A National Study of eHealth Standardization in Finland - Goals and Recommendations Medinfo 2007 Brisbane Wed 22 Aug, Session S126, 4 PM Juha Mykkänen a,

A National Study of eHealth Standardization in Finland

- Goals and Recommendations

Medinfo 2007Brisbane

Wed 22 Aug, Session S126, 4 PM

Juha Mykkänena, Maritta Korhonenb, Jari Porrasmaaa, Tuula Tuomainenb , Antero Ensioc

a Health Information Systems (HIS) R&D Unit, University of Kuopio, Finlandb Business and Administration, Savonia Univ. of Applied Sciences, Kuopio, Finland

c Ensitieto Oy, Varkaus, Finland

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in this presentation

• background and basis of the study

• materials and methods

• results

• recommendations + conclusions

• brief update (latest news)

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background of the study• in Nov 2004 various stakeholdes in Finland:

– Ministry of Social affairs and Health

– Ministry of Trade and Industry

– the Association of Finnish Local and Regional Authorities

– the Technical Research Centre of Finland / HL7 Finland

– the National Research and Development Centre for Welfare and Health Stake

– the Finnish Agency for Technology and Innovation TEKES

– the University of Kuopio and the Savonia University of Applied Sciences

– "standardization: an important enabler of the health service provision, the development of the economy, and the growth of the enterprises"

– but "lack of sustained solutions for the development and utilization of standards and participation in standardization activities"

• study form December 2004 to March 2005 by two national R&D projects (SerAPI, ZipIT-ojo), tasks:

– review the previous studies and recommendations and combine them with a wider view of standardization

– make recommendations for the improvements in the development of activities related to standardization on a national level

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standards and standardization

• standard: a document approved by and accepted body which contains rules, guidelines or features for generic and repeated use in products, processes or services [Project management institute]

• goals and motivations of standardization: – uniformity (quality, efficiency) – compatibility (services, applications, technologies)– objectivity (measurement, neutrality, multilaterality)– justice (control, equality)– hegemony (competitive advantage, market protection)

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areas of standardization in the study(classified by the required types of expertise)

medicineand

healthcare

information m

odels and elements

terminologies, classifications, codes

processes, pathways

quality of care

guidelines, knowledge

architecture

healthcare IT and IS

data types and formats

electronic clinical documents

message interfaces

archiving and long term storage

service and AP

I interfacessupport for processessecurity and confidentiality

IT, domain-neutral andcross-domain

electronic health records

standardization relevant to eHealth and HIS

data comm

unicationsidentificationeG

overnmenance and architecture

electronic documents

messaging and enveloping

interface technologiesprocess description and definitionsecuritysoftw

are production / development

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materials, methods & activities of the study

• perform a literature survey including national and international recommendations

• update an evaluation and selection framework of standards (Mykkänen, Tuomainen, An evaluation and selection framework for interoperability standards, Information and Software Technology 2007, in press)

• conduct surveys to probe current and target status– previous web-based survey – targeted e-mail survey to named experts– survey questions discussed in meetings with named experts– total response rate of surveys and meetings 66,7% (23/36)

• conduct interviews and project board reviews• construct recommendations based on the results and authors'

experience and views• result: a report in Finnish, a basis for further actions

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Finnish eHealth standards landscape 2005

CENISO

Dicom

TC215 TC251

SFS

KTM

Tekes

STM

HL7 Finland ry

StakesOSKE

Health LevelSeven Inc

SIG

IT-yrityksetPalveluntuottajatKuntaliittoStakesVTTYO+ AMK

DG InfoSoc

Yleinen teollisuusliitto

HoD/ Stakes

MirrorGroup

Tulosohjaus

Asiantuntijat Stakes yms.

[based on Pekka Ruotsalainen, 2005]

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results: general

• applicability and quality assurance key factors in relation to the goals and policies

– also usability, fast introduction, consistency across domains– no uniform view on the importance of international compatibility, existing

systems, fine-grained vs. framework standardization

• the most central areas: specification and support of healthcare processes, information structures, data types, semantic consistency, EPR (archive)

– followed by unified information models, desktop integration, terminologies, knowledge, shared IT services, workflow support

– different opinions: architectures, security solutions, technical and cross-domain aspects

• many types of participation and utilization of generic technology standards was emphasized

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results: goals and challenges• target: a coordinated and compatible set of standards for factual

needs of the market, utilizing experts in various areas, clear relationship between national and international levels

• main challenges– "Who is navigating?" - coordination and ownership, selection of standards,

production of recommendations, balanced participation in standards-related work

– "Random patch on top of patch" - quality assurance and evolution of goals, pressures for fast introduction, difficulty of finding right level of flexibility, accuracy needed for conformance and certification

– "Pile of paper standards" - relationship between de facto and de jure standardization, standards uptake, availability of specifications, local requirements are not easily traced to international work

– "Sticks and carrots" - commitment and business drivers, market demand instead of official enforcement

– learning

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recommendations based on the study

• 8 main recommendations• 51 detailed goals, 127 recommended actions on:

– policies: organization, steering, funding– relationship management: improve international and cross-domain

linkages– quality assurance: linkage to demand, expertise, models for selection

and evaluation– improved know-how in system acquisitions– establishment of education and support related to standards– balanced participation in standards activities– detailed recommendations for many standards areas, most urgent in

relation to the national EHR: core information sets, clinical documents, architecture and security

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main recommendations 1-41. intensify the the standardization relationship between the

healthcare IT and the domain-neutral IT: shared national goals, policies and procedures, steering groups for overall coordination and the healthcare-specific standards

2. assure the continuity of domain-neutral and healthcare-specific IT standardization using permanent funding

3. give primary preference to cross-domain and generic standards; develop and introduce healthcare-specific standards only on areas where they are essential

4. intensify and resource participation to the international standardization work and observation of international developments in standardization: identify mature standards for current local needs and avoid local overlaps with the international development

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main recommendations 5-85. support the participation (and balance) of healthcare

application vendors and health service providers in the development, localization and introduction of standards; standards compliance as a project funding criteria

6. support primarily the goals of the national health project, especially interoperable electronic health records: requires quick decisions

7. define the status, normativeness and mutual relationships of healthcare IT standards, guidelines and recommendations unambiguously and accurately

8. create a support and education network to ensure interoperability, to support introductions, to support the steering groups and to promote the recommendations

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conclusions and brief update

• many successful standards already used and providing everyday benefits

• to achieve the evident benefits of eHealth standardization, coordination, selection, expertise on many areas, collaboration, are required

• success is only measured through utilization on the market and the benefits to the users

• update late 2007:– several working and coordination groups in place to support the

national EHR (connections to standardization and to some extent recommendations 5-7)

– the national association for standardization SFS (de jure) has formed a unit for overall coordination of IT standardization, is creating healthcare-specific standardization steering group together with other key stakeholders (recommendations 1-4 on the agenda!)

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other results from the SerAPI project in Medinfo'07

• Model-Centric Approaches for the Development of Health Information Systems (Tuomainen et al.)

• Conformance Testing of Interoperability in Health Information Systems in Finland (Toroi et al.)

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THANK YOU

[email protected], University of Kuopio, HIS R&D Unit

Maritta Korhonen

Jari Porrasmaa

Tuula Tuomainen

Antero Ensio

This work is part of SerAPI

and ZipIT-ojo projects:

www.serapi.fi/

www.centek.fi/zipit/Projects are funded by the Finnish funding agency

for Technology and Innovation TEKES together with 5 hospital districts / cities / joint municipal

boards for healthcare and 17 companies.