Transcript Towards European Patient Summaries based on Triple Space

European Conference on eHealth 2006
October 12th-13th, 2006, Fribourg, Switzerland
Towards
European Patient Summaries
based on
Triple Space Computing
Dario Cerizza, Emanuele Della Valle, Doug Foxvog,
Reto Krummenacher, Martin Murth
www.tripcom.org
Dario Cerizza
Semantic Web Activities group
CEFRIEL – Politecnico di Milano
email: [email protected]
web: http://swa.cefriel.it
Outline

eHealth ongoing challenges





Current trends towards Triple Space Computing





© TripCom
Semantic Web technologies for semantic interoperability
Web Services technologies for message exchange
Tuple Space technologies for persistent publishing and retrieval
Triple Space Computing as a middleware for the European
Patient Summary
European Patient Summary


Interoperability and security for sharing clinical data
European strategies in eHealth
A Patient Summary at European level
Requirements for a supporting infrastructure
Emergency use case
TripCom project work plan
2
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
eHealth ongoing challenges

Integration problem in eHealth is more
complicated than in other sectors because

Very complex domain

Need to deal with the intensive use of knowledge




Privacy issues for the treatment of citizen data


Need to deal with security aspects
Life or Death implications

© TripCom
Archetypes of openEHR
Reference Information Model in HL7 v3
Medical terminologies: SNOMED, LOINC, ICD, UMLS, …
Heavy social and organizational impact
3
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
eHealth ongoing challenges
European strategies in eHealth
The ultimate goal is to facilitate the
pervasive delivery of healthcare
services at European level
Ilias Iakovidis (Deputy Head of Unit – ICT for Health, DG INFOSO, EC)
"European Commission activities in eHealth: The achievements and future
prospects." Med-e-Tel Luxembourg, April 5, 2006
© TripCom
4
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
eHealth ongoing challenges
European strategies in eHealth

The interest of European Commission on patient
summary is focusing on providing guidelines
for a European infrastructure for accessing
critical citizens’ health data

A patient summary is a concise clinical
document that makes citizens’ health data
available for


© TripCom
Unexpected contacts (emergency, …)
Shared clinical pathways (cross-organizational care
path, citizen movement, …)
5
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
eHealth ongoing challenges
A European Patient Summary (EPS)
It’s an infrastructure for a
patient summary
at European level
Hospitals,
clinics
Laboratories
General
Practitioners
Specialists
Researches
© TripCom
Citizens
Administrations,
Assurance companies
Ambulances
Home care
services
6
eHealth
Information
System
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
eHealth ongoing challenges
Requirements for such EU infrastructure

Multi-laterality


Subsidiarity



Assure EU citizens that only authorized care givers are able to
access their data
Reliable infrastructure

© TripCom
Have to be linguistically neutral by supporting the dealing with
the heterogeneity of medical coding systems
Privacy


Capable to cope with heterogeneity of data and application
among existing systems and eHealth standards
Enforce the ownership of patient data for each health authority
Multi-lingualism


Virtual common infrastructure to support communication among
healthcare parties distributed over Europe
Enable access to citizens’ health data anytime and anywhere
7
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Current trends towards Triple Space Computing
Semantic Web Technology

The proposals for eHealth standards similarly address
interoperability by:





This is very similar to the Semantic Web approach in
which semantic interoperability is achieved by


© TripCom
Defining a shared conceptual model
Deriving message structure from such conceptual model
Coding the information carried by messages using medical
terminologies (e.g., LOINC, SNOMED, ICD, UMLS, etc.)
Binding the resulting messages to “the technology of the day”
meaning EDI in the ’90s, XML and Web Services today
modelling the domain knowledge at conceptual level
interconnect applications using the modelled concepts
8
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Current trends towards Triple Space Computing
Web Services Technology

Web Services technologies (WSDL, SOAP,
UDDI, …) are a promising technology for
message exchange over the Web

But they mainly use synchronous message
exchange over Web protocols


How did the Web revolutionize human
communication?

© TripCom
Process and application integration is inflexible
By persistent publication of information and
search information published by others
9
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Current trends towards Triple Space Computing
Tuple Space Technology

Asynchronous communications by



Decoupling information exchange:



© TripCom
Persistent publication in a shared space
No need of a single central coordinator
Communication is asynchronous since the space
guarantees persistent storage of data  decoupled
in time
The processes run in completely different
computational environments  decoupled in space
Processes do not need to address their
communication partner  decoupled in reference
10
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Current trends towards Triple Space Computing
The publishing paradigm for the machine net
Message
Publishing
Email
Web
Human net
Triple Space
Machine net
So-called
Web
Services
"Triple Space Communication will change the Internet usage
through computers just as the Web revolutionized the Internet
usage through humans“
--- D. Fensel
© TripCom
11
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Triple Space Computing vision
Tuple Space
Technology
Semantic Web
Technology
Web Service
Technology
(Triple + Ontologies)
Triple Space Computing (TSC)
© TripCom
12
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Triple Space Computing capabilities

