f Healthcare software services - open interfaces and standards in Finland HL7/OMG Healthcare Services Specification Project London, 31 Jan 2006 Juha Mykkänen, University of Kuopio, HIS R&D unit SerAPI project, HL7 Finland CS SIG

f Overview  healthcare & health information systems in Finland  open service-oriented interfaces: efforts and specifications in Finland  HL7 Finland Common Services SIG  PlugIT project  SerAPI project  comparison of three services  experiences  national efforts  HSSP

f Kuopio Helsinki  Healthcare in Finland  Population 5.3 million  Life expectancy 74.6 / 81.5 years  GDP per capita 28,646 EUR (2004)  Growth competitiveness index score (World Economic Forum 2005) 5,94 (1st)  Healthcare 7.6% of GDP  Public healthcare funded by taxation  Basis: 278 primary health centres by 444 municipalities  5 university + 32 central/district hospitals in 20 districts = associations of municipalities  Private care 14%  Occupational health by private organisations  Information systems in healthcare in Finland  In primary health care, EPR used by 98% of GPs  In hospitals, HIS used since 1980s  Now: EPR to hospitals, integration, migration, web-based systems – National interoperable EHR by 2007? Healthcare & HIS in Finland

f Background: HL7 Finland Common Services SIG  HL7 Finland  held its 10th anniversary in October 2005  HL7 v2.3 messaging widely used in some domains  active in national work for EHR  CDA r2 used as a basis for the structure and archiving  HL7 Finland Common Services SIG (2002-)  initial focus on clinical context integration (CCOW)  work on service specifications from the background projects - national comments, balloting  3 available specification areas + implementation guides

f Background: PlugIT project  National R&D project to develop integration solutions for healthcare  Results: Service specifications, integration methods, centre of expertise  Oct 2001–Aug 2004, about 15 full-time + 15 part-time researcher/developers  Budget € 2 million, 84% by National Technology Agency TEKES 3 univ. depts, 1 polytechnic 12 applications vendors, 3 technology vendors 6 hospital districts, 2 municipalities Natl. healthcare programme / National EHR project

f Background: SerAPI  SerAPI project ( )  national R&D project  service-oriented architecture and web services  14 software companies, 4 public healtcare organisations, 3 research units  process / application / platform viewpoints  service specifications, methods and tools  participation in standards development (national / international)  Healthcare Services Specification Project  participation through both OMG and HL7  infrastructure work / individual services

f Open service specifications  HL7 Finland accepted  Context Management (context repository) ~ CCOW  Core services: User & Person information access + Access control ~ EIS, OMG PIDS  Core services: CodeAPI ~ Common Terminology Services Vocabulary API, OMG TQS  other publicly available  DRG classification  OID generation  other in progress and related  scheduling ~ e-booking  decision support  patient lists, care relationship, etc.

f Service implementations  several context service applications  context services available in core applications in hospitals and health centres  low effort implementation for single sign-on + patient synchronisation  recent additions for security in regional information systems  core service implementations in university hospitals  implementations in new core hospital systems  also legacy applications wrapped with interfaces - migration  several proprietary services, some specifications available in public  DRG classification, care relationship, decision support service pilot etc.

f Approach + interface technologies  incremental specification: from functional interface specification to technology-specific interfaces  simple http communication (context management)  http + XML (user, person, etc. HL7 specifications)  WSDL/SOAP with WS-I, "API style" (versions of user, person etc. core services, DRG, OID)  in addition to  CDA documents (national EHR core technology) - national "services"  HL7 messaging (v2.3  v3 + Web services transport)  others (EDI, custom solutions..)

f Different types of services: three cases  DRG (Diagnosis Related Groups) classifier interface  resource utilisation groups (NordDRG) to support e.g. invoicing and benchmarking  EPR (Electronic Patient Record) archive interfaces  variety of clinical documents stored in archives on organisational, regional and national level - note: national solution not yet specified  Context repository  single sign-on, synchronisation of several applications (used by one user) to one patient at a time etc.

f Comparison of service scenarios 1

f Comparison of service scenarios 2

f Emphasis in Finnish efforts  increased plug and play, reduced local tailoring  simplicity and genericity: start from minimal but sufficient  implementability  low introduction threshold  compatibility with existing systems  defined path from requirements to implementations  services as one part of the big picture  CDA (moving from regional to national level)  messaging (v2  v3 transition is beginning)  emerging architectures on local, regional and national levels  three-partite collaboration (vendors, hospital districts, research)

f Lessons & observations  important: pragmatic approach and right timing  acknowledge different types of services  clear usability improvement, low introduction threshold and little invasiveness have fostered the most uptake  start where there is most repeated point-to-point integration  nail down both functionality and information (does not mean sacrificing flexibility)  a unifying architecture would help  differences in organisations, in regions and nationally  "where to put the mandate.."  HSSP: practical, community-driven, multi-platform...  SOA main benefits: flexibility and interconnectivity  moving from closed consortia to open standards community  but quite bad conference call times for Europeans (EET).. :)

f Thank you  SerAPI project participants: National Technology Agency TEKES (grants no 40437/04, 40353/05 ), Medici Data Oy, Datawell Oy, Fujitsu Services Oy, Hospital district of Northern Savo, WM-data Oy, Commit; Oy, Intersystems B.V. Finland, Mediconsult Oy, Microsoft Oy, Oracle Finland Oy, Hospital District of Satakunta, Bea Systems Oy, Hospital District of Helsinki and Uusimaa, City of Kuopio, Kustannus Oy Duodecim, Mawell Oy