The Victorian Statewide eHealth Interoperability Maturity ...docs2.health.vic.gov.au/docs/doc/A140384D0265D09ECA257CF6000… · Functional Model The Functional Model depicts the high-level

The Victorian Statewide eHealth Interoperability Maturity Model (SEIMM) provides health organisations with the tools to perform a self assessment of their organisation’s current state and will assist them to plan and execute a transition to an uplifted future state. The SEIMM provides logical steps on gaining a higher level of interoperability that is underpinned by the Health Information Management Systems Society (HIMSS), Office of the Chief Information Officer (OCIO) Standards and the National objectives.

The SEIMM will be application agnostic and capability driven, with a strong focus on interoperability and integration.

Business to Business Interoperability Version 1 – March 2014

Department of HealthHealth Design Authority

Initial Draft

© 2014. Department of Health Pre-existing Intellectual Property – Commercial in Confidence. This material is a guide and provide indicative health ICT solution considerations. This material cannot be commercialised.

Functional ModelThe Functional Model depicts the high-level functions for an Electronic Medical Record (EMR) Core and associated applications that are either integrated, interfaced or standalone.The model will assist in providing an understanding of:

Current and Future scope of business capability for health organisationsIdentification of functional gaps and overlapsIdentification of application ownership

The Functional Model describes the functions and processes associated with an EMR Core and will assist organisations to drive the definition of the application design and how each function is supported by systems.

Administrative and Clinical Services Management - Functional Model

Department of Health

Health Design

Authority Initial Draft

EMR Core Services

.

Administrative Services

Associated Services

Core Capabili

ty

Optional EMR

Services: Higher Maturity (when core)

Legend

:

C

TerminologyAnalytics / Data Warehouse / Reporting

IntegrationSecurity / Business Continuity

Policy / Legislation / Standards / Identity and Access ManagementElectronic Health Record

Results Reportin

g

Diagnostic Results

Manage Medication History

Medications

ManagementMedication

Administration/

Charting

Clinical Alerts and

Allergies

Manage Clinical

Alerts and Allergies

Manage General Family

and Social HistoryAdvanced Care

Directives

Access General Family & Social History Details Event

Summaries

Continuity of Care

DocumentsShared

Health Summari

es

Discharge

Sumaries

Medication

Prescription and

Dispense RecordsElectroni

c Referrals

: External

Electronic

Referrals:

Internal

Emergency

Department

Emergency

Department

System

C

Patient Master Index

Patient Managem

ent

Episode Management

Hospital in the Home

Hospital in the Home Managem

entC

Theatre Managem

ent

Theatre Management and

Anaesthetics

PerioperativeInstrume

nt Management

ie. Chemoth

erapy Management

Speciality Managem

ent

ICUBiomedic

al

C

C

CQuality Assurance

and Complianc

eQuality

and Safety Management

ClinicalIncident and Risk ManagementClinicalRisk

Assessment

Specialist ServicesDiagnostic Services

Emergency

Department

Emergency

Department

System

C

Continuity of Care

Documents

Electronic

Referrals:

External

Theatre Managem

ent


Anaesthetics

PerioperativeInstrume

nt Management


Hospital in the Home Managem

ent

Patient Master Index:

Downtime

PMS Downtime Managem

ent

Sync Tempora

ry Patient Id with PMS:

Downtime

Electronic OrdersCreate Pathology OrderCreate

Diagnostic

Imaging Order

Create Inpatient Medication OrderCreate

Discharge and

Outpatient

Medication Order

Create Other Orders

Manage Order

Notification and

Routing, SigningClinical Order Sets

Record Patient

Observations and Intervent

ions

Document Clinical

CareRecord Clinical Care

Document

Information

Record Patient Clinical Details (Alerts, Allergies

etc.)Clinial

Pathways and Plans

Clinical Diagnosi

s and Procedur

es

Scanned Medical Record

Document and Image

ScanningDocumen

t and Image

IndexingOutpatie

nt Scheduling and

Attendance

Outpatient

Queue Management

Real Time

Location Services

Communications

Management

Financial Managem

entFinancial Management

SystemActivity Based

Costing Reporting and

Management

Clinical Costing

Rostering

Staff

Payroll

Human Resources

Billing Managem

entDistributed Billing ServicesConsolid

ated BillingNurse

Management

Acuity


Patient Managem

ent

Episode Management

Outpatient

Scheduling and

Attendance

Outpatient

Queue Management

Quality Assurance

and Complianc

eQuality

and Safety Management

ClinicalIncident and Risk ManagementClinicalRisk

Assessment

CommonServices

View Scheduli

ng Appointment

Notifications

View ED Attendan

ce Informati

on

View Patient

and Episode

Information

Administrative

Details

Imaging Management

System

Imaging Services

Diagnostic

Management

System and

Other...

Diagnostic Services Other...C

Access Passive Decision Support Informati

on

Active Decision Support

Clinical Protocols

/Pathway

s

Clinical Decision Support

Pathology

Management

System

Pathology Services PACS

Management

System

PACS Services

Disease and

Immunisation

Record

Disease & Immunisa

tion

Telemedicine

ManagementTelemedicine

PBS Claiming

Pharmacy

Stock Control

Dispense and

Pharmacy

ManagementFood

ServicesCatering and Food Management

Patient Entertain

ment Managem

ent

Patient Entertain

ment

Nurse Call

Communications

Management

Real Time

Location Services

Unified Communications


Document and Image

ScanningDocumen

t and Image

Indexing

Speciality Managem

entRadiothe

rapy Management

ICU

Endoscopy

ManagementRenal

Management

Respiratory

Management

Allied Health and Other...

Biomedical

Cardiology

Management

PICU / NICU

Management

Chemotherapy

Management

C

C

C

Services that may

only be relevant to core busines

s

Diagnostic

Management

System and

Other...

Diagnostic Services Other...C

FoundationsCore

service dependant

on core business

Common Services can be

replicated in various products depending on the adoption model.

The PAS feeds most

TPP, and therefore,

can be viewed in

those systems. CDS can also be a

part of multiple systems.

