Ehr models, standards and semantic interoperability

EHR models, standards andsemantic interoperability

David [email protected]

ELECTRONIC HEALTH RECORDS: A VIEW AT THE CURRENT DEVELOPMENTS OF HEALTHCARE DELIVERY MODELS

IN POLAND AND THE EU / ELEKTRONICZNA DOKUMENTACJA MEDYCZNA W POLSCE I EUROPIE

THE NATIONAL E-HEALTH CLUSTER CONFERENCE

ZAMEK TOPACZ, 6-7 AUGUST 2015

mailto:[email protected]

An interoperable world

• Technology allows us to be connected and to have access to our data everywhere at every time.

Why is this not true with health information?

EHR models, standards and semantic interoperability 2

Medicine vs. Medical Science

• In some aspects, medicine is still evolvingtowards becoming a complete science.

– Other sciences, such as Mathematics, use common models and notations since the XVI century.


Medicine vs. Medical Science

Physiological and biological systems

Clinical reasoning& decisions

Health observabledata

Virtual Physiological Human

Clinical informationmodels and

terminologies

Clinical decisionsupport systems and

clinical guidelines


Electronic Health Records

• The Electronic Health Record (EHR) is the main source of information of health organizations.

– It is a complete electronic registry of all events and data related to the health status of a person, from birth to death.

It enables an efficient management of clinical information


Hospital 1915 Hospital 2015



• The Edwin Smith papyrus is one of the oldest medical documents (1600 BC).

• For a computer, it is as incomprehensible as any other current document.



• We need to have models for the EHR (clinical information models).


Modeling the EHR

• A model is an abstract representation of systems, processes and data that helps in interpreting and implementing them.

– It is a reference to be followed to build (EHR) information systems.


Modeling the EHR

• But… does the “right” model exist?

© Linda Bird, MOH Holdings


Modeling the EHR

• The problems we are facing are:– Health data is complex.– Health data is variable.– Health data has specific semantics.

How can we agree on common formats and models?

How can we share our data and reuse other’s data?


Modeling the EHR

• It is not about creating and using a single and universal EHR system for everybody.


Finally standardization

was achieved…

Modeling the EHR

• We need to create models that are semantically interoperable.

– Semantic interoperability is the ability of sharing, aggregating, analyzing and using external information automatically and in a meaningful way.

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Modeling the EHR

SYSTEM A SYSTEM B

Healthinformation

Structure A

Model A

Language A

Structure B

Model B

Language B

Context A Context B

?Reference Model

Clinical inf. models

Terminology


Modeling the EHR

• A Reference Model provides the syntax (basic data structure and data types) to represent any kind of health information in the EHR.


Modeling the EHR

• How can we avoid building a nonsense?


Modeling the EHR

• We need blueprints or guides that define the specific configuration of the EHR information.

– Clinical information models or archetypes


Modeling the EHR

Real data

Archetype(a model of data structureswith an specific meaning)


Modeling the EHR

• Standards such as ISO 13606 for the communication of the EHR, or the openEHRspecifications provide both a reference model and an archetype model.

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Modeling the EHR

• We have libraries of archetypes ready to be used. E.g. http://www.openehr.org/ckm/


http://www.openehr.org/ckm/

Modeling the EHR

• It is not enough to have a reference model and archetypes, we need another piece: terminologies.

– They provide the semantic description of the data and the models.

– They provide a subset of possible data values (e.g. the set of possible diagnosis or allergies).


Modeling the EHR

25571000000103

(Discharge report)

SNOMED-CT

85097005

(Secondary diagnosis )

…

89100005

(Final diagnosis - discharge)


Modeling the EHR


Ref

ere

nce

mo

de

l

Arc

het

ypes

Term

ino

logi

es

Semantic interoperability

Modeling the EHR

Semantically interoperable

data

Reduce healthcare

costsImprove

healthcare (availability

of data)

Inclusion of personal

clinical data (PHR)

Clinicalresearch

Big data and

Linked data

Right data(quality of

data)

…


From theory to practice

Technical University of Valencia, Spain

ITACA Institute

Biomedical Informatics Group

(IBIME)

• Spin-off SME company created in 2010.

• Mission: to offer solutions and technologies for clinical data integration, standardization, analysis and reuse.

www.veratech.es


http://www.veratech.es/

From theory to practice


Reuse

• LinkEHR Normalization Platform

– A set of tools that facilitates the adoption of EHR standards based on the use of archetypes.

– It works over existing EHR systems and data.


www.linkehr.com

Reuse

http://www.linkehr.com

• Four main modules:– LinkEHR Integration: distributed data integration

engine.

– LinkEHR Editor: reference model independent archetype editor.

– LinkEHR Studio: transformation of existing legacy data into archetype-compliant standardized data.

– Clinical Information Model Manager: management and government of clinical models and archetypes.


Reuse

• Spanish National EHR System

– Provides access to a patient summary and to the most relevant clinical documents of the patients from 17 different regions.

– 8 documents have been modeled as ISO 13606 archetypes using LinkEHREditor.


www.msssi.gob.es/profesionales/hcdsns

• Population: 46 M• Tourists: ~65 M/year

Reuse

http://www.msssi.gob.es/profesionales/hcdsns


Concept management system developed by VeraTech

Reuse

• Clinical Document models for the National Unified EHR

– The objective is to provide support for continuity of care.

– 9 documents are being modeled as HL7 CDA archetypes using LinkEHREditor.


• Population: 3.3 M

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• Shared EHR system (Madrid region, Spain)

– Objective: to build an EHR system based on ISO 13606 and archetypes for 5.5 million people.

– Fed by existing primary and specialized care EHR systems. Data will be transformed using LinkEHRStudio.

– The challenge is to maintain the relationships between all the information.


Reuse


• Around 80% of clinical data has quality problems.

• We are developing a web service to automatically evaluate several qualitydimensions: unicity, correctness, consistency, temporal stability…

Qualize (VeraTech)Data quality automatic evaluation service.(Public Beta available in October 2015)


Reuse

• Archetype-based data warehouse environment

– Development of an integrated process for the modeling, extraction, transformation and load(METL) of existing health data into an archetype-based data repository.

– Oriented to facilitate the reuse of health data.


Reuse


LIS TransformationLegacy

XML

openEHRcompliant

data

openEHR data repository(Marand

Think!EHR)

Guidequeries

Applies transformation and aggregation rules

Archetypes

Define data structures

Edits

Archetype-based data warehouse environment to enable the reuse of electronic health record dataLuis Marco-Ruiza, David Moner, José A. Maldonado, Nils Kolstrup, Johan G. BellikaInternational Journal of Medical Informatics 84 (2015) 702–714

Reuse

• In Assisted Human Reproduction a multiple pregnancy is a severe problem due to premature births, low birthweight babies and obstetric problems.

• A Decision Support System was developed to help in deciding how many embryos needed to be transferred.– 8% decrease in multiple pregnancy

after the 6 first months.

Valencian Institute of InfertilityEach year it helps around 5,000 couples from 80 countries in search of treatment in reproductive medicine.


Reuse

Conclusions


Reference model

Archetype

Archetype-based data repository

Original data

Datareuse

Describes

Guidestransformations

Guidesqueries

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Conclusions(for SMEs)

• Success comes from solid foundations, long term vision of needs and applied technology and solutions for existing problems.


Thank you!

Questions?

David [email protected]

mailto:[email protected]

Healthcare

Ehr models, standards and semantic interoperability