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The MARC-HI EHR ProjectMohawk Applied Research Centre
Health Informatics
Electronic Health Records
Mark Yendt – Faculty, Electrical and Computer Engineering Technology
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MARC-HI Started at Mohawk College in 2007
Focus on applied research Complementary to academic research performed
by Universities Private sector partnerships essential to
success Results of research can be implemented
into and used to improve existing real-world systems.
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What is EHR? EHR – Electronic Health Record A secure and private lifetime record of an
individual's health and care history, available electronically to authorized health care providers
For example, all Medications, Lab Tests, Diagnostic Imaging Tests and Medical conditions are obtained through a single logical location.
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Why is the EHR important? Healthcare professionals make clinical
decisions based on knowledge Better knowledge translates to better care Knowledge starts with accurate, relevant clinical
information The EHR creates the capability to share
relevant clinical information when it is needed
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EHRs in the Healthcare Industry - Today
A majority of all hospitals have computerized record keeping systems (HIS) –
Detailed data on current episode of care is electronically available
In Ontario, only 8% of family doctors have computerized record keeping (EMR) –
Summary data is mostly kept in paper form No standard interoperability mechanism
is being used to allow all care providers to communicate with each other Some communication services between
different systems has been implemented using a peer-to-peer negotiated protocol
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The Interoperable EHR - Future
Canada Health Infoway is Canada's catalyst for collaborative change to accelerate the use of electronic health information systems and electronic health records (EHRs) across the country
Infoway has designed the Canadian Electronic Health Record Solution (EHRS) Blueprint to support interoperable EHR systems
This "Blueprint" document describes important aspects of the design
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JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE
(POS)
TerminologyRepository
Ancillary Data& Services
Registries Data& Services
EHR Data& Services
DataWarehouse
ImmunizationManagement
PHSReporting
SharedHealth Record
DrugInformation
DiagnosticImaging
LaboratoryHealth
Information
Hospital, LTC,CCC, EPR
PhysicianOffice EMR
EHR Viewer
Physician/Provider/
Patient
BusinessRules
EHRIndex
MessageStructures
NormalizationRules
Security MgmtData
Privacy Data Configuration
Physician/Provider
Physician/Provider
Lab System(LIS)
Lab Clinician
RadiologyCenter
PACS/RIS
Radiologist
PharmacySystem
Pharmacist
Public HealthServices
Public Health
Provider
Longitudinal Record Services
HIALCommunication Bus
Common Services
ClientRegistry
ProviderRegistry
LocationRegistry
EHR Infostructure - Conceptual Architecture
Content Source: Canada Infoway, Copyright 2007
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EHRS Blueprint Component Architecture
Designed to use Web Services Jurisdictional implementation envisioned to
use a Service Oriented Architecture (SOA) HL7v3 messaging for communication between
POS systems and Jurisdictions XML to be used as the implementation technology
for the messaging All valid messages defined using XSD (XML Schema
Definition) All encoded data to use standardized data encoding
including LOINC for lab data and SNOMED-CT for Terminology
Ultimate goal is to integrate all 150,000 health care providers across country
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MARC-HI EHR Project Build a Reference implementation of the Canadian
Electronic Health Care Solution. Use the Canada Health Infoway Blueprint as the guiding document
Goals of the reference system include: Providing feedback on effective development strategies to
implementing jurisdictions. Give guidance to the Standards Collaborative Working Groups
(SCWGs) within Infoway to support effective implementations Building a conformance/prototype testing environment to
evaluate interoperability between federated systems Integrate project back into the classroom
get faculty and students involved Making the results available as open source through Open
Health Tools
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Vendor-agnostic tooling To demonstrate interoperability
Toolsets and technologies from many leading vendors are being used in the project
SOA Orchestration Development Microsoft (IIs, Biztalk, VS.NET) Intel (SOA Expressway) Software AG (Web Methods) Sun (JCaps / Open ESB / Java development tools)
Databases Oracle (Oracle 10g database, HTB)
Infostructure Services (HL7v3 compliant tools) Initiate (Client Registry) Orion (Web Viewer)
Security Access Control HIPAAT (Consent Management Software)
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Project Status Project started in September 2007 Initial "get something working timeline" was 4 months
Hospital Discharge Summary Initial Demonstration of the project in January 2008 Satyam joined as a partner to the project
$1 Million project contribution Referral added as part of Phase II. Development of Discharge/Referral integrated with:
Initiate Client Registry Orion Web Viewer CIHI Data warehouse Application
Full Demonstration of Mohawk EHR Project at eHealth 2008 in Vancouver
Current Activities include: Building Lab domain Performance evaluations
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Discoveries Small focused team development is an excellent way to
do a proof of concept design Larger teams that are separated (Mohawk / Satyam
team) require a require more formal development methods.
Mohawk developed Lab Specifications Satyam implemented Specifications Developed system is tested and debugged as a team
HL7v3 is complicated! Many tools have difficulty dealing with the messages Nomenclature is abstract Practical training is difficult to obtain
Training courses in HL7v3 are available, but not always directly applicable or practical to problem
Development of technology to simplifies or hide the complexity of the XML messages.
MARC-HI plans to explore this area in future research
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Challenges Existing systems will need an integration
strategy for message construction. Message / Information mapping Unifying Data code representation (LOINC/SNOMED-
CT) Web Services will need to be integrated with
Legacy systems. Tooling to enable this still requires more
effort.
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Opportunities Opportunities:
Developers - Lack of qualified developers for Canadian projects that will be undertaken in the next few years
New Developers will need Training in terminology, HL7, XML, Web Services Canada is a leading edge adopter of HL7v3
Tool development – Current tools not satisfactory Need tools to support:
Nomenclature translation Simplifying implementation Improved automated testing
Participate in the project at MARC-HI NSERC - College and Community Innovation (CCI)
Program – MARC-HI has been invited to submit a full proposal
MARC-HI is looking for local partners currently working in the healthcare IT
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Project Contributors
ecGroup Inc.
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More Information http://www.mohawkcollege.ca/
marc/hi List of presentations and publications
on site Wiki documents project status and
current development activities Canada Health Infoway
http://www.infoway-inforoute.ca/