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Allan Oas, Director of Architecture, Registries and Public Health Surveillance

iEHR Architecture Presentation to Pan-Canadian Registries Standards Groups Feb 7 and Feb 10, 2005 Kelowna, BC. Allan Oas, Director of Architecture, Registries and Public Health Surveillance Solution Architecture Group (SAG) Canada Health Infoway Inc.

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Allan Oas, Director of Architecture, Registries and Public Health Surveillance

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  1. iEHR ArchitecturePresentation to Pan-Canadian Registries Standards GroupsFeb 7 and Feb 10, 2005Kelowna, BC Allan Oas, Director of Architecture, Registries and Public Health Surveillance Solution Architecture Group (SAG) Canada Health Infoway Inc.

  2. Context: Infoway Investment Programs 2003 - 2009 End User Adoption and Setting the Future Direction Innovation & Adoption The Electronic Health Record Interoperable EHR Drug Information Systems Laboratory Information Systems Diagnostic Imaging Systems Public Health Systems Domain Repositories and Healthcare Applications TeleHealth Cross Program Services Client, Provider and Location Registries Architecture and Standards Infostructure

  3. EHR Solution (EHRS) EHR Data & Services DomainRepository Services EHR Repository Services Registry Services • Health Information Access Layer (HIAL) • Standards, common and communications services to integrate applications across the continuum of care and healthcare delivery jurisdictions • Enables integrated access and view • Creates data and application abstraction layers • Most cost effective approach to integration Common Services H I A L Communication Bus Communication Bus Appl Appl Appl Appl Applications Summary of Key EHRS Architecture Concepts • EHR • Patient-centric, lifetime, federated databases • All clinically relevant data that needs to be shared • Encounter information • Structured, integrated and semantically consistent • Registries to identify people, providers and locations of care • Applications • Clinical data to share is “pushed” from source systems into EHR in near real time • EHR data is “pulled” into the provider’s application for one integrated view

  4. Larger size Jurisdictions • Provincial Client and Provider Registries • Provincial Lab and Drug Repositories • Supra-regional EHR and DI Repositories • Local EMR, CIS and EHR viewer applications REGIONAL\JURISDICTIONAL Client Registry Client Registry Provider Registry Provider Registry EHR EHR DI Repository Drug Repository Laboratory Repository Laboratory Repository DI Repository Drug Repository DI Repository Region 1 Region 2 LOCAL/REGIONAL EMR CIS EMR EMR EMR CIS CIS CIS EHR Viewer Common Services Common Services EHR Viewer EHR Viewer EHR Viewer REGIONAL\JURISDICTIONAL Communication Bus Communication Bus Communication Bus Communication Bus HIAL HIAL • Medium size Jurisdictions • Provincial Client and Provider Registries • Provincial Lab, Drug, DI and EHR Repositories • Local EMR, CIS and EHR viewer applications LOCAL Results of planning sessions with jurisdictions: Large and Medium Interoperability Models

  5. Client Registry Provider Registry EHR Drug Repository DI Repository Laboratory Repository CIS Common Services Communication Bus Communication Bus HIAL EMR EMR Results of planning sessions with jurisdictions: Small jurisdictions • Small Jurisdictions • A single integrated CIS solution may deliver all of the EHRS services at the jurisdictional level • Local physician office systems or viewers provide access REGIONAL\JURISDICTIONAL EHR Viewer LOCAL

  6. EHR Solution (EHRS) EHR Solution (EHRS) EHRS Locator EHR Infostructure (EHRi) EHR Infostructure (EHRi) EHR Data & Services EHR Data & Services EHR Repository & Services EHR Repository & Services DomainRepository Services DomainRepository Services Registry Services Registry Services Common Services Common Services H I A L H I A L Communication Bus Communication Bus Communication Bus Communication Bus Appl Appl Appl Appl Appl Appl Appl Appl Applications Applications EHRS EHRS EHRS EHRS EHRS EHRS EHRS Context: EHR Solution (Infoway Blueprint)Distributed, Message-based, Peer-to-Peer Network of EHRS Systems