CS

CS

View Summari

es

Specialty Summarie

s

F

FFFFFF

Logical Reference Design Contents

Logical ModelThe Logical Model is a high-level construct of a logical framework that depicts logical relationships between resources, activities, outputs and outcomes. It carries a wide frame of functions, integration management, devices, access management, standards and external integration requirements.The model will assist in providing an understanding of:

How to evaluate a health organisation and its logical relationshipsHow to plan for gaps and underlying fragmentationInformation regarding EMR Core and other related components

The Logical Model will assist to drive the business logical models and help to evaluate effectiveness of the program of work being delivered by health organisations.

Interoperability Strategic RoadmapThe Interoperability Strategic Roadmap depicts the high-level logical interoperability steps of implementing an Electronic Medical Record (EMR) Core that is underpinned by the HIMSS Asia Model, the State and National standards and recommendations. The interoperability map has a series of anchors to illustrate that core functions need to be deployed before a certain point. The anchors allow flexibility within the recommendations.The model will assist in providing an understanding of:

The logical steps of implementing an EMR with State and National components Organisational gaps and overlapsIdentifying components that have varying degrees of maturity levels, i.e Discharge Summary

The Interoperability Strategic Roadmap should drive business logic of new deployments.

OC

IO &

National

Recom

mendations

HIMSS Com

pliantElectronic M

edical Record

(Paperless)

Extended Core SystemI.e. Allied Health

Hospital in the HomeTelemedicine

Clinical Risk Assessment

Clinical Costing

Other ServicesI.e. Scanned Medical

Record

UnifiedCommunications

Individual Health Identifiers – Individual/

Organisation

Personally Controlled Electronic Health Record VIEW ~ National Prescriptions Dispense

Repository VIEW ~ Child EHR VIEW

Personally Controlled Electronic Health Record UPLOAD

National Prescriptions Dispense Repository

VIEW – Child HER VIEW

ICD10 ~ National Data Dictionary Australian Quality & Safety Health Service (AQSHSS)

LEGAL, STATUTORY & ETHICAL REQUIREMENTS (VAED,VEMD..etc)DISEASE, IMMUNISATION SURVEILLANCE

HL7 STANDARDS

IDENTITY & ACCESS MANAGEMENT

Java CAPS(JCAPS) ~ Health Integration Engine ~ INTEGRATION ~ INTEROPERABILITYSECURITY

National eHealth Security Access Framework

Personally Controlled Electronic VIEW

Nursing/Clinical Documentation Inc Vital Signs, Flow Sheet etcNursing Notes, eMar

integrated, CDS, PACSOrder EntryCPOE

2nd Level CDSComputerised

Assessment SystemPhysician

Documentation with templates, Progress Notes, Problem ListsDischarge Summary

Extensive PACSClosed Loop MedicationBar Coding patient bands

CPOE and Pharmacy5 rights medications

administrationThe hospital is paperlessData warehousing,

clinical information is shared, Data Continuity

through-out health service

HIMSS L1

HIMSS L2

HIMSS L3

HIMSS L4

HIMSS L5

HIMSS L6

HIMSS L7

FutureProjects

Other

PAS & BILLINGINTERFACED

OR INTEGRATED

MBSPBS

EMRSelf

AssessmentSNOMED

AMT

DISCHARGESUMMARY

SPECIALIST LETTER

eReferral

SecureMessage

DataHIS

NASH

O

R

M

O

M

O

M

R

O

R

O

Stan

dard

isat

ion Term

inology

MMMMMMMM

LEGEND: O R MOPTIONAL MANDATORYRECOMMENDED

Patient & ClientServices I.e. Patient

Administration System

Scheduling

Mobilty

Other Speciality SystemsI.e. Cardiology,

Respiratory, Mental Health, Aged Care,

Paediatrics

Administrative ServicesI.e. Claiming

Diagnostic ServicesI.e. Fetal Monitoring

Patient Acuity, Workload & Resource Mgmt M

M

M

M

O

O

O

Legi

slat

ion

Polic

y

Anchor Dependency

Extended EMR Core

National Agenda

OCIO & AusStandards

& CataloguesInc NHSD

TheatresPerioperative

Ambulatory, ED

Critical Care,ICU, NICU

O

O

O

Integrated/Interfaced

Major Anc. Fed DataOrders & Results

Controlled Medical Vocabulary

Clinical Decision Support Rules Engine

HIEConflict Checking

Major Ancillary Clinical System – Pharmacy, Lab

& Imaging

CDA

CDA

CDA Enabled

CDA

Architecture Design Check

Can be adoptedIn early stages of EMR, however

requires maturity to achieve

IHI intended outcome

Report Management

AccessChannels

Telephone PC eMail InternetPDA VoiceMobile PagerACCESS

CHANNELS

Telephone PC eMail InternetPDA VoiceMobile Pager

AccessChannels

ACCESSMANAGEMENT

CLINICAL SUPPORT SERVICES

OPERATIONSMANAGEMENT

Cardiology ServicesPharmacy Services

Diagnostic ImagingServices

Pathology Services

Allied Health Services

Intensive Care Services

Directory Services

Authentication Services

Authorisation Services

Encryption Services Portal Services

INTEG

RA

TIO

NM

AN

AG

EM

EN

TW

ork

flow

M

anag

em

ent

Exe

cution

STANDARD CODE SET/REFERENCE DATA MANAGEMENT

Rule

s M

anag

em

ent

Exe

cution

Pro

cess

/Eve

nt

Inte

gra

tio

n

Direct

ory

Ser

vic

es

Dat

a

Com

muni

cation

Pat

ient

Iden

tity

M

anagem

ent

User Management

Systems Management

Change Management

Security Management

Purchasing

B2B IntegrationPortal Web Access

HI ServicePCEHR

DHS Medicare

ELECTRONIC MEDICAL RECORD: CORE RESOURCEMANAGEMENT

Community Health

Emergency Services

Theatre Services


Referral Management

Discharge Summary

Management

Distribution Management

Publishing Change Request Management

Repository Management

PROGRAM-WIDE FUNCTIONSEXTERNAL INTEGRATION

Nash

Management Reporting

Agency/Portfolio Operations Reporting

Electronic TransferSecurity

ManagementCross


Provider Identification

Statutory Reporting

Electronic TransferSecurity

ManagementCross



Client

Managemen

t

Key:

Department of HealthHealth Design


Medical Devices

eReferralUnified Comms

National PrescriptionsShared Discharge Summaries

Mental HealthAged Care

Specialist Other Telemedicine

Disease Surviellience Immunisation


Initial Draft

Interoperability Artefact StackThe Interoperability Artefact Stack is an overlay of the high-level components of an EMR that is underpinned by the HIMSS Asia Model. It maps logical steps of when health organisations should consider next steps to improving interoperability.The model will assist in providing an understanding of:

Current and future scope of business capability for health organisationsIdentification of functional gaps and overlapsIdentification of logical next steps

The Interoperability Artefact Stack should drive next steps of interoperability.

