Implementation of a CEN/ISO 13606 Platform for Medicines Reconciliation

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Medicines reconciliation is a key process to improve health, welfare and patient security. It is also recognized that semantically interoperable systems based on the use of health standards is an adequate strategy to achieve a reliable medicines conciliation process. This paper describes a solution developed for medicines reconciliation at the Hospital de Fuenlabrada in Madrid. It is based on the use of a CEN/ISO 13606 based patient summary that is shared between primary care and the hospital center. The 13606 norm and archetypes were used to achieve the semantic interoperability of the clinical information together with SNOMED CT and the Spanish National Medication Database. This approach has showed that it is feasible to achieve a patient security improvement in an innovative and collaborative way.

Publication:
David Moner, Marta Terrón, Carlos Angulo, Luis Lechuga, Pablo Serrano, José Alberto Maldonado, Francisco J. Farfán, Montserrat Robles. "Implementation of a CEN/ISO 13606 platform for medicines reconciliation". XXIII International Conference of the European Federation for Medical Informatics (MIE 2011), Oslo

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Implementation of a CEN/ISO 13606 Platform for Medicines Reconciliation

  1. 1. Implementation of a CEN/ISO 13606 Platform for Medicines Reconciliation David Moner1, Marta Terrón2, Carlos Angulo1, Luis Lechuga2, Pablo Serrano2, José A. Maldonado1, Francisco J. Farfán2, and Montserrat Robles1 1 ITACA Institute, Universitat Politècnica de València, Spain 2 Hospital de Fuenlabrada, Madrid, Spain Contact: David Moner (damoca@upv.es) MIE 2011
  2. 2. Project description • Semantic interoperability must exist between all data sources. – The CEN/ISO 13606 norm and archetypes were used together with SNOMED CT and the Spanish National Medication Database. – The infrastructure is based on the use of the LinkEHR Normalization Platform. 2 Objective: To define and use a methodology and tools to guarantee medicines reconciliation between the Hospital de Fuenlabrada in Madrid and the primary care centres of its health area.
  3. 3. Medicines reconciliation • Medicines reconciliation is the process of evaluating the complete list of past and current medications of a patient to avoid medication errors. • It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. 3 • Up to 67% of patients' prescriptions histories have one or more errors. • Up to 46% of medication errors take place when new orders are written at transition points.
  4. 4. The CEN/ISO 13606 norm • The CEN/ISO 13606 norm for the Communication of the Electronic Health Record is the basis for health information systems semantic interoperability. 4 • It distinguishes two different models: - The Reference Model contains basic and generic entities to represent any kind of health information, together with context information. - Archetypes are formal definitions of domain concepts whose purpose is to provide a powerful, reusable and interoperable mechanism for the creation, description, validation and query of EHR information.
  5. 5. LinkEHR® Normalization Platform • The LinkEHR Normalization Platform facilitates the creation of normalized and federated views of clinical information which is distributed among heterogeneous health information systems. • LinkEHR is the only existing tool capable of handling archetypes as a data normalization mechanism. 5 www.linkehr.com
  6. 6. Architecture of the solution 6 LinkEHR Platform DATA NORMALIZATION DATA INTEGRATION NOMENCLATOR DIGITALIS LOGS ARCHETYPES INDEPENDENT WEB VIEWER HOSPITAL EHR (SELENE) Web Service The integrated and normalized view is offered through a web service interface to be used directly or to be integrated into other systems Primary care OMI-AP Hospital de Fuenlabrada FARMATOOLS SELENE Three basic steps: 1. Data integration 2. Archetype definition 3. Data normalization 1 2 3
  7. 7. Data integration 7 OMI-AP The primary care information system The hospital electronic health record system The hospital pharmacy information system Spanish National Medication Database SELENE FARMATOOLS Nomenclator The LinkEHR Integration Engine builds a virtual integrated XML view of all data of a patient existing in heterogeneous and distributed systems.
  8. 8. Archetype definition Knowledge sources Patient Summary specifications CKM archetypes Medication specifications Existing systems and clinical knowledge Defined archetypes Several CEN/ISO 13606 archetypes were defined using the LinkEHR Editor Medications Problems
  9. 9. Normalization 9 The tool generates an XQuery script that is able to transform the legacy data into CEN/ISO 13606 EHR extracts The LinkEHR Editor allows the specification of mappings and transformation rules between archetypes and data sources. MAP
  10. 10. Deployment • The LinkEHR Extract Server retrieves the integrated data, applies the normalization XQuery to it and offers the normalized XML documents through a web service interface. • This service was integrated into the hospital EHR system (Siemens Selene), providing access to the patient summary, including the medication list from both the hospital and the primary care centres. 10
  11. 11. Conclusions • We have demonstrated that CEN/ISO 13606 and the archetype methodology can be used in real environments. – Medicines reconciliation is a clear example that semantic interoperability technologies can highly improve the quality of care and patient security. • This project served as an introduction for several clinicians of a new way of using standards and semantic technologies. 11 This project has been financed in part by the Spanish Ministry Science and Innovation under Grant TIN2010-21388-C02-01, and by the Health Institute Carlos III through the RETICS Combiomed, RD07/0067/2001.
  12. 12. More info • You can see this technology working at MIE 2011 Workshop 14: “CEN/ISO 13606 Implementation and Communication of Health Information” • Tuesday, 30th August, 13:45 • Room N4 Christiania

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