Interoperabilidad entre los Sistemas de Laboratório Clinico

Transcription

1 V Congreso Iberoamericano de Informática Médica Normalizada 13 y 14 de Octubre 2011 Intendencia de Montevideo Interoperabilidad entre los Sistemas de Laboratório Clinico Lincoln de Assis Moura Jr, EE, MSc, DIC, PhD IMIA President-Elect and Treasurer Assis Moura ehealth Director lincoln.a.moura@gmail.com,

2 About IMIA IMIA was founded in 1967 An international, not-for-profit Association of Associations A 'bridging organization' to bring together the members of the global Health and Biomedical Informatics communities 61 Member Societies contacts in over 85 countries 25 WGs and 01 SIG More than 60 Academic and Corporate Members Represents over 50,000 people in Health and Biomedical Informatics 6 IMIA Regions: APAMI, NA, EFMI, IMIA-LAC, HELINA and MEAHI IMIA-LAC: Uruguay, Argentina, Brasil, Cuba, Venezuela, Chile, Mexico, Peru 2

3 IMIA Activities Medinfo Is IMIA s major meeting 13 Medinfos so far To be held every two years from 2013 on Nursing Informatics Is Nursing Informatics SIG major meeting To be held every other year from 2012 on Yearbook (since 1992) Comprehensive selection of Health and Biomedical Informatics papers published every year. Excellent source of first class references. 3

4 Official IMIA Publications Methods of Information in Medicine (Schattauer Publishers Stuttgart) Applied Clinical Informatics (Schattauer Publishers Stuttgart) International Journal of Medical Informatics (Elsevier) 4

5 Why is it Important to Act Globally? Contagious/infectious diseases do not recognize regional or international borders; they always find a way to sneak in ; The world population and individuals mobility are on the increase; Although knowledge generation is not homogeneous throughout the Regions, good and creative examples come from everywhere; Collaboration and experience exchange are crucial if redundant work is to be avoided; Global Health Information Standards are essential if systems across the world are to interoperate; Global collaboration is essential. Are we ready to face an outbreak of a pandemic disease? What are the ehealth requirements for facing such an outbreak? When will we be ready? 5

6 Important Global Ongoing Activities IMIA WHO Collaboration ( WHO has provided the vehicle, guidance and methods IMIA has provided coordination and knowledge The project has counted on funding from PEPFAR and IDRC 6

7 Other Preliminary Work IMIA JIC Collaboration Joint Initiative on SDO Global Health Informatics Standardization Current participants are ISO/TC215, HL7, CEN/TC251, CDISC, IHSTDO and GS1 It is difficult for emerging countries to take part in the standards World; IMIA believes we can leverage countries participation via IMIA Working Groups, especially those on Education, Health Informatics for Development and Standards; This is an initiative that can change the World of ehealth. 7

8 WGs and SIG Biomedical Pattern Recognition Mental Health Informatics Consumer Health Informatics Open Source Health Informatics Critical Care Informatics Organizational and Social Issues Dental Informatics Primary Health Care Informatics Health and Medical Informatics Security in Health Information Health Informatics for Development SIG NI Nursing Informatics Health Information Systems Smart Homes and Ambient Assisted Education Human Factors Engineering for Healthcare Informatics Informatics in Genomic Medicine (IGM) Intelligent Data Analysis and Data Mining Medical Concept Representation Systems Living Social Media Standards in Health Care Informatics Technology Assessment & Quality Development in Health Informatics Telehealth (provisional) Wearable Sensors in Healthcare 8

9 O Medinfo 2015 no Brasil é uma conquista da nossa Região e fruto do trabalho acumulado por todos nós ao longo de décadas. Será um evento para a IMIA-LAC. 9

10 Strong Conviction It is impossible to deliver services to thousands and millions of people using craft production methods; Industrial production processes must be used if we are to provide millions of people with good health services; ehealth can: improve quality, reduce costs, optimize the use of resources, and extend the reach of health services 10

11 Self-Assigned Mission Here To discuss ways by which HIS can be useful, long lasting, flexible and moreover SUSTAINABLE. Pla n D o Maturity Level Ac Incremental and iterative! t Che ck 11

