1. © 2006 Canada Health Infoway Inc. 1 January 16, 2007 Dennis Giokas Chief Technology Officer Canada Health Infoway Inc. Architecture and Standards at Infoway IHE Connectathon 2007

2. Outline 2 Key Definition Solution Architecture Standards for Interoperability Infoway, the EHR and IHE Conformance Testing Some Thoughts Going Forward

3. EHR An Electronic Health Record (EHR) provides each individual in Canada with a secure and private lifetime record of their key health history and care within the health system. The record is available electronically to authorized health providers and the individual anywhere, anytime in support of high quality care. This record is designed to facilitate the sharing of data – across the continuum of care, across healthcare delivery organizations and across geographies. 3 © 2006 Canada Health Infoway Inc.

4. 4 EHRS Conceptual Architecture JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Outbreak Mgmt PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Client Registry Provider Registry Location Registry Terminology Registry POINT OF SERVICE Hospital, LTC, CCC, EPR Physician Office EMR EHR Viewer Physician/ Provider Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Privacy Data Config- uration Physician/ Provider Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider Longitudinal Record Services HIAL Communication Bus Common Services

5. © 2006 Canada Health Infoway Inc. 5 End-User Perspective: EMR Application JURISDICTIONAL INFOSTRUCTURE POINT OF SERVICE Registries Data & Services EHR Data & Services Ancillary Data & Services Data Warehouse Outbreak Management PHS Reporting Health Information Physician Office EMR Physician/ Provider Business Rules EHR Index Message Structures Normalization Rules Longitudinal Record Services HIAL Communication Bus Security Mgmt Data Privacy DataConfiguration Provider Registry Location Registry Terminology Registry Common Services Patient Info End-user Info Patient History Drug Profile Laboratory Diagnostic Imaging EMR APPLICATION EMR Database Client Registry Shared Health Record Drug Information Diagnostic Imaging Laboratory

6. © 2006 Canada Health Infoway Inc. 6 EHRS EHRS In Canada Federated Databases, Peer-to-Peer, Message Based EHR SOLUTION (EHRS) EHR INFOSTRUCTURE (EHRi) EHR Viewer Point of Service Application Ancillary Data & Services Health Information Data Warehouse EHR Data & Services Registries Data & Services Longitudinal Record Services Health Information Access Layer (HIAL) EHR SOLUTION (EHRS) EHR INFOSTRUCTURE (EHRi) EHR Viewer Point of Service Application Ancillary Data & Services Health Information Data Warehouse EHR Data & Services Registries Data & Services Longitudinal Record Services Health Information Access Layer (HIAL)

7. Standards-based Solutions Standardized Architecture Standardized Interfaces Standardized Data Structures Standardized Data Vocabularies Standardized Functional Behaviour 7 © 2006 Canada Health Infoway Inc.

8. 8 EHR Infostructure: Standards Based Connectivity JURISDICTIONAL INFOSTRUCTURE Ancillary Data & Services Registries Data & Services EHR Data & Services Data Warehouse Outbreak Mgmt PHS Reporting Shared Health Record Drug Information Diagnostic Imaging Laboratory Health Information Client Registry Provider Registry Location Registry Terminology Registry POINT OF SERVICE Business Rules EHR Index Message Structures Normalization Rules Security Mgmt Privacy Data Configuration Longitudinal Record Services Hospital, LTC, CCC, EPR Physician Office EMR EHR Viewer Physician/ Provider Lab System (LIS) Lab Clinician Radiology Center PACS/RIS Radiologist Pharmacy System Pharmacist Public Health Services Public Health Provider HIAL Communication Bus Common Services EHR IP HIAL EHR IP EHR IP Standards EHR SCP Standards

9. © 2006 Canada Health Infoway Inc. 9 Standards Investment Portfolio Architecture Standards EHRS Blueprint EHR Use Cases EHR Data Model EHR Services Model EHR Interoperability Profiles Data & Messaging Standards eClaims (Primary Care, Oral, Vision, Chiro/Physio, Pharmacy) HL7 v3 (complete) Client Registry HL7 v2.4 & HL7 v3 (complete) Provider Registry HL7 v3 (complete) Drug Information Systems HL7 v3 (complete) Laboratory HL7 v3 (in development) Diagnostic Imaging/Teleradiology DICOM, IHE XDS-I (complete) iEHR Clinical Messaging HL7 v3 (in development) iEHR Technical Standards (in planning) Public Health Standards HL7 v3 (in development) Clinical Terminology Strategy (complete) Terminology Standards (SNOMED, LOINC, ICD10-CA, CCI)

