1. Interoperability between Heterogeneous Healthcare Information Systems John Gillson ICW Labs

9. HL7 functionalities – Business Logic component Source: Web Services Enablement for Healthcare HL7 Applications - Regio

11. HL7 functionalities – Business Logic component Source: Web Services Enablement for Healthcare HL7 Applications - Regio

12. HL7 Patient Referral example Sarah Johnson 12345 HL7-v3 Patient Referral Network Transmitting 11011010 HL7-v3 Patient Referral 12345 Sarah Johnson ^ ^ Application 1: HIS Database and back end applications Application 2: HIS Database and back end applications Interface Engine Interface Engine Source: Key Issues of Technical Interoperability Solutions in eHealth; Dogac

13. Communicating via Web Services Sarah Johnson 12345 <id> </id> <name> </name> <surname> </surname> </patient> <patient> Processing HL7- v3 Patient Referral Web Service Processing HTTP over TCP/IP Transmitting 11011010 <id> </id> <name> </name> <surname> </surname> </patient> <patient> HL7- v3 12345 Johnson Sarah Source: Key Issues of Technical Interoperability Solutions in eHealth; Dogac

20. Summary of EHR Standards Source: Key Issues of Technical Interoperability Solutions in eHealth; Dogac IHE XDS profile is content neutral; it does not specify how content should be structured and encoded. However, IHE continues to specify further profiles and one recent profile IHE XDS MS HL7 specifies medical summaries based on HL7 CDA standards and CRS CDA implementation IHE RID profile d oes n ot specify content; it s upports access t o existing p ersistent documents in well- k nown presentation formats such as CDA Level One, PDF and JPEG. CDA is organized into Three levels: “Level One“ Focuses on the content of n arrative documents; is only human readable. Level Two CDA models the fine-grained o bservations a nd instructions within each heading through a set of RIM Act classes. A completely structured document where the semantics of each i nformation entity is specified by a unique code will only be possible with “ Level Three&quot;. A reference m odel and the d ata structures for EHR content are d efined . EHR Content IHE XDS IHE RID HL7 CDA EHRcom

21. Summary of EHR Standards Source: Key Issues of Technical Interoperability Solutions in eHealth; Dogac In IHE XDS, the network and transport protocol is Internet; the messaging protocol is ebXML messaging (SOAP with attachments) over HTTP or SMTP (email) The network and transport protocol is Internet; the messaging protocol is Web services (http GET). HL7 CDA does not define how EHRs can be communicated; t he specification states that CDA documents can be transmitted in HL7 messages (in OBX segment) designed to transfer clinical documents. The Message package, which i s u nder d evelopment as EN 13606-5, will define how to c ommunicate t he EHR extract to a requesting process. EHR Communication Layer IHE XDS IHE RID HL7 CDA EHRcom

23. Master Patient Index (MPI) ‏ Main Patient Data Sarah Johnson ID = 1, H X Sarah Johnson ID = 63, MPI Sarah Johnson ID = 47, GP Y Jack Smith ID = 23, H X Jack Smith ID = 84, MPI Jack Smith ID = 1, GP Y GP Y Local Patient Data Hospital X MPI - Business Logic Sarah Johnson ID = 1 Sarah Johnson ID = 47 Jack Smith ID = 23 Jack Smith ID = 1

24. MPI - New Admission Hospital 1 New admission Master Patient Index (MPI) ‏ New index patient New Sarah Johnson ID = 1, Hospital 1 Sarah Johnson ID = 67, MPI Sarah Johnson ID = 1 Recycle Sarah Johnson ID = 1, Hospital 1 Map Sarah Johnson ID = 1, Hospital 1 Sara Johnston ID = 13, MPI Recycle Bin

25. MPI - Change of Patient Data Set Master Patient Index (MPI) ‏ Keep ? Decide Sarah Johanson ID =1, Hospital 1 Sarah Johnson ID = 67, MPI Sarah Johanson ID = 67, MPI Hospital 1 Changed data set Sarah Johanson ID = 1 Break up New Sarah Johanson ID =1, Hospital 1 Sarah Johnson ID = 67, MPI Sarah Johanson ID = 90, MPI ? Recycle Bin Recycle Sarah Johanson ID =1, Hospital 1 Break up mapping

27. Combining MPI and VMR Virtual Medical Record (VMR) ‏ Master Patient Index (MPI) ‏ Jack Smith ID = 1, Hospital 2 ID = 47, Hospital 1 Jack Smith ID = 47, Hospital 1 Jack Smith ID = 1, Hospital 2 Case 1 Document 1 Case 2 Case 3 Document 3 Document 5 Document 4 Document 2

29. HSB landscape

33. PXS – General architecture PXS Master Patient Index (MPI) ‏ Virtual Medical Record (VMR) ‏ Medical Service Bus (MSB) ‏ Document Management Adapter (DMA) ‏ Browser Patient Hospital HIS, RIS, PACS... Practitioner PCD, PVS... Hospital HIS, RIS, PACS... Practitioner PCD, PVS... P 1 Browser H 1 H n P n LifeSensor Adapter (LSA) HL7 HL7 HL7 HL7 HTTP HTTP Physician

34. PXS - Hospital Group Connectivity Source: ICW Developer Network – New to ICW Professional Exchange Server

35. PXS – Components PXS System Components Master Patient Index (MPI) ‏ Virtual Medical Record (VMR) ‏ Document Management Adapter (DMA) ‏ Medical Service Bus (MSB) ‏

38. PXS – MPI continued… Source: ICW Developer Network – New to ICW Professional Exchange Server

39. PXS – Components PXS System Components Master Patient Index (MPI) ‏ Virtual Medical Record (VMR) ‏ Document Management Adapter (DMA) ‏ Medical Service Bus (MSB) ‏

41. PXS – VMR continued… Source: ICW Developer Network – New to ICW Professional Exchange Server

42. PXS – Components PXS System Components Master Patient Index (MPI) ‏ Virtual Medical Record (VMR) ‏ Document Management Adapter (DMA) ‏ Medical Service Bus (MSB) ‏

44. PXS - Components PXS System Components Master Patient Index (MPI) ‏ Virtual Medical Record (VMR) ‏ Document Management Adapter (DMA) ‏ Medical Service Bus (MSB) ‏

46. PXS – MSB continued…