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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. - PowerPoint PPT Presentation
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iEHR Architecture
Presentation to Pan-Canadian Registries Standards GroupsFeb 7 and Feb 10, 2005Kelowna, BC
Allan Oas, Director of Architecture, Registries and Public Health SurveillanceSolution Architecture Group (SAG)Canada Health Infoway Inc.
2Interoperable EHR Architecture
Cross Program Services
Domain Repositories and
Healthcare Applications
End User Adoption and Setting the Future Direction
The Electronic Health Record
Architecture and Standards
Context: Infoway Investment Programs 2003 - 2009
Client, Provider and Location Registries
Innovation & Adoption
Drug Information
Systems
Laboratory Information Systems
Public Health
Systems
Diagnostic Imaging
Systems
Interoperable EHR
Infostructure
TeleHealth
3Interoperable EHR Architecture
EHR Solution (EHRS)
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
EHR Data & Services
EHR Repository
Services
DomainRepository
ServicesRegistryServices
Communication BusCommunication Bus
Common Services
H I
A L
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
Applications
Appl Appl ApplAppl
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
4Interoperable EHR Architecture
Results of planning sessions with jurisdictions: Large and Medium Interoperability Models
Larger size JurisdictionsProvincial Client and Provider Registries
Provincial Lab and Drug Repositories
Supra-regional EHR and DI Repositories
Local EMR, CIS and EHR viewer applications
Client Registry
ProviderRegistry
DI Repository
DrugRepository
Laboratory Repository
DI Repository
EHR
Communication BusCommunication BusCommon Services
HIA
L
Region 1 Region 2RE
GIO
NA
L\J
UR
ISD
ICT
ION
AL
LO
CA
L/R
EG
ION
AL
CIS
EHRViewer
EMR CIS
EHRViewer
EMR
Medium size JurisdictionsProvincial Client and Provider Registries
Provincial Lab, Drug, DI and EHR Repositories
Local EMR, CIS and EHR viewer applications
Client Registry
ProviderRegistry
DrugRepository
DI Repository
EHR
Communication BusCommunication BusCommon Services
HIA
L
RE
GIO
NA
L\
JUR
ISD
ICT
ION
AL
LO
CA
L
Laboratory Repository
CIS
EHRViewer
EMR CIS
EHRViewer
EMR
5Interoperable EHR Architecture
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
Client Registry
ProviderRegistry
DrugRepository
DI Repository
EHR
Communication BusCommunication BusCommon Services
HIA
L
RE
GIO
NA
L\
JUR
ISD
ICT
ION
AL
LO
CA
L
Laboratory Repository
EHRViewer
EMR
CIS
EMR
6Interoperable EHR Architecture
Context: EHR Solution (Infoway Blueprint)Distributed, Message-based, Peer-to-Peer Network of EHRS Systems
EHRS EHRS EHRS EHRS EHRS EHRS EHRS
EHR Infostructure (EHRi)
RegistryServices
EHR Data & Services
DomainRepository
Services
Communication BusCommunication Bus
Common Services
H I
A L
EHR Repository& Services
Applications
Appl Appl ApplAppl
EHR Solution (EHRS)EHR Infostructure (EHRi)
RegistryServices
EHR Data & Services
DomainRepository
Services
Communication BusCommunication Bus
Common Services
H I
A L
EHR Repository& Services
Applications
Appl Appl ApplAppl
EHR Solution (EHRS)EHRS
Locator
7Interoperable EHR Architecture
Context: Healthcare Provider’s View of EHR
EHR Solution (EHRS)
EHRClient
RegistryProviderRegistry
DomainRepository
(Lab)
DomainRepository(Pharmacy)
DomainRepository(Diagnostic
Imaging)
EMRDrug ProfilePatient History
Laboratory
Patient Info
Diagnostic Imaging
Communication BusCommunication Bus
Common Services
HIA
L
EHR Solution (EHRS)
EHREHRClient
RegistryClient
RegistryProviderRegistryProviderRegistry
DomainRepository
(Lab)
DomainRepository
(Lab)
DomainRepository(Pharmacy)
DomainRepository(Pharmacy)
DomainRepository(Diagnostic
Imaging)
DomainRepository(Diagnostic
Imaging)
EMRDrug ProfilePatient History
Laboratory
Patient Info
Diagnostic Imaging
Communication BusCommunication Bus
Common Services
HIA
L
Communication BusCommunication BusCommunication BusCommunication Bus
Common Services
HIA
L
Applications
Appl Appl
8Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
RadiologyCenterPACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
Lmeans “responds with”
Expanded view of architecture using Blueprint model:Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
9Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
Communication Bus
SerializationServices
TransformationServices
En / DecodingServices
Parser Services
Encrypt / DecryptServices
App ProtocolServices
Network ProtocolServices
Routing Services
Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
10Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
11Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
Common Services
Search /ResolutionServices
ManagementServices
Pub / SubServices
Alert / NotificationServices
InteroperabilityServices
SUBSCRIPTION
MANAGEMENT
CachingServices
Session MgmtServices
CONTEXT
INTEROP
INTEGRATION
ConfigurationServices
Permission MgmtServices
Authent’n MgmtServices
Security Services
SECURITY
Policy MgmtServices
AuditingServices
Log MgmtServices
GENERAL
Exception / ErrorHandlingServicesMapping Services
Service CatalogueServices
Broker Services
Queuing Services
Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
12Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
13Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
DATA
BUSINESS
EHR Services
Normalization Services
WorkflowServices
ReplicationServices
AssemblyServices
Key ManagementServices
Data Services
ETL Services
Business RulesServices
Domain Business Components(DI, Lab, Pharmacy, Registries)
Expanded view of architecture using Blueprint model: Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability
14Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