Decentralization and Distribution




Support for asynchronous interactions


Use semantic interoperability to cope with heterogeneity among
eHealth systems
Security and Trust mechanisms

© TripCom
Decouple interactions in time, location and reference among
healthcare institutions
Data and application interoperability


Each healthcare party provides a node of the shared space
Healthcare parties can communicate by publishing and
retrieving patient information in the shared triple space
Ensure a good level of fault-tolerance
Comply with the privacy regulations for the treatment of citizens’
data
13
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Triple Space Computing as a middleware
for the European Patient Summary

TSC infrastructure can address the requirements
of the EPS
EPS requirements

© TripCom
TSC capabilities
Multi-laterality
Decentralization and Distribution
Subsidiarity
Data and application interoperability
Decentralization and Distribution
Multi-lingualism
Data interoperability
Privacy
Security mechanisms
Reliability
Decentralization and Distribution
Asynchronous interactions
The EPS over TSC enables asynchronous,
reliable and meaningful communication among
heterogeneous eHealth systems
14
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
European Patient Summary Use Case
An English citizen
asks his General
Practitioner to
initialize his
summary in the
EPS
The GP publishes
the citizen’s clinical
information into the
EPS through the
electronic Health
Record
C
GP
Allergies (Morphine)
Immunizations (Tetanus)
Diseases (Calcium Deficiency)
…
Allergy to Morphine UMLS C0026459
Immunization to Tetanus Medline Plus 615
Calcium Deficiency UMLS C0020598
C = Citizen
GP = General Practitioner
© TripCom
15
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
European Patient Summary use case
Emergency care path
Hydrocodone
Paracetamol!
Medical benefits
•Language
comprehension
C
•Privacy respect
• Allergisch
•Avoidance of
gegen
Paracetamol
Morphium APRD00252 administering a
• Paracetamol
R
wrong
drug
?
…
TSC capabilities
C = Citizen
R = Rescuer
© TripCom
Allergisch gegen Morphium APRD00215
16
•Data
interoperability
•Application
interoperability
•Security
•Time & Location
autonomy
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
European Patient Summary use case
Emergency care path
Medical benefits
•Awareness of
patient clinical
situation
•Support for
interactions
•Privacy compliancy
…
R
C
• Allergico a Morfina
• Antitetanica
• Paracetamolo
Allergico a Morfina CAS 57-27-2
Antitetanica ICD A33
Paracetamolo CAS 103-90-2
C = Citizen
R = Rescuer
A = Ambulance doctor
© TripCom
17
TSC capabilities
•Data
interoperability
•Application
interoperability
•Time & Location
autonomy
•Security
•Asynchronous
interactions
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
European Patient Summary use case
Emergency care path
Medical benefits
C
• Allergico a Morfina
• Antitetanica
• Paracetamolo
• Carenza di Calcio
E
•Awareness of
patient clinical
situation
•Privacy compliancy
•Forestall
acceptance
•More efficient
treatment
TSC capabilities
C
Allergico a Morfina CAS 57-27-2
Antitetanica ICD Y58.4
C = Citizen
Paracetamolo CAS 103-90-2
A = Ambulance doctor Carenza di Calcio ICD E58
E = Emergency doctor
© TripCom
18
•Data
interoperability
•Application
interoperability
•Time & Location
autonomy
•Security
•Coordination
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
European Patient Summary use case
Semantic Interoperability in the TSC
Scenario actions
GP
A
Allergy to Morphine UMLS C0026459
Immunization to Tetanus MedLine Plus 615
Calcium Deficiency UMLS C0020598
Mobile
App.
EHR
• GP publishes the
summary of a citizen
using ICD, UMLS and
Medline Plus in a CEN
message
• A gets some
information about the
same patient, using
CAS and ICD in an
EHR message
TS details
Allergico a Morfina CAS 57-27-2
Antitetanica
Adapt ICD A33• TS manages all the
information that refers
Carenza di Calcio ICD E58
Adapt
to all different medical
coding systems
• TS treats the
mappings among all
medical coding
systems and message
structures
TS
© TripCom
19
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
TripCom project work plan
April 2006

Project start
December 2006

Detailed definition of the European Patient Summary
scenario
February 2008

First Prototype of the European Patient Summary over
Triple Space Computing
March 2009

© TripCom
Final Prototype of the European Patient Summary over
Triple Space Computing
20
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Conclusion

The European Patient Summary is a first step
towards a network of complementary healthcare
centres

Such eHealth scenario emphasizes the needs of:




Interoperability among heterogeneous systems
Coordination among multiple and different actors
Time and Location autonomy
Privacy for the treatment of data

TSC can be a suitable middleware for the EPS
and it can be also a new technology to
accomplish European challenges in eHealth
© TripCom
21
Sixth Framework Programme Priority 2
Information Society Technologies (IST)
Specific Targeted Research Project
Thank you very much for your
attention
Any question?
www.tripcom.org
This work is partially funded by the European Commission under the projects:
TRIPCOM (IST-FP6-4-027324) Specific Targeted Research Project
COCOON (IST-FP6-507126) Integrated Project
and the Austrian funded FITIT project TSC (809249)