  7. Applications Appl Appl Context: Healthcare Provider’s View of EHR

  8. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository JurisdictionalLab InfoSystem DrugInformationSystem CR DIS PR DI-r JLIS LR RadiologyCenter PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Expanded view of architecture using Blueprint model:Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID means “responds with” HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  9. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository JurisdictionalLab InfoSystem DrugInformationSystem CR DIS PR DI-r JLIS LR Communication Bus Transformation Services Routing Services En / Decoding Services Encrypt / Decrypt Services Serialization Services Parser Services Network Protocol Services App Protocol Services Pharmacy System PhysicianOfficeEMR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Radiologist Pharmacist Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  10. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository DrugInformationSystem JurisdictionalLab InfoSystem CR DIS PR DI-r JLIS LR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  11. Common Services EHR Data Repository EHR Services EHRIndex INTEROP SECURITY HIAL HIAL HIAL Business Components Data Access Interoperability Services Permission Mgmt Services Authent’n Mgmt Services DrugInformationSystem DiagnosticImagingRepository JurisdictionalLab InfoSystem CR DIS PR DI-r Search /Resolution Services Security Services Policy Mgmt Services JLIS LR GENERAL SUBSCRIPTION INTEGRATION Auditing Services Alert / Notification Services Service Catalogue Services Log Mgmt Services Pub / Sub Services Broker Services Exception / Error Handling Services Mapping Services MANAGEMENT Management Services Queuing Services PhysicianOfficeEMR Hospital,Community,etc., EPR LabSystem(LIS) PACS/RIS Pharmacy System CONTEXT Configuration Services Caching Services Session Mgmt Services Radiologist Pharmacist Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  12. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository DrugInformationSystem JurisdictionalLab InfoSystem CR DIS PR DI-r JLIS LR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  13. EHR Data Repository EHR Services EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS Data Services Key Management Services PR DI-r JLIS LR ETL Services Replication Services Assembly Services Normalization Services Domain Business Components (DI, Lab, Pharmacy, Registries) Business Rules Services Workflow Services Pharmacy System PhysicianOfficeEMR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Radiologist Pharmacist Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry DATA HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID BUSINESS Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  14. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository JurisdictionalLab InfoSystem DrugInformationSystem CR DIS PR DI-r JLIS LR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Positioning Current InitiativesThe Client Registry JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID means “responds with” HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  15. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository JurisdictionalLab InfoSystem DrugInformationSystem CR DIS PR DI-r JLIS LR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Positioning Current InitiativesThe Provider Registry JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID means “responds with” HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  16. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DiagnosticImagingRepository JurisdictionalLab InfoSystem DrugInformationSystem CR DIS PR DI-r JLIS LR PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Pharmacy System PhysicianOfficeEMR Radiologist Pharmacist Positioning Current InitiativesDrug, DI and Lab “Domain” Systems JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID means “responds with” HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician

  17. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DrugInformationSystem DiagnosticImagingRepository CR DIS PR DI-r JLIS LR Hospital,InformationSystem Positioning Current Initiatives (examples)Hospital Information System; Clinical Portal JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 EHR API Clinical Portal EHR API Physician/Provider Physician/Provider

  18. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DrugInformationSystem DiagnosticImagingRepository CR DIS PR DI-r JLIS LR Hospital,InformationSystem Positioning Current Initiatives (examples)iEHR services, including interfaces to all others JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 EHR API Clinical Portal EHR API Physician/Provider Physician/Provider

  19. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Health Business Transaction (HBT):Visit to the family physician -- The steps JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE • Health System Transactions • ========================== • Log-on to EMR • User Selects patient • View selected patient clinical dashboard • View selected HBT details • Record new provider referral • Record new HBT clinical summary • User closes patient chart • User logs-off EMR system HL7 EHR API

  20. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Interoperability Profile: Patient visit to family physicianHealth System Transaction #1: User logs-on to the EMR system • Establish HBT Context • Enable service • Broker service call to security services • Call security services with parameters • ----------------------------------- • Receive response from security service • Send response to calling application via communication bus JURISDICTIONAL INFOSTRUCTURE • Receive service call • Validate user authentication • Create User Id token • Package response • Call Broker Service with response EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID • Receive message • Open message • Parse message • Transform message • Route message HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE • Data Exchanged • ============== • System Id • Local Location Id • EHRi Location Id • Session Id • Timestamp • ------------------------ • User Id • User Id Token • EHRi Transaction (EHRiTx) • “Authenticate EHR user” • ========================== • Send system authentication and request for communication session • ----------------------------------------------------------------- • Receive response and establish context • Send/receive user authentication message • ----------------------------------------------------------------- • If error/warning, pass as response • Else a comm. session context is established, userauthentication token are written to it • Function terminates with success • Health System Transaction #1 • “Log-on to Electronic Medical Record System” • ========================== • User identification data is entered • User authentication is validated internally • EHRi user authentication is validated and atoken representing the user is returned • Errors/warnings are presented to the user • User is authenticated and a communication sessioncontext is created in the EHR API • The EHRi user token is written to the context and persisted in the EHR API HL7 EHR API Physician/Provider

