© ERS 2012 Gerard Freriks. ERS B.V.

EHR-Qᵀᴺ Polska 2012

EHR Qualities

Semantic Interoperability

Privacy

Gerard Freriks

(Lodz, 29 November 2012)

© ERS 2012

"It's the economy, stupid"

• Slight variation of the phrase "The economy, stupid"

which James Carville had coined

as a campaign strategist of Bill Clinton's successful 1992 presidential

campaign

against sitting president George H. W. Bush.

• Carville's original phrase was meant for

the internal audience of Clinton's campaign workers

as one of the three messages to focus on,

the other two messages being:

• "Change vs. more of the same"

and

• "Don't forget health care"

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© ERS 2012

MIE2012-Village of the Future

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© ERS 2012

MIE2012-Village of the Future • Point on the horizon

–All must communicate

–Now and in the future

–How?

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Blue Line It is the semantics stupid!

© ERS 2012

Topics - What is the EHR?

- Semantic Interoperability the Semantic Interoperability Stack

- Data and Information: Interoperability

Privacy

- Standards for Semantic Interoperability

- International Developments

- National/regional Governance Quality Assurance

- Conclusions

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I- Bakery

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Instructions Ingredients Moulds Kitchen

machines Oven Pastry

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I- Bakery

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Rules Information Presentation Software Hardware EHR

Instructions Ingredients Moulds Kitchen

machines Oven Pastry

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I- Bakery

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Instructions Ingredients Moulds Kitchen

machines Oven Pastry

Rules Information Presentation Software Hardware EHR

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Instruction Ingredients Moulds Kitchen tools Oven Pastry

Rules Information Presentation Software Hardware EHR

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EHR

SemanticHealthNet Dipak Kalra

© ERS 2012

EHR

SemanticHealthNet Dipak Kalra

© ERS 2012

EHR and Privacy

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ACL ACL ACL

ACL

ACL

ACL Trust

Flexibility

Patient Mandate

Author and

Patient

controlled

It is the Semantics stupid!

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Health Information Security

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450.000 records not secured

Names, Date of Birth, addresses, telephone

numbers, Patient ID, Governmental ID

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Health Information Security

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What is needed:

–Deploy top to bottom in each organisation – ISO 27799:2008 Health informatics

Information security management in health using ISO/IEC 27002

–Treat health software and the development of it

as a medical device

–Deploy 13606 EHR Communication

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Health Information Security

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CEN/ISO 13606 EHR Communication

–No patient identifiable data in the Record

–Each data object carries the Patient Mandate

(who has access to what kind of data)

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13606-4 Patient Mandate

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CEN/ISO 13606-4 TS: Security

–is a profile of the

• ISO 22600

• Privilege Management and Access Control

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13606-4 Patient Mandate

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13606-4 Patient Mandate

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13606-4 Patient Mandate

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13606-4 Patient Mandate

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13606-4 Patient Mandate

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13606-4 Patient Mandate

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© ERS 2012

Semantic

Interoperability

Stack

Common

Trusted

Facilities

Semantic Interoperability

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Semantic

Interoperability

Stack

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HL7

v3, CDA

RIM

EHR

Extract

Common

Facilities

Documentation

Archiving

Documentation

Archiving

Semantic Interoperability

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Semantic

Interoperability

Stack

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Semantic Interoperability Levels

Semantic Stack

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Semantic

Interoperability

Stack

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Semantic Interoperability Levels

FP7-SemanticHealth Project

© ERS 2012

Standards

EHR-systems

using

HL7

All viewpoints

programmed in

one system or

message

CEN/tc251

EN13606 EHRcom

Information Bus

CEN/tc251

System of Concepts for

Continuity of Care

CEN/tc251 Health

Health Information Services

Architecture

Enterprise

viewpoint

Information

viewpoint

Computation

viewpoint

Engineering

viewpoint

Technical

viewpoint

© ERS 2012

Standards Message based

EHR-systems

Archetype based

EHR-systems

Production of

message 1-3 years Minutes

IHE process

Programming

1-2 years

1-2 years

nil

nil

Roll Out 1 year nil

Total YEARS MINUTES

© ERS 2012

CEN/ISO13606

Standard

Reference Model

Archetype Object Model

Term List

Patient Mandate

EHR-extract exchange

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CEN/ISO13606

Standard Coding systems

Archetypes

Templates

Rules

Patient mandates

Software

Tools

Services

Tools

EN13606-1

EN13606-2

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CEN/ISO13606

Standard

© ERS 2012

Semantic

Interoperability Stack

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Model for Knowledge

Model of Meaning

Models of General Use

Models of Specific Use

Models of Archiving

Encyclopedia

Dictionary

Generic Phrases

Specific Phrases

‘Syntax’

