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NZ Primary Healthcare IT Integration - May 2014

Implementation Showcase

Peter JordanSolution Architect

Patients First

Who Are Those Guys?

www.patientsfirst.org.nz

Patients First is the NZ Primary Healthcare IT Group: one of six core bodies delivering the National Health IT Plan – by enabling effective integration and measures that matter.

National Solutions

GP2GP version 1 (90% adoption)NZ ePrescribing Service – 2 million scriptsHIE Test Platform… http://itp.patientsfirst.org.nz

o PMS Review – Round 2o GP2GP version 2.1 – Max Message 20Mbo E-Enrolment – Phase 1 Designo Integration PlatFORM“Interoperability is not a boat race. One team can’t win by

rowing better than another. We are all rowing the same boat.”

…on the slow boat to healthcare IT integration…

Rowing Together

Foundations…HISO 10040 Health Information Exchange

10040.3Documents

CDA

10040.2 CCR

SNOMED CTArchetypes

10040.1R-CDRs

XDS

• Challenges - encountered in early CDA implementations• Solutions – common Data Models & NZ CDA Toolkit• Lessons - learnt in the process

CDA Implementations

Project Solutions

• Implementation Types• GP2GP – Continuity of Care• E-Discharge Summaries – Connected Care• Community E-Prescribing – Order Filling Service

• Shared Components• Common Data Model – Semantic Integration• Client Software Adapter – NZ CDA Toolkit

Shared Data ModelC1: Bridge the logical data model in Business Requirements and the vendor’s physical data models - via the CCR/CCD standard (Sections/Entries). Highest or lowest common denominator?

“Don’t exclude anything that any one of us has.”• Mandatory Sections – none in GP2GP• Required Elements – only patient & record identifiers• Extensible – Name-Value Pairs• Linking Entries – to Encounters• External Documents – linked to any Entry• Project variances – e-Prescribing ordering elements

NZ CDA Toolkit

Client-side adapter; a class library facilitating the creation, validation, packing and consumption of CDAs.• C2: Data Typing – translates Data Model to CDA

– Which Act class – act or observation?– Constants for identifiers e.g. 2.16.840.1.113883.6.96 = SNOMED– Single NULL

• C3: Validation – Encapsulates Schema (structure), adds business level (content) – Removes some pain points (UCUM) – but not all (Schema mandates)

• C4: NZ-Specific Requirements – Additional Demographics• C5: Presentation – GP2GP version of standard CDA Style Sheet• C6: Transport Packaging – Project-specific

– GP2GP & e-Discharge: MIME package within HL7 v2.4 message– E-Prescribing: CDATA section in NZePS XML message

Gp2Gp Review

Have the challenges been overcome?• Data Model – Would GP2GP be possible without one?

– Vendor willingness to co-operate– Business Requirements imprecise; Implementation Guide, highly complex

• Toolkit Development – Common ownership:– Shared Source and Test Harness application– Co-operative development; teleconferences, workshops

• Reusability – Accumulate lessons learnt, not revisit• Validation – More granularity via XML Schematron• GP2GP Review – Vendor Issues in 1st Year

– Validation (legacy data)– User-Defined Codes containing spaces– Large message files (> 5Mb)

NZ ePrescription Service

•Scope – Nationwide community e-prescribing•Solution Design - Based on one Australian implementation•Endpoints - 4 GP PMS and 2 Pharmacy Vendors•Hosting - NZ Connected Health Network•Exchange - Vendor HIE Registry and Broker•Adapter - Client or Cloud Hosted options•Prescription - CDA document for each medication (item)•Messaging - Proprietary XML for metadata•Shared Component - NZ CDA Toolkit•Medication Standards - NZULM and NZ Formulary

HIE Integration Testing

New Zealand Solution

• Maturing CDA Landscape• NZ CDA Toolkit – Specifications, but not standards• HISO Standards – Simplified CDA Templates• Vendor Products – Native CDA Capability

• Integration as a Service• Certification and Integration – NHITB Strategy• Integration Test Platform – Web Site & Web Service

Certification & Integration• Patients First – Evaluate Primary Care • PMS Review – Clinicians & Technologists• Regime – Structured & Standards-Based• Analysis – 75% objective, 25% subjective• Initial Focus – Interoperability Standards• Plug & Play – Vendor & User Confidence

Integration Test Platform• ITP Services• Validation Tool – tests messages & documents• Downloads – sample test instances• Reporting – test results by application & version

• ITP Interfaces• Web Site – additional rendering examples & links• Web Service – RESTful business functionality

• ITP Validation Levels• Message Transport – CDA document wrappers• Document Formatting – Structural & Document Template• Data Content – Header, Section, Entry & Item Templates

Testing Discussion

Will the Integration as a Service approach succeed?• Feedback – Generally positive

– PMS vendors (GP2GP v2) & DHB CIOs

• Operational Principles – Broad consensus:– HISO as certifying authority, Patients First the endorsed test agency– ITP as enabler, rather than enforcer, of standards – educative feedback

• Usage – UAT moving into production for InterRAI & GP2GP v2• HISO Standards – Simplified CDA Templates

– Hierarchical Descriptions - (c/f XML Schematron –arcane conformance statements)– Human-understandable error and warning messages– Richer validation provided by OO languages

• Service-Oriented – Web Form and RESTful interfaces– Centrally hosted and targeted testing – persists beyond project lives– No silo-based testing of entire product suite deployments

eEnrolment Principles• A single electronic process for enrolment and registration• Standardised on a national basis• Generic forms web-based solution• Integrate with PMS• Reduce burden at practice level• Improve data quality• Remove 3 month stand down period for patients• Reduce risks

Integration PlatFORM• Consistency of interface• Certainty of integration• Pay for one build cost• Pay for one maintenance cost annually for integration• Reduce time to integrate• Reduce complexity• Guarantee information consistency between systems• Web based forms access and development integrated with

PMS forms with reach to all GP desktops• Point to point messaging alternative – RESTful Web Services