12 Why the concern with Architectures for ehealth? The vast majority of emerging and resource-impoverished countries: Do not have national ehealth policies; Have vertical health information systems for diseases such as AIDS, Malaria and TB, often donor-funded; Lack proper Human Resources for Health Informatics; Do not have access to standards; Do not appreciate the complexity of national ehealth infrastructure. From ehealth Enterprise Architecture for Emerging and Developing Countries, PPT presentation as part of NWIP for ISO 12

13 Enterprise-Wide ehealth PC Units Evidences Medical Centers Suppliers Hospitals The Cloud Clients Labs & Diag Centers FHP Team s Management & Operation Datacenter The HC Enterprise Interoperability with External Systemas 13

14 Interoperability of HIS No single Health Information System can encompass all the requirements of a Health Enterprise; Diversity is Good! Some things will always happen outside the reach of the Health Enterprise and its HIS; Therefore, HISes need to Interoperate : Interoperability is the ability of two or more systems to exchange information and to use the information that has been exchanged (IEEE); The only way to interoperate is by sticking to standards. 14

15 Conventional Systems EHR EHR EHR EHR HC Workers HC Workers HC Workers HC Workers Ciient Ciient Ciient Ciient Facilities Facilities Facilities Facilities EHR HC Workers Ciient Facilities EHR HC Workers EHR HC Workers Ciient Ciient Facilities Facilities LIS EHR HC Workers Ciient Facilities Scheduling PACS App 2 App 2 App 2 SIH Health Plan Management 15

16 Registries are Foundational! Management Other Organizations External Unities S1 S2 S3 S4 S5 S6 S7 S8 Suppliers Resources within Health Facilities Equipment Indivíduals Patients HC Workers Specialists Registries Describe the Health Enterprise and its Resources 16

17 Towards The Cloud HC Workers Messaging Service Terminology Service Shared EHR Domain Tables Suppliers Clients HC Facilities Indicators Interoperability Layer Local EMR Mobile Applications Clinical Lab System Scheduling Vertical Systems 17

18 ISO Capacity-Based ehealth Architecture Roadmap 18

19 SIGA Saúde São Paulo City Health Information System SIGA Saúde is São Paulo City Integrated and Distributed System for Managing the Public Health Care System. It was conceived in 2003 and development began in The system belongs to São Paulo City, which is willing to share it with other cities, states and countries. Uses free-software & open-code concepts. 19

20 SIGA Saúde IT Model Management (Surveillance, Auditing and Billing) SMS-SP Dept of Health Patient Flow Organization & Control Interne t (Specialties, Beds, Exams) Electronic Health Record (Outpatients) SP City Datacenter Role-based Secure Access 20

21 Key Identification within the Country Identify People Uniquely Individuals, patients, health workers Identify Health Workers Uniquely All types of workers and their profiles Identify Health Organizations Uniquely Who they are and what they do What they have (equipment) Identify Relationships Among Them Who works where and when and in which role National Registries: Can organize the Referral and CounterReferral Model, and provide answers to who attended whom and where 21

22 SIGA Saúde Figures, MM registered users 1.5 MM primary care scheduling / month 200 MM specialized care consultations / month Over 2 MM prescriptions attended over the counter / month 70,000 scheduling requests processed / day 35,000 authorizations of high cost & complexity procedures / month 30% reduction in the waiting time for specialized consultations & procedures Medication available at local pharmacies - supply chain control. 22

23 SIGA Saúde evaluation 23

24 SIGA Saúde Lab Integration 32 millions exams in 2009 (2.6M / month) About 300 different labs exams without previous authorization Others need prior authorization Manual process: transcription errors, duplication of exams, bad resource allocation Ordering HC providers 403 Primary care Units 100 Emergency and Specialized Units 15 Hospitals Executing Labs Private Labs (3) + Public Labs (6) Lab Reporting in Brazil Using CDA IHIC Rio de Janeiro, 2010 Deborah Pimenta, SMS-SP, SP Paula Borges Pereira, DASA, SP Beatriz de Faria Leão, Zilics, SP 24

