Epidemiology History and Introduction NHS Insight HIPAA and Finance Norwegian Perspective Medical Business Process Map Epidemiology Pilot Epidemiology

The Patient and Family Journey

EpidemiologyHistory andIntroductionNHS Insight

HIPAA andFinance

NorwegianPerspective

Medical BusinessProcess Map

EpidemiologyPilot

EpidemiologyPanel

OASIS eHealthTechnical

Committee

Provider and HL7

Perspective

Norwegian Perspective



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Electronic PRocess for

Home Healthcare

Dan PattynChief Technical Officer

Forum 9000Quality Systems for

Quality Care



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

The Electronic PRocess (EPR)Pilots

• Extending the ebXML Model to eGovernment Service Solutions– e-Healthcare for the Home– e-Government in local communities– e-Building

• Deliverables– Templates and Specifications for eprXML based

implementations of semantic interoperability in different Communities of Interest

– Open Implementation Framework– Legacy System Migration and/or Integration



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

EPR Pilot 1: Hjemmebasert Pleie&OmsorgIntegrert tjenesteplanlegging og rapportering.(Oppgavebeskrivelse/Rapportering med PDA-phone. SIM-kort = Digital signatur )



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

EPR Pilot 2: Digitalt ByggesakskontorElektronisk samarbeidsarena

(Oppgavebeskrivelse/Rapportering/Inspeksjon med PDA-phone. SIM-kort = Digital signatur )



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

EPR Uses Workcards as a GUI Metaphor

Participant and Context

Based Architecture

Participant can be:1. Traditional User2. Machine or Device acting

as a Proxy for a User

Environmental Context dynamically modifies Declarative Display Metaphor



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

e-Healthcare Pilot Participants

Business CentricMethodology TC

SemanticRegistry TC

USAForum 9000

BCM-EPR SCNorway

EPR Forum

Home HealthcarePilot

Semantic ContentMgmt. SC

NorwaySINTEF

OMG

W3C

eGOVNorway

eGOV TC

Informatics Stds.OpenEHR, HL7, etc.

Content AssemblyMechanism TC

METU

CUNY



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Perspective

Perspective

Tools

The eGovernment Challenge

Experience Enablers MiniaturizationEnvironmental SensingEmbedded IntelligenceAdaptive LearningNetworked Communication

Experience Innovation LeversGranularityExtensibilityLinkageEvolvabilityEventsEvent Context

1. Need Structured Specifications2. Medical EcoSystem Centric3. Collaborative Services Centric4. Dynamic Contextual Information5. Context Control Mechanisms6. Shift from “System” to

“Workspace” Focus7. Occasionally Connected

Workspaces



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Medtronic CareLink Patient Co-Creation Experience

Primary Doctor

Medical Specialists

Patients with Similar

Condition

Pacemaker Manufacturer

Emergency Services

Doctor on Call at Out-of-Town

Hospital

Scan and Diagnostics

Clinic

Source: The Future of Competition, Figure 1-1, Page 9

Patient



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Vo ca bula r ie s

E v e nts

W orkflow

W ordprocessor

Spreadsheet

Outliner

Da i ly P ro c e d u re s P e r io d -E n d P ro c e d ure s F in a n c ia l R e p o r t ing P ro c e d u re s

Work Order

PrepareSource

DocumentPost

Journals,Ledg ers

PrepareJournalVoucher

Journal Voucher

Post GeneralLedg er

Journal Voucher

Obtain AccountBalances forWorksheet

Worksheet

PrepareTria l

Balance

Trial Balance

Analyze AccountBalances. PrepareAdjusting Entries

and Adjusted TrialBalance

Journal VoucherPostGeneralLedg er

Journal VoucherAdjustableTrial Bar

PrepareFinancial

Statements

FinancialStatements

Obtain PostC lo sing Tria l

Balance

Post C losing TB

J.V. File

Journal VoucherPostGeneralLedg er

Journal Voucher

PrepareC lo sing

Entries andPost to GL

Tabulations

Artifacts

Exam ples:PowerpointGraphics toolHTML fram es

Models

Co lla bo ra tio nA gre e m e nt ( CPA )

Pattern(s)

