Transcript EFMI-DavidMoner

CEN EN13606 Normalisation Framework
Implementation Experiences
David Moner1, José A. Maldonado1, Diego Boscá1, Carlos
Angulo1,Montserrat Robles1, Daniel Pérez2 and Pablo Serrano3
1 IBIME group, ITACA Institute, Universidad Politécnica de Valencia
2 Hospital General Universitario de Valencia, Valencia, Spain
3 Hospital de Fuenlabrada, Madrid, Spain
Contents
• Semantic interoperability of clinical data
• The LinkEHR Normalisation Platform
• Implementation experiences
• Discussion and conclusions
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Semantic interoperability of
clinical data
• Our objective: the semantic interoperability of
clinical information.
And all the information
we would like to include
Alerts
Current history
Past history
Medications
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Semantic interoperability of
clinical data
• Semantic interoperability requires:
A standard
labelling and
structure for data
A high-level definition
of clinical concepts
Reference Model
Archetype model
A semantic
description of
clinical concepts
Terminologies
and Ontologies
ISO/CEN EN13606
The standard for the communication and
semantic interoperability of health information
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The LinkEHR normalisation
platform
• LinkEHR-Ed is a tool for:
– Defining archetypes based on any reference model.
– Normalise legacy data into standard documents.
• But LinkEHR-Ed is just one part of a bigger
system: the LinkEHR Normalisation Platform.
• This platform allows to reach the semantic
interoperability of the EHR of a patient whose data
are distributed among heterogeneous HIS.
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EFMI STC 2010
Standardized and flexible health data management
with an archetype driven EHR system (EHRflex)
EFMI STC 2010
LinkEHR-Ed: A tool for the description and normalization
of legacy clinical data
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Implementation experiences
• The LinkEHR Normalisation Platform is
being used at the three steps towards the
semantic interoperability of existing EHR
systems:
1. Definition of clinical archetypes.
2. Normalisation of legacy EHR systems.
3. Communication of EHR extracts.
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Implementation experiences
1. Definition of archetypes
• Hospital de Fuenlabrada (Madrid)
– Use of EN13606 archetypes for pressure
ulcer nursing control.
• The archetype creation methodology was
evaluated.
• Both reference models were compared and tested.
http://www.revistaesalud.com/index.php/revistaesalud/article/view/308/641
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Implementation experiences
1. Definition of archetypes
• European Patient Smart Open Services
(epSOS)
– EN13606 implementation specifications have
been developed following the agreed epSOS
data sets: Patient Summary, ePrescription
and eDispensation.
– EN13606 archetypes have been implemented
following those specifications.
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Implementation experiences
1. Definition of archetypes
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Implementation experiences
2. Normalisation of data
• Hospital General Universitario de Valencia
– LinkEHR Integration Engine implementation for over 6
years
• Integration of distributed data sources (more than 20
databases).
• Virtual Federated EHR viewer for all the organisation (~1000
health professionals, ~500,000 patients)
– Full migration to EN13606 EHR Extracts in development
using the LinkEHR Normalisation Platform.
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Implementation experiences
2. Normalisation of data
• Hospital de Fuenlabrada (Madrid)
– Use of EN13606 for medication conciliation
between primary and specialised care.
• Agreed definition of a primary-care patient
summary archetype.
• Communication of normalised legacy data to
support patient transitions between primary care
and the hospital.
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Implementation experiences
3. EHR extracts
• The semantic interoperability of the Patient
Summary is being tested between the Hospital
General Universitario in Valencia (HGUV) and
the Hospital de Fuenlabrada in Madrid.
– Based both on the Spanish and epSOS definition of
the contents of the Patient Summary.
– The information is communicated using the CEN
EN13606 norm.
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Implementation experiences
3. EHR extracts
1. Agree a concept definition and define the archetype
•
We have used two different definitions
–
–
•
Spanish National Patient Summary
epSOS Patient Summary
They can be easily edited or modified
with open source archetype editors like
LinkEHR-Ed
http://www.linkehr.com
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Implementation experiences
3. EHR extracts
2. Map the archetype to original/legacy data
•
With these mappings we can
automatically generate transformation
programs for the EHR system.
Existing
EHR systems
XML
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Implementation experiences
3. EHR extracts
3. Deploy the transformation program in the EHR server
•
Set up a standard EN13606 extract server in both hospitals to
generate and communicate the standardized information
–
Transformation is applied on demand
–
Web-service based
–
Includes a standard EN13606 web viewer
Mapped
Archetype
HF
HIS
EHR
Server
Mapped
Archetype
EN13606
XML Standard
Information
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EHR
Server
CHGUV
HIS
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Implementation experiences
3. EHR extracts
• The project was developed in July 2009.
• The archetype definition took approx. 4h
• The archetype mapping and generation of
EN13606 standardized data, just one day.
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Discussion and conclusions
• EN13606 strengths:
– Flexibility of the norm to represent all types of clinical
data. It does not impose technical limitations for this.
– Seamless transition of existing systems to the
EN13606 norm.
– Archetypes are easily developed and understood by
health professionals.
– There already exist tools that can help in this duty.
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Discussion and conclusions
• EN13606 weaknesses:
– Lack of previous implementation experiences.
– Lack of methodologies for developing
archetypes.
– Lack of support from a community of users.
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Discussion and conclusions
• We have launched an open web page for
the community of developers and adopters
of the EN13606 norm.
http://www.en13606.eu
• In the next months an open international
association for the management and
evolution of the EN13606 will be created.
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Thank you for your attention!
CEN EN13606 Normalisation Framework
Implementation Experiences
David Moner
[email protected]
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