Models of Storage Database Schema

CEN/ISO 13606-1

CEN/ISO 13606-3

CEN/ISO 13606-2

SNOMED

WHO

Loinc

SIAMS

© ERS 2012

International

Developments - Renewal CEN/ISO 13606

- Integration of 13606 with:

- System of Concepts for Continuity of Care (ContSys CEN/ISO 13940)

- Health Information Services Architecture (HISA CEN/ISO 12967)

- Harmonisation with HL7 CDA

- FP7 SemanticHealthNet (make 13606, CDA, coding systems and ontologies work together)

http://www.eurorec.org/RD/SemanticHealthNet.cfm

- Clinical Information Modeling Initiative http://informatics.mayo.edu/CIMI/index.php/Main_Page

- New FP7 2013 call:

- epSOS EU-USA, Semantic Interoperability EU-USA, ...

© ERS 2012

International

Developments

© ERS 2012

International

Developments

© ERS 2012

International

Developments

© ERS 2012

International

Developments

© ERS 2012

(Inter-)National Governance

INFOstructure G

overn

ment

(Inte

r-)

National P

roje

ct

IT- Vendors

Healthcare

Providers Patients

Insu

rers

Onto

logy / C

odin

g s

yste

ms

Clin

ical In

form

atio

n M

od

els

Sta

nard

isatio

n o

rga

nis

atio

ns

Local Communities

Direction

Quality Assurance

Re-Users of data

© ERS 2012

(Inter-)National Governance

• Essential elements

–All actors co-operating in their natural role

–Direction based on expertise, knowledge and authority. Not too much money.

–One standing (virtual) organisation)

–With ongoing secured funding. The INFOstructure is not a one time project.

Govern

ment

(Inte

r-)

National P

roje

ct

IT- Vendors

Healthcare

Providers Patients

Insure

rs

Onto

logy / C

odin

g

syste

ms

Clin

ical In

form

atio

n

Models

Sta

nard

isatio

n

org

anis

atio

ns

Local Communities

Direction

Quality Assurance

Re-Users of data

© ERS 2012

(Inter-)National Governance

Govern

ment

(Inte

r-)

National P

roje

ct

IT- Vendors

Healthcare

Providers Patients

Insure

rs

Onto

logy / C

odin

g

syste

ms

Clin

ical In

form

atio

n

Models

Sta

na

rdis

atio

n

org

anis

atio

ns

Local Communities

Direction

Quality Assurance

Re-Users of data

INFOSTRUCTURE

–Production, Maintenance, Publication of all semantic interoperability artefacts is very

resource intensive (money and expertise)

–Even big countries can not create a full Semantic Stack on their own

–European countries (and more) had better co-operate and provide jointly the

resources needed

© ERS 2012

(Inter-)National Governance

Govern

ment

(Inte

r-)

National P

roje

ct

IT- Vendors

Healthcare

Providers Patients

Insure

rs

Onto

logy / C

odin

g

syste

ms

Clin

ical In

form

atio

n

Models

Sta

na

rdis

atio

n

org

anis

atio

ns

Local Communities

Direction

Quality Assurance

Re-Users of data

INFOSTRUCTURE

Ongoing projects

–SemanticHealthNet (SHN)

–Clinical Information Modeling Initiative (CIMI)

–...

© ERS 2012

(Inter-)National Governance

Govern

ment

(Inte

r-)

National P

roje

ct

IT- Vendors

Healthcare

Providers Patients

Insure

rs

Onto

logy / C

odin

g

syste

ms

Clin

ical In

form

atio

n

Models

Sta

na

rdis

atio

n

org

anis

atio

ns

Local Communities

Direction

Quality Assurance

Re-Users of data

© ERS 2012

Conclusions

1. No semantic interoperability without the

Semantic Stack

2. Base standards, Coding systems and

Ontologies constitute the Semantic Stack

3. Using Base Standards

profiles/archetypes/templates

define the clinical statements

4. The Patient Mandate is an integral part

of Interoperability

© ERS 2012

Conclusions

5. International co-operation is shaping up

6. International, European and

National/Regional Governance structures

will be set up