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Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, 26 -27 April 2012) Joint ITU-WHO Workshop on e-Health Standards and Interoperability (Geneva, Switzerland, 26 -27 April 2012) Combining Medical-Managerial Information and Communications Technology Standards to promote Interoperability in Health-Care: A Status Report Prof. Basile P. Spyropoulos Biomedical Technology Laboratory Medical Instrumentation Technol. Department, Technol. Education Institute (TEI) of Athens, Greece Geneva, Switzerland, 26 -27 April 2012 1

Background Contemporary Health-Care in most countries is characterized by isolated and small-scale applications that Background Contemporary Health-Care in most countries is characterized by isolated and small-scale applications that cannot promote effectively enough, communication and informationsharing among Health-Care Providers, Medical Institutions and Health Insurance Organizations. Therefore, interoperability of Health-Care Information Systems has become one of the most crucial and challenging aspects in National Health Systems and other Healthcare Providers. Geneva, Switzerland, 26 -27 April 2012

Objectives The aim of the presentation is to report on Research and Development activities Objectives The aim of the presentation is to report on Research and Development activities during the last 15 years: First, attempting the Harmonization of Medical-Managerial and Information. Communications Technology (ICT) Standards. Second, promoting Interoperability in contemporary Health-Care. Geneva, Switzerland, 26 -27 April 2012 3

Results We have developed various systems promoting Interoperability, mostly based on semantically annotated Web-Services, Results We have developed various systems promoting Interoperability, mostly based on semantically annotated Web-Services, covering important Medical issues such as: On-line Medical Education Means based on Patient Records. Means supporting the Acquaintance of Health-Care Personnel to Operational-Cost Monitoring. Medical Decision-making and Treatment within the emerging Hi-Tec Home-care environment. Medical House-Call as an emerging IT-supported Option in contemporary Health-care. Digital Blood - Banking and modern Transfusion Medicine. Geneva, Switzerland, 26 -27 April 2012 Patient treatment at home and medical data exchange in the emerging networked society. Supporting technically the post-discharge Continuity of Medical Care. A Web-based “Quality System Advisor” supporting: The Certification of Hospital Departments (Out-patient, Emergency, Surgery etc. ) The Accreditation of in vitro Diagnostics and Transfusion Medicine Services. 4

An example: Schematic representation of a Transfusion Medicine related Web-service B. Spyropoulos et al, An example: Schematic representation of a Transfusion Medicine related Web-service B. Spyropoulos et al, Towards Digital Blood-Banking, ITU-T Kaleidoscope, Mar del Plata, Argentina, 31 Aug-1 Sep 2009 5

Some Standards, Clinical Terminologies etc. employed in the above mentioned projects Standard Organizations Common Some Standards, Clinical Terminologies etc. employed in the above mentioned projects Standard Organizations Common Standards Clinical Terminologies & Vocabularies WHO ICD-9/10 (other: SNOMED, LOINC, ABC, CCC etc. ) ISBT (International Society of Blood Transfusion) ISBT 128 Standard Technical Specification 4. 1. 0 ANSI ASTM E 2369 -05 Continuity of Care Record ISO 13606 -1: 2008 (EHR communication) ISO-22870 (Point-of-Care Testing) CEN pr. EN-13940 European Standard for Continuity of Care HL 7 (Health-Level 7) CDA (Clinical Document Architecture) ACR/NEMA 300 (1985) DICOM (NEMA Standard PS 3 & ISO 12052: 2006) IEEE Numerous mainly hardware-related Standards ITU Numerous Telecommunication-related Standards Geneva, Switzerland, 26 -27 April 2012

Discussion Clinical terminologies and vocabularies, such as SNOMED, ICD-9, ICD-10, and LOINC are already Discussion Clinical terminologies and vocabularies, such as SNOMED, ICD-9, ICD-10, and LOINC are already in use for several years and they provide a well established description of the Medical-domain knowledge. Furthermore, the HL 7 -CDA (Health Level 7 Clinical Document Architecture) is already in use by several countries, providing for a common representation of clinical documents, enabling the clinical document exchange and facilitating document management. Geneva, Switzerland, 26 -27 April 2012 7

