CEN EN13606 Normalisation Framework

Implementation Experiences

David Moner1, José A. Maldonado1, Diego Boscá1, Carlos Angulo1,Montserrat Robles1, Daniel Pérez2 and Pablo Serrano3

1 IBIME group, ITACA Institute, Universidad Politécnica de Valencia

2 Hospital General Universitario de Valencia, Valencia, Spain

3 Hospital de Fuenlabrada, Madrid, Spain

Contents

• Semantic interoperability of clinical data

• The LinkEHR Normalisation Platform

• Implementation experiences

• Discussion and conclusions

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EN13606 experiences 3

Semantic interoperability of

clinical data

• Our objective: the semantic interoperability of

clinical information.

Alerts

Current history

Past history

Medications

And all the information

we would like to include

4

Semantic interoperability of

clinical data

• Semantic interoperability requires:

A standard

labelling and

structure for data

A high-level definition

of clinical concepts

A semantic

description of

clinical concepts

Reference Model Archetype modelTerminologies

and Ontologies

ISO/CEN EN13606The standard for the communication and

semantic interoperability of health informationEN13606 experiences

The LinkEHR normalisation

platform

• LinkEHR-Ed is a tool for:

– Defining archetypes based on any reference model.

– Normalise legacy data into standard documents.

• But LinkEHR-Ed is just one part of a bigger system: the LinkEHR Normalisation Platform.

• This platform allows to reach the semantic interoperability of the EHR of a patient whose data are distributed among heterogeneous HIS.

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EFMI STC 2010

LinkEHR-Ed: A tool for the description and normalization

of legacy clinical data

EFMI STC 2010

Standardized and flexible health data management

with an archetype driven EHR system (EHRflex)

Implementation experiences

• The LinkEHR Normalisation Platform is

being used at the three steps towards the

semantic interoperability of existing EHR

systems:

1. Definition of clinical archetypes.

2. Normalisation of legacy EHR systems.

3. Communication of EHR extracts.

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Implementation experiences

1. Definition of archetypes

• Hospital de Fuenlabrada (Madrid)

– Use of EN13606 archetypes for pressure

ulcer nursing control.

• The archetype creation methodology was

evaluated.

• Both reference models were compared and tested.

http://www.revistaesalud.com/index.php/revistaesalud/article/view/308/641

Implementation experiences

1. Definition of archetypes

• European Patient Smart Open Services

(epSOS)

– EN13606 implementation specifications have

been developed following the agreed epSOS

data sets: Patient Summary, ePrescription

and eDispensation.

– EN13606 archetypes have been implemented

following those specifications.

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Implementation experiences

1. Definition of archetypes

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Implementation experiences

2. Normalisation of data

• Hospital General Universitario de Valencia

– LinkEHR Integration Engine implementation for over 6

years

• Integration of distributed data sources (more than 20

databases).

• Virtual Federated EHR viewer for all the organisation (~1000

health professionals, ~500,000 patients)

– Full migration to EN13606 EHR Extracts in development

using the LinkEHR Normalisation Platform.

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Implementation experiences

2. Normalisation of data

• Hospital de Fuenlabrada (Madrid)

– Use of EN13606 for medication conciliation

between primary and specialised care.

• Agreed definition of a primary-care patient

summary archetype.

• Communication of normalised legacy data to

support patient transitions between primary care

and the hospital.

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Implementation experiences

3. EHR extracts

• The semantic interoperability of the Patient

Summary is being tested between the Hospital

General Universitario in Valencia (HGUV) and

the Hospital de Fuenlabrada in Madrid.

– Based both on the Spanish and epSOS definition of

the contents of the Patient Summary.

– The information is communicated using the CEN

EN13606 norm.

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Implementation experiences

3. EHR extracts

1. Agree a concept definition and define the archetype

• We have used two different definitions

– Spanish National Patient Summary

– epSOS Patient Summary

• They can be easily edited or modified

with open source archetype editors like

LinkEHR-Ed

http://www.linkehr.com

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Implementation experiences

3. EHR extracts

2. Map the archetype to original/legacy data

• With these mappings we can

automatically generate transformation

programs for the EHR system.

XML

Existing

EHR systems

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Implementation experiences

3. EHR extracts

3. Deploy the transformation program in the EHR server

• Set up a standard EN13606 extract server in both hospitals to

generate and communicate the standardized information

– Transformation is applied on demand

– Web-service based

– Includes a standard EN13606 web viewer

EHR

Server

XML

EN13606

Standard

Information

Mapped

Archetype

CHGUV

HISHF

HIS

EHR

Server

Mapped

Archetype

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Implementation experiences

3. EHR extracts

• The project was developed in July 2009.

• The archetype definition took approx. 4h

• The archetype mapping and generation of

EN13606 standardized data, just one day.

Discussion and conclusions

• EN13606 strengths:

– Flexibility of the norm to represent all types of clinical data. It does not impose technical limitations for this.

– Seamless transition of existing systems to the EN13606 norm.

– Archetypes are easily developed and understood by health professionals.

– There already exist tools that can help in this duty.

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Discussion and conclusions

• EN13606 weaknesses:

– Lack of previous implementation experiences.

– Lack of methodologies for developing

archetypes.

– Lack of support from a community of users.

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Discussion and conclusions

• We have launched an open web page for

the community of developers and adopters

of the EN13606 norm.

http://www.en13606.eu

• In the next months an open international

association for the management and

evolution of the EN13606 will be created.

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Thank you for your attention!

CEN EN13606 Normalisation Framework

Implementation Experiences

David Moner

damoca@upv.es

22EN13606 experiences