Com m unity ofInterest

Do cum e nts

Rule s

Transactions

Exam ples:Graphics toolCASE toolStructure Tool

Exam ples:WordOpen OfficeDocum ent tool

Exam ples:ExcelLotusHTML tables

Collaboration

Cla ss ifi ca tio ns

Vocabularies

Exam ples:RegistryLotus NotesHTML / PortalsGroove

Step 2 :Build Templates with

Familiar Business Tools

Eve n tsR u le s

T ra n sa ctio nT ra n sa ctio n

Sch e maSch e ma

C on tractC on tractA g reem en t P a ttern

W ork f lowW ork f lowM o d elin g &B u sin ess P a ttern s

re q u e st

p ro ce ss

re q u e st

p ro ce ss

re sp o n se

p ro ce ss

re je ct

a cce p tp ro p o se

co u n te r

E x cha n g eE x cha n g e

Specif ica tionSpecif ica tionM o d el & S ch em a s

N o u n s

Ve rb sT ra n sp o rt

R o le sC oncep tC oncep tR eg istry

Tem

plat

eTe

mpl

ate

--dri

ven

driv

en

B us ines s G oa lsB us ines s G oa lsG o a l P a ttern

CAM templateAsse mb ly

C o n te xt

Step 3 :Deploy with DeclarativeComponent Operations

Business Layer

Conceptual Layer

Business Drivers: Model / Process / ConstraintsTarget Constructs & Patterns Target Constructs & Patterns

Implementation Layer

Physical - Message & PresentationPhysical - Message & Presentation

Extension Layer

Contract -Collaboration Partner Specific Constraints

Publ

ish

Baseline Specification per CoIBaseline Specification per CoI

Concepts in OntologyConcepts in Ontology

Business Goals

Frameworks & Standards

Legacy

Authoritative Sources

1

2

3

4

Step 1 :Use Layers to Define

Business Needs

While Referencing the Information Architecture



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Motivation Time People

Specifications Schema

Workflow

Contract

Directory S

ervices

Presentation

Artifact relationships

Data/Codes Services/Functions Network

Source: BCM Lubash Pyramid

Core Components

Core Components WSDLWSDL

XFormsXForms

TransportRouting, Packaging

TransportRouting, Packaging

Collaboration PartnerAgreements- CPA

Collaboration PartnerAgreements- CPA

MSHSOAP

MSHSOAP

MessagesMessages

RolesRoles

Collaboration PartnerProfiles - CPP

Collaboration PartnerProfiles - CPP

NounsNouns

EventsEvents

Digital Bag

RulesRules

VerbsVerbs

Content Assembly Mechanism - CAM

Content Assembly Mechanism - CAM

BP SpecificationBP Specification

ProcessProcess

Semantic Interoperability Standards Stack



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Commitment Pattern Template

Request Dialysis

Accept Alter

Accept

Contract Patterns - Agreement Patterns - Commitment Patterns

SendAgentPrimary Care Physician

RecieveAgentDialysis Clinic

Action Event

Information RuleWhat Why

How When

Two Hours from Receipt of Request

ResponseByDate

Priority: UrgentPriority

Friday 4 Apr 04 2 pmProvisional Schedule

Dialysis TreatmentTask

Dialysis TreatmentRequest

Priority: Urgent

Friday 4 Apr 04 2 pmAccepted Schedule


Dialysis TreatmentAccept

ActionEvent

InformationRuleWhatWhy

HowWhen

Priority: UrgentProposed New Schedule

Friday 4 Apr 04 2 pmAccepted Schedule


Dialysis TreatmentAlter



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Open Implementation Framework Services for Occasionally Connected Applications

Where / Who

Action Event


How When

Action Event


How WhenService Oriented

Open Implementation Framework

(Autonomous Portal Agent)

Where / Who

ProcessServices

Collaboration Services

Digital Bag

Metadata Services

Digital Bag

Digital Bag



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Social Network Aspects of Digital Bags

Home Dialysis Equipment

ProcessServices


Digital Bag

Metadata Services

Digital Bag

Digital Bag Digital Bag


ProcessServices

Digital Bag

Metadata Services



ProcessServices

Digital Bag

Metadata Services


Social Network

Primary Care Physician Social Worker



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

EventsRules

TransactionTransaction

SchemaSchema

ContractContractAgreement Pattern

WorkflowWorkflowModeling & Business Patterns

request

process

request

process

response

process

reject

accept propose

counter

Exchange Exchange

SpecificationSpecificationModel & Schemas

Nouns

VerbsTransport

RolesConceptConceptRegistry

Tem

plat

eT

empl

ate --

driv

en

driv

en

Business GoalsBusiness GoalsGoal Pattern

CAM templateCAM template

Context

Business Agreement Languages (RINs)

Choreography & Coordination Lang.

