorities

Country Communities

Country Communities

Country Communities

Common RequirementsFunctional Conformance Criteria

Implementers

InitiativeMembers

Initiative Members

InitiativeMembers

Align CustomerProviders

Next stepsreflecting aims from Day 1, and responses at end of Day 2

• 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

• 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

• 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 teleconferenceConsider a second workshop – technically focussed – which will explore chosen Use case

• Develop the governance and behaviour• Day 2 Response:

Project focussed – must deliver an outcomeLight governance

• Options for a use case (Medications?)• Day 2 Response:

– 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