UNBLOCKING SEMANTIC

INTEROPERABILITY FOR EHR

Sam Forouzi

March 2014

Summary

• Overview of Semantic Interoperability

• Understanding Health Information

• Historic Problems & Solutions

• Current Challenges and a need for innovative solutions

Semantic Interoperability

Semantic Interoperability for EHR

• Information Exchange among Actors on-time– Information: must be meaningful, complete, up-

to-date, and use-full

– Exchange: information recipient must be able to interpret incoming information according to the source

– Actors: Systems, Devices, and Humans

– On-time: Notification in real-time and on-demand

Interoperability: Care Organization

Workflow: Care Organization

Patient is Registered / AdmittedProprietary Interfaces are used to notify hospitals departmental

LIS

DIS

Pharmacy

Bed Management

HIS

System Integration: Care Organization

HIS

Integration Engine

LIS Pharmacy

DIS

Bed Management

Filter

Translate

Transform

ADT Notification

Interoperability: Universally

• Source of Truth

• Actor Identification & matching

• Entity Identification & matching

• Rules & Procedures

• Interpretations

• Normalization

• Ownership

• Technologies & Standards

Health Information

Personal Health Information

Healthy Living

• Behaviours

• Personal Actions

• Education

• Coaching

• Planning

• Executions

• Consultation

• Progress and Results Tracking

Health Care

• Preventing Care vs. Care for Conditions

– Primary Care

– Acute Care

– Home Care

– Long-Term Care

– Ambulatory Care

– Allied Care

Information Systems

Healthy Living

• Personal Portals

• Mobile Apps

• Devices

• Paper based

• Not available

Health Care

• EMRs

• Paper Based

• HIS

• LIS

• RIS

• DIS

• CIS

• EHR

• Patient Portals

History: Past Problems & Solutions

History

•Hospital Info. Systems

•Clinical Systems

•Proprietary Interfaces

•HL7 v2.x

1980s

•IEs

•EMR Vendors

•CDA

1990s •HL7 V3

•Canadian EHRs, Acute Care Integrations

•US EMR adaption, HIEs & ACOs

2000s

•US CCD, BB+, FHIR, Portals, NwHIN, State Wide HIE

•Can: EMR, Local Integration Areas Models, CDS

2010-14

CurrentChallenges

Vital Signs

Costs

Quality

Access to Care

Safety

Errors

Care Recipients

Chronic Cases

Population

Knowledge

Aging Population

Wait-time

Facts

• 2011 Canadian healthcare spending was11.6% of GDP (38% of Nat. budget)National Health Expenditure Trends, 1975 to 2011. CIHI

• 75% of healthcare spending is consumed by chronic disease managementCenters for Disease Control, 2012, http://www.cdc.gov/chronicdisease/

• In 2008/2009, more than 2.3 million Canadians were living with diabetes.

Public Health Agency of Canada

Innovative Solutions

• Let people manage their health information• Develop and promote universal identifiers• Improve operation by refining workflows and

procedures • Standardize – refine existing standards but not reinvent

or-localize• Educate: track or use information for all actors• Identify and target source of truth for building a

normalized and complete EHR• Use proven technologies• Reduce dependencies and technical requirements

QUESTIONS?