Health Information Exchange Standards - Compliance via Integration Testing
1. Health Information Exchange Standards Compliance via Integration Testing…
Peter Jordan, Solution
Architect
Andrew Terris, CEO
HINZ Conference 2013
Paper Presentation
28 November 2013
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2. Introduction
HISO 10040 Health Information Exchange
10040.1
R-CDRs
XDS
10040.2
CCR
SNOMED CT
Archetypes
10040.3
Documents
CDA
• Testing HIE Standards – CDA compliance
• NZ Solution – Integration as a Service & certification
• Discussion & Conclusions - meeting the challenges
4. New Zealand Solution
• Maturing CDA Landscape
• NZ CDA Toolkit – Specifications, but not standards
• HISO Standards – Simplified CDA Templates
• Vendor Products – Native CDA Capability
• Integration as a Service
• Certification and Integration – NHITB Strategy
• Integration Test Platform – Web Site & Web Service
6. Integration Test Platform
• ITP Services
• Validation Tool – tests messages & documents
• Downloads – sample test instances
• Reporting – test results by application & version
• ITP Interfaces
• Web Site – additional rendering examples & links
• Web Service – RESTful business functionality
• ITP Validation Levels
• Message Transport – CDA document wrappers
• Document Formatting – Structural & Document Template
• Data Content – Header, Section, Entry & Item Templates
9. Practical Discussion
Will the Integration as a Service approach succeed?
• Feedback – Generally positive
– PMS vendors (GP2GP v2) & DHB CIOs
• Operational Principles – Broad consensus:
– HISO as certifying authority, Patients First the endorsed test agency
– ITP as enabler, rather than enforcer, of standards – educative feedback
• Usage – UAT moving into production for InterRAI & GP2GP v2
• HISO Standards – Simplified CDA Templates
– Hierarchical Descriptions - (c/f XML Schematron –arcane conformance statements)
– Human-understandable error and warning messages
– Richer validation provided by OO languages
• Service-Oriented – Web Form and RESTful interfaces
– Centrally hosted and targeted testing – persists beyond project lives
– No silo-based testing of entire product suite deployments
10. Summary & Conclusions
• Progress
- All CDA types used in national projects
- Adding clinical coding analysis
• Going Forward
- Compliance testing as part of product certification
- Objective criteria for informed purchasing decisions
• Acknowledgements
- Alastair Kenworthy & Dr. Peter Sergent.
- HL7 NZ and various HIT/PMS software vendors!
“Interoperability is not a boat race. One team can’t win by
rowing better than another. We are all rowing the same boat.”
11. Reference Sources
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W3C. Extensible Markup Language (XML). http://www.w3.org/XML/
HL7. Clinical Document Architecture Release 2. http://www.hl7.org/implement/standards/index.cfm
Atalag K, Hay D, Kenworthy A, Le Maitre A. Interoperability Reference Architecture. Version 1.0 December 2011
HISO 10040.3. Health Information Exchange: Structured Documents. Version 1.0 April 2012
http://www.ithealthboard.health.nz/sites/all/files/HISO%2010040.3%20HIE%20Structured%20Documents%20v1.pdf
HISO 10043. CDA Common Templates. Draft 10 April 2013 http://www.ithealthboard.health.nz/sites/all/files/vPC%20CDA%20Common%20Templates.pdf
HISO 10047. Comprehensive Clinical Assessments for Older People. Draft 10 April 2013
http://www.ithealthboard.health.nz/sites/all/files/VPC%20Comprehensive%20Clinical%20Assessments%20for%20Older%20People.pdf
Jordan P. Clinical Document Architecture Implementations - Lessons Learned To Date. HINZ Conference 2012
http://www.hinz.org.nz/uploads/file/2012conference/Papers/P9_Jordan.pdf
Tech Target. Integration as a Service: Definition. http://searchcloudapplications.techtarget.com/definition/integration-as-a-service at June 2012
Wikipedia. Integration Testing: Definition. http://en.wikipedia.org/wiki/Integration_testing at 3 June2013
Rishel W. Gartner Blog Network. Health Interoperability January 9, 2013 http://blogs.gartner.com/wes_rishel/category/interoperability/
MSDN. Improving XML Document Validation With Schematron. http://msdn.microsoft.com/en-us/library/aa468554.aspx#schematron_topic4
HL7 Book. The Eclipse Instance Editor. http://hl7book.net/index.php?title=Eclipse_Instance_Editor
Lantana Consulting Group. CDA Validator. https://www.lantanagroup.com/validator/
AHML. Australian Healthcare Messaging Laboratory. http://www.ahml.com.au/
NIST. Meaningful Use Test Methods. http://healthcare.nist.gov/use_testing/index.html
Intelliware Software. e-Health Testing Platform. http://www.intelliware.com/case_study/e-health-testing-platform/
IHE. Integrating The Healthcare Enterprise. http://www.ihe.net/
PMS Requirements – final report http://174.142.164.230/~whmroot/_patientsfirst.org.nz/wp-content/uploads/2013/02/PMS-Requirements-Final-Report-v1-.1.pdf
Commonwealth Fund – eMR adoption http://www.commonwealthfund.org/News/News-Releases/2012/Nov/International-Survey.aspx
http://174.142.164.230/~whmroot/_patientsfirst.org.nz/wp-content/uploads/2013/02/PMS-Review-Findings-2011-Executive-Summary-Report-FINAL.pdf
Wikipedia. Representational State Transfer: Definition. http://en.wikipedia.org/wiki/Representational_state_transfer
12. Questions & Suggestions
• Additions to the Integration Test Platform?
• Thanks for attending!
peter.jordan@patientsfirst.org.nz
andrew.terris@patientsfirst.org.nz