Trust in Interoperability

1. Trust in Interoperability Prof.dr. Robert A. Stegwee Chair, HL7 The Netherlands Co-chair, HL7 International Council Chair, CEN TC251 Principal Consultant, Capgemini Professor of E-Health, Univ of Twente robert.stegwee@capgemini.com

2. Topics • Interoperability has many aspects • Role of Healthcare Standards in Trust • How HL7 helps build Trust in Interoperability

3. Pharmacy Medication Orders and Lists Many types of healthcare information need to be exchanged Government Agencies/ Public health/ research Lab Test Orders and Results Payers/ financial systems Hospitalization Summaries Home Health Monitoring Device Patient Medical Imaging Orders and Results Doctors and other clinicians notesand orders

4. Exchange requires Interoperability • The ability of two or more systems or components to exchange information • Such a system comprises people, process, and technology • AND the ability to use the information exchanged • Can be safely processed by the technology • Fits with the flow of the processes • Makes sense to the people doing their job

5. How to trust the information exchanged Do I know it hasn’t been tampered with? Does it come from a trusted source? Does it make sense in the context of my patient? Will I be liable for decisions based on faulty or missed information? The case of the out-of-hours house visit … Also: How to trust the exchange of information

6. Health IT Standards to help build Trust • Data protection • Role-based access control • End-to-end security • Logging • Authentication • Clinical Registry based Authentication of Professionals • Authentication of Systems linked to Certification • Certification of Systems • Certification of software systems • Certification of their implementation and use

7. Professional Standards to build Trust • Agreement on data content and structure • What data should be made available in which circumstance • What are acceptable ranges of currency of data • Agreement on process • What describes professional conduct, guidelines • Which steps should be carried out before a referral or order • A process to review these agreements • Review the content of the agreements • Review the compliance with the agreements

8. Some HL7 Standards to help build Trust • Electronic Health Record System Functional Model • EHR-S FM as a basis for system certification • EHR-S Functions are understood and certifiably present • If you don’t have a certified EHR-S, I won’t exchange information with you • Use-cases as foundation of HL7 v3 messages • Professional conduct can be modeled • Detailed models of clinical content • Applicable across services, messages and documents

9. The HL7 Process helps to build Trust • Involvement of clinical professionals • Clinical professionals are leading the development • Modeling and Vocabulary Facilitators help structure content • Health informatics professionals assess options and feasibility • Ability to involve professional societies in ballot process • Open ballot process, based on ANSI rules • Every comment needs to be addressed • Possibility to test standards in real life practice • Draft Standard for Trial Use – make sure it works first!

10. Thank you for your attention I trust …. you have questions!