Lmeans “responds with”
Positioning Current InitiativesThe Client Registry
15Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
means “responds with”
Positioning Current InitiativesThe Provider Registry
16Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
L
means “responds with”
Positioning Current InitiativesDrug, DI and Lab “Domain” Systems
17Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
EHR Data & Services
Clinical Portal
EHR API
Interoperability Services
Security Consent Configuration
Hospital,InformationSystem
HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR API
Physician/Provider
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
Physician/Provider
HIA
L
Positioning Current Initiatives (examples)Hospital Information System; Clinical Portal
18Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
EHR Data & Services
Clinical Portal
EHR API
Interoperability Services
Security Consent Configuration
Hospital,InformationSystem
HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR API
Physician/Provider
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
Physician/Provider
HIA
L
Positioning Current Initiatives (examples)iEHR services, including interfaces to all others
19Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus Communication Bus
Common Services
HIA
L
EHR Data & Services
Interoperability Services
Security Consent Configuration
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
Health Business Transaction (HBT):Visit to the family physician -- The steps
Health System Transactions==========================1) Log-on to EMR2) User Selects patient3) View selected patient clinical dashboard4) View selected HBT details5) Record new provider referral6) Record new HBT clinical summary7) User closes patient chart8) User logs-off EMR system
Health System Transactions==========================1) Log-on to EMR2) User Selects patient3) View selected patient clinical dashboard4) View selected HBT details5) Record new provider referral6) Record new HBT clinical summary7) User closes patient chart8) User logs-off EMR system
PhysicianOfficeEMR
HL7
EHR API
20Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICECommunication Bus Communication Bus
Common Services
HIA
L
EHR Data & Services
Health System Transaction #1“Log-on to Electronic Medical Record System”==========================1) User identification data is entered2) User authentication is validated internally3) EHRi user authentication is validated and a
token representing the user is returned4) Errors/warnings are presented to the user5) User is authenticated and a communication session
context is created in the EHR API6) The EHRi user token is written to the
context and persisted in the EHR API
Health System Transaction #1“Log-on to Electronic Medical Record System”==========================1) User identification data is entered2) User authentication is validated internally3) EHRi user authentication is validated and a
token representing the user is returned4) Errors/warnings are presented to the user5) User is authenticated and a communication session
context is created in the EHR API6) The EHRi user token is written to the
context and persisted in the EHR API
Interoperability Services
Security Consent Configuration
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Interoperability Profile: Patient visit to family physicianHealth System Transaction #1: User logs-on to the EMR system
EHRi Transaction (EHRiTx)“Authenticate EHR user”==========================1) Send system authentication and request for
communication session-----------------------------------------------------------------1) Receive response and establish context2) Send/receive user authentication message-----------------------------------------------------------------1) If error/warning, pass as response2) Else a comm. session context is established, user
authentication token are written to it3) Function terminates with success
EHRi Transaction (EHRiTx)“Authenticate EHR user”==========================1) Send system authentication and request for
communication session-----------------------------------------------------------------1) Receive response and establish context2) Send/receive user authentication message-----------------------------------------------------------------1) If error/warning, pass as response2) Else a comm. session context is established, user
authentication token are written to it3) Function terminates with success
1) Receive message2) Open message3) Parse message4) Transform message5) Route message
1) Establish HBT Context2) Enable service3) Broker service call to
security services4) Call security services
with parameters-----------------------------------1) Receive response from
security service2) Send response to
calling application via communication bus
1) Receive service call2) Validate user authentication3) Create User Id token4) Package response5) Call Broker Service with
response
Data Exchanged==============1) System Id2) Local Location Id3) EHRi Location Id4) Session Id5) Timestamp------------------------1) User Id2) User Id Token
Data Exchanged==============1) System Id2) Local Location Id3) EHRi Location Id4) Session Id5) Timestamp------------------------1) User Id2) User Id Token
21Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICECommunication Bus Communication Bus
Common Services
HIA
L
EHR Data & Services
Health System Transaction #2“User selects patient from roster”==========================1) User patient list is displayed from local data2) User points and clicks on a specific patient to
select the patient3) The EMR system establishes this patient ID as part
of its context4) The system proceeds to the clinical dashboard5) The EHR is not involved at this stage and is
