Www.kith.no ~samhandling for helse og velferd The use of eHealth standards in Norway Vigdis Heimly 13.04.10, TDT4213 Kliniske informasjonssystemer

www.kith.nowww.kith.no ~samhandling for helse og velferd

The use of eHealth standards in Norway

Vigdis Heimly 13.04.10, TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd

Why do we need standards?


~samhandling for helse og velferdVigdis Heimly 13.04.10, TDT4213 Kliniske informasjonssystemer


The Norwegian Centre for Informatics in Health and Social Care• Limited company• Not for profit• Owned by

– The Ministry of Health– The Ministry of Social Affairs– The Norwegian Association of Local and Regional

Authorities (KS)

• Established in 1990



Company Goals

• Contribute to coordinated and cost-efficient application of secure information technology in the health sector

• Establish necessary standards for safe communication within the Health sector and between the health sector and outside sectors



Norwegian standardisation policy• Adapt European or international standards, when

possible• National standards are developed when

international standards are missing• Keep standards as stable as possible when

disseminated– Health care organisations and vendors need to be

confident that they get return on investment when implementing standard

• Long overlap period is necessary when replacing standards



Standard Norge

• Norwegian Standardisation Body• KITH defines eHealth Standards on behalf of

Standard Norge• Standardisation activities are financed by

Directorate of Health



European Standardisation

• CEN/TC251: European Health Informatics Committee was also established in 1990

• Included 6 Working Groups and related Task Forces that drafted standards

• Norwegian delegates participated actively• Few existing systems that could be used as basis

or pilots• Draft were produced and tried out. • Feedback was used as basis for revised

standards



Examples of CEN pre-standards

• ENV 1613 (1995) Messages for exchange of laboratory information

• ENV 12538 (1997) Messages for patient referral and discharge

• ENV 13606 (1999) Electronic healthcare record communication

• ENV 13940 (2001) System of concepts to support continuity of care



International classifications in Norwegian use

• ICD 10, International Classification of Diseases• ICF, International Classification of Functioning,

Disability and Health• ATC, Anatomical, Therapeutic, Chemical

classification of therapeutic drugs• ICPC 2, International Classification of Primary

Care• SNOMED RT, The Systematized Nomenclature

of Human and Veterinary Medicine, Reference Terminology (national profile, pathology)

KS Fagråd for IKT i helse- og omsorg 25.09.09, Vigdis Heimly


Find code



Other standards

• HL7 version 2.x message standards are used for hospital internal communication

• Some services based on HL7 v3 RIM have been developed and used by a few hospitals from 2009

• DICOM (Digital Imaging and Communication in Medicine) is used in radiology



Generation 1: EDIFACT

• CEN/TC251 developed syntax independant information models

• The expert group EEG9 of the CEN workshop eBES (European Board for EDI/EC Standardization) defined EDIFACT message syntax

• National profiles were developed in the 90ties. Laboratory messages are in widely use.



2nd generation: XML

• Extensible Markup Language (XML) is a text format derived from ISO SGML.

• XML standards have been developed by many groups at local, regional or national level.

• Norwegian XML schemas was inpired by the early work of HL7 and used HL7 datatypes.

• Dissemination has been slow.



European and international standards

• Implementation and dissemination of existing messages has high priority and will continue for many years

• Likely that number of message standards will be more than 50 before new standards overtake

• Cross-border semantic ad syntactic interoperability is a goal, but not likely



Test and certification

• A test server facility was established by KITH in 2005

• Certification and testing is free of charge• In 2010, the server handles about 30 eHealth

messages



Norwegian Collaboration Architecture

• all messaging traffic should use the national broadband network, the Norwegian Health Net

• only standardized messages should be used• the vendor’s message implementations should

be approved by the Norwegian Testing and Approval Service at the Norwegian Centre for Informatics in Health and Social Care (KITH)

• the ebXML framework should be used• application receipts should be sent for all

messages.



Collaboration Architecture



EHR in Norway

• All (28) cathegories of authorised health care professionals are obliged by law to record relevant information

• Need to know principle by law• Traditional role based access control is not

sufficient• The patient may refuse to give som actors

access to their record• Makes it challenging to develop EHR systems



EHR standards

• First national standard in 2001• National standard was revised in 2007• Based on pre-standard ENV13606-1

(architecture)• Includes in addition:

– Access control– Patient consent– Archieving– Editing, corrections and deletions



What about legislation?• Norwegian legislation does not allow shared data

repositories containing health information• Requests for health information have to be

considered individually by a health professional• Only health information relevant and necessary

for the purpose of the request can be distributed• The patient has the right to refuse the distribution

of health information– The patient's explicit consent is not mandatory when it

comes to distribution of health information, but such a consent is normally sufficient to make distribution legal


National EHR standard

• Does not include any specification of content• Specifies how standards for content should be

defined• Based on the standard, a number of national

content scpecifications have been developed – Corresponds to Archetypes as defined in EN13606-

2:2007– Clinical content specified by these archetypes are

also referenced from new message standards– Makes communication of EHR content easier



EPJ

eMelding

EPJ


EHR standards, future

• Partly overlapping initiatives: ISO EN 136060 EHR com and HL7 v3 RIM

• European decision should be taken regarding which way to go

• International standards for clinical content should be considered



Where do we need new standards?

• Study was done in 2009 in order to get an overview of the status of electronic collaboration in the Norwegian health sector today

• Report for Innovation Norway• Solutions that should support shared care and

empower the patient are to a large extent lacking.



Non relevant

1 Standards Are missing. Few systems with collaboration support implemented.

2 Some standards available Few systems with collaboration support implemented.

3 The most essential standards are available and several systems that can be used for collaboration are implemented.

4 Certified and standardized collaboration solution is commonly available.


References

• Standardisering og samhandlingsarkitektur• The use of eHealth standards in Norway - A brief history • Te@mwork 2007 - Electronic Cooperation in the Health and Social

Sector • Health Informatics and Telemedicine in Norway • Health and Social Sectors with an "e"• Information technology strategies for health and social care in

Norway• PACS in Norway• EHR and Archetypes• See also: KITHs publication page


Documents

Www.kith.no ~samhandling for helse og velferd The use of eHealth standards in Norway Vigdis Heimly 13.04.10, TDT4213 Kliniske informasjonssystemer