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INTEROP19|
H E A L T H
I N T E R O P E R A B I L I T Y
S Y M P O S I U M 2 0 1 9
Pragmatic
standardisation of
clinical models
S i l j e L j o s l a n d B a k k e
2
Aboutme
• Silje Ljosland Bakke
• Registered nurse, health informatician
• Information architect @ Nasjonal IKT
• Board member & clinical co-lead @ openEHR
• @siljelb
3
“Pragmaticstandardisation”…? 🤔
Calvin and Hobbes by Bill Watterson for August 11, 1995
4
What’supin
Norway?
• Standardising clinical information
• Using openEHR
• Been at it since 2014
• arketyper.no is world leading
• Almost 600 participants
• Implementers closely involved
• Working closely with openEHR Clinical
5
Howdoyoumodel
the(clinical)world?
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
6
Principlesformodellingtheclinicalworld
• Clinical information models must be defined by healthcare professionals ⇒ There
must be a very low threshold to participate
• Healthcare changes all the time ⇒ Models must be changeable when needed
• Model content must be predictable ⇒ Tight governance is required
• Vendors and solutions come and go ⇒ Models must be independent of vendors
• Clinical modelling is difficult and expensive ⇒ Modelling must be done once and
shared freely
• Persistence and exchange must be based on identical models ⇒ Models must be
suitable for a variety of use cases
7
Thisrequirespragmaticstandardisation
• Gradually and step by step instead of all in one go
• Constant maintenance instead of 5 year revision cycles
• Careful selection of what to standardise and what not to
• Standardisation of one reusable concept is infinitely better
than no standardisation
8
Clinician
engagement
• Clinicians are busy
treating patients
• Traditional
standardisation
processes unsuitable
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
9
10
11
Sohowtoget
cliniciansengaged?
• Make participation
quick and easy
• Give them something
they want
• Seeing is believing
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
12
Howmuchshouldwe
standardise?
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
13
14
Whatmustbestandardised?
• Only information for reuse or sharing must be standardised
• If the information is only relevant within the context where
its originally recorded, the definition can be local
Misunderstanding alert!
Reuse or sharing does not necessarily imply exchange between solutions.
15
Threequestionsabouttheneedtostandardise
1. What kind of information is this, and what is its context?
2. Will the information be reused in a structured way within
the context where it was recorded?
3. Is it likely the information will be reused outside of the
context where it was recorded?
16
Example:
17
18
1. Cancer diagnosis w/ ICD-10 code, diagnostic certainty and
date of confirmation. Context: Cancer investigation and treatment
2. Yes, both for clinical and registry use
3. Yes, for example for CDS, analytics, or reimbursement
Answer: Should be standardised
19
1. TNM clinical classification 6th edition, primary tumour, colon
cancer. Context: Cancer investigation and treatment.
2. Yes, both for clinical and registry use
3. Perhaps?
Answer: Should be standardised if possible
20
1. Obscure registry specific questions about lymph node metastases,
no standardised codes, phrased as a questionnaire.
Context: Cancer registry
2. Yes, for registry use
3. Probably not
Answer: Choose your battles…
22
Whatifyouwanttostandardise,butrunoutof
time?
• Make sure there’s agreement on
a modelling pattern
• Agree on a standard way to
differentiate pre-standard from
standard models
• Next time, start modelling work
at an earlier stage? 😉
23
Structure isn’tNirvana
• Structured information isn’t a goal in itself
• Structuring should be done when it has
clear, identified value
• It must be possible to capture nuances using free text
• For some use cases, free text is adequate or better
24
Thanks for listening!
Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/

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Pragmatic standardisation of clinical models - Interop19

  • 1. 1 INTEROP19| H E A L T H I N T E R O P E R A B I L I T Y S Y M P O S I U M 2 0 1 9 Pragmatic standardisation of clinical models S i l j e L j o s l a n d B a k k e
  • 2. 2 Aboutme • Silje Ljosland Bakke • Registered nurse, health informatician • Information architect @ Nasjonal IKT • Board member & clinical co-lead @ openEHR • @siljelb
  • 3. 3 “Pragmaticstandardisation”…? 🤔 Calvin and Hobbes by Bill Watterson for August 11, 1995
  • 4. 4 What’supin Norway? • Standardising clinical information • Using openEHR • Been at it since 2014 • arketyper.no is world leading • Almost 600 participants • Implementers closely involved • Working closely with openEHR Clinical
  • 5. 5 Howdoyoumodel the(clinical)world? Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
  • 6. 6 Principlesformodellingtheclinicalworld • Clinical information models must be defined by healthcare professionals ⇒ There must be a very low threshold to participate • Healthcare changes all the time ⇒ Models must be changeable when needed • Model content must be predictable ⇒ Tight governance is required • Vendors and solutions come and go ⇒ Models must be independent of vendors • Clinical modelling is difficult and expensive ⇒ Modelling must be done once and shared freely • Persistence and exchange must be based on identical models ⇒ Models must be suitable for a variety of use cases
  • 7. 7 Thisrequirespragmaticstandardisation • Gradually and step by step instead of all in one go • Constant maintenance instead of 5 year revision cycles • Careful selection of what to standardise and what not to • Standardisation of one reusable concept is infinitely better than no standardisation
  • 8. 8 Clinician engagement • Clinicians are busy treating patients • Traditional standardisation processes unsuitable Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
  • 9. 9
  • 10. 10
  • 11. 11 Sohowtoget cliniciansengaged? • Make participation quick and easy • Give them something they want • Seeing is believing Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
  • 12. 12 Howmuchshouldwe standardise? Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/
  • 13. 13
  • 14. 14 Whatmustbestandardised? • Only information for reuse or sharing must be standardised • If the information is only relevant within the context where its originally recorded, the definition can be local Misunderstanding alert! Reuse or sharing does not necessarily imply exchange between solutions.
  • 15. 15 Threequestionsabouttheneedtostandardise 1. What kind of information is this, and what is its context? 2. Will the information be reused in a structured way within the context where it was recorded? 3. Is it likely the information will be reused outside of the context where it was recorded?
  • 17. 17
  • 18. 18 1. Cancer diagnosis w/ ICD-10 code, diagnostic certainty and date of confirmation. Context: Cancer investigation and treatment 2. Yes, both for clinical and registry use 3. Yes, for example for CDS, analytics, or reimbursement Answer: Should be standardised
  • 19. 19 1. TNM clinical classification 6th edition, primary tumour, colon cancer. Context: Cancer investigation and treatment. 2. Yes, both for clinical and registry use 3. Perhaps? Answer: Should be standardised if possible
  • 20. 20 1. Obscure registry specific questions about lymph node metastases, no standardised codes, phrased as a questionnaire. Context: Cancer registry 2. Yes, for registry use 3. Probably not Answer: Choose your battles…
  • 21. 22 Whatifyouwanttostandardise,butrunoutof time? • Make sure there’s agreement on a modelling pattern • Agree on a standard way to differentiate pre-standard from standard models • Next time, start modelling work at an earlier stage? 😉
  • 22. 23 Structure isn’tNirvana • Structured information isn’t a goal in itself • Structuring should be done when it has clear, identified value • It must be possible to capture nuances using free text • For some use cases, free text is adequate or better
  • 23. 24 Thanks for listening! Photo: Haukeland University Hospital https://www.flickr.com/people/haukeland/