Interoperability and Orion Health James Hardacre May 25th 2011 This presentation is a short outline of Orion Health’s approach to interoperability, with a special focus on our activities in the NHS

Outline Orion Health: what we do Our 3-pronged approach to interoperability Our ITK Proof of Concept experience NHS Trust experience: Heart of England As a specialist in healthcare integration, interoperability is something we take very seriously. I’m going to quickly describe what we do, how we approach interoperability, and provide a short description of our experience with the proof of concept trials with the Interoperability Tool Kit (ITK) – which we worked on with Connecting for Health in 2009.

Orion Health Overview Specialists in Healthcare Integration for 18 years Technology is important, experience ensures success We integrate best-of-breed health information systems… Between health IT systems Between health organizations On the desktop With functionality and ease Mission “Provide Universal Access to Patient Information” Usual short introduction to Orion Health Our Clinical Portal is designed to provide a unified view of relevant patient data across a Trust or a series of NHS organisations…. BUT today our focus is on the integration of data at the back-end – where we have a technology called Rhapsody (some of you may have heard of it). In a few minutes, David is going to talk about his experience using HL7 in integrating his Trust in Birmingham – the technology underpinning that effort is Rhapsody Integration Engine.

Global presence demands a comprehensive approach to interoperability 1993: Founded in New Zealand First HL7 project: 1994 2011: 8 offices in 6 countries, clients in 30 countries, 470 employees 2 So, Orion Health is active not just in the NHS, but in healthcare systems around the world. This means that we must take seriously questions of interoperability. From the beginning we have been heavily involved in using standard interfaces. Indeed, one of Orion Health’s very first projects was the creation of infrastructure for New Zealand’s National Health Identifier (NHI). This was the first nationwide deployment of an electronic health ID number for every patient, anywhere in the world. The infrastructure behind it was based on HL7 messaging, and was also one of the earliest national deployments of the HL7 standard. This experience has stood us in good stead for other nationally-significant projects – including the infection disease and bioterrorism monitoring system in the USA, used by Centers for Disease Control (CDC) in Atlanta which is based on our Rhapsody technology. So, we’ve been in this from the beginning.

Our 3 approaches for interoperability Native support for standards Support for international efforts Eg. IHE www.ihe.org, HL7 Local ITK cooperation I want to talk very briefly about 3 aspects of our interoperability approach

Native support for standards Health-specific integration products Native libraries of common protocols HL7 2.x & 3.x , XML, etc. etc. Re-useable communication points Exportable interface configurations Riff on this for a couple of minutes – no more. You can add a couple of bullet points if you wish

Support for international efforts Rhapsody: now an FDA Class I medical device IHE Connectathons in Europe and USA IHE profiles now in use in France for the national EHR interoperability standard Internationally, we’re very serious about technical and quality standards. Just last week, our Rhapsody integration engine was registered as a Class I Medical Device with the US Food and Drug Administration (FDA) This means we are now entering a rigorous certification process, Users even in the NHS will benefit from the fact that Rhapsody must now be passed regularly through a rigorous quality management programme. Integrating the Healthcare Enterprise (IHE) – another important activity in which we are involved, particularly in relation to the implementation of regional Health Information Exchange projects in the United States. Interesting to note – IHE profiles have been adopted by France as the standard method for accessing and loading data onto their national spine (called DMP – Dossier Medial Personnel – Personal Medical Record). And all French IT vendors are now having to certify their applications with the government to ensure that they can interoperate with the DMP infrastructure. So – national interoperability is not just something that is going on with ITK!

ITK Activities 2009 - ITK Discharge Summary PoC ITK Spine Mini-Services Project Currently Underway In 2009, Orion Health worked alongside Connecting for Health and a number of other vendors to undertake a Proof of Concept (PoC) for the transmission of Discharge summaries (We may want to mention we’re currently moving forward with a Spine connectivity project with ITK - this may be commercial in confidence)

ITK PoC – Discharge Summary Profile 3 source systems: Orion Health Clinical Portal System C MediSec SRC BlueWire Generating CDA XML discharge documents Receiving Systems: PCTI & Liquid Logic The PoC involved 3 source systems for the Discharge Summaries Orion Health Clinical Portal System C MediSec Bluewire The CDA XML documents generated with routed via Rhapsody to receiving systems provided by PCTI and Liquid Logica

Discharge Summary generated in hospital system Brief overview of what the PoC systems looked like, from an Orion Health perspective: 1) Discharge summary completed in the documentation module of our Clinical Portal

Sending confirmation in Rhapsody 2) Sample of what the sending confirmation message looked like in the Rhapsody monitoring console (sorry not very excite)

Received in target system The XML CDA document was received and rendered in the target system

But now, over to the real world… David Hextell, Head of Systems Development Heart of England NHS Foundation Trust

THANK YOU