unaware of any specific patient having been selected
Health System Transaction #2“User selects patient from roster”==========================1) User patient list is displayed from local data2) User points and clicks on a specific patient to
select the patient3) The EMR system establishes this patient ID as part
of its context4) The system proceeds to the clinical dashboard5) The EHR is not involved at this stage and is
unaware of any specific patient having been selected
Interoperability Services
Security Consent Configuration
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Interoperability Profile: Patient visit to family physicianHealth System Transaction #2: User selects a patient from the EMR patient index
EHRi Transaction (EHRiTx)“User selects patient from roster”==========================1) Nothing happens with the EHR2) The communication session context
is maintained in the EHR API
EHRi Transaction (EHRiTx)“User selects patient from roster”==========================1) Nothing happens with the EHR2) The communication session context
is maintained in the EHR API
Data Exchanged==============1) None
Data Exchanged==============1) None
22Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICECommunication Bus Communication Bus
Common Services
HIA
L
EHR Data & Services
Health System Transaction“View selected patient clinical dashboard”==========================1) Local patient data is accessed using local Client ID2) 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)
3) If resolution of Client ID fails, a dialog allows forhuman intervention to resolve;
4) Else, response is received from EHRi and data isconsolidated with local data to create list
5) The patient clinical dashboard is displayed and theuser can navigate the different panes
Health System Transaction“View selected patient clinical dashboard”==========================1) Local patient data is accessed using local Client ID2) 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)
3) If resolution of Client ID fails, a dialog allows forhuman intervention to resolve;
4) Else, response is received from EHRi and data isconsolidated with local data to create list
5) The patient clinical dashboard is displayed and theuser can navigate the different panes
Interoperability Services
Security Consent Configuration
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Interoperability Profile: Patient visit to family physicianHealth System Transaction #3: User views selected patient clinical dashboard
EHRi Transaction (EHRiTx)“Get Client Clinical Dashboard”==========================1) Relying on established session, send clinical
dashboard query message-----------------------------------------------------------------1) Receive response2) If resolution is required on Client or Provider, then
send resolution info to application-----------------------------------------------------------------1) Else HBT context is established and Clinical
Dashboard data is writtent to it2) Function terminates with success
EHRi Transaction (EHRiTx)“Get Client Clinical Dashboard”==========================1) Relying on established session, send clinical
dashboard query message-----------------------------------------------------------------1) Receive response2) If resolution is required on Client or Provider, then
send resolution info to application-----------------------------------------------------------------1) Else HBT context is established and Clinical
Dashboard data is writtent to it2) Function terminates with success
Data Exchanged==============1) EHRi Session ID2) EHRi HBT ID3) EHRi User ID4) EHRi Location ID5) Local Client ID6) Client ID Data7) EHRi Client ID8) Local Provider ID9) Provider ID Data10)EHRi Provider ID11)Clinical Dashboard
Query Parameters12)Clinical Dashboard
Query Response: 1)HBT data2)HBT Event Data
Data Exchanged==============1) EHRi Session ID2) EHRi HBT ID3) EHRi User ID4) EHRi Location ID5) Local Client ID6) Client ID Data7) EHRi Client ID8) Local Provider ID9) Provider ID Data10)EHRi Provider ID11)Clinical Dashboard
Query Parameters12)Clinical Dashboard
Query Response: 1)HBT data2)HBT Event Data
23Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICECommunication Bus Communication Bus
Common Services
HIA
L
EHR Data & Services
Health System Transaction“View Selected HBT Details”===============================1) TBD
Health System Transaction“View Selected HBT Details”===============================1) TBD
Interoperability Services
Security Consent Configuration
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7 (DI)
HL7 (Lab)
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Interoperability Profile: Patient visit to family physicianHealth System Transaction #4:User drills-down into last patient visit to ER
EHRi Transaction (EHRiTx)“Get HBT Details”==========================1) TBD
EHRi Transaction (EHRiTx)“Get HBT Details”==========================1) TBD
Data Exchanged==============1) TBD
Data Exchanged==============1) TBD
Appendix: Registries and Clinical System Interoperability Example
26Interoperable EHR Architecture
JURISDICTIONALINFOSTRUCTURE
POINT OF SERVICE
Pharma
Pharmacist
Client Registry
Drug InformationSystem
Repository
Sea
rch
/ R
eso
lve
Clinical Portal
Physician
DIS APIPATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client
Pharmacy Profile4) Request Drug Profile5) Request DUR6) Enter new prescription
CR API
CLIENT REGISTRATION
1) Search Client2) Create New Client, or3) Update Existing Client
PHARMACY PROFILE
4) Request Drug Profile5) Request DUR6) Enter new Prescription
DIS API
CR APIHL7 (CR)
HL7 (CR)
HL7 (CR)
HL7 v3(CeRx) HL7 v3
(CeRx)
HL7 v3(CeRx)
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.
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.
CR
AP
I
CR API DIS APIEMPI Query
7) Query patient8) Obtain all related MRNs9) x-ref and join DIS data
EHR Logical Architecture (Not desired)NL Example: Early thinking (No EHR Services)
27Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONALINFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
PharmacySystem
Pharmacist
PATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client
Pharmacy Profile4) Request Drug Profile5) Request DUR6) Enter new prescription
EHR API
DrugInformation
SystemRepository
HIA
L
PHARMACY PROFILE
4) Request Drug Profile5) Request DUR6) Enter new Prescription
Clinical Portal
Physician
EHR API
HL7HL7
Interoperability Services
HL7 v3 (CeRx)
Security Consent Configuration
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.
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.
Search / ResolveGet EHR ID
CLIENT REGISTRATION
1) Search Client2) Create New Client, or3) Update Existing Client
HL7(CR)
ClientRegistry H
IAL
GenerateEHR
Client ID
HIA
L
means “responds with”
Sample EHR Logical Architecture (Interim State)NL Example: Basic EHR Infostructure, CR, DIS)
28Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONALINFOSTRUCTURE
POINT OF SERVICECommunication BusCommunication Bus
Common Services
HIA
L
PharmacySystem
EHR Data & Services
Pharmacist
PATIENT ENCOUNTER============================Client Registration1) Search Client2) Create New Client, or3) Update Existing Client
Pharmacy Profile4) Request Drug Profile5) Request DUR6) Enter new prescription
EHR API
DrugInformation
system
Search / ResolveGet EHR ID
PHARMACY PROFILE
4) Request Drug Profile5) Request DUR6) Enter new Prescription
CLIENT REGISTRATION
1) Search Client2) Create New Client, or3) Update Existing Client
Clinical Portal
Physician
EHR API
HL7HL7
HL7(CR)
Interoperability Services
HL7 v3 (CeRx)
Security Consent Configuration
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).
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).
EHR Services
Business Components
DISCR
Dat
a A
cces
s
EHRIndex
ClientRegistry H
IAL
GenerateEHR
Client ID HIA
Lmeans “responds
with”
Sample EHR Logical Architecture (Target State)NL Example: Initial EHR Infostructure (CR, EHR, DIS)
29Interoperable EHR Architecture
EHR Data & Services
JURISDICTIONAL INFOSTRUCTURE
POINT OF SERVICE Communication Bus
Common Services
Pharmacy System
EHR Data & Services
Pharmacist
EHR API
Clinical Portal
EHR API
HL7
Interoperability Services
Security Consent Configuration
PACS/RIS
LabSystem(LIS)
Hospital,Community,etc., EPR
HL7 HL7 HL7
DrugInformation
System
HIAL
DiagnosticImaging
Repository
JurisdictionalLab InfoSystem
HIAL HIAL
EHR Services
Business Components
DISCR
Dat
a A
cces
s
PR
LR
DI-r
JLIS
EHR APIEHR APIEHR API
Physician/ProviderLab TechnicianRadiologist
HL7 v3(CeRx)
HL7 (CR)
HL7 (PR)
HL7 (LR)
HL7
HL7 (DI)
HL7 (Lab)
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.
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.
EHR DataRepository
EHRIndex
GenerateEHR
Client ID
ClientRegistry H
IAL
GenerateEHR
Provider ID
GenerateEHR
Location ID
ProviderRegistry H
IAL
LocationRegistry H
IAL
PhysicianOfficeEMR
HL7
EHR API
Physician/Provider
Physician/Provider
HIA
Lmeans “responds with”
means “responds with”
Sample EHR Logical Architecture (Target State)Full EHR Infostructure Capability