(BPSS)

Business Collaboration Specification

Collaboration Profile Agreement (CPA)

Context Driven Information

Exchanges (CAM)

Semantic Registry



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Perspective

Perspective

Tools

The eGovernment Challenge

1. Federated Registry Services2. Informational and Terminological

Model Integration3. e-ID Services4. e-Authentication Services5. Declarative Access Rights



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

eGOV SuperStructure Portal

Digital BagCollaboration Services

ProcessServices

Digital Bag

Metadata Services



ProcessServices

Digital Bag

Metadata Services

Collaboration ServicesCollaboration Services

ProcessServices

Digital Bag

Metadata Services


Digital Bag

eGOVNorwayRegistry

Digital BagDigital Bag


ProcessServices

Digital Bag

Metadata Services


AccessPoint

CredentialServiceProvider

E-Authentication Service hands off Authenticated User



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Issues

• Secure Authenticated Delivery and Tracking: – Messaging system, envelope format and payload with

exchange source profile controls– PKI Adoption Challenges (from PKI Action Plan)

• Software Applications Don’t Support It• Costs Too High• PKI Poorly Understood• Too Much Focus on Technology, Not Enough On Need• Poor Interoperability

PKI Challenges Source:

http://www.oasis-open.org/committees/pki/pkiactionplan.pdf



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

• Integration of BCM Choice Point technology to provide flow control and linking and switching for EPR.

• Create BPSS of discrete workflow components – especially intra-enterprise exchanges.

• Create BCM contract and CPA templates for EPR participant roles and agreements.

• Look at applicability of CAM templates for formalizing information quality control and context rules.

BCM-EPR Tasks



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Additonal Information and Contacts

• OASIS ebXML Business Centric Methodology TC– http://www.oasis-open.org/committees/tc_home.php?wg_abbrev=bcm– http://www.oasis-open.org/ committees/download.php/5931/BCM%20Executive

%20Brochure.pdf – http://www.businesscentricmethodology.com

• OASIS ebXML Registry Semantic Content SC – http://www.oasis-open.org/ committees/sc_home.php?wg_abbrev=regrep

-semantic

• OASIS Content Assembly Mechanism TC– http://oasis-open.org/committees/cam/

• EPR Forum– http://www.eprForum.org



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

OASIS Business Centric Methodology Technical Committee (TC) Chairs: Mike Lubash – [email protected] Mattocks - [email protected]

OASIS Business Centric Methodology EPR Subcommittee (SC) Chairs: Hans A. Aanesen – [email protected] ; eprXML System ArchitectDan Pattyn – [email protected] ; BCM MethodologistDavid Webber – [email protected] ; XML Specialist

OASIS ebXML Registry Semantic Content Management Subcommittee (SC) Chairs: Carl Mattocks - [email protected]

Norway EPR ForumHans A. Aanesen – [email protected]

Additional Information and Contacts



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Value Co-Creation via Customer Centric Collaboration

• Customer relationships based on experiences rather than products

• The product is no longer the basis of value

• Real-time customer experiences on-the-fly, shaped by the customer "context" is the value proposition

• Real-time insights required to deliver on-demand customer value and service that's meaningful to individuals within the context of their day and location

(Feb 2004)



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Backup Slides



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

1994 Cooperative Clinical Information Systems

1988-1992 Role Interaction Networks (RINs)

2002 Open Source Commodity Portals

1990-1992 Agility Forum

1994 World Wide Web

1999 W3C XML, RDF

Metaprocess ArchitecturalFramework

1996 Foundation for Intelligent Physical Agents (FIPA)

2000-2003 FIPA AgentCities Project

1997 SINTEF WORKWARE Interactive Process Modeling 2000 ebXML, Semantic

Registry and OASIS Stds.

