Published on March 17, 2014
UNBLOCKING SEMANTIC INTEROPERABILITY FOR EHR Sam Forouzi March 2014
Summary • Overview of Semantic Interoperability • Understanding Health Information • Historic Problems & Solutions • Current Challenges and a need for innovative solutions
Semantic Interoperability for EHR • Information Exchange among Actors on-time – Information: must be meaningful, complete, up- to-date, and use-full – Exchange: information recipient must be able to interpret incoming information according to the source – Actors: Systems, Devices, and Humans – On-time: Notification in real-time and on- demand
Interoperability: Care Organization
Workflow: Care Organization Patient is Registered / AdmittedProprietary Interfaces are used to notify hospitals departmental LIS DIS Pharmacy Bed Management HIS
System Integration: Care Organization HIS Integration Engine LIS Pharmacy DIS Bed Management Filter Translate Transform ADT Notification
Interoperability: Universally • Source of Truth • Actor Identification & matching • Entity Identification & matching • Rules & Procedures • Interpretations • Normalization • Ownership • Technologies & Standards
Personal Health Information
Healthy Living • Behaviours • Personal Actions • Education • Coaching • Planning • Executions • Consultation • Progress and Results Tracking
Health Care • Preventing Care vs. Care for Conditions – Primary Care – Acute Care – Home Care – Long-Term Care – Ambulatory Care – Allied Care
Information Systems Healthy Living • Personal Portals • Mobile Apps • Devices • Paper based • Not available Health Care • EMRs • Paper Based • HIS • LIS • RIS • DIS • CIS • EHR • Patient Portals
History: Past Problems & Solutions
History •Hospital Info. Systems •Clinical Systems •Proprietary Interfaces •HL7 v2.x 1980s •IEs •EMR Vendors •CDA 1990s •HL7 V3 •Canadian EHRs, Acute Care Integrations •US EMR adaption, HIEs & ACOs 2000s •US CCD, BB+, FHIR, Portals, NwHIN, State Wide HIE •Can: EMR, Local Integration Areas Models, CDS 2010-14
Vital Signs Costs Quality Access to Care Safety Errors Care Recipients Chronic Cases Population Knowledge Aging Population Wait-time
Facts • 2011 Canadian healthcare spending was11.6% of GDP (38% of Nat. budget) National Health Expenditure Trends, 1975 to 2011. CIHI • 75% of healthcare spending is consumed by chronic disease management Centers for Disease Control, 2012, http://www.cdc.gov/chronicdisease/ • In 2008/2009, more than 2.3 million Canadians were living with diabetes. Public Health Agency of Canada
• Let people manage their health information • Develop and promote universal identifiers • Improve operation by refining workflows and procedures • Standardize – refine existing standards but not reinvent or-localize • Educate: track or use information for all actors • Identify and target source of truth for building a normalized and complete EHR • Use proven technologies • Reduce dependencies and technical requirements
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