ERS. Boundaries between structuring applications and messaging. Trondheim. Tuesday 21 September Electronic Record Services B.V.

Transcription

1 ERS Electronic Record Services B.V. Boundaries between structuring applications and messaging Trondheim Tuesday 21 September 2010 ERS 2010

2 ERS Gerard Freriks Past chair CEN/TC251 wg1 Vice-president EuroRec ERS b.v.

3 ERS I N FOCRMATION T DOCUMENTATION

4 ERS Agenda 1. 2LM Paradigm and Innovation 2. EN13606 and Innovation 3. Missing Semantic Interoperability Stack - INFOstructure 4. EN13606 Consortium/Association

5 -1- Two Level Modeling Paradigm and Innovation 5

6 2LM Paradigm - Innovation ERS Effect on Society Easy access to data, information and knowledge Instantly connecting, synchronising people and organisations New Products Old Products

7 ERS 2LM Paradigm - Innovation Effect on Society Easy speedy access to data, information, knowledge and people plus organisations Instantly connecting, synchronising people, organisations and business processes New Products EHR-systems Old Products EMR-systems

8 2LM Paradigm - Innovation ERS Effect on society - Innovation Infrastructure - Infrastructure R&D - New products One-off Commodity

9 2LM Paradigm - Innovation ERS Effect on society - Innovation Infrastructure - Infrastructure Digital Agenda Infrastructure Infostructure R&D - New products One-off Commodity Legislation Standards EMR? EHR

10 -2- EN13606 Introduction (High level) and Innovation 10

11 Bakery ERS Instructions Ingredients Moulds Kitchen machines Oven Pastry

12 Bakery/EHR expectations ERS Instructions Rules Ingredients Information Moulds Presentation Kitchen machines Software Oven Hardware Pastry EHR

13 EHR s now ERS Instructions Rules Ingredients Information Moulds Presentation Kitchen machines Software Oven Hardware Pastry EHR

14 ERS EHR systems now

15 EHR-systems we need ERS Instruction Rules Ingredients Information Moulds Presentation Kitchen tools Software Oven Hardware Pastry EHR

16 Integrated Care Electronic Health Record Definition (ISO/tc : EHR - Definition, Scope and Context) The IC-EHR has a standardised information model, which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated healthcare and it contains information which is retrospective, concurrent and prospective. EHR Shareable EHR Non-shareable EHR Integrated Care EHR ERS 16 ERS Electronic Record Services

17 EN13606 Basics ERS Internet Network Time Internet Network Database Common Trust Database Internet Network Space User User Context, Community, Culture

18 EN13606 ERS Basics Many, many unique identifiers HL7 Internet v3, EHR Network CDA RIM Extract Internet Network Database Database Internet Network Common Model User User Documentation Archiving Documentation Archiving

19 EN13606 ERS Basics Enterprise viewpoint Information viewpoint Computation viewpoint Engineering viewpoint Technical viewpoint CEN/tc251 System of Concepts for Continuity of Care CEN/tc251 EN13606 EHRcom Information Bus CEN/tc251 Health Health Information Services Architecture EHR-systems using HL7 All viewpoints programmed in one system or message copyright 13ERS 2010

20 EN13606 Basics Paradigm: Two-Level-Model Coding systems Archetypes Templates Rules EN Tools EN Software Tools Services 20 copyright ERS 2009

21 EN13606 Basics Archetypes/Templates 21 copyright ERS 2009

22 EN13606 Basics Archetypes/Templates Input forms screens Ehr-Extract Messages Templates Templates Templates Archetypes Output forms screens Querries API Applications Applications Services PAS MPI Pacs RIS e-prescription Clinical Paths Work flow Case management Data Mining Reporting Billing...

23 EN13606 Basics IC-EHR Architecture LinkEHR Archetypes Templates Archetypes Templates Archetypes Templates LinkEHR Archetypes Templates LinkEHR 23 copyright ERS 2009

24 HL7 Virginia Lorenzi (2009)!"#$%"&'$()(*("+,$)-$-./+0 ERS 1 2& $6&')&+$ )"& 8.9":-$;<$=.&>="&-?, 8 D$-"$C$=.&>="&-?,E 1!BC$-"$!BC 8 ;$-"$D$=.&>="&-?, 1 6,-)=.-+,$)&5%:(+$ 8 -)=+$4"3$(+,)'&F$(+G+%"7=+&-F$-+,-)&'F$73"(:5-)"&$ 7%.&&)&'F$.&($73"(:5-)"&$="G+E$ 8 -)=+$4"3$5"==:&)5.-)"&E 24 ERS Electronic Record Services

25 Message based paradigm versus Archetype based paradigm Production of message Message based EHRsystems Archetype based EHR-systems 1-3 years Minutes IHE process Programming 1-2 years 1-2 years nil nil Roll Out Total 1 year nil YEARS MINUTES ERS 25 ERS Electronic Record Services

