INTEROPERABILITY INTEGRATEDCARE

Transkript

1 INTEROPERABILITY POWERINGTHEIDEAOF INTEGRATEDCARE

2 Index Introduction UnderstandingInteroperability TheAimsandMeansofInteroperability TypesofInteroperability MappingofInteroperabilityStandards How CanClinicalDataBeMadeMeaningfuland Usable? TheCuriousCaseofHealthDataExchange WebAPIs HL7FHIR SMARTonFHIR Pushvs.PulModelsofExchange SemanticInteroperability Conclusion

3 1.Introduction ImagineapatientisadmitedintheICUanywhereinthecountry.Multipledevicesareconnected tothatsinglepatient,andeachdeviceisgeneratingavastamountofdataeveryfew seconds. Thishealthcaredataislockedindatasilos,controledbydiferentstakeholders.Therealityis manyofthem arereluctanttosharethisinformationwithothers. 1

4 2.UnderstandingInteroperability Thelackofdatainteroperabilityhasplaguedhealthcareformanyyears;itisresponsiblefor drivinguphealthcarecostsandnegativelyafectingyourhealthuntilnow. Tounderstandinteroperability,wemustfindanswerstothefolowingquestions: Whathappenstothecolectedhealthdata? How doesittravelfrom onesystem toanotherintheenterprise? Whocanaccessthedataandhow easilyitcanbeaccessed? How welisthedatalinkedtootherdataofasinglepatient? How welisthisdatalinkedtootherdataofsimilarpatientsinthesame healthcarefacility? Candataofasinglepatientbel Candataofasinglepatientbeleveragedforaful-scalepopulationhealth managementsystem? MilionsofpatientsinhealthcaresetingsacrosstheUSgenerateavastamountofhealthdata. Patientsservedbyradiology,oncology,cardiology,andotherdepartments,alconnectedto multipledevicesgeneratingsheervolumesofdata. 2

5 Today shealthitchalengesnotonlyafecttheprovidersbutalhealthcarestakeholders.hereare somechalengesthatwearefacingtoday, 31%ofsurveyedhealthcentersreportdatasecuritybreaches. Careteamsarenotabletocolaboratewithpatientsandtheirfamiliesbecausetheycannotview thesameehr. Majoramountofdataremainsmissing,inaccurate,andnon-standardized. Theneedlessduplicationoftests,medications,andtreatmentsaddstorisinghealthcarecosts. Systemscannotintegratedatafrom diferentsources eventhosefrom withinthesame organization. Healthinformationanalysisandrelatedresearchareobstructedbylackofclinicaldata warehouses;onlyclinicaldata silos exist. Thepressureofthesemajorchalengesonhealthcaresystemshasneverbeenhigher.Thisisdue torisingexpectations,agingpopulations,andespecialyinemergingeconomies,thecombined chalengesofinfectiousdiseaseandtherisingincidenceofchronicilness. 3

6 3.TheAimsandMeansofInteroperability InSanDiego,whereIlive,wehavehealthsystemsthathaveno businesscaseforexchangingdata,butmorethanthat,wehavebig healthcaresystemswheredatafrom theemergencyroom can'tbesharedwith acutecareunitinthehospital.that'snotaninteroperabilityproblem,that'sa problem ofthewaysystemsevolveandthebusinessneedsofour respectivestakeholders.there'snotthewiltoovercomethechalenges,nor apparentlythecapabilitiestodoso. CharlesJafe,CEO,HL7 4

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8 4.TypesofInteroperability Interoperabilityhelpstomaketherightdataavailabletotherightpeopleattherighttimeacross theorganization.theinteroperablehealthitecosystem canberelieduponandmeaningfulyused byrecipients. Anenterprise-widehealthcareinteroperabilitystrategyisneededtoensurethemeaningfuland appropriateuseofinsight-richdata,helpingtotransform healthcaredeliveryforeveryone. ExistingInteroperabilityStandardsandOrganizations Standards Organisations 6

9 5.MappingofInteroperabilityStandards Insummary,thereisnosingleorganizationthatcoversalthestandardsneededforDigitalHealth. However,standardscanbecombinedtoprovideafulyinteroperableDigitalHealthservice. 7

10 6.HowCanClinicalDataBeMadeMeaningful andusable? InformationtechnologyisrapidlyadvancingwithimmensegrowthintheHealthITmarketplacein thebackground.ithasbroughtarushofhealthitorganizationsintothefield,addingtothesheer volumeandawidevarietyofclinicalinformationoriginatingwithdiferentsystems.theonslaughtofstructuredandunstructureddataaddstothechalengeofdeliveringacomprehensive andintegratedview ofpatientcarethroughenterprise-wideinteroperability. Clinicalinformationshouldbeeasytosearch,retrieve,andinterpretforanygivenuser sneeds.it ismadepossiblebyaddingmetadatatagsindicom toprovideacontext.ourprimarygoalisto makeinteroperabilityanongoingjourneywithmanyroutesbywhichitcanbeeasilyreached. WhataretheMajorTechnicalChalenges&SolutionsforDelivering MeaningfulInformation? Seamlessdeliveryofmeaningfulclinicalinformationacrosstheenterpriseisessential.Itrequires advancedanalogousmethodsandtoolsforefectiveimagecapture,processworkflow management,imagedatamanagement,centralizedstoragesystem,andtheabilitytoaccessandshare datathroughouttheenterprise. 8

11 Severalchalengesmustbesolvedtobuildafulyintegrated enterpriseecosystem,including: Disparate Images Acquisition Acquisition Devices DataFormats& Protocols Metadata Storage Solutions: Acquisitionand Capture DataFormats& Protocols EnterpriseData Recovery Cross-enterprise DataDiscovery Patient Demographic DataDiscovery EHR Integration 9

12 7.TheCuriousCaseofHealthDataExchange Since1987,HL7Internationalhasbeenworkingonhealthcaredatastandardstocreateand improvethestandardsinusethroughoutthehealthcareindustry.hl7standardsareessentialfor providerstointegratedatafrom diferentvendors. Diferentsystemshavevariedworkflowswhicharesupposedtoworkwelinapatientfacilityor anambulatoryenvironment.thetechnologyleveragedshouldbeflexibleandeasilyconfigurable. Let'sunderstandthetraditionalhealthdataexchangepaternusingHL7V2. 1.TraditionalDataExchange AdoctortypesdataintotheEHR. DataleavestheEHRinanHL7v2orCDAformatdocument. Thedataissentoveraninterfacetothereceivinghealthsystem. Thereceivinghealthsystem parsesthedataandimportsitintotheirdatabase. TypicalPointtoPoint 10

13 2.DataExchangewithanIntegrationEngine Today,mostproviderspreferanintegrationengineatthecoreofaltheirinterfaces.Integration enginesarequickandsimplifytheworkflow forcentralmonitoring,flow control,alerting,data mapping,andmore,toorganizedataflow withintheseapplications. Interoperabilitymeanstheabilityofhealthinformation systemstoworktogetherwithinandacrossorganizational boundariesinordertoadvancethehealthstatusof,andthe efectivedeliveryofhealthcarefor,individualsand communities. -InteroperabilityDefinitionbyHIMSS 11

14 8.WebAPIs AnAPI,orapplicationprogramminginterfacetoenablecommunicationbetweenmultiplehealth systemssuchasehrs,mobileapps,iotdevices,etc.apisplayavitalroleforanyauthorized applicationtoreceiveand/orsenddatawithstringentsecurityauthentication. MajorAPIUsageCategories: 1.APIsforthetraditionalproviderintegrationstrategy 2.OpenAPIforclinicaldatasharing 1.APIsforProviderIntegration APIscansupplementthecurentmethodsofHL7v2exchangebyoferingacheaper,lighter,and easierformatofinteroperability.providerscancreatearobustapitofacilitateexternal data-sharingrequestsbysimplysharingtheirapprovedapistandards. 12

