Towards semantic interoperability solutions Dipak Kalra
Health information flows needing semantic interoperability Wellness Fitness Complementary health Citizen in the community rapid bench to bed translation Social care Occupational health School health real-time knowledge directed care Point of care delivery Teaching Research Clinical trials explicit consent implied consent Disease registries Screening recall systems Continuing care (within the institution) Education Research Epidemiology Data mining de-identified implied consent +/- consent Public health Health care management Clinical audit Long-term shared care (regional national, global) 2
Drivers for trans-border information and knowledge sharing • Cross-border health care – – – • public health measures: prevention, immunisations etc. detecting and tracking critical events: antibiotic resistance, infectious outbreaks, bio-terrorism etc. treatment effectiveness clinical outcomes safety signals Research – – • consistent care pathways and standards of care Comparisons – – – • elective care Population health – – • emergency care epidemiology multi-national clinical studies Common products and services – – cross-border EHR systems and services consistent implementation of clinical guidelines and decision support 3
The EHR landscape - for archetypes Treatment Medication and prescriptions Symptoms and history Body physical examination findings Advice and education Hypotheses, Self management and health issues home monitoring Chronic Conventional (problems and Well-being and fitness, medical summary Prevention and disease diagnoses), risks screening, rehabilitation after illness management population health Tests and investigations measures Care planning Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Protocols, guidelines, care pathways Communication, team-based collaboration Consent, permissions, disclosures, complaints 4
Hospital admission Hi gh pr Advice ior Self managementand education Hypotheses, Symptoms and ity home monitoring health issues Chronic and history disease Conventional (problems and Well-being and fitness, , o medical summary healthand Mental Prevention fte management screening, fra diagnoses), risks population illness rehabilitation after health Body physical gmplanningu measures Tests and investigations n examination findings Care Social en se welfare, culture, religion, dr ts attitudes, expectations, hopes, e-u fears Procedures and operations se Protocols, guidelines, care d pathways Cardiovascular medicine Treatment Medication and prescriptions Communication, team-based collaboration Consent, permissions, disclosures, complaints
architecture identifiers for people policy models structural roles functional roles purposes of use care settings pseudonymisation record structure and context Resources needed to support rich semantic interoperability reference models data types archetypes templates near-patient device interoperability Consistent workflow guidelines care pathways decision support algorithms clinical terminology systems classification systems terminology sub-sets value sets and micro-vocabularies post-co-ordination multi-lingual mappings semantic context model categorial structures clinical terminology privacy Rich EHR representation, access interoperability and interpretation 6
Initiatives striving for harmonisation • Clinical Information Modeling Initiative (CIMI) • Semantic. Health. Net 7
Clinical Information Modeling Initiative (CIMI) • International collaboration of several SDO’s, national e. Health 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 open. EHR archetype approach as its starting point • Specifications will be openly accessible, freely usable 8
• European Commission sponsored Network of Excellence in Semantic Interoperability – – Dec 2011 to Nov 2014 3 m Euro 17 Partners > 40 internationally recognised experts 9
Semantic. Health. Net 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 10
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