ehisa 2012 learning from others session case study 1 -...

eHISA 2012 – Learning from Others Session

Case Study 1 - Spain HCDSNS

Historia Clínica Digital del Sistema Nacional de Salud

Arturo Romero Gutiérrez

Project Director, HCDSNS

Subdirección General de Información Sanitaria e Innovación

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What is the project overall

Different regions brought together

How was it started? How far is it? How costly?

Evolving Governance Structure

Technical challenges

Summary

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System architecture plainly explained

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Our vision

• Information from Electronic Health Records will be shared

within a secure, accessible, reliable environment

• Electronic Health Records will have support from different

systems, but will share common data structures

• Terminology in use will be communicated between

different systems without altering meaning

• All professionals will be enabled to manage clinical

information according to requirements of interoperability

• Citizens will have access to their own documents

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Key tools

Connectivity

Web Services

Terminologies

Modeling Messages

Communications network

Messages

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Central Node

Region B node

EHR Primary Care

EHR Hospitals

Connectivity: view from the regions

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Central node

Region A node

Region B node

Region x

Region y

Region = A

Patient = xyz

Document = ijk

Section =123

Label 1 = Value a

Label 2 = Value b

Region = A

Patient = xyz

Document = ijk

Section =123

Label 1 = Value a

Label 2 = Value b

Clinicians Patients

Connectivity: using networks

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Pacientes

Origin

Professionals

Patients who travel

Destination

Professionals

Destination EHR

Origin EHR

Connectivity: sharing

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header

body

section

entry

What is being communicated?

Documents: PDF

entry

Messages: CDA (HL7)

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Análisis de Requerimientos del Sistema (ARS)

System Requirements Analysis

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Manual de Operación

Operations Manual

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CMDIC: our first data model for national EHR

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Workshop: CMDIC Self-audit

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Connectivity map (April 2012)

Connectivity = Technical capacity for connecting nodes

Activation = Document references avalilable for national access

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Starring (in order of appearance)

Engineers

Clinicians

Clinical Information Specialists

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Governance Structure Information Technology

Support for regions

Development (central)

IT Strategies

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Healthcare Information

Consensus facilitation

Project Direction

Functional issues

Monitoring

Contents design

red.es

Financing channels administration

Support for regions (peripheral development)

Co-Starring

European Union

State Administration

Autonomous Communities

– Ministry of Health

– red.es (Public Entity)

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Interoperability ≈ agreements

• Technical: networks, communication protocols

• Syntactic: message structuring

• Semmantic: terminology normalization

– SNOMED CT © IHTSDO

– Other vocabularies, classifications, ontologies

• Cognitive: interpretation by professionals, patients,

knowledge based software …

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Reference models

Reference Model

EN/UNE

13606 HL7 CDA

openEHR

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Título del documento

Document = COMPOSITION

Labels

Values

Patient Organization

Healthcare context data

Document title

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RecordComponent

Folder

Composition

Section

EHR Conformant to ISO 13606 RM

Entry

Cluster

Item

Link

Element DataType

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Workshop: ISO 13606 RM drag and drop

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Models: information + knowledge

Modeling

Reference

Model

Archetypes

CMDIC

Other

standards

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Terminologies

Terminologies

SNOMED CT

Classifications

Catalogs Other

nomenclatures

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Relationships

Concepts

Terminology: SNOMED CT core data

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pneumonia

inflammation

metapneumonic effusion

lung has location

has morphology

has cause

Is a disorder

pneumonia (disorder)

Descriptions

pneumonia

pneumonic focus

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Terminologies: Browsers (cloud apps)

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CDA Scheme

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Strategic tools

• Shared financing sources

• Sanidad en Línea: Compromise letter

• HCDSNS Monitor (Excel Model)

• Follow-up sessions (videoconference)

• Lab testing

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Semantic Resources Factory

http://www.msps.es/profesionales/hcdsns/areaRecursosSem/factoria.htm 34

http://www.msps.es/profesionales/hcdsns/areaRecursosSem/factoria.htm

Subset browsers

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Subset browsers: medicines description

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Subset editing (Excel model)

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Systematic mapping: VMPP medicines

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Terminology binding

Archetypes Terminologies Binding

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Managers

Professionals

Organizations

Patients

Documents

Certificates

References

(documents)

Primary Care Center

Hospitals

Systems Hospitals

server

Primary Care

server

Regional

node Nodo

SNS

TSI

SNS eID Server stSNS

Terminology

Services

Citizens

Referent entities for HCDSNS

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¿Where are the attributes of quality?

Emitting region

Receiving region

ID SNS

Nodo SNS:

disponibilidad

y transacciones

Emitting region

Documents: access, types, contents

SNS Node:

availability and

transactions

Receiving region

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Emitting region

Receiving region

ID SNS

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¿Where are the attributes of quality?

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To retrieve documents and data we need…

Labels

Patient Organization

Values

Binding Subsets

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Code Legible text

Document title

Healthcare context data

Document

Components

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Service providers

Organization B

Organization A

Modelo dual (y sus consecuencias)

Contents

Free text

Controlled terminology Subset 1

Subset 2

Catalog values

Internal codes

Subset 3

Message

st

sa

EHR Extract

Normalized data structures

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Organization B

Regions

Regions

Regions

Collaborative workflow for terminology

stSNS

Other… eCIE

Subsets

SNOMED CT

Models SNS eID

Mapping

Extensions HCDSNS

msg

Regions

msg

SN

S W

eb S

ervi

ces

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Thanks for your attention…

[email protected]

[email protected]

[email protected]

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Content types

• Personal identification codes

– PIC(region)= n ↔ PIC(sns) = 1

• Clinical contents models (consensus)

– CMDIC = Minimum Basic Data for Clinical Documents

• Aiming to semantic interoperability

– SNOMED CT, CIE9MC, CIAP-2, NANDA-NIC-NOC, …

• Synergic platform for EU Projects support

– epSOS Pilot – Patient Summary

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Controversial or relevant issues

• Access of citizens to their own data

• How to consolidate EHR from various regions?

• What information model(s) should we use?

• What reference terminologies should we use?

• How to bind models to terminologies

• Effect on secondary uses of EHR information

• …

• What level of interoperability should we pursue? …

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Keys to Semantic Interoperability

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<label

coding_system=“system_name”

version=“version_id”

OID=“n.n.n.n.n.n.n.n”

code=“value”>

Readable contents, narrative text

</label>

I provide a

message

I receive the message;

codes have the same

meaning here

System A System B

¿Why? Because we share:

- a reference model (names for message elements general types)

- archetype(s) (how components are organized)

- terminology binding (which content is associated to which element)

- terminology resources (what data may exist in messages and what they mean)

Labe

ls

Labe

ls

Attributes

Content

Attributes

Content

SNS <prescription

coding_system=“Nomenclátor_Alcántara”

version=“20120501”

OID=“2.16.724.4.21.5.4”

code=“123456”>

Medicamento ficticio de pruebas

</prescription>

Interoperability

Integration Platform

Messages

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HCDSNS Collaboration model