15 2.OpenAPIforSharingClinicalData AggregationofmedicalhistoryofasinglepatientispossiblewitheasyaccesstodataviaanAPI. Toprovideapatient scompleteclinicalinformationviaapi,providersmustcombinedataand returnittotherequestingapplicationviaapi.theintegrationlayercanhelphealthorganizations tobreakfreefrom EHRdatasilosandgaintotalcontrolofpatient'smedicaldata. 13

16 9.HL7FHIR Aswehavelearntabove,HL7v2isawel-establishedstandardthathelpstoconnectenterprise applications.leveraginghl7v2alsohasmanychalenges.it'slimitedtomoderndevicesand appswhicharetryingtoleverageavailableclinicalinformationofapatient.implementingdata privacyandsecurityarealsoamongthepressingchalenges. TheFHIRstandardhasanAPIdesignedwithamoreflexibleandlightweightmethodofclinical dataexchange.fhirutilizesrestfulwebservicesalongwithsoapwebservices,making securityeasiertomaintain. Webserviceshavereadilydefinedsecurityprotocols(HTTPS)andcommonlyusedauthentication techniqueslikeoauth2.0.securitymeasuresimplementationbecomeseasierwithfhirwith flexibilitytoleveragewidelyusedsecuritystandards.combiningthefhirapiwithmultiple advancedwebservicesisthefutureoftechnology. 14

17 10.SMARTonFHIR SMARTisanacronym for'substitutablemedicalapplicationsandreusabletechnologies'.itwas createdin2010andimplementedattheharvardmedicalschooldepartmentofbiomedical InformaticsandBostonChildren shospitalcomputationalhealthinformaticsprogram. 'SMARTonFHIR'isasetofopenspecificationstointegrateappswithEHRs,healthportals,HIE (HealthInformationExchange),andotherHealthITsystems. SMARTwasstartedwithanobjectivetodefineadatastandardwhichwouldmakea buildonce, goanywhere modelpossible.smartisastandardthatworksinassociationwithandontopof FHIR.Thisiswhyhealthtechindustrycommonlyrefertoitas'SMARTonFHIR'. SMARTfocusesonformalizingthemethodforinteractingwithFHIRinterfaces,outlininghow the mobileappswilbe'launched'from theehr.smartalsofocusesonstandardizingthesecurity protocolsusedbythird-partiestoexchangedataintoehrsystems. SMARTfolowsadedicatedapproachtoproduce'how-todocumentation'designedtohelp developerstounderstandwhatfhirmakesavailableandhow tobuildalongsidesmartfor futureroloutstoalivehealthcareseting. ThegoalofSMARTisaudaciousandcanbeexpressed concisely:aninnovativeappdevelopercanwriteanapp once,andexpectthatitwilrunanywhereinthehealthcare system.further,thatappshouldbereadily substitutableforanother. -KennethMandl,MD,MPH Chair,SMARTAdvisoryCommitee 15

18 HowtoimplementaSMARTonFHIRapp? Theprocessofimplementationhappensinthefolowingsteps: 1. Therequiredspecificationisdeveloped. 2. EHRvendorsimplementthestandardsaswelasspecifications. 3. ThehealthsystemsEHRconsumersinstal,update,andconfiguretheirsystemsto consolidatethestandards. 4. Applicationsaredevelopedontopofthehealthsystem sspecifications. SMARTstrivedtoproducespecificationsthatworkformodern-dayhealthcareappdevelopers andareimplementablewithintoday sevolvingtechnologylandscape.smartonfhiraddresses theneedsofend-usersandappdeveloperswhileprovidinganopen-standards-basedplatform thatalignswiththeneedsofclinicalsystem vendors.tobuilduponthemomentum,we recommendastrongpushtowardearlyplatform adoptioninserviceofbusinesscasesthat providevaluetoday. 16