10. © 2006 Canada Health Infoway Inc. 10 Infoway, the Interoperable EHR Agenda and IHE Leverage IHE integration profiles as much as possible DI domain Co-authoured XDS-I content supplement Funded development of XDS-I MESA tool set Driven XDS/XDS-I through the Standards Collaboration Process – declared as a pan-Canadian Standard (with Stable for Use designation) Client Registry Authoured/funded a change proposal to PIX and PDQ to support our client registry (HL7 v3) messaging standard Funded development of MESA tool set changes EHR infostructure Reviewing ITI integration profiles for consideration as pan-Canadian standards The EHR Index will comply to the XDS Registry actor…but support event notifications, and other data types Coordinate with IHE to avoid duplication Leverage IHE technical committees to develop new profiles and/or propose changes to existing profiles e.g. support for HL7 v3 messaging, enhance the XDS Registry, participate in the XDS federation discussion Leverage MESA tools for conformance testing Provide resources to profile development/change proposals through IHE Canada

11. © 2006 Canada Health Infoway Inc. 11 Conformance for pan-Canadian Standards Definition of Conformance Conformance includes the development of pan-Canadian standards business requirements, the conformance testing against these business requirements, and certification. Scope Functional, message level interoperability, privacy and security, usability Infoway Standards Collaborative and the eHealth Collaboratory will share responsibilities for conformance on pan-Canadian Standards Standards Collaborative will undertake the development of business requirements, including the development of conformance statements, for the pan-Canadian approved standards; The eHealth Collaboratory (Collaboratory) will undertake the building of the conformance testing environment, the development of the testing processes and will undertake the actual conformance testing against the established business requirements.

12. © 2006 Canada Health Infoway Inc. 12 eHealth Collaboratory Purpose The eHealth Collaboratory has been established to provide independent certification and procurement support services to dramatically improve clients ability to deploy standards-based, interoperable and usable healthcare IT systems Vision Will be nationally recognized as the trusted authority that provides an effective service offering enabling the Pan-Canadian EHR

13. © 2006 Canada Health Infoway Inc. 13 Collaboratory Key Conformance Test Offerings Functionality Do solutions offer the required functionality as specified in the Pan-Canadian standards? Interoperability Do solutions interoperate as required? At the message level? At the interoperability profile level? Privacy and Security Are solutions adhering to basic privacy and security standards? Usability In a clinical setting, are the solutions easy to use, safe and likely to have high adoption?

14. © 2006 Canada Health Infoway Inc. 14 Collaboratory Services Currently developing and will maintain a set of persistent test harnesses and reusable tools Will provide web-based interaction with repositories and remote- access toolset Vendors point of service systems will be certified against standardized tests by the Collaboratory - results will be available online Jurisdictional EHR systems (the back-end Drug, Lab, DI, etc.) will be conformance tested to ensure they correctly implement the standards

15. © 2006 Canada Health Infoway Inc. 15 Summary The Interoperable EHR is becoming a reality in Canada! Our messaging and vocabulary strategy, requirements and specifications go beyond departmental integration and are designed to support: Lifelong, longitudinal, patient-centric summary of key clinical data which has value over time – the Interoperable EHR Large scale, loosely coupled, federated systems interoperability requirements using a peer-to-peer message oriented communications model Semantic interoperability between systems Interoperability Profiles need to move beyond the departmental and tightly coupled systems integration to support an Interoperable EHR set of functions Design patterns of List, Get, Put With registry, consent, privacy/security, audit, decision support, alert, and business process orchestration capabilities XDS registry moving towards a full EHR Index

16. © 2006 Canada Health Infoway Inc. 16 Website:www.infoway-inforoute.ca E-mail:dgiokas@infoway-inforoute.ca Thank you!