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eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Extending “Certification of
Electronic Health Records”
at a Pan-European Level
(Prague, 19 February 2009)
Georges De Moor, MD, PhD
Gent University, Gent, Belgium
EuroRec President
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Electronic Health Records (EHR)
All stakeholders across the EU have recognized that
the Electronic Health Record is:
-a key tool in the provision of safe, high quality and
effective care ;
-and a critical factor for clinical research .
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec
(http://www.eurorec.org )
• The « European Institute for Health Records »
• A European not-for-profit organisation (April 16, 2003)
• Mission: the promotion of high quality Electronic Health
Record systems (EHRs) in Europe
• Federation of National ProRec Centres (incl. all types of
stakeholders)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Established ProRec Centers
Austria
Belgium
Bulgaria
Denmark
France
Italy
Germany
Ireland
Romania
Slovenia
Spain
Slovakia
Serbia
The Netherlands
United Kingdom
New applicants:
Cyprus
Greece
Hungary
Norway
Poland
Portugal
Sweden
“ Differences in languages, cultures and HC-delivery/funding systems ”
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Contacts and Liaison
DG INFSO
BT and TC 251
TC 215
IHTSDO
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Trends in Health Systems
The Old World
The New World
Provider-focused
Patient and family-focused
Illness
Wellness
Site-of-care
Continuum of care
Episode Management
Disease Management
Supply Management
Demand Management
Solitary Decision Making
Collaborative,
evidence-based decisions
Efficiency
General care
Effectiveness
Specialized care
(from UHN, Toronto)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Trends in eHealth systems
• Patient-centered
(gatekeeper?)
and longitudinal (life-long) records
• Multi-disciplinary / multi-professional
• Transmural and virtual
• Structured and coded (cf. semantic interoperability)
• Intelligent (cf. decision support)
• More sensitive content (e.g. genetic data)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
The eHealth Contexts
In Health and eHealth, the data are delivered from multiple
sources using many different communication channels.
The data may be used by different types of users for different
purposes (e.g.: care, research, management…).
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EHR systems
« The boundaries between EHR systems are fading away… »
Settings: primary care, acute hospital care, tertiary care, …
Content: summary records, emergency records, discharge records, …
Approach: problem-oriented, care pathway-, clinical pathway-oriented, …
Context: prevention, diagnostic, therapeutic (care & cure), monitoring,
palliation (or combination), research, …
Author: medical record (EMR), nursing record, administrative record,
patient personal health record (PHR)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
eHealth Stakeholders
Clinicians:
care… (access to medical records, e-prescription, care pathways…
administrative simplifications !…)
Researchers:
clinical trials, disease management studies,
post-marketing surveillance, health economics…
Health Authorities:
pharmacovigilance, healthcare management,
quality assessment, utilisation review…
Data-brokers & industry:
Third Party Payers:
research, marketing, promotion…
billing, reimbursement…
Academics:
education…
IT-vendors:
software development
Regulators:
legislation
Patients:
their role in the future…?
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Secondary use of (medical) data
Patient
Clinician
TRUST
EHR (EMR, EPR…)
PHR
Privacy Enhancing Techniques
Clinical Trials
& Research
Billing
Safety and
Adverse
Event
Registers
Prof. Dr. Georges De Moor, MD, PhD
Knowledge
Mgmt
Platforms
Marketing
Decision
Support
Systems
Healthcare
Management
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec: History of EC Projects
- MediRec (1994-95), Medical Records and Quality
- ProRec (1996-98), Promotion Strategy for EHRs in Europe
- Widenet (2000-03), Establishing EuroRec’s Network
- RIDE (2008-10), Semantic Interoperability (partner)
- EHR-Implement (2008-10), Political, Social and Economical aspects
when implementing national EHRs systems
- QREC (2006-08), Quality Labeling and Certification of EHRs in Europe
- EHR-Q-TN (2009-2011), Thematic Network
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
The QREC project: Main Objective
To develop formal methods and to create a mechanism
for the quality labelling and certification of EHR systems
in Europe (in primary- and in acute hospital-care settings)
EuroRec Institute was coordinating partner
QREC had 12 partners and 2 subcontractors
Project duration was 30 months (1/1/2006-30/6/2008)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Q-REC Rationale (Why Certification is Essential)
- To assure the quality of EHR systems: patient safety
- Sharing of information requires a quality assessment of EHR products
with a view to ensuring interoperability with other systems
- Certification of EHRs is essential for both the buyers and the suppliers
to ensure that EHR systems are robust enough to deliver the anticipated
benefits.