A schematic representation of an interim interoperability solution Semantically annotated Web-services conforming with Medical A schematic representation of an interim interoperability solution Semantically annotated Web-services conforming with Medical and ICT Standards Isolated and small-scale Health-Care applications with no interconnectivity in most countries Graphics: S. M. Wasson, Virtual Information Exchange: Healthcare’s Present and Future HIE Solution www. relayhealth. com Geneva, Switzerland, 26 -27 April 2012 8

Barriers and opportunities concerning Standards adoption and compliance Barriers Different priorities due to the Barriers and opportunities concerning Standards adoption and compliance Barriers Different priorities due to the Countries’ development levels. Understanding the Standards’ necessity and perspectives. Cost of the adoption process. Personnel level and training. Integration of existing Biomedical Equipment and ICT. Lack of necessary resources. No National Health System or Strategic Policies Framework. Professional Unions resistance. Limited International contacts. No Treaties and commitments. Geneva, Switzerland, 26 -27 April 2012 Opportunities The Health-Care Internationalization procedure acceleration. Very positive outcomes of pilotprograms for serious needs. The miniaturization trend of ICT & Biomedical Technology (BMT). Their strongly falling prices. The merging of Equipment, ICT and Medical Decision Making. Medical-Pharmaceutical advance and BMT Innovation transform radically Healthcare delivery. International Cooperation and increased funds’ availability. 9

Conclusions It is not realistic enough to expect that all careproviders will soon agree Conclusions It is not realistic enough to expect that all careproviders will soon agree on adopting a single standard, allowing for the interoperability of different health care information systems. However, what appears currently to be the most appealing interim approach, towards optimization of systems’ interoperability, includes Semantically annotated Web-Services, delivering Health-Care relevant information: Conforming to the most important medical, managerial and ICT Standards. Ensuring the well-defined machine-interpretable meaning of the exchanged data. Geneva, Switzerland, 26 -27 April 2012 10

Additional Slides An overview of indicative already developed applications demanding Interoperability Geneva, Switzerland, 26 Additional Slides An overview of indicative already developed applications demanding Interoperability Geneva, Switzerland, 26 -27 April 2012 11

An overview of already developed indicative applications demanding Interoperability On-line Medical Education Means based An overview of already developed indicative applications demanding Interoperability On-line Medical Education Means based on Patient Records. Means supporting the Acquaintance of Health-Care Personnel to Operational-Cost Monitoring. Medical Decision-making and Treatment within the emerging Hi-Tec Home-care environment. Medical House-Call as an emerging IT-supported Option in contemporary Health-care. Digital Blood-Banking and contemporary Transfusion Medicine. Patient treatment at Home and Medical Data Exchange in the emerging Networked Society. Supporting technically the post-discharge Continuity of Medical Care. Web-based Systems supporting the Certification of Hospital Departments and the Accreditation of in vitro Diagnostic Laboratories. Geneva, Switzerland, 26 -27 April 2012 12

On-line Medical Education Means based on Patient Records An important role is assigned to On-line Medical Education Means based on Patient Records An important role is assigned to the employment of Medical Records for the Continuous Medical Education (CME) procedures. Medical records are used in a variety of ways and they serve a multiplicity of purposes. Beyond the explicit involvement of records in therapeutic process, there are several other discernible uses, such as in research, in teaching, in the allocation of resources, and in the reconstruction of the patient’s personal history. The technological substratum of records, on the one hand, constitutes itself knowledge and, on the other, it plays a decisive role in forming the character and the extent of the knowledge, which the records themselves represent at each particular stage of their mutual interaction. A further important issue related to CME is the elaboration, adoption and dissemination of appropriate Medical Guidelines, as well as, the development of computerized procedures, associated to their employment. B. Spyropoulos, The "Networked Society" Hospital as an important interdisciplinary Distance Learning Facility, EDEN 10 th Anniversary Conference "Learning without limits: Developing the next Generation of Education", Stockholm, June 10 -13, 2001. 13