25 Standards used for SIGA Saúde Lab Integration Identification: Patient s National Health Card Number HC provider and HC provider - National CNES Messages: TISS: XML schemas (simpletypes, complextypes, Messages, WSDL) HL7 v3 - Lab orders and results information content (tags translated) HL7 v3 pan-canadian Messaging Standards Vocabulary: LOINC - Logical Observation Identifiers Names and Codes 25

26 References 26

27 OIDs defined 27

28 SIGA Saúde Lab Integration Lab Orders LAB 2 LAB 1 LAB 3 LAB N XML SIGA Web Service: LAB XML Lab Order Sample Collection Authorization UBS AE AMAS Health Care Units Hospital Emergenc y 28

29 Order Message 29

30 30

31 SIGA Saúde Lab Integration Lab Results LAB 1 LAB 2 LAB 3 LAB N XML SIGA Web Service: SIGA XML Lab Results (Common, Micro, Pathology) - CDA UBS AE AMAS Hospital Emergency Health Care Units 31

32 Results 250 lab exames were translated and mapped to the Brazilian Procedures OIDs defined (Brazilian unique identifiers) Implementation Guide for CDA R 2 Lab Results for the integration with Lab systems to SIGA Saúde Project deployed in one region of the city and under evaluation A 4th Lab Information Systems, used the Clinical Labs owned by the Dept of Health is, now, also part of the effort, doubling the number of exams. 32

33 Lab Report CDA Structure Header 33

34 CDA entry 34

35 Example <recordtarget> <patientrole> <id root=" " extension="numero CNS"/>  <patient> <name> <given> ADRIANO MONTEIRO DA SILVA</given> </name> <administrativegendercode code="m" codesystem=" " codesystemname="administrativegender"> </administrativegendercode> <birthtime value=" "/> </patient> </patientrole> </recordtarget> 35

36 Body of CDA  <component> <structuredbody> <component> <section>  <code code=" " codesystem=" " displayname="hemograma Painel Diferencial + Plaquetas"/> <text> <linkhtml href=" 36

37 <entry> <organizer classcode="battery" moodcode="evn"> IHE Lab <templateid root=" "/> <id root=" " extension="cneslab-numero único CDAnúmero do resultado"/> <code code=" " codesystem=" " codesystemname="loinc"/> <! = Hemograma completo PAINEL --> <statuscode code="completed"/> <effectivetime value=" "/> <component typecode="comp">  <observation classcode="obs" moodcode="evn"> <id root=" " extension="cneslabnumero único CDA-número do resultado"/> <code code=" " codesystem=" " displayname="hematocrito"> </code> <statuscode code="completed"/> <effectivetime value=" "/> <value unit="%" value="28.0" xsi:type="pq"/> 37

38 Results 250 lab exams were translated and mapped to the Brazilian Procedures OIDs defined (Brazilian unique identifiers) Implementation Guide for CDA R2 Lab Results for the integration with Lab systems to SIGA Saúde Project deployed in one region of the city and under evaluation 38

39 Screenshots 39

40 A (Sample) Lab Report 40

41 SIGA SADT Lab System Integration Management (Surveillance, Auditing and Billing) SMS-SP Dept of Health Patient Flow Organization & Control Clinical Lab Internet (Specialties, Beds, Exams) Electronic Health Record (Outpatients) SP City Datacenter Role-based Secure Access 41

42 Major Challenges Technical Difficulties Labs don t know much about standards LOINC is a comprehensive and thus complex terminology Project Complexity SP City Dept of Health hires the Clinical Lab Services, with the condition that Clinical Labs hired Zilics to develop the system, but The Dept of Health is responsible for managing the project, however They are NOT experts on the subject, and They rely on Prodam (the Datacenter Company), which, in turn Rely on Zilics, which is paid by the Clinical Labs, which work at different paces Governance is the Major Issue WHO s going to take care of LOINC in Brazil? And HOW? LOINC is NOT an ISO Standard! How to avoid having N versions of LOINC in Brazil? Solution under study: SBIS as the Coordinating Body for that effort. 42