INTEG

RA

TIO

NM

AN

AG

EM

EN

T

HL7 STANDARDS

Medicare Benefit Schedule ~ Pharmaceutical Benefit Scheme ~ Australian Medicines Terminology

ICD10 ~ National Data Dictionary ~ BETTER TERMINOLOGY SETS

Australian Quality & Safety Health Service (AQSHSS)

LEGAL, STATUTORY & ETHICAL REQUIREMENTS (VAED,VEMD..etc)

EXTENDED CORE ~ SPECIALTY SYSTEMS

CATALOGUES (imaging, pathology)

Java CAPS(JCAPS) ~ Health Integration Engine ~ INTEGRATION ~ INTEROPERABILITY

PAS & BILLING INTEGRATED OR INTERFACED

HOSPITAL IN THE HOME/TELEMEDICINE

RISK Management, INCIDENT REPORTING

BUDGET, CASEMIX, CONTRACT MGMTPATIENT ACUITY, WORKLOAD & RESOURCE MGMT

DISEASE, IMMUNISATION SURVEILLANCE

Office of the Chief Information Officer STANDARDS

UNIFIED COMMUNICATIONS

SECURITY


SCANNED MEDICAL RECORDS

Secure Message Data ~ Health Identifer Service ~ NASHIndividual Health Identifiers – Individual/Organisation

Secure Message Data ~ National Health Service Directory ~ Electronic Language Standards (Aust. Standard)

Discharge & Event Summary/Specialist Letter/E Referral

Personally Controlled Electronic Health Record VIEW ~ National Prescriptions Dispense Repository VIEW ~ Child EHR VIEW


National Prescriptions Dispense Record UPLOAD ~ Electronic Transfer Partners

SNOMED ~ Australian Medicine Terminology


Establish before this checkpoint





Interoperability Artefact Stack

Interoperability Self Assessment & Strategic PlanThe Interoperability Self Assessment & Strategic Plan is a high-level tool that notionally allows health organisations to rate themselves against the HIMSS Model and the Functional Model. The tool allows health organisations to nominate strengths and weaknesses. Health organisations can plot a future state while creating a pathway to the optimal HIMSS and interoperability capability.The model will assist in providing an understanding of:

The logical steps to improve interoperability capabilityHealth organisations pathwayIdentifying varying degrees of maturity from an EMR perspective

The Interoperability Self Assessment & Strategic Plan should drive business logic and engagement of key deployments.

Capability4

Capability3

Capability2

Capability1

Capability0

Semantic InteroperabilityCDA: referrals, discharge summary,

Specialist letter, Event Summary.CDSS, Message confirmations,

PCEHR, NPDR,(HIE, BI, RIE > 50% optimal capability),

Messaging b2b, CEHR, EHR> 70% clinical system interoperableIntermediate Clinical Syntax National, State and Local Codesetsare common is all internal systems

and are recognised in downstream systems.(HIE, BI, RIE at 50% optimal capability), ISO Standards, AS Standards, Snomed

AMT70% of clinical system interoperable

Common Identifiers & Basic Clinical Syntax:

IHI, HPI-I & O, Global Org Urs, (HIE, BI, RIE at 20% optimal capability),

Bi-directional I.e. orders & results interfacing enabled,

PACS, eReferrals, SCTT, NASH50% of clinical system interoperable

Administrative Syntax: Administrative data connected,

Ancillaries are fed by PAS, PBS and MBS

5% of clinical system interoperable

Unstructured Environment:Manual Process are in place

For transmitted data

HIMSSL1

HIMSSL2

HIMSSL3

HIMSSL4

HIMSSL5

HIMSSL6

HIMSSL7 EXPERT

OCIO & AustralianisationOCIO & Aus Standards, ICD10, AQSHSS, VAED, VEMD etc, Disease & Immunisation Surveillance, Identity management,

HL7 standards, JCAPS, Integration, security, legislation, policy,EMR core established and integrated

Major Ancillary Pharmacy

Lab &Imaging

Major AncillaryFed Orders & Results

Controlled VocabCDS rules

EngineHIE

Conflict checking

Nursing/ClincalDocumentation

Vital Signs, Flow Sheet, Nursing

Notes, eMARIntegrated,

CDS, PACSOrder entry

CPOE, 2nd LevelCDS

ComputerisedAssessment

System

Physician DocumentationWith templates,Progress Notes,Problem Lists,

Discharge Summary,Extensive

PACS

Closed lo loopMedication,

Bar Coding patientBands,

CPOE and pharmacy orders

5 rights medicationadministration

The hospital is paperless, data

warehousing, clinical information is shared,

data continuity through-out health service

Nursing NotesNursing/Clinical Docs, Inc vital signs

and flow chart

Physician Doc with templates

Progress NotesProblem List

Bar Coding patient bands

Closed loop Medication

Data Warehouse

Clinical information share

Data Continuity throughoutHealth service

Paperless

Current State

LEGEND: Current State Future StatePartial Complete

B2B Information Flow ModelThe Information Flow Model illustrates the key concepts and relationships, constraints, rules and information flows from a health organisations' perspective and, more broadly, business to business.The model will assist to:

Identify the key functions inside and outside the businessHighlight the flows of information between business functionsIdentify commonality between information flows

The Information Flow Model will assist in the definition and development of systems interfaces.

Interoperability at the information level

Facsimile

Telephone

Scanner

Printer

CDA Document (View)

<entry> <observation classCode="OBS" moodCode="EVN">  <id root="81FEB786-C465-11DE-B347-E8CA56D89593"/>  <code code="116223007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" codeSystemVersion="20090731" displayName="Comorbidity"/>  <value xsi:type="CD" code="236629009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" codeSystemVersion="20090731" displayName="Chronic radiation cystitis"/> </observation> </entry> 

Structured andfully qualified data

Document

Clinical Terminology

Standards

Human Review of

documents IHI

HPI-I

HPI-O

Medications

HL7 2.x

Human interpretation of unstructured clinical document Human interpretation of clinical content

required. Syntactic understanding for certain data classes (primarily administrative, eg. the patient)

Human interpretation of partially structured clinical information. Broader syntactic understanding achieved, eg. referred service, allergies, alerts, meds

Capable of Semantic Interoperability –system interpretation of all information.

