BEYOND TECHNICAL
INTEROPERABILITY
  The Spanish experience


                  Javier Etreros / Icíar Abad
               ...
THE SPANISH NHS

                                        17 Autonomous
                                        Communities...
THE SPANISH NHS




Start point
THE SPANISH NHS


      UNEQUIVOCAL IDENTIFICATION


Each region includes its users in their regional DB.
All Regional DBs...
THE SPANISH NHS
THE PRAGMATIC APPROACH: First step

                          To Access to the full Electronic
       NOT
...
ELECTRONIC
                      HEALTH RECORD




                      ALLERGIES
                      CURRENT PROBLEMS
...
INTEROPERABILITY STRATEGY

Semantic dimension: to make information
understandable by any organization and in
any language ...
CURRENT WORK

Interoperability
    strategy                    DECISION
                               TERRITORIAL        ...
INTEROPERABILITY STRATEGY

                A 3 year specific ROADMAP was define to reach the
ROADMAP          objectives
...
INTEROPERABILITY STRATEGY

                                                 Report on the
Short-term




                 ...
CURRENT WORK

NEW STRATEGIES in the EHR within NHS




           MAPPING AND TRANSLATION TOOLS
INTEROPERABILITY STRATEGY
                                        308.000 active concept
   Snomed CT                     ...
CURRENT WORK
SNOMED CT: a multilingual terminology

               417312002                 417312002                    ...
CURRENT WORK




 International
Core (Snomed)
CURRENT WORK

                                              Subconjunto
                                              ALER...
THANKS
FOR YOUR
ATTENTION
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Interoperability in a Highly Decentralised Country- Lessons Learned

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Interoperability in a Highly Decentralised Country- Lessons Learned. Abad I. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Interoperability in a Highly Decentralised Country- Lessons Learned

  1. 1. BEYOND TECHNICAL INTEROPERABILITY The Spanish experience Javier Etreros / Icíar Abad Sanitary Information Institute Quality agency Ministtry of Health and Social Policy
  2. 2. THE SPANISH NHS 17 Autonomous Communities 2 Autonomous Cities (Ceuta y Melilla) Languages: Spanish plus 3 more languages, co-oficial languages. DECENTRALISED: transfer of care 1981-2001
  3. 3. THE SPANISH NHS Start point
  4. 4. THE SPANISH NHS UNEQUIVOCAL IDENTIFICATION Each region includes its users in their regional DB. All Regional DBs are connected at a national level. Region There is a single national code for each user al DB1 Region al DB2 NHS DB Region (Within al DB3 NCP)
  5. 5. THE SPANISH NHS THE PRAGMATIC APPROACH: First step To Access to the full Electronic NOT Health Record YES Sets of relevant clinical data to be share: > 30 scientific societies + autonomous communities Discharge report Specialised surgery report PATIENT SUMMARY Emergency Room report Primary care report Laboratory report Imaging report & Imaging Nurse care report
  6. 6. ELECTRONIC HEALTH RECORD ALLERGIES CURRENT PROBLEMS PATIENT SUMMARY IMMUNIZATIONS TREATMENT Patient Summary (PS)
  7. 7. INTEROPERABILITY STRATEGY Semantic dimension: to make information understandable by any organization and in any language with the level needed to take clinical decisions that affects people’s health ¿?
  8. 8. CURRENT WORK Interoperability strategy DECISION TERRITORIAL Decision BOARD EXPERT GROUP Semantic interoperability Consultancy EXPERT GROUP Technical interoperability PILOT Execution
  9. 9. INTEROPERABILITY STRATEGY  A 3 year specific ROADMAP was define to reach the ROADMAP objectives  Seek for short-term solutions regarding semantic interoperability of the Patient Summary. Objectives  Recommendations about the standards that should be adopted as a long-term solution to reach semantic interoperability in the EHRNHS project.  SNOMED-CT terminology for variables without standardization in the Patient Summary and as a Main necessary step to reach complete interoperability in the Agreements long term scenario.  Follow up of reference models (EHRNHS).
  10. 10. INTEROPERABILITY STRATEGY Report on the Short-term EHRNHS requirements 1 2 Inventory of Health Terminology TRAINING Medium-term 6 3 Subset priority 4 OID´s Reference model 5 Mapping and translation tools 7 IDENTIFICATION OF FUNCTIONAL NEEDS Long-term TO CREATE A NATIONAL SEMANTIC SERVICES SYSTEM 8 Coordination of different national extensions
  11. 11. CURRENT WORK NEW STRATEGIES in the EHR within NHS MAPPING AND TRANSLATION TOOLS
  12. 12. INTEROPERABILITY STRATEGY 308.000 active concept Snomed CT 791.000 descriptions 951.000 relaciones Spain joins IHTSDO in 2009, to develop SNOMED-CT as the clinical terminology of reference within the health records. PATIENT SUMMARY SUBSETS: VACCINATIONS ALLERGIES PROBLEM LIST MEDICINES NURSE CARE CROSS-MAPPING WITH THE EXISTING TERMINOLOGIES: ICD, ICPC, NANADA-NIC-NOC, Snomed for Anatomic pathology.
  13. 13. CURRENT WORK SNOMED CT: a multilingual terminology 417312002 417312002 417312002 Suspected hypertension Sospecha de hipertensión Misstänkt hypertoni Sospecha de hipertensión. 417312002 Sospecha de hipertensión Nacional Sospita d´hipertensió Version of Hipertesioz goganbehartzen Snomed CT Sospeita de hipertensión 417312002 417312002 417312002 Sospita d´hipertensió Sospecha de hipertensión Sospeita de hipertensión
  14. 14. CURRENT WORK International Core (Snomed)
  15. 15. CURRENT WORK Subconjunto ALERGIAS PERFILES PROFESIONALES Médico de familia Especialista/s en Especialista/s en Especialista/s en con ejercicio en Medicina de Urgencias Dermatología Alergología Farmacología Clínica Atención Primaria Revisión Herramienta de Discusión trabajo en grupo Validación Tiempo estimado de trabajo del Grupo: 2 ó 3 meses Subconjunto alergias VALIDADO (extensión es-ES)
  16. 16. THANKS FOR YOUR ATTENTION

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