OHT Charter Project
Submission
Mohawk Applied Research Centre in
Health Informatics (MARC HI)
Presented by
Canada Health Infoway Inc.
Canada Health Infoway
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Created in 2001
$1.6 billion in federal funding
Independent, not-for-profit corporation
Accountable to 14 federal/provincial/territorial
governments
• Goal by 2010
− Every Canadian will benefit from modern health
information systems; and, 50 per cent of
Canadians will have an electronic health record
accessible by authorized health care providers.
Infoway business strategies
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Participate in health care renewal
Collaborate with our partners
Target the investments
Support solution deployment
Promote solution adoption and benefits
realization
Focus on standards and interoperability
• Common architecture
accepted and in use by
jurisdictions
• Updated architecture
includes privacy and
security requirements
• Extensive standards
development and
implementation
underway
• Pan-Canadian EHR
standards governed by
the Infoway Standards
Collaborative
• Architecture and
standards are freely
available
EHR Solution
EHR Infostructure
Ancillary
Data and
Services
Health
Information
Data
Warehouse
EHR Data
& Services
Registries
Data &
Services
Longitudinal Record Services
HIAL
Point Of
Service
Applications
Point Of
Service
Applications
EHR Viewer
EHR
Locator
What is
MARC HI?
Mohawk Applied Research Centre
for Health Informatics
ecGroup Inc.
Inaugural Private Sector Partners
Who is Mohawk College?
Large Ontario college with specific strengths in healthcare and IT
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10,000 full time postsecondary students across 4 campuses
1400 enrolled in the Mohawk-McMaster Institute for Applied Health
Sciences
42,000 Continuing Education registrants
NSERC (Natural Sciences and Engineering Research Council of Canada)
accredited Applied Research program (pending)
Joint degree programs with McMaster University
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Mohawk-McMaster-Conestoga BScN Nursing
Mohawk-McMaster collaborative degree/diploma in Medical Radiation
Sciences
Mohawk-McMaster Bachelor of Technology (Engineering)
Committed to Co-op Education
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33 co-op programs
2000 co-op students placed with over 300 companies
Mohawk is a charter member of the Open Healthcare Tools (OHT)
consortium
Overview of MARC HI
Mohawk Applied Research Centre in Health Informatics
• 2 FT faculty | 3 FT developers | 3 Students | 10 FTE “offshore
dev team”
Applied research vs. academic research
• Focus on real world solutions to real world problems
• Private/public sector partnerships essential to success
Furthering the goals of Canada’s EHR:
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Demonstrate interoperability between federated systems
Develop, adopt and deploy re-usable solutions across Canada
“Evidence-based” standards development
Mitigate implementation project risk
EHR Reference Implementation Project
• Build a working EHRS based on the Infoway Blueprint
and the pan-Canadian messaging standards
EHR Architecture
EHR Project Governance
MARC HI Advisory Council
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Mohawk College – Cheryl Jensen, VP Technology
Canada Health Infoway – Ron Parker
Clinician Rep – Dr. Marion Lyver, Healthy Futures
Jurisdiction/Customer Rep – Roger Girard, CIO Manitoba
eHealth
− Jurisdictional Steering Committee
• Vendor Rep – Gary Teelucksingh, Satyam
− Vendor Steering Committee
EHR Project’s Guiding Principles
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Abide the pan-Canadian standards and the EHRS Blueprint
Open source project-developed software through OHT
Employ a loosely-coupled, product-agnostic design
Undertake the project as Applied Research
Manage the project under the college’s governance
structure
• Leverage private and public sector partners to sustain the
project
• Be INCLUSIVE; seek the participation of a broad base of
stakeholders
Who are the Participants in MARC HI?
ecGroup Inc.
Takeaway
This is a credible, well-governed
project that has successfully
established strong private and
public sector partnerships.
What is the project’s status?
EHR Project Scope and Current Status
Phase 1
• Discharge Summary
Phase 2a (eHealth 2008 – EHR Interoperability Showcase)
• Referrals
• Retrieve Lab Reports
Phase 2b
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Rest of iEHR domain
Rest of Lab domain
IN PROGRESS
Drugs domain
Diagnostic Imaging domain
Public Health Surveillance
NeCST
Completed
EHR Project Scope and Status cont…
R&D Phase (overlaps the other phases)
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Health System Management
EHR Load/stress testing
PKI/Security/Privacy
Chronic Disease Management
Mobile eHealth technologies
PHRs
Pervasive secure email
Info/Infra-structure Design
Client
Registry
Provider
Registry
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Registry
Servers
Lab
Repository
Shared
Health Record
Shared Health
Record Servers
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Business
Rules
MSMQ
A – authenticate
B – submit transmission payload to queue
C – establish authorization
D – apply business rules
E – write content to repository
F – exception handling
Message
Structures
EHR Index
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Longitudinal Record Services
LRS Servers
D
C
E
B
Security Mgmt
Data
Audit Logging
A
B
HIAL
A
CDMS / ACS
Servers
Privacy Data
C
Web
Services
B
D
Common Services
Communication Bus
PKI CAs (2)
Test
client
A
F
EHR Viewer
An EHRS “Framework” is Emerging
Vocab.