Structured documents and/or atomic data using standard codesets

Ad hoc transport mechanisms -Fax, email, mail, person to person

Structured Document CDA level

1b

Structured Document CDA level 2

Structured Document CDA level

3a Structured Document CDA level

3b

Secure message delivery

Person to person

communications

u

Direct system to system exchange of clinical information


Health Design


Electronic Data

Interchange

Interoperability at the Information Level

Interoperability at the Information LevelThe Interoperability Information map depicts the high-level steps to achieve Semantic Interoperability which covers system interpretation of all information using structured documents and/or atomic data with underpinning standards and codesets.The model will assist in providing an understanding of:

The logical steps of moving towards future semantic interoperabilityOrganisational gaps and overlapsIdentifying components that have varying degrees of maturity levels, i.e Faxing –CDA structured documentation

The Interoperability at the Information Level provides a futuristic roadmap that should drive business logic of new deployments.

It should be noted that semantic interoperability, while ideal, is not achievable in the near future and agencies should aim for achievable levels of interoperability.

Message Flow Interoperability ModelThe Message Flow Model illustrates the key concepts and relationships, constraints, rules and information flows from a health organisations' perspective and, more broadly, business to business.The model will assist to:

Identify the key functions inside and outside the businessHighlight the messages between business functionsIdentify commonality between information flows

The Message Flow Interoperability Model will assist in the definition and development of systems interfaces.

Interoperability Message Flows

Application Review – Comparing Quality with InteroperabilityThe Application Review Model illustrates the strategic view of health organisation’s application suite and whether to tolerate, invest, eliminate or migrate their applications. The model draws upon the application’s ability to interoperate and is rated against the HIMSS level score that can be achieved using the Interoperability Self Assessment & Strategic Plan model

The model will assist agencies to:

Identify the applications that should be tolerated, invested, eliminated or migratedHighlights the strengths and weaknesses of each product

Overview of Security Threats in an Interoperable Health SectorOne of the potential impacts of enabling interoperability in that information must be exchanged between organisations. This in itself potentially opens organisations to a range of different security threats, in addition to those that we attempt to mitigate against every day. Of particular interest are the specific messaging threats (item 3), and threats to messaging partners and services upon which we are dependent, such as the national Healthcare Identifiers service.

Some mitigation approaches are suggested. In addition organisations should be conscious of standards such as ISO 17799, ISO27001, and the National eHealth Security and Access Framework. Best practice security techniques should be employed, including strong threat response processes, staff education and awareness, regular penetration testing, etc.

Qua

lity

Cond

ition

High

Exce

llent

Low

Low

Low Interoperability Poor Quality

High Interoperability

Excellent Condition

Excellent Quality

Low Interoperability

High Business

ValuePoor Quality

Eliminate/Migrate

Invest

Pharmacy

Pathology

EMR

Respiratory

Cardiobase

PAS

Imaging

Emergency

Department


PACS

HIH

Mental Health

CancerManagem

ent

PYXSIS

Food Service

s

Aged Care

Cancer Registr

y

Finance

Antenatal& Birthing Outcome

HumanResour

ces

Business

Intelligence

Private Billing

WoundCare

10_0 5 15__+

7.5_

1 32 4 76 98 11

13

12

140

13

24

68

79

51 0

AnswerYes/No Score

The application has a sunset or end of life date

Is there general acceptance of the application?

The application meets the health organisation’s expectations now and in the future?

The application is easy to use?

The application is critical to the health organisation?

2 Yes= -2, No= 2

Yes = 2, No=0

0 Yes = 2, No=0

0 Yes = 2, No=0

Yes = 2, No=02

Interoperability AssessmentLEGEND: Non-clinical

Application

Business Directive to

replace application

Clinical Application

Notification of

Replacement

QUALITY CONDITION RATING SCALE = Y

Provide Interoperability Self Assessment scoreMultiplying interoperability capability with

HIMSS

/10Total Score

Total Score /35

INTEROPERABILITY ASSESSMENT = X

Y AXISX AXIS

Application Review – Comparing Quality with Interoperability Capability

Maintain

Invest

Eliminate

Migrate

The application may lack flexibility and interoperability, however the application is

important and meets the expectations of the organisation

The application rates well against interoperability and business requirements. Future investment into the product maybe

consideredThe application is rated low against interoperability, quality and business

requirements. The application needs to be eliminated from the suite. The application needs to be replaced and

migration activities may or may not be required

DEFINITION AND DESCRIPTION

Note: Axis X only reaches 15 although the overall score is calculated to be up to 35. Any score achieved above 15 is considered extremely high and therefore negates the need for > values of 15.


Health Design Authority

Initial Draft

0

Uplift/Maintain

Ord

ers

Res

ults

Ord

ers

Res

ults

eRef

erra

leR

efer

ral

Dis

char

ge S

umm

ary

Dis

char

ge S

umm

ary

Sha

red

Hea

lth S

umm

ary

eReferral eRefe

rral


Administrative and Clinical Services Management - Functional Model


Initial Draft

EMR Core Services

.