Means supporting the Acquaintance of Health-Care Personnel to Operational-Cost Monitoring The developed system consists Means supporting the Acquaintance of Health-Care Personnel to Operational-Cost Monitoring The developed system consists of databases, and allows for every user: various related First, to select one or more out of 37 discrete medical specialties. Second, to set up a custom-made menu of available diagnostic and treatment activities out of the ones contained in the system. Third, to attach them either a nominal value, proposed by the system, which is based upon realistic, empirically collected data, or to individually price them. The developed tool allows for every user to set up an individually designed menu of available diagnostic and treatment actions, and to attach them a nominal value. Thus, the employment of this method enables the formation of a medical record, which is intrinsically, however latent, related to the costs caused and the expected reimbursement. B. Spyropoulos, Supporting the Acquaintance of Health-Care Personnel to Operational-Cost Monitoring (Invited Lecture), CD-ROM Proceedings of TEHRE 2002, 8 -11 December, The New Connaught Rooms, Covent Garden, London, United Kingdom. 14

Medical Decision-making and Treatment within the emerging Hi-Tec Home-care environment We argue that a Medical Decision-making and Treatment within the emerging Hi-Tec Home-care environment We argue that a qualitatively new mobile home-care is presently emerging out of the combined employment of: The modern wireless mobile telephony networks and equipment. The contemporary digital entertainment electronics. The commercially available computer hardware and software. This new mobile home-care allows us for to be optimistic about the reduction of patients’ unnecessary hospitalization, as well as, a much more attractive way for the patient to lend himself to be treated, in the near future. B. Spyropoulos, M. Botsivaly, Reducing Hospital length of stay through the formation of a Hi-Tec Home-care Environment, Proceedings IEEE/Create Net Broad Nets 2005 Conference: BROADMED 1 st IEEE/Create Net International Workshop on "Telemedicine over broadband wireless networks", October 3, 2005, Boston, MA, USA. 15

Medical House-Call as an emerging ITsupported Option in contemporary Health-care The revival of house Medical House-Call as an emerging ITsupported Option in contemporary Health-care The revival of house - call in Medical Practice is due, beyond the health-insurance adaptation to the altering social conditions, to the highly developed equipment made available to the General Physician of the emerging networked society. Patient care, comparable to that of an emergency room, at home is made possible thanks to: The Personal Digital Assistant, with embedded Cellphone safekeeping detailed patient-records, and permitting Electronic Order Entry. The sophisticated point-of-care diagnostic equipment and reagents. Various other technical means, embedded in the so Called "smart home" residential environment. B. Spyropoulos, Medical House-Call: An outdated Ritual or an emerging IT-supported Option in contemporary Health-care? , 24 th TEPR 2008, May 17 -21, 2008, Fort Lauderdale, FL, USA 16

Digital Blood - Banking and contemporary Transfusion Medicine In this paper it was attempted Digital Blood - Banking and contemporary Transfusion Medicine In this paper it was attempted to report the efforts of our group during the last decade, to contribute to the design and the implementation of a universal Information System with integrated Web-Services, covering the most important Aspects of modern Transfusion Medicine, i. e. Medical. Managerial and Educational issues, Clinical and Laboratory Quality Assurance, Haemovigilance, Financial-Managerial topics, and finally, post Transfusion Continuity of Care. Although the system components described do not yet fulfill all legal-administrative demands for clinical employment, they constitute a low-cost suggestion towards semantically annotated Web Services supporting bidirectional Exchange of Transfusion relevant medical and managerial Data, among various Points of care over an integrated Blood and Blood Product Network. B. Spyropoulos, M. Botsivaly, A. Tzavaras, P. Spyropoulou, Towards Digital Blood-Banking, ITU-T Proceedings Kaleidoscope-Conference, Mar del Plata, Argentina, 31 Aug-1 Sep 2009 17