(EHR systems and related product quality - data portability and interoperabilityare difficult to judge!)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
QREC: ORIGIN
Several EU-member states (Belgium, Denmark, UK, Ireland,France
…) have already proceeded since many years with (EHRs-) quality
labelling and/or certification (more often in primary care) but these
differ in scope, in legal framework under which they operate, in
policies and organisation, and perhaps most importantly in the
quality and conformance criteria used for benchmarking …
These differences represent a richness but also a risk: harmonisation
efforts should help to avoid further market fragmentation in Europe
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec’s Central Repository and Tools
EuroRec has installed a central repository of « validated » quality
criteria and other relevant materials and has developed tools that can
be used to harmonise quality labelling, product documentation and
procurement specification of EHR systems.
EuroRec will not impose particular certification models or specific
criteria on any member country but wishes to foster, via authorized
channels, the progressive adoption of consistent and comparable
approaches to EHR system quality labelling. EuroRec should be
considered as a service provider.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EHRs Quality Criteria: just a few Business Cases
• An e-Health programme wishing to implement quality labelling or
certification as to ensure consistent EHR system functionality
regionally or nationally
• A purchaser wishing to procure an EHR system module
• A vendor/developer wishing to document his system or to (re-)
develop an EHR system module or wishing to interface a given
module of his system across multi-vendor systems
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Benefits for the Stakeholders
Industry
Market ( R.O.I.)
EHRs - Quality Labelling / Certification
Quality and Safety
Efficiency of HC Delivery Systems
Health Services Management
Patients, Clinicians
Public Health
Prof. Dr. Georges De Moor, MD, PhD
Health Authorities
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
A growing number of strategic eHealth projects
Are or become certification dependent, e.g.:
•
•
•
•
•
•
•
•
Administrative simplification
Electronic billing
Care pathways and disease management projects
Electronic prescription
Interaction with validated databases
Secure medical data exchange (summary records!)
Interoperability, operability and portability
...
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Certification: a powerful weapon…
New instruments
Authority
4
New functions
3
Physicians
1
€
Vendors
2
Pressure
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
How to Manage Certification?
EuroRec has Multiple Options:
1. Authority: Government (or mandated subcontr.) vs. Non Gov.
2. Self-certification by Industry (also an option!)
3. National based vs. Pan European (or joint, cf. specific/generic)
4. Mandatory vs. voluntary (with or without incentives)
5. Formal audit/testing vs. self-assessment (or pre-test assessment)
6. Scoring/rating scheme: pass/fail or more graded approach
7. Scheme review rate (1,2,…n year cycles)
8. Quality Assurance vs. Quality Improvement focus
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec’s Workflow
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Typology of EHR System Statements
• Source Statements/ Referenced Statements (RS)
– faithfully extracted from existing original EHR system
specifications and test plans
– translated if necessary
• Fine Grained Statements (FGS) (at present: n>1500)
– usually derived from source statements
– made more generic, decomposed, reworded, corrected
• Good Practice Requirements (GPR) (n~150)
– recomposed from FGS into the more common useful building
blocks
– may enhance or extend the scope of FGS: “push the boat out
a bit”
• Generic Test Criteria
– derived from FGS and/or GPR
– formally worded as testable functions
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Methodology for the Repository Design
1.
2.
3.
4.
5.