Associated Services

Core Capability

Optional EMR Services:

Higher Maturity (when core)

Legend:

C

Terminology

Analytics / Data Warehouse / Reporting

Integration

Security / Business Continuity

Policy / Legislation / Standards / Identity and Access Management

Electronic Health Record

Results Reporting

Diagnostic Results

Manage Medication

History

Medications Management

Medication Administration/

Charting

Clinical Alerts and Allergies

Manage Clinical Alerts and Allergies

Manage General Family and

Social History

Advanced Care Directives

Access General Family & Social History Details

Event Summaries

Continuity of Care Documents

Shared Health Summaries

Discharge Summaries

Medication Prescription and

Dispense Records

Electronic Referrals: External

Electronic Referrals: Internal

Emergency Department


System

C


Patient Management

Episode Management



Management

C

Theatre Management


Anaesthetics

Perioperative

Instrument Management

ie. Chemotherapy Management

Speciality Management

ICU

Biomedical

C

C

C

Quality Assurance and

Compliance

Quality and Safety

Management

ClinicalIncident and Risk

Management

ClinicalRisk Assessment

Specialist ServicesDiagnostic Services


EmergencyDepartment

System

C

Continuity of Care Documents

Electronic Referrals: External

Theatre Management


Anaesthetics

Perioperative

Instrument Management



Management

Patient Master Index: Downtime

PMS Downtime Management

Sync Temporary Patient Id with PMS: Downtime

Electronic Orders

Create Pathology Order

Create Diagnostic Imaging Order

Create Inpatient Medication Order

Create Discharge and Outpatient

Medication Order

Create Other Orders

Manage Order Notification and Routing, Signing

Clinical Order Sets

Record Patient Observations and

Interventions

Document Clinical Care

Record Clinical Care Document

Information

Record Patient Clinical Details

(Alerts, Allergies, etc.)

Clinial Pathways and Plans

Clinical Diagnosis and Procedures


Document and Image Scanning

Document and Image Indexing

Outpatient Scheduling and

Attendance

Outpatient

Queue Management

Real Time Location Services

Communications Management

Financial Management


System

Activity Based Costing Reporting and Management

Clinical Costing

Rostering

Staff

Payroll

Human Resources

Billing Management

Distributed Billing Services

Consolidated Billing

Nurse Management

Acuity


Patient Management

Episode Management


Attendance

Outpatient

Queue Management


Compliance

Quality and Safety

Management


Management


Imaging Management

System

Imaging Services

Diagnostic Management System and

Other...

Diagnostic Services, Other...

C

Pathology Management

System

Pathology Services

PACS Management

System

PACS Services

Disease and Immunisation

Record

Disease and Immunisation

Telemedicine Management

Telemedicine

PBS Claiming

Pharmacy

Stock Control

Dispense and Pharmacy

Management

Food Services

Catering and Food

Management

Patient Entertainment Management

Patient Entertainment Nurse Call

Communications Management

Real Time Location Services

Unified Communications


Document and Image Scanning

Document and Image Indexing

Speciality Management

Radiotherapy Management

ICU

Endoscopy Management

Renal Management

RespiratoryManagement

Allied Health and Other...

BiomedicalCardiology Management

PICU / NICU Management

Chemotherapy Management

C

C

C

Services that may only be

relevant to core business

Diagnostic Management System and

Other...

Diagnostic Services, Other...

C

Foundations

Core services that are optional depending on core business of entity.

Distributed Services can be replicated in various products depending on

the adoption model. The PAS feeds most TPP, and therefore, can be

viewed in those systems. Distributed Decision Support can

also be a part of multiple systems.

DS

View Summaries

Specialty Summaries

F

F

F

F

F

F

F

© 2014. Department of Health Pre-existing Intellectual Property – Commercial in

Confidence. This material is a guide and provide indicative health ICT solution

considerations. This material cannot be commercialised.

Clinical Decision Support

Clinical Protocols/Pathways

Consolidated Active Decision

Support

Access Passive Decision Support

Information

View Scheduling Appointment Notifications

View ED Attendance Information

View Patient and Episode

Information

Administrative Details

Access Passive Decision Support

Information

Active Decision Support

Decision Support Non-Consolidated

DistributedServices

DS

Access

Channels

INTEG

RA

TIO

N M

AN

AG

EM

EN

T


Initial Draft

Logical Model

CLINICAL SUPPORT SERVICES

Cardiology Services

Pharmacy Services

Diagnostic ImagingServices

Pathology Services

Allied Health Services

Intensive Care Services

Community Health Emergency Services

Theatre Services Administrative Services

Mental HealthAged Care

Specialist Other Telemedicine

Disease Surveillance Immunisation

OPERATIONSMANAGEMENT

User Management Systems Management Change Management Security Management Purchasing

Report Management Referral Management

Discharge Summary Management

PROGRAM WIDE

Management Reporting

Agency/Portfolio Operations Reporting

Electronic Transfer

Security Management

Cross Repository Management


Statutory Reporting

Electronic Transfer

Security Management

Cross Repository Management


B2B Integration

Portal Web Access

HI Service

PCEHR

DHS Medicare

EXTERNALINTEGRATION

Nash

eReferral

Unified Comms

National Prescriptions

Shared Discharge Summaries

STA

ND

AR

D C

OD

ES

ET/

REFER

EN

CE

DA

TA M

AN

AG

EM

EN

TD

istributio

n

Man

agem

ent

Publish

ing

Change

Req

uest

Managem

ent

Rep

osito

ry M

anag

emen

t

ELECTRONIC MEDICAL RECORD: CORE

Work

flow

M

anagem

ent

Exe

cution

Rule

s M

anag

emen

t Exe

cution

Proce

ss/E

vent

Inte

gra

tion

Direc

tory

Ser

vice

sD

ata C

om

munic

ation

Patien

t Id

entity

M

anag

emen

t

ACCESSMANAGEMENT

Directory Services Authentication Services

Authorisation Services Encryption Services Portal Services

ACCESSCHANNELS

Telephone PC eMail InternetPDA VoiceMobile Pager Biomedical DevicePatient Kiosk

RESOURCE MANAGEMENT

Clinical Reporting

Research


Interoperability Strategic Roadmap

OC

IO &

National R

ecomm

endationsH

IMSS C

ompliant

Electronic Medical R

ecord (Paperless)

Extended Core Systemi.e. Allied Health

Hospital in the HomeTelemedicine

Clinical Risk Assessment

Clinical Costing

Other Servicesi.e. Scanned Medical Record

UnifiedCommunications

Individual Health Identifiers –Individual/Organisation



National Prescriptions Dispense Repository VIEW – Child EHR

VIEW

ICD10 ~ National Data Dictionary


LEGAL, STATUTORY & ETHICAL REQUIREMENTS (VAED,VEMD..etc)


HL7 STANDARDS



SECURITY


Personally Controlled Electronic Health Record VIEW

Nursing/Clinical Documentation Inc. Vital Signs, Flow Sheet, etc.Nursing Notes, eMar integrated,

