ERS - NTNU · ERS© Electronic Record Services ERS Integrated Care Electronic Health Record DeÞnition (ISO/tc215 20514: EHR - DeÞnition, Scope and Context) The IC-EHR has a standardised

© ERS 2010

Electronic Record Services B.V.

ERS

Boundaries between structuring applications and messaging

Trondheim

Tuesday 21 September 2010

zondag 19 september 2010

Electronic Record Services BV

ERS

© copyright ERS 2010

Gerard Freriks

Past chair CEN/TC251 wg1

Vice-president EuroRec

ERS b.v.



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I C TN FO RMATION

DOCUMENTATION



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Agenda

1.2LM Paradigm and Innovation

2.EN13606 and Innovation

3.Missing Semantic Interoperability Stack - INFOstructure

4.EN13606 Consortium/Association



-1-

Two Level ModelingParadigm

and

Innovation

5zondag 19 september 2010


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Old Products

New Products

Effect on SocietyEasy access todata, informationand knowledge

Instantly connecting,synchronising people

and organisations

2LM Paradigm - Innovation



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Old Products

New Products

Effect on SocietyEasy speedy access to

data, information, knowledgeand people plus organisations

Instantly connecting,synchronising

people, organisations and business processes

EMR-systems


EHR-systems



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Effect on society - Innovation

Infrastructure - Infrastructure

R&D - New products One-off Commodity




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R&D - New products

One-off Commodity

EMR?

EHR


LegislationStandards

InfrastructureInfostructure

DigitalAgenda



-2-

EN13606 Introduction(High level)

and Innovation



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Bakery

Instructions Ingredients MouldsKitchen

machinesOven Pastry



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Bakery/EHR expectations

Rules Information Presentation Software Hardware EHR


machinesOven Pastry



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EHR’s now


machinesOven Pastry




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EHR systems now



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EHR-systems we need

Instruction Ingredients Moulds Kitchen tools Oven Pastry



ERS©Electronic Record Services

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Integrated CareElectronic Health Record

Definition(ISO/tc215 20514: EHR - Definition, Scope and Context)

The IC-EHR has a standardised information model,which is independent of EHR systems.Its primary purpose is the supportof continuing, efficient and quality integrated healthcare andit contains informationwhich is retrospective, concurrent and prospective.

16

EHR

Non-shareable EHR Shareable EHR

Integrated Care EHR



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EN13606Basics

Internet

Network

Internet

Network

User

Database DatabaseInternet

Network

User

Time

Space

Context, Community, Culture

CommonTrust



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Many, many unique identifiers

EN13606Basics

Internet

Network

Internet

Network

User

Database DatabaseInternet

Network

User

HL7v3, CDA

RIM

EHRExtract

CommonModel

DocumentationArchiving

DocumentationArchiving



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EHR-systems

usingHL7

All viewpointsprogrammed in one system or message

CEN/tc251EN13606 EHRcomInformation Bus

CEN/tc251System of Concepts for

Continuity of Care

CEN/tc251 Health Health Information Services

Architecture

Enterpriseviewpoint

Informationviewpoint

Computationviewpoint

Engineeringviewpoint

Technicalviewpoint

EN13606Basics



EN13606Basics

Paradigm: Two-Level-ModelCoding systemsArchetypes

TemplatesRules

SoftwareTools

Services

Tools

EN13606-1

EN13606-2



EN13606Basics

Archetypes/Templates



EN13606Basics

Archetypes/Templates

TemplatesTemplat

es

TemplatesEhr-ExtractMessages

Input formsscreens

Output formsscreens

Querries

API

Archetypes

ApplicationsServices

PASMPIPacsRISe-PrescriptionClinical PathsWork flowCase managementData MiningReportingBilling...