2003 OASIS Business Centric Methodology (BCM)

2001 IOM Crossing the Chasm Report



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Open Implementation Framework Prototype

-Workflow Form Debugger / Stepper- Execution Workflow Tracking and Workflow Resumption after interruption- Reactive ECA Rule Engine integrated with Schedule and Workflow (Sharable Schedules among users who are patients)

Metadata Services

Patients are Users-Plug & Play Web Forms for portable medical records- Plug & Play Workflows, Medical Protocols, Clinical Guidelines- User-Defined Patient Lists and PopulationsCustomizable Workflows- Hierarchical Modeling: Question ItemsFormsWorkflowsComplex Workflows- Automatic Creation of Web Forms Automatic Generation of DBMS Schema Automatic Linking of Code Between Forms and Data- Five Minutes to LearnPreview / Test forms during editing Forms Repository

Care Team Collaboration Services

Digital Bag

Traditional Architecture- Mozilla Web Browser- Apache with SSL Web Server- ZOPE Application Server- PostgreSQL RDBMS- Linux, Windows OS-Skinnable User Interface

Simple-to-U

se Developm

ent Tools ZO

PE Web M

anagement Interface,

DTM

L/SQL/Python

MetaData Engineering Architecture- Meta Meta Model Support- Deployment Metadata for Introspection- Web Browser Metadata Creation Tools- Systematic Method of Metadata Management for Interactive Process Models (SINTEF)- Portable via Simple XML upload / download- Separation of patient identifiers from other data

Pro

cess Services Process Virtual Machine

- jCAM, Blackboard, ruleCore RuleEngine, etc.



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

OASIS Business Case

$

Time

Semantic Interoperability Barrier

Structuring Barrier

$

$Data

Exchange Costs

Data Quality Costs



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Value Stream Management in a Co-Creation Environment

• “Artifacts with Durable Business Value” can be re-sequenced for more value extraction

• If Value is created by Context, how much infrastructure investment is needed for definition, capture, and movement of Context– Distributed Context Management with Persistent State Information

– Distributed Decision Support based on Environmental Context

• Currently need Standards Effort focused on a Collaboration Environment with ebXML business primitives that add value to Service Oriented Architecture (SOA)



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Specification Value Stream Management

• Current Practice– Monolithic “blob” of linear text in

proprietary word processor format - “ignorance wrapper”

– Little focus on Business Protocols• Little emphasis on sequence

and interactions• Roles and Responsibilities• Exception Handling

– Focus on Documents• No common and controlled

vocabularies• No fine granularity

configuration management• No Structured Documentation

– Product Planning by looking in the “Rear View Mirror”

• Value Barriers– No common understanding– No packaging of business operational

procedures (services)– No accountability based on roles and

responsibilities– Artifacts have no Durable Business

Value because of the lack of re-composable document fragments

• No Reuse• No Reconfiguration

– Scaleability Problems• Data Scale Barriers• Structuring Barriers• Integration Barriers

– Precludes Automation & Outsourcing– IT / Business Alignment Issues



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Cross-Enterprise Service Centric Digitization

Transaction Centric Digitization of Simple Task & Processes

Process Re-Engineering

Process Improvement

Value Co-Creation via Customer Centric Collaboration

Extreme Mobility Infrastructure

Occasionally Connected Application

Wearable Computing

Business Process Evolution



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

The Digital Bag- A Universal Nomadic Work Object -

• A Digital Bag is an architectural model for a universal nomadic work object that maintains data, process and work context independently from any one system.

• In technical terms, a Digital Bag is a compound XML document that exists independently from all applications, persistent data stores and processing technologies.



HIPAA andFinance



EpidemiologyPilot

EpidemiologyPanel


Committee

Provider and HL7

Perspective

Digital Bag Architectural Model

• directory services information• data in appropriate format and structure for the collective intent of participants

• work flow processes

• work process metadata, which determine what work steps are intended for the current instance of the digital bag, the genealogy of the instance as created, and the recent history of interactions executed between the current digital bag instance and any participant.