CDS, PACSOrder Entry

CPOE2nd Level CDS

Computerised Assessment System

Physician Documentation with Templates, Progress Notes,

Problem ListsDischarge Summary

Extensive PACS

Closed Loop MedicationBar Coding patient bands

CPOE and Pharmacy5 rights medications

administration

The hospital is paperlessData warehousing, clinical information is shared, Data

Continuity throughout health service

HIMSS L1

HIMSS L2

HIMSS L3

HIMSS L4

HIMSS L5

HIMSS L6

HIMSS L7

FutureProjects

Other

PAS & BILLINGINTERFACED

OR INTEGRATED

MBSPBS

EMRSelf Assessment

SNOMEDAMT

DISCHARGESUMMARY

SPECIALIST LETTER

eReferral

SecureMessage Data

HISNASH

O

R

M

O

M

O

M

R

O

R

O

Stan

dard

isat

ion Term

inology

M

M

M

M

M

M

M

M

LEGEND: O R MOPTIONAL MANDATORYRECOMMENDED

Patient & ClientServices i.e. Patient

Administration System

Scheduling

Patient Mobility Program

Other Speciality Systemsi.e. Cardiology, Respiratory, Mental Health, Aged Care,

Paediatrics

Administrative Servicesi.e. Claiming

Diagnostic Servicesi.e. Fetal Monitoring

Patient Acuity, Workload & Resource Management

M

M

M

M

O

O

O

Legi

slat

ion

Polic

y

Anchor Dependency

Extended EMR Core

National Agenda

OCIO & AusStandards

& CataloguesInc. NHSD

TheatresPerioperative

Ambulatory, ED

Critical Care, ICU, NICU

O

O

O

Integrated/Interfaced

Major Anc. Fed DataOrders & Results

Controlled Medical VocabularyClinical Decision Support Rules

EngineHIE

Conflict Checking

Major Ancillary Clinical System –Pharmacy, Lab & Imaging

CDA

CDA

CDA Enabled

CDA

Architecture Design Check

Can be adoptedin early stages of EMR,

however, requires maturity to achieve

IHI intended outcome


Initial Draft

Capability LevelLow High


ExpertHIMMS L-7HIMSS L-5 HIMSS L-6HIMMS L-4HIMSS L-3HIMSS L-2HIMSS L-1

HL7 STANDARDS

Medicare Benefit Schedule ~ Pharmaceutical Benefit Scheme ~ Australian Medicines Terminology

ICD10 ~ National Data Dictionary ~ BETTER TERMINOLOGY SETS


LEGAL, STATUTORY & ETHICAL REQUIREMENTS (VAED,VEMD, etc.)

EXTENDED CORE ~ SPECIALTY SYSTEMS

CATALOGUES (imaging, pathology)


PAS & BILLING INTEGRATED OR INTERFACED

HOSPITAL IN THE HOME/TELEMEDICINE

RISK MANAGEMENT, INCIDENT REPORTING

BUDGET, CASEMIX, CONTRACT MANAGEMENT

PATIENT ACUITY, WORKLOAD & RESOURCE MANAGEMENT


Office of the Chief Information Officer STANDARDS

Elec

tron

ic M

edic

al R

ecor

d -C

OR

E

UNIFIED COMMUNICATIONS

SECURITY


SCANNED MEDICAL RECORDS

Secure Message Data ~ Health Identifer Service ~ NASH

Individual Health Identifiers – Individual/Organisation

Secure Message Data ~ National Health Service Directory ~ Electronic Language Standards (Aust. Standard)

Discharge & Event Summary/Specialist Letter/eReferral



National Prescriptions Dispense Record UPLOAD ~ Electronic Transfer Partners

SNOMED ~ Australian Medicine Terminology


Nat

iona

l eH

ealth

Age

nda

Term

inol

ogy

& s

tand

ards

Oth

erTe

chno

logy










Interoperability Artefact Stack


Initial DraftMaturity LevelLEGEND: Low High



Initial Draft

Major Public Health Service

Vic Statewide Health Information Exchange

Or Vic Statewide PCEHR Conformant Repository

Business to Business Information Flow Model

Diagnostic Services

Private Hospital

Other Victorian Health Service

Messaging IntermediaryMessaging Intermediary

Messaging Intermediary

GP Clinic

Specialist Clinic

Community Pharmacy

Ord

ers

Res

ults

Ord

ers

Res

ults

Discharge SummaryOther clinical documents

Allied Health Service Community Health Service

Discharge Summary Discharge SummaryOther clinical documents

Discharge Summary

DischargeSummary

eReferralShared Health Summary

Discharge Summary

Dispense Record

Prescription Record

eReferral

eRef

erra

leR

efer

ral

Dis

char

ge S

umm

ary

Dis

char

ge S

umm

ary

Discharge SummaryOther clinical documents

Viewing

Discharge SummaryDischarge Summary

Other clinical documentsViewing

Discharge Summary

Shar

ed H

ealth

Sum

mar

y

eReferral eRefe

rral


Capability5

Capability4

Capability3

Capability2

Capability1

Capability0

Business Process Integration & Semantic Interoperability(Future State)

External providers are able toreach into other unconnected

external organisations

Advanced Clinical SyntacticCDA: referrals, Discharge Summary,

Specialist letter, Event Summary,CDSS, Message confirmations,

Telemedicine, Community Pharmacy i.e. PCEHR, NPDR, Results sharing

(HIE, BI, RIE > 50% optimal capability), Messaging b2b, CEHR, EHR

> 70% clinical system interoperable

Intermediate Clinical Syntactic National, State and Local Codesetsare common in all internal systems

and are recognised in downstream systems.(HIE, BI, RIE at 50% optimal capability),

ISO Standards, AS Standards, SNOMEDAMT - Terminology


Common Identifiers & Basic Clinical Syntactic:

IHI, HPI-I & O, Global Org Urs, (HIE, BI, RIE at 20% optimal capability),

Bi-directional i.e. orders & results interfacing enabled,

PACS, eReferrals, SCTT, NASH50% of clinical system interoperable

Administrative Syntactic:Administrative data connected,

Ancillaries are fed by PAS, PBS and MBS


Unstructured Environment:Manual Processes are in place

for transmitted data

HIMSSL1

HIMSSL2

HIMSSL3

HIMSSL4

HIMSSL5

HIMSSL6

HIMSSL7

EXPERTFuture State

OCIO & AustralianisationOCIO & Aus Standards, ICD10, AQSHSS, VAED, VEMD, etc. Disease & Immunisation Surveillance, Identity management,