Applicati

ons



EN13606Basics

IC-EHR Architecture

Archety

pes

Templa

tes

Archety

pes

Templa

tes

Archety

pes

Templa

tes

Archety

pes

Templa

tes

LinkEHR

LinkEHR

LinkEHR



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HL7Virginia Lorenzi (2009)

!"#$%"&'$()(*("+,$)-$-./+01 2&-+34.5+$6&')&+$73+7.3.-)"&8 .9":-$;<$=.&>="&-?,

1 @3"73)+-.3A$-"*43"=$!BC8 D$-"$C$=.&>="&-?,E

1 !BC$-"$!BC8 ;$-"$D$=.&>="&-?,

1 6,-)=.-+,$)&5%:(+$8 -)=+$4"3$(+,)'&F$(+G+%"7=+&-F$-+,-)&'F$73"(:5-)"&$7%.&&)&'F$.&($73"(:5-)"&$="G+E$

8 -)=+$4"3$5"==:&)5.-)"&E24



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Message based paradigm

versus

Archetype based paradigm

25

Message based EHR-systems

Archetype based EHR-systems

Production of message

IHE processProgramming

Roll Out

Total

1-3 years Minutes

1-2 years1-2 years

nilnil

1 year nil

YEARS MINUTES


Exchange HL7Exchange HL7 DCM EN13606 ExchangeEN13606 Exchange EN13606 EHR-system

Messageto exchange between proprietary databases

NOT conformant to ISO18308

Scope

EHR ExtractReference Model describing documentation of:Structure of a document,archiving,digital signaturespatient mandate,semantic linksConformant to ISO18308

Scope Reference ModelEn13606-1

EHR-SystemReference Model describing documentation of:Structure of a document,archiving,digital signaturespatient mandate,semantic linksConformant tom ISO 18308

Model describing how tomake constraints on EN13606-1 EN13606-2

Model describing how tomake constraints on EN13606-1

Not specifiedPatient Mandate for complete record or any part of it EN13606-4 Patient Mandate

DCMDescribing what gets documented about:Information components/concepts

Describing what gets documented about:Information components/concepts

EN13606 representation of DCM ArchetypeDefinition of how a topic is stored in a conformant database

MessageReference Information Modelto produce statements

RIM

Model describing a knowledge domain DMIMDescribing the information needs in a domain for exchange Archetype Library

Domain Information that can be stored in a database

Model describing according tothe scope of the specific messages

RMIM / CDA / (Templates)

Model describing local context the exchange:structuredomain content

TemplateDescription of the structure and content used in a local context for a report, screen

Standard Message Technical respresentation XML-Schema Defines the content of the exchange EHR-Extract

EHR-Extract/Archetype/Template

Defines the content of the record

Describing model/tech spec of messageswith all degrees of freedom removed

IHE profile Not necessary because of EN13606Not necessary because of EN13606-1

IT-vendors adapt software in a region/country leading to database conversions

ImplementationImmediate implementation of the extract without re-programming need.No database conversions are needed

Implementation Implementation

Immediate implementation of the extract without re-programming need.No database conversions are needed

Install with all users in a region in a country

Roll-outImmediate automatic implementation of the extract and its describing archetypes/template

Roll-out Roll-out

I Immediate automatic implementation of the extract and its describing archetypes/template

Not possible Local adaptability Possible Local adaptability Local adaptability Possible



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versus


27

Message Paradigm

Unflexible

Flexible+10

-10

0

Stable

Unstable

+10

-10

0



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versus


28

Unflexible

Flexible+10

-10

0

Stable

Unstable

+10

-10

0 Message Paradigm



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versus


29

Unflexible

Flexible+10

-10

0

Stable

Unstable

+10

-10

0

EN13606-1 EN13606-2



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Message standards:Edifact, HL7, IHE

No Innovation



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What is the EHR?eHealth Infrastructure?