  21. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Interoperability Profile: Patient visit to family physicianHealth System Transaction #2: User selects a patient from the EMR patient index JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE • Data Exchanged • ============== • None • EHRi Transaction (EHRiTx) • “User selects patient from roster” • ========================== • Nothing happens with the EHR • The communication session contextis maintained in the EHR API • Health System Transaction #2 • “User selects patient from roster” • ========================== • User patient list is displayed from local data • User points and clicks on a specific patient toselect the patient • The EMR system establishes this patient ID as part of its context • The system proceeds to the clinical dashboard • The EHR is not involved at this stage and isunaware of any specific patient having been selected HL7 EHR API Physician/Provider

  22. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Interoperability Profile: Patient visit to family physicianHealth System Transaction #3: User views selected patient clinical dashboard JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE • Data Exchanged • ============== • EHRi Session ID • EHRi HBT ID • EHRi User ID • EHRi Location ID • Local Client ID • Client ID Data • EHRi Client ID • Local Provider ID • Provider ID Data • EHRi Provider ID • Clinical DashboardQuery Parameters • Clinical DashboardQuery Response: • HBT data • HBT Event Data • EHRi Transaction (EHRiTx) • “Get Client Clinical Dashboard” • ========================== • Relying on established session, send clinicaldashboard query message • ----------------------------------------------------------------- • Receive response • If resolution is required on Client or Provider, then send resolution info to application • ----------------------------------------------------------------- • Else HBT context is established and ClinicalDashboard data is writtent to it • Function terminates with success • Health System Transaction • “View selected patient clinical dashboard” • ========================== • Local patient data is accessed using local Client ID • An EHRi request is sent for the “clinical patient picture”, this request carries client ID data andparameters qualifying what to bring back (type ofdata and # of records) • If resolution of Client ID fails, a dialog allows forhuman intervention to resolve; • Else, response is received from EHRi and data isconsolidated with local data to create list • The patient clinical dashboard is displayed and theuser can navigate the different panes HL7 EHR API Physician/Provider

  23. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access JurisdictionalLab InfoSystem DiagnosticImagingRepository DrugInformationSystem CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Interoperability Profile: Patient visit to family physicianHealth System Transaction #4:User drills-down into last patient visit to ER JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE • Data Exchanged • ============== • TBD • EHRi Transaction (EHRiTx) • “Get HBT Details” • ========================== • TBD • Health System Transaction • “View Selected HBT Details” • =============================== • TBD HL7 EHR API Physician/Provider

  24. End www.infoway-inforoute.ca aoas@infoway-inforoute.ca

  25. Appendix: Registries and Clinical System Interoperability Example

  26. Client Registry Drug InformationSystemRepository Pharma Physician Pharmacist EHR Logical Architecture (Not desired)NL Example: Early thinking (No EHR Services) HL7 (CR) CR API JURISDICTIONALINFOSTRUCTURE EMPI Query 7) Query patient 8) Obtain all related MRNs 9) x-ref and join DIS data CR API DIS API HL7 v3 (CeRx) HL7 (CR) Search / Resolve PHARMACY PROFILE 4) Request Drug Profile 5) Request DUR 6) Enter new Prescription CLIENT REGISTRATION 1) Search Client 2) Create New Client, or 3) Update Existing Client POINT OF SERVICE HL7 v3 (CeRx) HL7 v3 (CeRx) • PATIENT ENCOUNTER • ============================ • Client Registration • Search Client • Create New Client, or • Update Existing Client • Pharmacy Profile • Request Drug Profile • Request DUR • Enter new prescription Clinical Portal DIS API CR API DIS API HL7 (CR) CR API In this model, each Jurisdiction Infostructure level system uses patient and other required strong identifiers (e.g., provider, encounter) based on point-of-service generated IDs (e.g., MRNs). The CR-EMPI source systems make the CR-EMPI aware of client identifiers. The point of service applications and Infostructure systems query the CR EMPI for these identifiers in order to access data within any Infostructure System. The level of queries and maintenance of MRNs in the EMPI is not scalable to hundreds or thousands of point-of-service systems. There are performance issues accessing CR/EMPI for every Drug system interaction.

