A National Study of eHealth Standardization in Finland Goals and Recommendations

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A National Study of eHealth Standardization in
Finland- Goals and Recommendations
Medinfo 2007 Brisbane Wed 22 Aug, Session S126, 4
PM
Juha Mykkänena, Maritta Korhonenb, Jari
Porrasmaaa, Tuula Tuomainenb , Antero Ensioc a
Health Information Systems (HIS) RD Unit,
University of Kuopio, Finland b 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 RD 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)
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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

• 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 1-4

• 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
• assure the continuity of domain-neutral and
  healthcare-specific IT standardization using
  permanent funding
• give primary preference to cross-domain and
  generic standards develop and introduce
  healthcare-specific standards only on areas where
  they are essential
• 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 5-8

• 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
• support primarily the goals of the national
  health project, especially interoperable
  electronic health records requires quick
  decisions
• define the status, normativeness and mutual
  relationships of healthcare IT standards,
  guidelines and recommendations unambiguously and
  accurately
• 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
juha.mykkanen_at_uku.fi, University of Kuopio, HIS
RD 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.