Towards semantic interoperability solutions

Dipak Kalra

2

Health information flows needing semantic interoperability

Point of care delivery

Continuing care (within the institution)

Long-term shared care (regional

national, global)

TeachingResearch

Clinical trials

explicit consent

EducationResearch

EpidemiologyData mining

de-identified

+/- consent

Public healthHealth care

managementClinical audit

implied consent

Citizen in the community

Social careOccupational

healthSchool health

WellnessFitness

Complementary health

rapid bench to bed translation

Disease registriesScreening recall

systems

implied consent

real-time knowledge directed care

3

Drivers for trans-border information and knowledge sharing

• Cross-border health care– emergency care– elective care– consistent care pathways and standards of care

• Population health– public health measures: prevention, immunisations etc.– detecting and tracking critical events: antibiotic resistance, infectious outbreaks, bio-terrorism etc.

• Comparisons– treatment effectiveness– clinical outcomes– safety signals

• Research– epidemiology– multi-national clinical studies

• Common products and services– cross-border EHR systems and services– consistent implementation of clinical guidelines and decision support

4

Hypotheses, Hypotheses, health issues health issues

(problems and (problems and diagnoses), risksdiagnoses), risks

TreatmentTreatmentMedication and prescriptionsMedication and prescriptions

Symptoms Symptoms and historyand history

Body physical Body physical examination findingsexamination findings

Procedures and operationsProcedures and operations

Conventional medical summaryConventional medical summary

Care planningCare planning

Advice and educationAdvice and education

Chronic Chronic disease disease

managementmanagementTests and investigationsTests and investigations

Self management and Self management and home monitoringhome monitoring

Protocols, guidelines, care Protocols, guidelines, care pathwayspathways

Prevention and Prevention and screening, screening,

population health population health measuresmeasures

Communication, team-based collaborationCommunication, team-based collaboration

Well-being and fitness, Well-being and fitness, rehabilitation after illnessrehabilitation after illness

Consent, permissions, disclosures, complaintsConsent, permissions, disclosures, complaints

Social welfare, culture, religion, Social welfare, culture, religion, attitudes, expectations, hopes, attitudes, expectations, hopes,

fearsfears

The EHR landscape - for archetypes

TreatmentTreatmentMedication and prescriptionsMedication and prescriptions

Symptoms Symptoms and historyand history

Body physical Body physical examination findingsexamination findings

Procedures and operationsProcedures and operations

Hypotheses, Hypotheses, health issues health issues

(problems and (problems and diagnoses), risksdiagnoses), risks

Conventional medical summaryConventional medical summary

Care planningCare planning

Advice and educationAdvice and education

Chronic Chronic disease disease

managementmanagement

Tests and investigationsTests and investigations

Self management and Self management and home monitoringhome monitoring

Protocols, guidelines, care Protocols, guidelines, care pathwayspathways

Prevention and Prevention and screening, screening,

population health population health measuresmeasures

Communication, team-based collaborationCommunication, team-based collaboration

Well-being and fitness, Well-being and fitness, rehabilitation after illnessrehabilitation after illness

Consent, permissions, disclosures, complaintsConsent, permissions, disclosures, complaints

Social welfare, culture, religion, Social welfare, culture, religion, attitudes, expectations, hopes, attitudes, expectations, hopes,

fearsfears

Cardiovascular medicineCardiovascular medicine

Mental healthMental health

Hospital admissionHospital admission

High priority, often used re-used

High priority, often used re-used

fragments

fragments

6

Resources needed to support rich semantic interoperability

Rich EHR interoperabilit

y

reference modelsdata typesarchetypestemplatesnear-patient device interoperability

guidelinescare pathwaysdecision supportalgorithms

clinical terminology systemsclassification systemsterminology sub-setsvalue sets and micro-vocabulariespost-co-ordinationmulti-lingual mappingssemantic context modelcategorial structures

architectureidentifiers for peoplepolicy modelsstructural rolesfunctional rolespurposes of usecare settingspseudonymisation

workflow

reco

rd s

truct

ure

an

d c

onte

xt

privacy

clin

ical

term

inolo

gy

Consistent representation,

access and interpretation

7

Initiatives striving for harmonisation

• Clinical Information Modeling Initiative (CIMI)• SemanticHealthNet

8

Clinical Information Modeling Initiative (CIMI)

• International collaboration of several SDO’s, national eHealth programmes, and large providers e.g. IHC, VA, Kaiser– providing a common format for the specification of clinical

models– so that semantically interoperable information may be created

and shared in health records, messages and documents

• Building on the openEHR archetype approach as its starting point

• Specifications will be openly accessible, freely usable

9

• European Commission sponsored Network of Excellence in Semantic Interoperability– Dec 2011 to Nov 2014– 3m Euro– 17 Partners – > 40 internationally recognised experts

10

SemanticHealthNet concept and objectives• Leverage a clinically-driven work-plan– heart failure, exemplifying chronic disease management, evidence based care

and shared care

– cardiovascular prevention, exemplifying public health and national / global strategies

• Bring together the globally best of breed semantic resource producers including commitment from the top SDOs– to develop harmonised resources meeting the clinical needs,

adapting their standards as necessary

• Engage stakeholders: patients, clinicians, industry, ministry, insurance, on priorities, scope, governance, adoption

• Establish a scalable, sustainable, well-governed European Virtual Organisation for semantic interoperability