ACL ACLACL

ACL

ACL

ACL



-4-

What is missing:

the Semantic Stack

as INFOstructure



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What is needed

1. Legislation2. the Semantic Stack

as a (European) Servicea shared quality assured library of:

- Archetypes, Templates

- Terminologies/Codes and

- Ontologies3. Quality Assurance4. Shared IPR and Licenses5. Accountable organisation(s)



What is needed

Transport over Time and Distance

Transport across organisation, culture and language barriers

TRUST andstability

areESSENTIAL

d

t t

Transport

d

Public DomainLegislationStandardsSpecificationsArchetypes

Codes



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R&D - New products

One-off Commodity

EMR EHR

R&D - InnovationDigital Agenda

LegislationStandards

InfrastructureInfostructure

DigitalAgenda



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What is neededSemantic Interoperability Stack

Database

EN13606 Kernel

Ontology

Coding system

Archetypes

Templates

Protocols

Protocols

Protocols

Action

Action

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Action

Model of Knowledge

Codes/terms

Model ofDocumentation/Archiving

Real use

Model of Meaninggeneral Use

Model of Meaningspecific Use

Encyclopeadia

Dictionary

Syntaxis

Paper/Document

Generic Phrase

Specific Phrase

DCM



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What is needed

Database

EN13606 Kernel

Ontology

Coding system

Archetypes

Templates

Protocols

Protocols

Protocols

Action

Action

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Action

Model of Knowledge

Codes/terms


Real use

Model ofgeneral Use

Model ofspecific Use

Actors

Experts: ontologies, hc providers

Experts: Informaticians, coders, hc providers

Informaticians, hc providers

Informaticians, hc providers

IT industry

IT Industry en IT departments hc organisations



ConceptSemantic Interoperability Stack

Profiles



ConceptSemantic Interoperability Stack

ArchetypeEN13606

TemplateHL7 v3



-6-

EN13606Consortium/Association



EN13606Consortium/Association

EN13606 Consortium:

A public association with

the scope to promote and

improve Open Standards

42

www.EN13606.orgzondag 19 september 2010

http://www.EN13606.org

http://www.EN13606.org


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EN13606 ConsortiumUptake

UK

Sweden

Spain

Slovakia

Australia

Germany

Norway

Ireland

USA

Netherlands

Brazil

New Zealand

Serbia

USA

Singapore



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What is needed

Database

EN13606 Kernel

Ontology

Coding system

Archetypes

Templates

Protocols

Protocols

Protocols

Action

Action

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Clinical Pathway /

Clinical Study

Action

Model of Knowledge

Codes/terms


Real use

Model ofgeneral Use

Model ofspecific Use

Actors

SDO: IHTSDO, WHO

SDO: IHTSDO, WHO

SSO: EN13606 Association

Users: National, Regional, Local

SSO: EuroRec ?(QA implementations)Vendors, IT-departments

SSO: EN13606 Association

Har

mon

ised

IPR

, Lic

ense

s

Coo

pera

tion



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SDO's and EN13606 Consortium

Proposal: IPR, Licensing and the EN13606 Consortium

1.The EN13606 Consortium is founded to own, produce, maintain and publish artefacts derived from the Open Standards CEN/ISO EN13606 and needed for the implementation of the Two Level Modelling paradigm.

2.Authors of original works -to their discretion- can hand over IP Rights to the EN13606 Consortium.

3.The EN13606 Consortium publishes artefacts, with an IP owned by others or itself, that pertains to the human readable parts, only.

4.The Licensing policy that will be used by the EN13606 Consortium for all artefacts owned, produced, maintained and published will bethe Creative Commons license: CC-BY-SA.

5.The EN13606 Consortium needs a legal entity that can hold IP Rights and execute the Licensing policy and be able to enter into agreements with SDOʼs and SSOʼs.

6.The EN13606 Consortium will establish an Association as the legal Public entity.



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END


Documents

ERS - NTNU · ERS© Electronic Record Services ERS Integrated Care Electronic Health Record DeÞnition (ISO/tc215 20514: EHR - DeÞnition, Scope and Context) The IC-EHR has a standardised