Typology of EHR system statements (the quality criteria)
Generic information model for the repository
Design of indices (indexing system, ontology)
Planning of the repository management workflow
Design of web-based user interface requirements
•
Review of other relevant work of this kind
– e.g. HL7, CCHIT, ISO TC/215, academic work
Learning from early iterations of statement classification
Testing of the pilot repository
•
•
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Typology of Indexes
Multiple indexing of each statement to maximise the likelihood of finding
all relevant statements when searching via the indices
Business Functions (50 in 8 subcategories)
Care Settings (18 in 3 subcategories)
Component Types (18 in 4 subcategories)
•A0 EHR data (record) management
•A2 Administrative services
•A00 EHR data entry
•A20 Appointments and scheduling
•A01 EHR data analysis
•A21 Patient consents, authorisations, directives
•A02 EHR data content
•A22 Patient demographic services
•A03 EHR data structure
•A23 Certificates and related reporting services
•A04 EHR data display
•A24 Patient financial and insurance services
•A05 EHR data export/import
•A3 Care Supportive services
•A09 EHR generic data attributes
•A30 Supportive care service requests (orders)
•A1 Clinical functions
Business
Functions
service
reporting
(results)
Health
care enterprises
•B0 Generic or ubiquitous •A31 Supportive care•B1
•C3
Directory services
•C0 EHRS functional component
•A10 Clinical: medication management
•A32
Laboratory
services
•B10 Long-term care
(institution)
•B01 Regional healthcare network
•C30
Directory: patients
•C1
EHRS distribution)
infrastructure component
(specific
•A11 Clinical: long-term illness management
•A33 Imaging services•B11 General practice
•C31 Directory: personnel
•C10 EHRS Interoperability component
•B02 Virtual or telehealth
•A12 Clinical: health needs assessment
•A34 Diagnostic and therapeutic
services
(other):
•B12 Secondary
care
•C32(hospital)
Directory: equipment
ECG/EEG etc.
•C11
Security
management
component
Personal health
•A13 Clinical: care planning and care•B03
pathways
•B13
Tertiary
care
centre
(specialist
hospital)
•C33
Directory:
health
service directories
•A35 Pharmacy services
•A14 shared care
•B04 Community •C2
and Knowledge
home care resources
•B14 Domain specific
•C34 Directory: service resources
•A4 Analysis
and reporting
•C20 Knowledge:
terminology
•A15 Clinical: alerts, reminders and •B05
decision
support
Health,
wellness
and prevention
•B15
Profession
specific
•C35 Third parties
•A40 Screening
•C21
Knowledge:
ontology and preventive health
•A16 Clinical: workflow and task management
•B06 Occupational
health
•B2 Secondary uses
•C4 Profiling or authoring tool
•A41 Care
setting reports
•C22 Knowledge:
archetype
•A17 Clinical: patient screening and •B07
preventive
services
Publiccare
health
•B20 Research and
knowledge
discovery
•C5
Documentation,
support etc.
•C23 Knowledge: template
Care Settings
Component Types
Prof. Dr. Georges De Moor, MD, PhD
•C24 Knowledge: data set
•C25 Knowledge: guideline
•B21 Education •C6 EHR system functional component
•B22 Health service and planning
•C26 Knowledge: algorithm
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Good Practice Requirements - Links
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec Languages
(non-exhaustive list)
• English (default language)
• Bulgarian
• Danish
• Dutch
• French
• German
• Italian
• Romanian
• Slovakian
• Slovenian
• Serbian
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec Use Tools
The EuroRec Composer ™
To compose user defined, re-usable and exchangeable baskets of Fine Grained
Statements.
The EuroRec Certifier ™
To format a EuroRec Basket content to obtain the basic layer for the certification of
EHR systems. This is done by adding structure and attributes to the selected Fine
Grained Statements (e.g. mandatory, optional...)
The EuroRec Documenter ™
To document EHR systems and their functions, enhancing their understanding and
comparability by using the EuroRec statements.
The EuroRec Procurer ™
To list and describe, for purchase purposes, required functionalities and product
characteristics using EuroRec statements.
The EuroRec Scripter ™
To produce and link Test Scenarios to EuroRec Baskets for Certification,
Documentation and/or Procurement purposes.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec stakeholders
(Users of the EuroRec tools)
• National or Regional Healthcare Authorities (quality labelling)
• EHR System providers (self assessment/ product documentation)
• Health IT purchasers (procurement)
• Health IT professional users
• Health IT research and education
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec
Baskets
Certifier
Composer
Procurer
Documenter
Certification
Documentation
EuroRec
Repository
of
Statements
Procurement
Test
Criteria
Sets
Scripter
Test
Scenarios
Test
Procedures
EuroRec Use Tools
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EuroRec at your Service !