HL7 standards, JCAPS, integration, security, legislation, policy,EMR core established and integrated

Major Ancillary Pharmacy

Lab &Imaging

Major AncillaryFed Orders & Results

Controlled VocabCDS rules

EngineHIE

Conflict checking

Nursing/ClinicalDocumentation

Vital Signs, Flow Sheet, Nursing

Notes, eMARIntegrated,

CDS, PACSOrder entry

CPOE, 2nd LevelCDS,

ComputerisedAssessment

System

Physician Documentationwith templates,Progress Notes,Problem Lists,

Discharge Summary,Extensive

PACS

Closed loopmedication,

Bar Coding patientbands,

CPOE and pharmacy orders,

5 rights medicationadministration

The health organisation is paperless, data

warehousing, clinical information is shared,

data continuity throughout health

organisation

Nursing Notes

Nursing/Clinical Docs, Inc vital signs and flow chart

Physician Doc with templates

Progress NotesProblem List

Bar Coding patient bands

Closed loop medication

Data Warehouse

Data Continuity throughoutHealth service

Paperless

Current State

Future State

Interoperability Self Assessment & Strategic Plan

LEGEND: Current State Not StartedPartial CompleteDepartment of HealthHealth Design Authority

Initial Draft

Future State

Clinical information share

1 2 3 4 5 6 7

2 4 6 8 10 12 14

3 6 9 12 15 18 21

4 8 12 16 20 24 28


References:

- HIMSS Interoperability Definition Final, April 5, 2013- Principles of Health Interoperability HL7 and SNOMED, Tim Benson, 2010- The Information Systems Interoperability Maturity Model (ISIMM): Towards Standardizing Technical Interoperability and Assessment within Government, Stefanus and Jamieson, (c) 2012, MECS- NEHTA eHealth Interoperability Framework, 2013

Interoperability at the information level

Facsimile

Telephone

Scanner

Printer

CDA Document (View)

 <entry> <observation classCode="OBS" moodCode="EVN">  <id root="81FEB786-C465-11DE-B347-E8CA56D89593"/>  <code code="116223007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" codeSystemVersion="20090731" displayName="Comorbidity"/>  <value xsi:type="CD" code="236629009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" codeSystemVersion="20090731" displayName="Chronic radiation cystitis"/> </observation> </entry> 

Structured andfully qualified data

Document

Clinical Terminology Standards

Human Review of documents

IHI

HPI-I

HPI-O

Medications

HL7 2.x

Human interpretation of unstructured clinical document Human interpretation of clinical content

required. Syntactic understanding for certain data classes (primarily administrative, eg. the patient)

Human interpretation of partially structured clinical information. Broader syntactic understanding achieved, eg. referred

service, allergies, alerts, meds

Capable of Semantic Interoperability –system interpretation of all information.

Structured documents and/or atomic data using standard codesets

Ad hoc transport mechanisms -Fax, email, mail, person to person

Structured Document CDA

level 1b


level 2


level 3a


level 3b

Person to person communications

u

Direct system to system exchange of clinical

information


Initial Draft

Electronic Data Interchange

Interoperability at the Information Level

Secure message delivery


Administrative ServicesFinancial

Management


System

Activity Based Costing Reporting and Management

Clinical Costing

Rostering

Staff

Payroll

Human Resources

Billing Management

Distributed Billing Services

Consolidated Billing

Nurse Management

Acuity


Patient Management

Episode Management


Attendance

Outpatient

Queue Management


Compliance

Quality and Safety

Management


Management


EnterpriseApplicationIntegration

Med

icat

ion

orde

rs

Order S

tatus Indicators Pat

ient

Dat

a (fo

r ED

)

Pat

ient

Dat

a (fo

r The

atre

sys

tem

s)

Pat

ient

Clin

ical

info

rmat

ionP

atie

nt E

piso

de /

Vis

it In

form

atio

n

Patient Theatre procedure details

Patie

nt D

ata

Disc

harg

e Su

mm

ary

Det

ail

Patient Information

Clinical Information

Dispense R

ecord

Patient E

pisode / Visit Inform

ation

Clin

ical

Ale

rts

Medications O

rders

StandardCodesets

Master Data Management

Spec

ialis

t Clin

ical

Info

rmat

ion Discharge Sum

mary Detail

Clinical Information

Patient Episode / Visit Information

Path

olog

y O

rder

s

Diag

nost

ic Im

agin

g / R

adio

logy

Ord

ers

ExternalProvider Details

StandardCatalogues

Med

icat

ions

Ord

er S

tatu

s Ind

icat

or

Med

icat

ions

Ord

er S

tatu

s Ind

icat

or

Med

icat

ions

Ord

er S

tatu

s Ind

icat

or Pathology Results

Diagnostic Imaging / Radiology Results

Patient Information

Pathology Orders

D iag nos tic I mag ing / R adio log y O

rde rs

Path

olog

y Re

sults

Diag

nost

ic Im

agin

g / R

adio

logy

Res

ults

Request for Image

Image Link

Image Display via Viewer

GP with discharge summaryPCEHR NPDR HI Service NHSD

Enterprise Master Patient

Index

Message Transformation

Prov

ider

Deta

ils

Discharge Summary

Transmission

Disc

harg

e Su

mm

ary

PCEHRInterfaces

NPDRInterfaces

HI ServiceInterfaces

Patie

nt a

nd

Prov

ider

Deta

ils

Pres

crip

tion

and

disp

ense

da

ta

Clin

ical

do

cum

ents

/ PC

EHR

View

Critical component that caters for

variations in HL7 messaging standards

Message Flow Interoperability Model


Initial Draft© 2014. Department of Health Pre-existing Intellectual Property – Commercial in Confidence. This material is a guide and provide indicative health ICT solution considerations. This material cannot be commercialised.

Qua

lity

Cond

ition

High

Exce

llent

Low

Low

Low Interoperability Poor Quality

High Interoperability

Excellent Condition

Excellent Quality

Low Interoperability

High Business Value

Poor Quality

Eliminate/Migrate

Invest

Pharmacy

Pathology

EMR

Respiratory

Cardiobase

PAS

Imaging

EmergencyDepartment


PACS

HIH

Mental Health

CancerManagement

PYXSIS

Food Services

Aged Care

Cancer Registry

Finance

Antenatal& Birthing Outcome

HumanResources

BusinessIntelligence

Private Billing

WoundCare

10_0 5 15__+7.5_1 32 4 76 98 11 1312 14

01

32

46

87

95

10

AnswerYes/No Score

The application has a sunset or end of life date

Is there general acceptance of the application?