  27. DrugInformationSystemRepository Pharmacy System Physician Pharmacist Sample EHR Logical Architecture (Interim State)NL Example: Basic EHR Infostructure, CR, DIS) JURISDICTIONALINFOSTRUCTURE CLIENT REGISTRATION 1) Search Client 2) Create New Client, or 3) Update Existing Client EHR Data & Services Search / Resolve ClientRegistry Get EHR ID HIAL HL7(CR) GenerateEHRClient ID HL7 v3 (CeRx) HIAL means “responds with” PHARMACY PROFILE 4) Request Drug Profile 5) Request DUR 6) Enter new Prescription Consent Configuration Security Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 • PATIENT ENCOUNTER • ============================ • Client Registration • Search Client • Create New Client, or • Update Existing Client • Pharmacy Profile • Request Drug Profile • Request DUR • Enter new prescription Clinical Portal EHR API EHR API In this model, the client registry system “generates” a global unique ID (EHR ID) for patients. The Drug Informaton System (DIS) will use the EHR patient ID to store prescribing and dispensing data. Point-of-service applications query the Client Registry and obtain the EHR patient ID and will use this ID as a token throughout the entire business transaction. This model eliminates the need for communication between the DIS and CR, and reduces the transactions to the CR to one per business transaction.

  28. EHR Services EHRIndex Business Components Data Access DrugInformationsystem CR DIS Pharmacy System Physician Pharmacist Sample EHR Logical Architecture (Target State)NL Example: Initial EHR Infostructure (CR, EHR, DIS) JURISDICTIONALINFOSTRUCTURE EHR Data & Services CLIENT REGISTRATION 1) Search Client 2) Create New Client, or 3) Update Existing Client EHR Data & Services Search / Resolve ClientRegistry Get EHR ID HIAL HL7(CR) GenerateEHRClient ID HL7 v3 (CeRx) means “responds with” HIAL PHARMACY PROFILE 4) Request Drug Profile 5) Request DUR 6) Enter new Prescription Consent Configuration Security Interoperability Services Common Services HIAL Communication Bus Communication Bus POINT OF SERVICE HL7 HL7 • PATIENT ENCOUNTER • ============================ • Client Registration • Search Client • Create New Client, or • Update Existing Client • Pharmacy Profile • Request Drug Profile • Request DUR • Enter new prescription Clinical Portal EHR API EHR API In this model, the client registry generates a global unique id (EHR ID) for patients. The DIS will use the EHR patient ID to store prescribing and dispensing data. EHR services will use the CR to map any local MRN found within transactions to the corresponding EHR patient ID. The POS applications do not necessarily have to be aware of the EHR patient ID or they can continue to provide this ID themselves after querying the CR (compatible with prior model).

  29. EHR Data Repository EHR Services EHRIndex HIAL HIAL HIAL Business Components Data Access DrugInformationSystem JurisdictionalLab InfoSystem DiagnosticImagingRepository CR DIS PR DI-r JLIS LR PhysicianOfficeEMR Pharmacy System PACS/RIS LabSystem(LIS) Hospital,Community,etc., EPR Radiologist Pharmacist Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability JURISDICTIONAL INFOSTRUCTURE EHR Data & Services ClientRegistry EHR Data & Services HL7 (CR) HIAL GenerateEHRClient ID means “responds with” HL7 (PR) ProviderRegistry HIAL HL7 v3 (CeRx) HL7 (DI) HL7 (Lab) GenerateEHRProvider ID means “responds with” HL7 (LR) LocationRegistry HIAL Configuration Consent Security GenerateEHRLocation ID Interoperability Services Common Services HIAL Communication Bus POINT OF SERVICE HL7 HL7 HL7 HL7 HL7 HL7 EHR API EHR API EHR API Clinical Portal EHR API EHR API EHR API Physician/Provider Physician/Provider Physician/Provider Lab Technician In this model, the client, provider, location registries and EHR Services generate (respond with) global unique ids for patient, providers, encounters, and other required strong identifiers. All Infostructure systems use these unique Ids to store clinical data about a person. The EHR Services will map any local ID to the corresponding EHR ID. The Domain services (DIS, DI, Lab) systems rely on the EHR Services to ensure that the necessary EHR IDs are provided with every transaction.

  30. End www.infoway-inforoute.ca aoas@infoway-inforoute.ca

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