1. Developing & maintaining a central repository with quality criteria
2. Developing tools: certification, procurement and product doc.
3. Providing guidance and assistance to all stakeholders
4. Assisting Authorities in introducing / adopting certification
5. Training and accreditation of surveyors (European level)
6. Set-up of certification session (incl. scenario
scripting/operations)
7. Validation of clinical archetypes (clinical models)
8. Continous & total Q.A. of processes and procedures
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Certification – Step 1
• Agree - as authority - with the users and suppliers what
should be certified.
• Select appropriate criteria to be validated during a
particular certification session:
– initial certification might be comprehensive;
– but is later often limited to specific (new/changed)
functions.
• Use the Indexes and Good Practice Requirements as
filters.
• If needed, complete the set with new statements (and
send to the EuroRec repository).
• Result => Basket of Fine Grained Statements
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Certification – Step 2
• Structure the Basket:
– Order
– Grouping in subsets
• Define:
– Essential (mandatory) criteria
– Optional criteria
– Criteria “for later”
• Assign weights to individual criteria and/or subsets
• Produce certification documentation (for the suppliers &
users)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Certification – Step 3
• Define test scripts
• Link to each script a number of FGS / criteria that will be
validated by that script
• Combine scripts in a test scenario
• Link one or more test scenarios to a certification session
• Produce certification forms (to be completed during a
certification session…)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
13 mei 2008
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Unveiling the EuroRec Seal
• To have a “base” level set of functions
that can be accredited across Europe.
• This will greatly appeal to the supplier industry and allow for
more early stage accreditation of systems across national
boundaries.
• Harmonisation of the certification will favour harmonisation of
products.
• Develop a strong, growing and profitable EHR supplier industry
that can be competitive globally.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Content of the Seal (1)
• Not all EHR functions can - at present - be harmonised
across the European Community:
– Specific regulations (incl. HC reimbursement systems);
– Linguistic and cultural issues;
– Differences in available services (e.g. drug- and other
databases in use);
– Even sometimes different options regarding evidence
based medicine (EBM) issues ! (cf. decision support
modules).
• First versions of the EuroRec seal & criteria will therefore
mainly focus on what is really essential and thus be related
to “generic” aspects, e.g. “the trustworthiness of the
content of an EHR”.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Content of the Seal (2)
• The first set of selected criteria will:
– not be too specific, e.g not related to very particular
functions;
– correspond with what is considered essential (e.g.
security, medication management, ....)
• Fair chance that a large number of existing EHR products
will conform to the chosen criteria.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
The GPR with most selected FGS
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
EHR-Q-TN: EuroRec’s new Project
Thematic Network on Quality Labelling and
Certification of EHR Systems (2009-2011)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Beneficiaries
United Kingdom
Austria
Belgium
Spain
Bulgaria
Slovenia
Croatia
Slovakia
Cyprus
Serbia
Czech Republic
Romania
Portugal
Denmark
28 Partners
Poland
Estonia
25 Countries
Norway
France
Germany
Netherlands
Luxembourg
Greece
Italy
Hungary
Ireland
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Objectives of the EHR Q Thematic Network
1.
2.
3.
4.
5.
6.
7.
Validate and Customise the EuroRec criteria on eprescription and patient summaries in 24 countries
Database of stakeholders (incl. EHRs vendors)
Inventory of legal issues
Local coordination & education
Annual EHR-QTN International Conferences
Five Regional EHR-QTN Conferences EHR-QTN
(Mediteranian, Eastern, Central, Western and Nordic
regions)
In each country one workshop every year on:
•
Validation of EuroRec Repository (Y1)
•
Tools for certification, product documentation &
procurement (Y2)
•
Procedures for EHR Quality Labelling and Certification
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Other EuroRec Activities and Services
1. An Inventory of Certification Criteria for EHR systems
2. An Inventory of Standards relevant for EHR systems
3. EHR Archetype validation
4. Open Source Components and XML Schemas
5. EHR Tutorials
6. Register of Health Coding Systems in use in Europe
7. Events
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
The EuroRec Institute is partnering the openEHR Foundation in
developing governance practices for archetype development, and
the quality criteria and editorial policies by which certified libraries
of archetypes can be recognised. As part of the quality labelling and
certification of EHR-systems, it may take joint responsibility for the
governance of archetypes and templates alongside the openEHR
Foundation.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
What is a Clinical Archetype
A clinical archetype is an agreed, formal and
interoperable specification
for representing a given clinical entity such as a
clinical observation, a finding, a plan or a treatment
within an electronic health record
•
•
•
•
invented and maintained by openEHR
ratified by CEN: EN 13606 Part 2
being balloted by ISO
to be quality labelled by EuroRec
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Patient safety management and the pursuit of evidence based care
require computable information that can be linked to and queried by
alerting components, decision support and clinical pathway systems.
