RIDE Overview Asuman Dogac Middle East Technical University

RIDE Overview Asuman Dogac Middle East Technical University Ankara, Turkey METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

RIDE Partners METU-SRDC, Turkey p OFFIS, Germany p IFOMIS, Germany p EUROREC, EU p CNR, Italy p NTUA, Greece p DERI, Ireland p IHE-D, Germany p OLE, Belgium p METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

RIDE Roadmap METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

Goals and Challenges p Goal 1: Establishing a Europe-wide Secure Network to Exchange Medical Summaries (EHR) across Member States n n n 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: p p n CEN pr. EN 13606, or IHE Profiles, or HL 7 messaging, or, … All will be detailed as possible alternatives in the RIDE Roadmap specification Version 1 METU-SRDC EUROREC Meeting, Geneva, October 10, 2006

MEMBER STATE A Local Physician Local System Authenticate Medical Summary+ Digital Signature Mary Brown Member State A Locator Service METU-SRDC EUROREC Meeting, Geneva, October 10, 2006 Local Data A Medical Repository Summary Metadata

Local Data Repository A MEMBER STATE B Healthcare Provider Registry Health Professional Registry Member State A Locator Service Record Reference Member State C Locator Service Mary Brown Member State B Locator Service Choose Record Authenticate Member State D Locator Service Dr. Hans Schmidt Request Medical Summary Local System METU-SRDC EUROREC Meeting, Geneva, October 10, 2006 Member State E Locator Service

European Healthcare Network Member State Healthcare Network Patient Identity Registry Healthcare Profession al Registry Healthcare Provider Registry Member State Healthcare Network Locator Service Audit Services Regional Health Organization Individual Healthcar e Providers Hospitals, Clinics, etc Member State Healthcare Network METU-SRDC European Healthcare Network Professional Identity Service Provider Identity Service Member State Healthcare Network Interface Member State Healthcare Network EUROREC Meeting, Geneva, October 10, 2006 Member State Healthcare Network

Functionalities of the European Healthcare Network p p p p 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… p Each Member State network has: n One or more Data Repositories which store and provide Medical Summary documents p p n n 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… p p p 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… p p p 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… n n n n 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… p p p p p 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 p p p p 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 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 p p p 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: n n p p p An architecture based on CEN pr. EN 13606 proposals will be available soon A set of IHE Profiles to be demonstrated at Wo. HIT in session 15 HL 7 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 pr. EN 13606 p p p EHR Content can be defined through EHRcom Policy content can be defined through CEN pr. EN 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 p Local or regional or national repository will provide the following asynchronous two Web Services: n EHR Info Message type Web service 6. 1. 4. 8 p 6. 1. 4. 2 p n Query EHR info message type Provide EHR information message type EHR Message Type Web Service 6. 1. 4. 9 p 6. 1. 4. 3 p METU-SRDC Request EHR message type Provide EHR message type EUROREC Meeting, Geneva, October 10, 2006

EHR Related Agent Functionality p Given Patient Identifier or Patient Demographics information it should return n p p 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 HL 7 message wrapper “ HL 7 Web Services Profile details how to implement HL 7 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! METU-SRDC EUROREC Meeting, Geneva, October 10, 2006