The use of ehealth standards in Norway

Transcription

1 The use of ehealth standards in Norway Torbjørn Nystadnes, KITH Archetypes and Architecture Oslo, 26 November 2009

2 In the beginning... KITH was established in 1990 The same year as CEN/TC251 - Norway has participated from the start According to its statutes, KITH should establish the standards necessary for safe communication within the Norwegian health sector and between the health sector and actors outside this sector Solutions that could form the basis for standards were scarce both in Norway and the rest of Europe Most of the standards therefore had to be developed almost from scratch - as pre-standards

3 KITH's policy European or international standards should be adapted whenever possible National standards should be developed from scratch only if existing European or international standards doesn't cover the requirements When a standard has been disseminated and is actively used by the health sector, it should be kept as stable as possible for several years This policy has been imperative in order to get the standards accepted

4 1. Generation: CEN & EDIFACT Profiles on syntax independent CEN message pre-standards like ENV 1613 (Exchange of laboratory information) ENV (Patient referral and discharge) EDIFACT messages standards defined by the CEN workshop ebes expert group EEG9 Some of these messages, especially the laboratory service reports, were implemented by several vendors and put into widespread use

5 2. Generation: XML messages The transition from EDIFACT to XML started around year 2000 Since no European or international standards for XML ehealth message syntax were available, a national methodology was developed Inspired by the early work of HL7 regarding use of XML Using a subset of the data types defined in CEN TS A large number of standards have been produced KITH runs a test server for ehealth messages This has speeded up the dissemination The Directorate for Health runs a program for dissemination of electronic messages (to 2013)

6 2. Generation: EHR KITH published a basic EHR standard in 2001 Based on the pre-standard ENV It does also encompass topics where detailed national legislation exist, like access control, archiving, patient rights and deletion/correction of EHR information A revised version was published in 2007 A number of standards for the clinical content of EHRs have also been developed These are also referenced from message standards These standards corresponds to archetypes and may be transformed to such if needed

7 What about the hospitals? DICOM standards are used for digital imaging HL7 version 2.x messages are to some extend used between systems within hospitals Standards from IEEE and others are used for communication with medical devices A few services based on HL7 v3 RIM have been developed and implemented in some hospitals More such services are expected to be developed and taken into wide-spread use

8 What next? At some point in time, the national standards should be replaced by (profiles on) European and/or International standards In order to achieve cross-border semantic and syntactic interoperability Two partly overlapping alternative candidates: HL7 v3 RIM and CDA (Clinical Document Architecture) Described in the report from "NIKT Arkitekturforum" ISO EN Health Informatics - Electronic Health Record Communication Which will be presented in this seminar

9 There are some obstacles... To replace an already implemented standard with a new standard is quite a challenge It takes considerable time Whether the standard to be replaced is a nationally developed standard or an international standard, is of minor importance The new standard have to provide substantial benefits for the users If not, the willingness to invest in the new standard will be negligible.

10 The objectives of the seminar To provide information on two important European (CEN) Standards that also have been accepted as International Standards..and on the use of these standards in our neighbouring countries To discuss the prerequisites for a decision regarding a transition to a new generation of ehealth standards Do we know enough to take such a decision? If not, what can be done to provide the information needed?

11 epost: Torbjørn Nystadnes Telefon: