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METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
RIDE OverviewAsuman Dogac
Middle East Technical UniversityAnkara, Turkey
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
RIDE Partners METU-SRDC, Turkey OFFIS, Germany IFOMIS, Germany EUROREC, EU CNR, Italy NTUA, Greece DERI, Ireland IHE-D, Germany OLE, Belgium
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
RIDE Roadmap
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Goals and Challenges Goal 1: Establishing a Europe-wide Secure
Network to Exchange Medical Summaries (EHR) across Member States European Healthcare Network proposed is the sum of
the intercommunicating Member State Networks Minimum necessary specification is provided to make
the framework as widely adoptable as possible The technologies that can be used to implement such a
network includes: CEN prEN 13606, or IHE Profiles, or HL7 messaging, or, …
All will be detailed as possible alternatives in the RIDE Roadmap specification Version 1
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Authenticate
Local System
Local DataRepository ALocal Data
Repository A
Member State A Locator Service
MEMBER STATE A
Mary Brown
Local Physician
Medical Summary+Digital Signature
Medical Summary Metadata
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
MEMBER STATE B
Dr. Hans
Schmidt
Mary Brown
Health Professional
Registry
Health Professional
Registry
Authenticate
Local System
Request Medical Summary Member State E
Locator Service
Member State D Locator Service
Member State C Locator Service
Member State A Locator Service
Record Reference
ChooseRecord
Local DataRepository ALocal Data
Repository A
Healthcare ProviderRegistry
Member State B Locator Service
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Hospitals, Clinics,etc
Individual Healthcar
e Providers
Regional Health
Organization
Healthcare Professional Registry
Healthcare Provider Registry
Patient Identity Registry
Locator Service
Audit Services
Professional Identity Service
Provider Identity Service
Member State Healthcare Network Interface
Member State Healthcare Network
European Healthcare Network
Member State Healthcare
NetworkMember State
Healthcare Network
Member State Healthcare
NetworkMember State Healthcare Network
European Healthcare Network
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Functionalities of the European Healthcare Network Transmission of complete requested Medical Summary to a
remote clinician at another Member State, Providing authorization services to determine appropriate
clinician access to Medical Summaries, respecting patient’s privacy and patient’s consent,
Providing a technical infrastructure which will support secure communication (authentication of systems, message integrity, message confidentiality) between two healthcare provider systems even when they are located at different Member States,
Providing patient identity matching between Member States,
Providing document (Medical Summary) integrity, attestation for possible legal cases about medical errors,
Providing auditing systems to monitor and audit the medical events and transactions
To provide this Member State Networks need to provide some functionalities
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Member State Data Repositories… Each Member State network has:
One or more Data Repositories which store and provide Medical Summary documents
A Data Repository is nothing but a location or a set of locations storing Medical Summaries
A Data Repository also stores Digital Signature documents of Medical Summaries and also has access control mechanisms based on patient consents
A Health Professional Registry which stores and provides health professional’s identity information
A Healthcare Provider Registry which maintains the identifiers of healthcare providers (clinics, doctor offices, hospitals, etc) and other related information like location of facility, speciality and public certificates
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Member State Network Services…
The Locator Service which indexes all submitted medical summaries and serves to provide locations of medical summaries in the Member State Healthcare Network
Medical summaries are indexed with the patient demographic information and other metadata attributes
Metadata format and terminologies used in the metadata needs to be standardised
The locator service, when receives a document request, after authentication, serves this request by checking its own indices as well as forwarding the request to the Locator Services of the other Member States
However, to improve efficiency and response time, the locator service may mandate the Member States to be checked to be stated in advance
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Member State Network Services… The Locator Service uses a matching algorithm that determines
which records are likely matches This is a challenge for Europe because the work on matching is
highly sensitive to local characteristics of the data set The locator service may additionally provide a subscription
based service where an authorized user can request info when a piece of content is updated
Health Professional Identity Service provides professional identity information as signed security assertions
Healthcare Provider Identity Service serves as an interface to the Healthcare Provider Registry to provide the provider identity information
Each Member State provides an Auditing service which records all the medical and administrative event logs passing through its Locator Service
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
The Architecture also provides the infrastructure for…
Electronic Health Records Electronic Health Records – Images and Signals Documentation of Current Medication Episodic Medical Summary Collaborative Medical Summary Permanent Medical Summary Emergency Dataset Laboratory Results
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Challenges…
Standards for metadata and terminologies How to match patient identifiers Standards for Audit Records Interoperability of Medical Summary content Achieving chain of trust Standards for identifying the clinicians and the
roles of Clinicians Authenticating the Healthcare Providers Standards for patient consent forms Digital signatures for patient consent …
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Semantic Interoperability Semantic interoperability aims to give the machines the
ability to process semantics (Humans already have this ability !)
Semantic interoperability builds on top of the technical interoperability layer
Without technical interoperability, it does not make sense to talk about semantic interoperability layer
For sharing EHRs there are alternative proposals which can be used to achieve technical interoperability
Technical interoperability for the described scenario is not achieved yet!
There is not a single full scale deployed implementation to achieve the mentioned functionality!
And there are gaps in the standards to achieve this!
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Interoperability as Addressed in the RIDE Project
RIDE roadmap is intended to enumerate possible alternatives but will avoid recommending a particular technology direction
The proposed architectures will fully support privacy and security of healthcare data
RIDE will provide proof-of-concept public domain implementations of each possible alternative so that the interested parties can download and use it to get a first hand experience: An architecture based on CEN prEN 13606 proposals will be
available soon A set of IHE Profiles to be demonstrated at WoHIT in session 15 HL7 Web services to be available soon …
Note further that to ensure interoperability there is a need for certifying interface conformance
EHR certification is being addressed in the QREC Project Further interface certification is needed
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
A Proposal for implementing the Proposed Architecture through CEN prEN 13606 EHR Content can be defined through EHRcom Policy content can be defined through CEN prEN
13606-4 EHR content can be made available from a local,
regional or national repository Member State networks can be designed as a (or
a collection of) Communicating Communities Communicating Community Identifier, Enterprise
Identifier and Identification of message by Originator are provided by the Community Registries
Locator Service can be implemented through EHR Related Agent
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
A Web Service based Architecture Local or regional or national repository will
provide the following asynchronous two Web Services: EHR Info Message type Web service
6.1.4.8 Query EHR info message type 6.1.4.2 Provide EHR information message type
EHR Message Type Web Service 6.1.4.9 Request EHR message type 6.1.4.3 Provide EHR message type
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
EHR Related Agent Functionality Given Patient Identifier or Patient Demographics
information it should return The end points of the EHR Info Message and the EHR Message
Web services To provide this functionality, either the EHR Agent
dynamically searches to find such Web services, or, it searches them in the background and provides a registry of previously found Web services
“All message types defined in this standard shall use HL7 message wrapper “
HL7 Web Services Profile details how to implement HL7 Web services
This profile can be used which also handles the security and trust issues
METU-SRDC EUROREC Meeting, Geneva, October 10, 2006
Thank you very much for your Attention!