The application meets the health organisation’s expectations now and in the future?

The application is easy to use?

The application is critical to the health organisation?

2 Yes= -2, No= 2

Yes = 2, No=0

0 Yes = 2, No=0

0 Yes = 2, No=0

Yes = 2, No=02

Interoperability AssessmentLEGEND: Non-clinical

ApplicationBusiness Directive to replace applicationClinical Application

Notification of Replacement

QUALITY CONDITION RATING SCALE = Y

Provide Interoperability Self Assessment scoreMultiplying interoperability capability with HIMSS

/10Total Score

Total Score /28

INTEROPERABILITY ASSESSMENT = X

Y AXIS

X AXIS

Application Review – Comparing Quality with Interoperability Capability

MaintainUplift

Invest

EliminateMigrate

The application may lack flexibility and interoperability, however the application is important and meets the expectations of the organisation.

Consider uplifting product to improve interoperability capability.

The application rates well against interoperability and business requirements. Future investment into the product maybe considered

The application is rated low against interoperability, quality and business requirements. The application needs to be eliminated from the suite

ORThe application needs to be replaced and migration activities may or may

not be required

DEFINITION AND DESCRIPTION

Note: Axis X only reaches 15 although the overall score is calculated to be up to 28. Any score achieved above 15 is considered extremely high and therefore negates the need for > values of 15.


Initial Draft

0

Maintain


Messaging vendor

GP Practice

National Service - PCEHR

National Service - Identifiers

Internally hosted health applications

External (traditional) hosting services – health applications

Internet

Cloud Services

Infrastructure As a Service

Platform asa Service

Software asa Service

PatientAdmin

ClinicalApplications

ApplicationDelivery

Hosted Applications

Hosted Databases

DatabaseServers

Interfaces

Internet,Patient Portal

Externalinterfaces

Leased LineDark Fibre

VPN

1

1

2

2

ExternalInterfaces

PCEHRSystem

Portals

ExternalInterfaces

HI Service

Messaging Distributor

Systems

GP ClinicalSystem

ExampleMessage

Flows

Denial of ServiceFalse websiteTraditional Virus

Intrusion prevention and detectionMalware DetectionIP FilteringAntivirus

1

3

Malware attack RansomwareTraditional virusPhysical security threat

Intrusion prevention and detectionMalware DetectionAntivirusDisaster RecoveryStrong physical security

2

1

1

1

1

12

2

2

2

Message AlterationLoss of confidentialityFalsified messageMan in the middlePrincipal spoofingForged claimsMessage replay

PKI signatures and encryptionStrong registration authority and certificate authority processesPrivate networks

3

12

2

1

2

Directory, email

Overview of Security ThreatsIn an Interoperable Health

Sector


Initial Draft


Glossary

AMT – Australian Medicines Terminology

BI – Business Intelligence

CDA – Clinical Document Architecture, an HL7 standard

Child EHR – Child Electronic Health Record, a new national initiative based on the NSW Health Bluebook

ED – Emergency Department

EDI – Electronic Document Interchange

DHS – Commonwealth Department of Human Services, now incorporating Medicare Australia

Discharge Summary – A clinical document produced when a patient is discharged from a health service. Usually generated by the clinical system or EMR.

EMR – Electronic Medical Record

EMR Core – The EMR Core represents the key functions that make up an EMR system. Refer to HDF paper “EMR Core and Models” for more information.

eReferral – Electronic referral. An electronic way of achieving a care handover.

HL7 – Health Level 7

HL7 Standards – A number of standards supporting various elements of HL7, from version 2.x messaging to version 3 CDA.

HI Service – Healthcare Identifiers Service. A national service hosted by DHS that support acquisition and use of national healthcare identifiers.

HIE – Health Integration Engine

HIMSS – Healthcare Information and Management Systems Society

HIMSS Model – The HIMSS Electronic Medical Record Adoption Model (EMRAM). Refer to HDF paper “EMR Core and Models” for more information.

HPI - I – Healthcare Provider Identifier - Individual: A unique number assigned to all individuals involved in healthcare service delivery

HPI - O – Healthcare Provider Identifier - Organisation: A unique number assigned to every organisation involved in healthcare service delivery

ICU – Intensive Care Unit

ICD10 – International Classification of Diseases version 10. A clinical terminology set in common use within Australia

IHI – Individual Health Identifiers. An identifier for all recipients of healthcare in Australia

Interoperability – The ability to exchange and use information (Princeton)

Java CAPS (JCAPS) – Java Composite Application Platform Suite. An Enterprise Application Integration tool

MBS – Medicare Benefits Schedule

NASH – The National Authentication Service for Health. A project being delivered through NEHTA that will deliver the first nationwide security service to enable healthcare organisations and individuals to exchange e-health information

NESAF – National eHealth Security Access Framework. A security guide for agencies, especially those participating in the national eHealth agenda

NDD – National Data Directory

NHSD – National Health Service Directory

NICU – Neonatal Intensive Care Unit

NPDR – National Prescription and Dispense Repository

NSQHSS – National Safety & Quality Health Service Standards

OCIO – Victorian Office of the Chief Information Officer

PACS – Picture Archiving and Communication System

PAS – Patient Administration System. A system used for the recording of patient and provider information to support management and coordination of service provision

PBS – Pharmaceutical Benefits Scheme

PCEHR – Personally Controlled Electronic Health Record

RIE – Research Integration Engine

SCTT Referral – Service Coordination Tool Templates

SEIMM – Statewide eHealth Interoperability Maturity Model

SMD – Secure Message Delivery. A set of Australian standards to support point-to-point messaging in healthcare

SNOMED CT – Systematic Nomenclature of Medicine – Clinic Terminology

Unified Communications – A term used to describe voice and data services being delivered over the same infrastructure


Initial Draft© 2014. Department of Health Pre-existing Intellectual Property – Commercial in Confidence. This material is a guide and provide indicative health ICT solution considerations. This material cannot be commercialised.