Patient treatment at home and medical data exchange in the emerging networked society A Patient treatment at home and medical data exchange in the emerging networked society A significant portion of Care related to Cardio-respiratory Diseases is provided at Home, usually but not exclusively, after the discharge of a patient from Hospital. We have developed an integrated system, supporting the Continuity of Care of Cardio-respiratory Diseases at Home that includes: First, a prototype lap-top based portable monitoring system that comprises of low-cost commercially available components, supporting patient’s wellbeing observation, by enabling periodical or continuous vital-signs monitoring at Home; second, software supporting Medical Decision Making related to Tachycardia and Ventricular Fibrillation, as well as, Fuzzy-rules based software supporting Home-Ventilation optimization; third, a typical Continuity of Care Record (CCR) adapted to support also the creation of a Home-Care Plan; and finally, a Prototype Ontology, based upon the HL 7 Clinical Document Architecture (CDA), serving as basis for the development of Semantically Annotated Web-Services that allow for the exchange and retrieval of Home. Care information. The flexible hardware design and the adaptable data-exchange mechanism of the system, result in a useful and standard-compliant tool, for Cardiorespiratory Diseases related Home-Care. B. Spyropoulos et al. , Ensuring the Continuity of Care of Cardio-respiratory Diseases at Home: Monitoring Equipment and Medical Data Exchange over Semantically annotated Web Services, Methods of Information in Medicine, 2010; volume 49; issue 2, pp. 156 -160. 18

Supporting technically the postdischarge Continuity of Medical Care Software for the formation of a Supporting technically the postdischarge Continuity of Medical Care Software for the formation of a Continuity of Care Record, combining the ANSI-E 2369 (CCR), the ISO 13606 -1 and the pr. EN 13940 standards. An integrated prototype Notebook-based system enabling the monitoring of Biosignals, Thoracic Impedance, Respiratory, Carotid and Pulmonary Sounds, in vitro Diagnostics Point of Care testing, and the post-discharge supported Respiration or Ventilation. Medical Decision-making support for Cardiovascular and Respiratory Diseases, enabling post-discharge monitoring evaluation for emergency response, and ensuring Mechanical Ventilation settings Optimization. Design of Semantically annotated Web-Services ensuring the Continuity of Care, including post-discharge Care Plan and Pharmacovigilance. Software for Virtual Audiovisual Remote monitoring, supporting the continuity of care. B. Spyropoulos, M. Botsivaly, A. Tzavaras, Supporting technically the Continuity of Medical Care: Status report and perspectives, Proceedings of the ITU-T Kaleidoscope Conference, Cape Town, 19 South Africa, 12 -14 December 2011

A Web-based System supporting the Certification of Hospital Departments and the Accreditation of Diagnostic A Web-based System supporting the Certification of Hospital Departments and the Accreditation of Diagnostic Laboratories This designed and partially implemented on-line “Certification and Accreditation Consultant”, promotes the optimization of the documentation of the routine processes, in the Outpatient, Emergency and Surgery Departments and other associated Surgical Units. After a thorough analysis of patient treatment processes, support is offered over a controlledaccess website, providing for a “scaffold of expertise” for each Unit. The Website comprises of managerial knowledge, subject-related standards, legislation, and relevant medical directives and guidelines, issued by the pertinent scientific Societies. B. Spyropoulos et al. , A web-based System supporting the Certification of the Outpatient and Emergency Departments and providing for post-discharge Continuity of medical Care Software, Springer IFMB Proceedings (EMBEC Sep. 14 -18, 2011, Budapest, Hungary), 2011. B. Spyropoulos et al. , A web-based System supporting the Certification of a Surgical Department 20 in a general Hospital, Springer IFMB Proceedings (EMBEC Sep. 14 -18 2011, Budapest, Hungary).

Thank you very much for your interest about Interoperability in Health-Care ! 21 Thank you very much for your interest about Interoperability in Health-Care ! 21