26 Exchange HL7 DCM EN13606 Exchange Message to exchange between proprietary databases NOT conformant to ISO18308 Not specified Message Reference Information Model to produce statements Scope RIM DCM EHR Extract Reference Model describing documentation of: Structure of a document, archiving, digital signatures patient mandate, semantic links Conformant to ISO18308 Model describing how to make constraints on EN Patient Mandate for complete record or any part of it Describing what gets documented about: Information components/concepts EN13606 representation of DCM Scope Reference Model En EN EN Archetype EN13606 EHR-system EHR-System Reference Model describing documentation of: Structure of a document, archiving, digital signatures patient mandate, semantic links Conformant tom ISO Model describing how to make constraints on EN Patient Mandate Describing what gets documented about: Information components/ concepts Definition of how a topic is stored in a conformant database Model describing a knowledge domain Model describing according to the scope of the specific messages Standard Message Technical respresentation Describing model/tech spec of messages with all degrees of freedom removed DMIM RMIM / CDA / (Templates) Describing the information needs in a domain for exchange Model describing local context the exchange: structure domain content XML-Schema Defines the content of the exchange EHR-Extract IHE profile IT-vendors adapt software in a region/ country leading to database conversions Implementation Install with all users in a region in a country Roll-out Not necessary because of EN13606 Immediate implementation of the extract without re-programming need. No database conversions are needed Immediate automatic implementation of the extract and its describing archetypes/template Implementation Roll-out Archetype Library Template EHR-Extract/ Archetype/Template Implementation Roll-out Not possible Local adaptability Possible Local adaptability Local adaptability Possible Domain Information that can be stored in a database Description of the structure and content used in a local context for a report, screen Defines the content of the record Not necessary because of EN Immediate implementation of the extract without reprogramming need. No database conversions are needed I Immediate automatic implementation of the extract and its describing archetypes/template

27 Message based paradigm versus Archetype based paradigm Stable +10 Flexible Message Paradigm 0-10 Unstable -10 Unflexible ERS 27 ERS Electronic Record Services

28 Message based paradigm versus Archetype based paradigm Stable +10 Flexible Message Paradigm 0-10 Unstable -10 Unflexible ERS 28 ERS Electronic Record Services

29 Message based paradigm versus Archetype based paradigm Stable EN EN Flexible Unstable Unflexible ERS 29 ERS Electronic Record Services

30 Message standards: ERS Edifact, HL7, IHE No Innovation

31 ERS

32 What is the EHR? ERS ehealth Infrastructure? ACL ACL ACL ACL ACL ACL

33 -4- What is missing: the Semantic Stack as INFOstructure 33

34 ERS What is needed 1. Legislation 2. the Semantic Stack as a (European) Service a shared quality assured library of: - Archetypes, Templates - Terminologies/Codes and - Ontologies 3. Quality Assurance 4. Shared IPR and Licenses 5. Accountable organisation(s)

35 What is needed t Transport Public Domain TRUST and Legislation stability Standards are Specifications ESSENTIAL Archetypes Codes d t Transport over Time and Distance Transport across organisation, culture and language barriers 35 copyright ERS 2009

36 R&D - Innovation ERS Digital Agenda Effect on society - Innovation Infrastructure - Infrastructure Digital Agenda Infrastructure Infostructure R&D - New products One-off Commodity Legislation Standards EMR EHR

37 What is needed Semantic Interoperability Stack ERS Ontology Model of Knowledge Encyclopeadia Coding system Codes/terms Dictionary DCM Archetypes Action Protocols Clinical Pathway / Clinical Study Model of Meaning general Use Generic Phrase Templates Action Protocols Clinical Pathway / Clinical Study Model of Meaning specific Use Specific Phrase EN13606 Kernel Model of Documentation/Archiving Syntaxis Database Action Protocols Clinical Pathway / Clinical Study Real use Paper/Document

38 What is needed ERS Actors Ontology Model of Knowledge Experts: ontologies, hc providers Coding system Codes/terms Experts: Informaticians, coders, hc providers Archetypes Action Protocols Clinical Pathway / Clinical Study Model of general Use Informaticians, hc providers Templates Action Protocols Clinical Pathway / Clinical Study Model of specific Use Informaticians, hc providers EN13606 Kernel Model of Documentation/Archiving IT industry Database Action Protocols Clinical Pathway / Clinical Study Real use IT Industry en IT departments hc organisations

39 Concept Semantic Interoperability Stack Profiles

40 Concept Semantic Interoperability Stack Archetype EN13606 Template HL7 v3

41 -6- EN13606 Consortium/Association 41

42 EN13606 Consortium/Association EN13606 Consortium: A public association with the scope to promote and improve Open Standards 42

43 EN13606 Consortium ERS Uptake UK Sweden Spain Slovakia Australia Germany Norway Ireland USA Netherlands Brazil New Zealand Serbia USA Singapore

44 What is needed ERS Actors Ontology Harmonised IPR, Licenses Coding system Archetypes Templates EN13606 Kernel Database Action Action Action Protocols Protocols Protocols Clinical Pathway / Clinical Study Clinical Pathway / Clinical Study Clinical Pathway / Clinical Study Model of Knowledge Codes/terms Model of general Use Model of specific Use Model of Documentation/Archiving Real use SDO: IHTSDO, WHO SDO: IHTSDO, WHO Cooperation SSO: EN13606 Association Users: National, Regional, Local SSO: EN13606 Association SSO: EuroRec? (QA implementations) Vendors, IT-departments

45 ERS SDO's and EN13606 Consortium Proposal: IPR, Licensing and the EN13606 Consortium 1.The EN13606 Consortium is founded to own, produce, maintain and publish artefacts derived from the Open Standards CEN/ISO EN13606 and needed for the implementation of the Two Level Modelling paradigm. 2.Authors of original works -to their discretion- can hand over IP Rights to the EN13606 Consortium. 3.The EN13606 Consortium publishes artefacts, with an IP owned by others or itself, that pertains to the human readable parts, only. 4.The Licensing policy that will be used by the EN13606 Consortium for all artefacts owned, produced, maintained and published will be the Creative Commons license: CC-BY-SA. 5.The EN13606 Consortium needs a legal entity that can hold IP Rights and execute the Licensing policy and be able to enter into agreements with SDOʼs and SSOʼs. 6.The EN13606 Consortium will establish an Association as the legal Public entity.

46 ERS END