Service
Native HL7v3 messages
Non-native “mapped”
messages
LRS
LRS Meta data model based on HL7v3
HIAL
PoS WSDL
Audit
Log
ACS
CDMS
EHR
Index
PRS
PR
CRS
CR
SHRS
Customizable “black boxes”
A consistent above-the-HIAL interaction “framework”
SHR
eHealth 2008 Interoperability Showcase
Shared
Health Record
Client
Registry
Lab
Repository
HSM
Data WH
Provider
Registry
MARC HI
Business
Rules
EHR Index
MSMQ
Longitudinal Record Services
Audit
Log
CDMS / ACS
Servers
Privacy
Policies
Common Services
HIAL
Communication Bus
Web
Services
PKI CAs (2)
EHR Viewer
Takeaway
MARC HI has yielded demonstrable
results. The EHR Reference
Implementation project is a working
example of Canada’s national EHRS
Blueprint.
OHT Charter Project
Proposal
Overview
This charter was developed in accordance
with the OHT Development Process and is
jointly submitted by Mohawk College and
Canada Health Infoway – both OHT members.
It outlines the mission, scope and expected
contributions of the Canadian EHRS Reference
Implementation project.
The project charter is a living document that
will be updated to reflect the evolution of the
mission, scope and development processes.
Mission
The Canadian EHRS Reference
Implementation project aims to build, with
public and private sector partners, a working
EHR system based on the Infoway EHRS
blueprint and utilizing the pan-Canadian
health information messaging standards
Scope
The scope of the project is to build a working
version of the Canadian EHRS blueprint
covering all interactions in all domains:
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Labs
Drugs
Diagnostic Imaging
interoperable EHR
Public Health Surveillance
The EHRS reference implementation will be
leveraged to support applied research into
areas important to the Canadian EHR
initiative.
Expected Contributions
A Working EHRS
• Software developed and source code contributed under the auspices
of the Canadian EHRS Reference Implementation Project will be
open sourced through OHT
Test Harnesses
• Tooling to programmatically develop HL7v3 test messages based on
the pan-Canadian standards will be developed
• SOAP-based test message “transmitters” based on the Canadian TLI
(transport layer interoperability) specification will be developed
New ITS
• Applied research, engineering, and prototype tooling development
will be undertaken regarding the development of a new, simplified
Implementable Technology Specification (ITS) for HL7v3 messages
• The impact of these new message formats will be objectively
measured using the EHRS reference implementation as the test bed
IP Issues
None anticipated
• Note: we will be providing open-source
components that may require consumers of
the work to have their own licensing…
− (for example, as open-source the Biztalk scripts,
it is presumed that anyone using those has a
licensed copy of Biztalk)
• For this reason, we propose that as part of
every “package” we provide an implementation
guide that outlines the assumptions and prerequisites for use of the materials
Deviations
None anticipated
Canadian EHRS Reference Implementation
3Q2008
Content
Pressures
• learning curve regarding HL7v3
• learning curve regarding panCanadian standards
• ambiguity of elements of the
pan-Canadian EHRS blueprint
• engineering constraints around
providing a secure, highavailability, high-traffic SOA
environment
• inherent complexities of service
orchestration
• immaturity of some of the
standards and vendor products
Added
• discharge summaries (iEHR
domain)
• referrals (iEHR domain)
• lab report list/get (lab domain)
• full support for Lab domain
• full support for DI domain
• full support for Drug domain
• full support for Public Health
Surveillance (PHS domain)
• investigation of PHR support
(Applied Research)
• investigation of CDM (Applied
Research)
Deleted & Changed
Dependencies
• pan-Canadian standards
development processes
• resource availability
• HL7/ISO harmonization
activities
Packaging Editions
• eHealth 2008 Interoperability
Demo
Milestones
• 2008/05 – EHR
Interoperability Demo
Statistics
• 4 profiles supported
• 9 HL7v3 interactions supported
Canadian EHRS Reference Implementation
3Q2008
3Q09
iEHR (7), Lab (3), PIX/PDQv3 (native), Drug? (3)
* PHR, Consent Management, CDM
EHR Interoperability Showcase
2Q09
1Q09
iEHR (7), Lab (3), PIX/PDQv3 (native)
* EHR index, ExID, Orchestration, TLI, New ITS, HSM
4Q08
3Q08
HL7 IHIC Conference presentation
EHR Interoperability Showcase
iEHR (2), Lab (1), PIX/PDQv3 (facade), HSM (1)
* Applied Research topics investigated