Integration of EHRs with CDISC, CDASH and ODM A European Initiative
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- Bertram Jacobs
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1 Budapest, Hungary 22nd 23rd April 2009 Session 2 11:00-12:30 European perspective of EHR integration Chair: Udo Siegmann (Parexel) Integration of EHRs with CDISC, CDASH and ODM A European Initiative Jozef Aerts XML4Pharma
2 The problem EDC system and Hospital Information Systems (HIS) are two completely separated systems Investigators need to re-enter information into EDC that was already entered into the HIS, or is available in EHRs Investigators need to use a different computer for EDC
3 The current process Data source HIS / EHR Data entry EDC From the year 584 A.D.
4 Modern times : one possible scenario Can you provide info on Subject XYZ? EDC system Hosp.Inf.System Hmm... Need to transform that into something my ecrf understands... I can provide you an EHR...
5 The value of standards - but can it help in integration? Too many standards?
6 Standards and Integration Standards for clinical research information exchange: CDISC ODM Standards for Electronic Health Records??? (C)EN HL7-v3-XML VistA (Veterans Affairs) OpenEHR, OpenEMR
7 Towards a worldwide standard for EHRs? ISO, CEN, HL7 and CDISC... talk to each other HL7-v3-XML datatypes unacceptable for CEN Compromise: ISO datatypes Grudging acceptance (G.Grieve) Metadata Open Forum metadataopenforum.org/download.php?1aaeb486434ef7b142363ef8c3dc0b07 Acceptance can take many many years ISO is still full of compromise Non-ideal at all, making implementation expensive
8 Another approach - transformations intermediate formats using XSLT Prepopulation data Must be easy to generate from the EHR EDC system must be able to ask for it EDC system must be able to read it Independent from EHR standard As there is not a single one Uncomplicated, easy (costs!) to implement
9 IHE = Integrating the Healthcare Enterprise An IHE CDASH ODM initiative Implementing the IHE profiles Retrieve Form for Data Capture (RFD) Clinical Research Data Capture (CRD) Project: can we extract information from an HL7 Continuity of Care Document and feed it into an EDC system with CDASH forms?
10 The team The Godfather : Landen Bain IHE / EHR: Kevin Power and John Gedeon (Cerner) Jason Colquitt and Daemon Whittenburg (Greenway Medical) CDASH: Rhonda Facile (CDISC) and Gary Walker (Quintiles) ODM: Andrew Fowler (XClinical) and Jozef Aerts (XML4Pharma)
11 The task Design a format that Can easily be generated from the EHR Can be read by the EDC system In order to prepopulate the CDASH form So that EHR system and EDC system do not need to know about each others details Generic solution Vendor neutral format EHR system neutral format Develop the XSLT transformation stylesheets to go from HL7-v3-XML CCD to the new format
12 CDISC ODM Annotation for EHR-integration
13 Continuity of Care Document - ODM
14 The missing link: Prepopulation data Generated by XSLT from the EHR-system. Read by the EDC to prepopulate the ecrf.
15 The process (other scenarios possible) Can you provide info on Subject XYZ? EDC system Hosp.Inf.System I can provide you an EHR... PrepopData (ODM) EHR (CCD) XSLT
16 The result prepopulated ecrf
17 Results so far Defined the PrepopData format (and conventions for OIDs) based on ODM 1.3 ClinicalData Constructed XSLT to transform Continuity of Care Document (HL7) to PrepopData.xml Constructed XSLT to transform OpenEHR extract to PrepopData.xml Demo at Chicago Connectathon 2009
18 Advantages of this approach Many EDC systems can read & write ODM XSLT can easily be generated for different HIS / EHR systems Approach is generic Easy to implement (costs!) Needed: SNOMED to CDISC CT mapping
19 A European initiative Mostly US based companies are currently involved But Europe is far ahead in implementation of EHR Start integration projects in Europe Proove genericity of concept Develop the first commercial implementations!
20 This is not rocket science! So we should start implementing! Es ist nicht genug zu wissen, man muss auch anwenden. Es ist nicht genug zu wollen, man muss auch tun. Il ne suffit pas de savoir, il faut aussi appliquer. Il ne suffit pas de vouloir, il faut aussi agir. Knowing is not enough; we must apply. Willing is not enough, we must do. Johann Wolfgang vom Goethe
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22 Extra slides
23 G.Grieve, Metadata Open Forum
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