19 11.Pushvs.PulModelsofExchange APIsalow applicationstopultheinformationitneedsfrom whenitisneeded.witheachupdate intheapplication,thetraditionalv2interfacescontinualypushthepatientdata.rather,aspecific pieceofclinicaldatasuchasorderstatus,curentbloodpressure,location,etc.shouldbe receivedinreal-time.real-timeapproachisnotpossiblewithv2. AHybridApproachtoDataExchange 83%ofhealthcareprovidersusesomecloudserviceorapplicationwithintheirITarchitectureaccordingtotheHIMSSAnalyticsCloudSurvey. Ifwedecidetofolow thegroundbreakingfhirapiapproachtodataexchange,werequireanextremelyflexibleapproachtomanagehealthdata.modernhealthitdepartmentsneedacentral commandtohelpguidetheflow ofdatabetweensystemstoensurethateachapplicationand healthcareproviderhastherightpatientdata,attherighttime,withtherightinsights. AsFHIRAPIconnectivitybecomescommon,thetransparencyofEHRdatabaseswilsurely increase.externalapplicationsforpatientsandproviderswilhavetheabilitytoimportandexport clinicaldatamoreeasilywithouttheneedforproviderstodirectlygiveaccesstotheehr database.thischangewillikelycauseafundamentalshiftawayfrom dependenceonehr functionality. 17

20 HybridIntegrationDataflowusingCorepointIntegrationEngine: 18

21 12.SemanticInteroperability Tomovetowardsamoreholisticmulti-platform,multi-networkapproachSemanticInteroperabilitycanplayavitalrole.Today'smobileoperatorsareworkingwithhealthcarepartnerstodeliver value-addeddigitalhealthservicesinfivemainareas: DataHosting,ManagementandSupport/CloudServices Multiple health devices taking keyreadings with a centralized data storage,usualyin a cloud-basedehrrequireapowerfulinteroperablesystem.the dataalsoneedstobepresented backtocreateinsightforpatientsandhealthcareprofessionals. 19

22 HospitalInformation&CommunicationSystems SystemsthathelphealthcareprofessionalstoaccesstheirpatientsDigitalHealthrecords wherevertheyareinthehospital. PatientRelationshipManagement&CustomerCare Servicescanrangefrom medicalappointmentremindersthroughsmstocalcenters,to assist healthcareprovidersinpatientengagement. 20

23 ContentServices,HealthAccess,andMonitoringSolutions Providingnecessaryguidancetoindividualsfortheself-managementand prevention of their healthconditions. ConsumerDeviceManagement&Supply Fitnessdevicesorsmartwatches,enablingindividualstomanagetheirownhealthandwelness. 21

24 13.Conclusion Lackofinteroperabilityisoneofthegreatestchalengestoachievingimprovementstohealthcare andcosteficiencypromisedbyemerginge-healthsystems.ontheotherhand,implementingthe curentstandardsforinteroperabilityisalsohard.butaninteroperablehealthcareecosystem ofersgreatopportunitiestopositivelyinfluencepatientsandprovidersthroughhighlyintegrated caredeliverymodels. Healthcareorganizationsshouldlookholisticalyatadvancedandsecuredatasharingstrategies thatspantheentirepatientcarecontinuum.healthcaretechnologydevelopersshouldseekinput andcolaborationwithfederalagenciestoinform governanceimplementationandensurebroad participationacrossexistingoperatinghealthinformationnetworks,includingthosefocusedat thevendor,enterprise,regional,andstatelevels. Thefutureofhealthcaredeliverywilbeaboutdemystifyingtheconcepts,connectingthedots, eliminatingdisconnects,sharingdataalongthevaluechaintounderstanditasawhole.interoperabilityofdatatosupportthefruitfulcolaborationofalthemajorhealthcarestakeholderswilbe key. 22

25 Wearealeadingsoftwaredevelopmentcompanyaimingtoempower,and inspiretheworldwithnext-gensolutions.wehelpinsimplifingeverystepof thedevelopmentprocess,from system architecturedesigntoquality delivery.ourinteligentprocessesenablequickdeploymentof enterprise-gradesolutionsagainstthetoughest,andmostcomplex chalenges. Wearere-imagininghow technologycanempower Healthcare,AI,Analytics,andFinancialorganizationstobuildsolutionsfor everydayuseinbusinessapplications. With10+yearsofexperience,and200+customersworldwide,we're leveragingtechnologytobuildthefuturetoday. DiscussYourProject osplabs.com Texas California Maryland Mumbai 2019