August 24-25, 2006, Cologne, Germany
| International HL7 Interoperability Conference IHIC 2006
August 24-25, 2006, Cologne, Germany |
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To the IHIC 2006 conference program committee
Email: jari.porrasmaa@uku.fi
Jari Porrasmaa,
University of Kuopio / Healthcare information systems R&D unit
Association of Finnish Local and Regional Authorities
PO BOX 1627, SF-70211 Kuopio, Finland
jari.porrasmaa@uku.fi
Jari Porrasmaa currently works in the national healthcare development program of Finland.
His focus is on the structuring and standardisation of electronic patient and health records.
These areas are coordinated under the Association of Finnish Local and Regional authorities
and is funded by the ministry of health and social affairs. The different working groups and
tasks range from coordination of projects to standardisation and implementation
issues related to HL7. Mr. Porrasmaa is also working actively in research and development
projects organised in a national collaboration with several hospital districts and healthcare IT
vendors. He also participates actively in the work of HL7 Finland and HL7 international.
A document oriented approach to building a national EHR - a case study of applying the CDA R2 standard in Finland
case study
30-40 min
This presentation gives an overview of the development of a national EHR solution in Finland. Several topics are covered
but the main focus is on the implementation of the Clinical Document Architecture R2 standard.
This case study gives an overview of Finland's efforts in building a national EHR implementation. The project is examined from two viewpoints: firstly, how the national development and specification work is organised - secondly, how the international CDA R2 standard is localized and implemented. Regarding both viewpoints attention is given to pitfalls and bumps that the project has run into and also reasons why some approaches seem to yield better results.
As developing healthcare IT solutions is not a new phenomena, a brief summary of historical aspects is given in the presentation including various legacy systems and other already adopted standards. This serves as the starting point for organising the national project and detailed specification tasks. The Ministry of Social Affairs and Health has defined the strategy for developing the national EHR solution. Among the ministry funded projects in recent years have been the definition of a core structured data set, structuring of different health record products, implementing CDA R2 interfaces and setting up the national code server, Recently the Social Insurance Institution of Finland was selected as the national actor responsible for the procurement of several national IT services.
The main portion of the case study focuses on how the Clinical Document Architecture release 2 standard has been localised and what the current status of implementation is. An overview of the different implementation guides that HL7 Finland has produced is given. All the different document types covered by the guides can be divided into two categories: 1) narrative CDA documents based on medical speciality, a specific service type or some other defining factor 2) tightly structured forms designed for some very specific use case. Implementation approach used in both types is described in the presentation. To provoke discussion, an example of implementation falling beyond Ğa HL7 conformance profileğ is presented. Is this innovation or abusing HL7 artefacts? Some scope issues are also discussed - sometimes using a specific tool or a standard will make you try to fit anything within that approach (the nails you are pounding away with a hammer might be screws).
A comprehensive national secure health information network implementing the goals set by electronic health record requirements can not be achieved only by creating standardised data content. Several other IT services need to be specified and implemented. Some of these relate to document management and authentication and some are more general in nature and can be applied to other areas. Current high level architecture and some services within the architecture are presented briefly: these include document storage/archival service, electronic signatures and national messaging services.
The case study is concluded with a summary and some thoughts on future challenges, such as personal health records.