Universal translator aims to connect data across Canada

HAMILTON, ONT. – A team at Hamilton Health Sciences is leading the charge to devise a ‘universal translator’, a set of technologies that will allow the electronic records used by hospitals, doctors’ offices and other medical organizations to talk to each other more easily.

The Centre for Data Science and Digital Health, also known as CREATE, says it’s well along the road to producing the foundational technologies that will enable the interoperability of digital health records across the country.

The new architecture aims to connect organizations and clinicians using electronic health records via the Fast Healthcare Interoperability Resources (FHIR) standard.

While FHIR has been touted as a ‘magic bullet’ that will connect disparate systems, there are already too many versions of FHIR and one has trouble understanding another.

CREATE is working in close partnership with Canada Health Infoway, along with Ontario Health and British Columbia’s Provincial Health Services Authority, to develop and implement a common, Canadian flavour of FHIR that will make communications simpler.

“One of the problems has been that FHIR is a language that has many dialects,” explained Jeremy Petch, PhD, head of CREATE, the group that won a contract from Canada Health Infoway to lead the development of a universal translator.

He asserted, “There’s going to be a standardized, Canadian dialect for FHIR, so that you can plug into Canadian healthcare databases and exchange data.”

The project will help ensure that all healthcare providers, not just bigger organizations like hospitals and nursing home chains, can make use of the standard and communicate across the system.

“There are many small organizations that don’t have the ability to manage FHIR on their own, or to manage an identity server,” said Dr. Petch. He explained that CREATE and its partners are developing a service that healthcare providers can plug into, where numerous services are all managed for them.

It can be thought of as a cloud service that healthcare providers can tap into. Inside the cloud, the architecture is checking identities behind the scenes, and it’s acting as a hub that enables one provider to quickly communicate with another.

The project is working on a provincial basis, with the first iterations in Ontario and British Columbia. After it’s shown to work in these provinces, the partners hope that other provinces will adopt the same architecture.

Recently, in separate projects, some strides have been taken in connecting hospitals and nursing homes using FHIR. However, the success stories have been limited to organizations using large electronic systems, like MEDITECH, Oracle/Cerner, Epic and PointClickCare.

Getting these systems to talk to one another has been a painstaking process, with one vendor working with another to ensure their systems can communicate.

In contrast, the approach used by CREATE is to deploy standards that have been specified by Infoway in its recent Pan-Canadian Interoperability Road Map, and to produce a system that everyone can tap into.

This includes not only the major vendors, but also the scores of mid-sized and smaller vendors providing apps to medical organizations.

“So, all vendors will know, if they write to this new standard, they will be able to exchange data,” said Dr. Petch. “You won’t have to create a one-off for Oracle and another for Epic and another for MEDITECH. You’ll just have to do it once.”

After years of struggling with healthcare interoperability in Canada, many believe the solution spearheaded by CREATE in support of the Pan-Canadian Interoperability Road Map will make a big difference. “It’s the only viable path forward,” said Dr. Ted Scott, VP innovation and partnerships at Hamilton Health Sciences.

He said the system will be produced and tested first in Ontario and BC. “Other provinces will then be able to replicate the solution,” said Dr. Scott.

CREATE and its team of engineers and data scientists were chosen to lead the effort, said Dr. Petch, because they already have expertise with large systems and deployments. They’re also leaders in developing AI solutions for healthcare, and AI is expected to be heavily used in the new system.

Dr. Scott added that CREATE, as the main developer, avoids the biases and political issues that sometimes occur when vendors or government agencies lead projects. “We’re a neutral party,” he said.

The project is in the first year of what Dr. Scott said will likely be a multi-year effort, as there’s a lot of work to be done.

A major component of the project is to create FHIR-powered apps that can be used by all clinicians and organizations to reach the data they need.

This work is being done using HALO, an Infoway-led standard that allows existing systems to connect to each other as part of the new solution.

Already, progress has been made on the development of an important app – a Canadian version of the International Patient Summary, which gives access to a patient’s key medical information, including medications, problems, allergies, vaccinations, test results and procedures.

Additional apps will be added to the Ontario system, over time, and other provinces that adopt the ‘universal translator’ architecture will be able to fine-tune it to their own needs.

Once there are enough apps available on the provincial systems, clinicians won’t have to open different programs to obtain the information they need. Instead, they can simply access the universal translator, which will query other databases and bring back the required data.

Dr. Scott estimated that it could take 10 years to get this new system up and running across Canada.

In addition to the technical work being done, he added there’s the human factor, as well – clinicians and healthcare organizations across Canada must agree to actually use it. “Getting people aligned to this core approach is crucial,” said Dr. Scott.

Already, there has been a great deal of buy-in across Ontario and British Columbia. Dr. Petch noted that the architecture has been finalized and that testing in Ontario was to begin in late March.

CREATE is also working on a second project, funded through an Innovation Grant from Canada Health Infoway that’s associated with the universal translator.

On this front, it’s working to convert the reams of free-form text found in clinical notes to a structured form that can be more easily accessed when querying electronic medical records.

Dr. Petch demonstrated a system that can read clinical notes and pull key data out of the free text and place it into a medical summary. It’s doing this via artificial intelligence and large language models. Dr. Petch said the CREATE team fine-tuned an LLM and has been further developing and evaluating the application using real clinical data from Hamilton Health Sciences – data that has been de-identified to protect privacy.

He explained that other large language models – like ChatGPT – often use data picked up from non-clinical sources found on the Internet and the quality of their decision-making suffers. “They’re not using real clinical notes,” said Dr. Petch. “They get incorrect results and hallucinations.”

By deploying real clinical data to build and test their own solution, said Dr. Petch, CREATE has achieved higher-quality outcomes.