The efficient management of health services and the support of
public health and clinical research through audits and population
analyses also require EHRs that can semantically be processed. All
these purposes of use ideally require that the clinical findings within
EHRs are represented and organised consistently across vendor
products and communities of use: semantic interoperability.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
openEHR Semantic architecture
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
When authoring an archetype, additional details need to be
provided about each node such as the number of occurrences that
are permitted within instances of EHR data, the terminology
values that may be used, numeric ranges and measurement units.
Schematic diagram of an archetype for adverse reaction (to medication)
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Messages: “an older way to support semantic interoperability”
• Enterprise viewpoint will contain the use case, i.e. the standardised
work process;
• Information viewpoint contains the Message Information Model;
• Computational viewpoint is about the choreography of messages in
the interaction schemas;
• Engineering viewpoint is the level where the XML schema is
defined.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Archetypes and Templates
Archetypes and templates can play a key role in semantic
interoperability.
Archetypes define what is maximally documented in the world
about a specific health record entity.
An archetype defines a data structure, including optionality and
multiplicity, data value constraints, and relevant bindings to natural
language and terminology systems.
Templates define what in a specific context at a specific point in
time, will be stored, retrieved, presented, exchanged and archived.
In part, clinical meaning within an EHR will be expressed through
the structure of the archetype/template, and in part the meaning
will be expressed through codes from coding systems
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Archetypes and Templates
A way to view this metaphorically is:
• codes are the words in a dictionary;
• the structure of the archetype/template is the grammar;
• with both codes and archetypes sentences can be formed that
make or do not make sense;
• but archetypes define what makes sense;
• and templates define what makes sense in a specific context.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
To support semantic interoperability clinical archetypes need to be
shared and used consistently by EHR system vendors and their users,
so that the EHR data they create is consistently organised. Archetypes
therefore need to be shared and managed as a common knowledge
asset, and incorporated into the design of clinical applications, rather
like a terminology system.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Given that many archetypes may be needed to cover a given domain, it
is also important for them to be mutually consistent and bind to
terminology systems in appropriate and consistent ways. This is
necessary in order to minimise the diversity of ways in which a given
kind of EHR data might be represented.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Clinical archetypes need to be quality assured, since they will direct the
ways in which clinical data are captured, processed and communicated.
It is important that the design of individual archetypes is an accurate
and faithful reflection of good practice for the clinical disciplines in
which each of them might be used.
They need to be optimally designed for their purpose, and considered
trustworthy within their intended communities of use.
Large and comprehensive sets of archetypes are needed that cover
whole clinical domains in a systematic and inclusive way, catering for
the inevitable diversity of use cases and users but helping to foster
consensus and best practice. For these to be endorsed by health
systems, implemented by vendors and trusted by end users, these
archetypes need to be quality assured and to be published and
maintained by reliable certified sources.
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Some Conclusions
• Certification is a powerful weapon: use it!
• Continuity of certification should be guaranteed (a credibility issue)
• Efficiency: do not (re-)invent the wheel
• Take advantage of the growing EuroRec repository and of the
broadening certification scope (e.g. EHRs in other settings and other
eHealth applications)
• Align choices & strategies with European and International ones
(cf. standards, clinical models and coding systems ...)
• Professionalize the certification procedures
• Build a long term, incremental and consistent certification roadmap
which is in harmony with your overall healthcare strategy
• ...EuroRec is your partner and is at your service !
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009
eHEALTH FOR INDIVIDUALS, SOCIETY AND ECONOMY
Welcome to our next
EuroRec Annual Conference
Sarajevo (Sept 2, 2009)
in conjunction with MIE 2009
(http://www.eurorec.org)
The topics of the Conference are:
-
Quality labeling of EHR systems
Secondary use of health data
PHR (Patient Health Records)
Clinical models and Archetypes
www.mie2009.org
Prof. Dr. Georges De Moor, MD, PhD
Prague, 19.02.2009