EHR Qualities Semantic Interoperability Privacy - Gerard Freriks
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  • 1. EHR-Qᵀᴺ Polska 2012 EHR Qualities Semantic Interoperability Privacy (Lodz, 29 November 2012) Gerard FreriksGerard Freriks. ERS B.V. © ERS 2012
  • 2. "Its the economy, stupid"• Slight variation of the phrase "The economy, stupid" which James Carville had coined as a campaign strategist of Bill Clintons successful 1992 presidential campaign against sitting president George H. W. Bush.• Carvilles original phrase was meant for the internal audience of Clintons campaign workers as one of the three messages to focus on, the other two messages being:• "Change vs. more of the same" and• "Dont forget health care" 2 © ERS 2012
  • 3. MIE2012-Village of the Future 3 © ERS 2012
  • 4. MIE2012-Village of the Future• Point on the horizon–All must communicate–Now and in the future–How? It is the semantics stupid! Blue Line 4 © ERS 2012
  • 5. Topics- What is the EHR?- Semantic Interoperability the Semantic Interoperability Stack- Data and Information: Interoperability Privacy- Standards for Semantic Interoperability- International Developments- National/regional Governance Quality Assurance- Conclusions © ERS 2012
  • 6. © ERS 2012
  • 7. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines 7© ERS B.V.
  • 8. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines Rules Information Presentation Software Hardware EHR 8© ERS B.V.
  • 9. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines Rules Information Presentation Software Hardware EHR 9© ERS B.V.
  • 10. Instruction Ingredients Moulds Kitchen tools Oven Pastry Rules Information Presentation Software Hardware EHR 10 © ERS 2012
  • 11. EHRSemanticHealthNet Dipak Kalra © ERS 2012
  • 12. EHRSemanticHealthNet Dipak Kalra © ERS 2012
  • 13. EHR and Privacy ACL Trust ACL FlexibilityIt is the Semantics stupid! ACL Patient Mandate ACL ACL ACL Author and Patient controlled 13 © ERS 2012
  • 14. Health Information Security 450.000 records not secured Names, Date of Birth, addresses, telephone numbers, Patient ID, Governmental ID 14© ERS B.V.
  • 15. Health Information Security What is needed: –Deploy top to bottom in each organisation – ISO 27799:2008 Health informatics Information security management in health using ISO/IEC 27002 –Treat health software and the development of it as a medical device –Deploy 13606 EHR Communication 15© ERS B.V.
  • 16. Health Information Security CEN/ISO 13606 EHR Communication –No patient identifiable data in the Record –Each data object carries the Patient Mandate (who has access to what kind of data) 16© ERS B.V.
  • 17. 13606-4 Patient Mandate CEN/ISO 13606-4 TS: Security –is a profile of the • ISO 22600 • Privilege Management and Access Control 17© ERS B.V.
  • 18. 13606-4 Patient Mandate 18© ERS B.V.
  • 19. 13606-4 Patient Mandate 19© ERS B.V.
  • 20. 13606-4 Patient Mandate 20© ERS B.V.
  • 21. 13606-4 Patient Mandate 21© ERS B.V.
  • 22. 13606-4 Patient Mandate 22© ERS B.V.
  • 23. 13606-4 Patient Mandate 23© ERS B.V.
  • 24. Semantic Interoperability Stack Common Trusted FacilitiesSemantic Interoperability © ERS 2012
  • 25. Semantic Interoperability Stack HL7 EHR v3, CDA Extract RIM Common FacilitiesDocumentation Documentation Archiving ArchivingSemantic Interoperability 25 © ERS 2012
  • 26. Semantic Interoperability StackSemantic Interoperability Levels Semantic Stack 26 © ERS 2012
  • 27. Semantic Interoperability StackSemantic Interoperability LevelsFP7-SemanticHealth Project 27 © ERS 2012
  • 28. StandardsEnterprise CEN/tc251 System of Concepts for EHR-systemsviewpoint Continuity of Care usingInformation HL7 CEN/tc251viewpoint EN13606 EHRcom Information Bus All viewpointsComputation programmed inviewpoint CEN/tc251 Health one system or Health Information Services Architecture messageEngineeringviewpointTechnicalviewpoint © ERS 2012
  • 29. Standards Message based Archetype based EHR-systems EHR-systemsProduction of 1-3 years Minutes messageIHE process 1-2 years nilProgramming 1-2 years nil Roll Out 1 year nil Total YEARS MINUTES © ERS 2012
  • 30. CEN/ISO13606 StandardReference ModelArchetype Object ModelTerm ListPatient MandateEHR-extract exchange © ERS 2012
  • 31. CEN/ISO13606 Standard Coding systems Archetypes Templates Rules Patient mandatesEN13606-2 Tools SoftwareEN13606-1 Tools Services © ERS 2012
  • 32. CEN/ISO13606 Standard © ERS 2012
  • 33. Semantic Interoperability Stack Model for Knowledge EncyclopediaSNOMEDWHOLoinc Model of Meaning DictionarySIAMS Models of General Use Generic PhrasesCEN/ISO 13606-3 Models of Specific Use Specific PhrasesCEN/ISO 13606-2CEN/ISO 13606-1 Models of Archiving ‘Syntax’ Models of Storage Database Schema 33 © ERS 2012
  • 34. International Developments- Renewal CEN/ISO 13606- Integration of 13606 with: - System of Concepts for Continuity of Care (ContSys CEN/ISO 13940) - Health Information Services Architecture (HISA CEN/ISO 12967)- Harmonisation with HL7 CDA- FP7 SemanticHealthNet (make 13606, CDA, coding systems and ontologies work together) http://www.eurorec.org/RD/SemanticHealthNet.cfm- Clinical Information Modeling Initiative http://informatics.mayo.edu/CIMI/index.php/Main_Page- New FP7 2013 call: - epSOS EU-USA, Semantic Interoperability EU-USA, ... © ERS 2012
  • 35. InternationalDevelopments © ERS 2012
  • 36. InternationalDevelopments © ERS 2012
  • 37. InternationalDevelopments © ERS 2012
  • 38. InternationalDevelopments © ERS 2012
  • 39. (Inter-)National Governance INFOstructure Direction Healthcare Patients Stanardisation organisations Ontology / Coding systems Clinical Information Models Providers (Inter-) National ProjectGovernment Local Communities Insurers Re-Users of data IT- Vendors Quality Assurance © ERS 2012
  • 40. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance• Essential elements –All actors co-operating in their natural role –Direction based on expertise, knowledge and authority. Not too much money. –One standing (virtual) organisation) –With ongoing secured funding. The INFOstructure is not a one time project. © ERS 2012
  • 41. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance INFOSTRUCTURE–Production, Maintenance, Publication of all semantic interoperability artefacts is veryresource intensive (money and expertise)–Even big countries can not create a full Semantic Stack on their own–European countries (and more) had better co-operate and provide jointly theresources needed © ERS 2012
  • 42. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance INFOSTRUCTUREOngoing projects–SemanticHealthNet (SHN)–Clinical Information Modeling Initiative (CIMI)–... © ERS 2012
  • 43. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisationsGovernment systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance © ERS 2012
  • 44. Conclusions1. No semantic interoperability without the Semantic Stack2. Base standards, Coding systems and Ontologies constitute the Semantic Stack3. Using Base Standards profiles/archetypes/templates define the clinical statements4. The Patient Mandate is an integral part of Interoperability © ERS 2012
  • 45. Conclusions5. International co-operation is shaping up6. International, European and National/Regional Governance structures will be set up © ERS 2012