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Towards semantic interoperability solutions Dipak Kalra Health information flows needing semantic interoperability Wellness Fitness Complementary health Citizen in the community rapid bench to bed translation Social care Occupational health School health real-time knowledge directed care Point of care delivery Teaching Research Clinical trials explicit consent implied consent Disease registries Screening recall systems Continuing care (within the institution) Education Research Epidemiology Data mining de-identified implied consent +/- consent Public health Health care management Clinical audit Long-term shared care (regional national, global) 2 Drivers for trans-border information and knowledge sharing • • • • • Cross-border health care – emergency care – elective care – consistent care pathways and standards of care Population health – public health measures: prevention, immunisations etc. – detecting and tracking critical events: antibiotic resistance, infectious outbreaks, bio-terrorism etc. Comparisons – treatment effectiveness – clinical outcomes – safety signals Research – epidemiology – multi-national clinical studies Common products and services – cross-border EHR systems and services – consistent implementation of clinical guidelines and decision support 3 The EHR landscape - for archetypes Treatment Medication and prescriptions Symptoms and history Body physical examination findings Advice and education Hypotheses, Self management and health issues home monitoring Chronic and Conventional (problems medical summary Prevention and Well-being and fitness, disease diagnoses), risks screening, rehabilitation after illness management population health Tests and investigations measures Care planning Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Protocols, guidelines, care pathways Communication, team-based collaboration Consent, permissions, disclosures, complaints 4 Hospital admission Treatment Medication and prescriptions Symptoms and history Advice and education Hypotheses, Self management and health issues Chronic home monitoring Prevention and and disease Conventional (problems medical summary Well-beingscreening, and fitness, diagnoses), risksrehabilitation after illness management population health measures Tests and investigations Care planning Social welfare, culture, religion, attitudes, expectations, hopes, fears Mental health Body physical examination findings Procedures and operations Cardiovascular medicine Protocols, guidelines, care pathways Communication, team-based collaboration Consent, permissions, disclosures, complaints record structure and context Resources needed to support rich semantic interoperability architecture identifiers for people policy models structural roles functional roles purposes of use care settings pseudonymisation reference models data types archetypes templates near-patient device interoperability Consistent workflow guidelines care pathways decision support algorithms clinical terminology systems classification systems terminology sub-sets value sets and micro-vocabularies post-co-ordination multi-lingual mappings semantic context model categorial structures clinical terminology privacy Rich EHR representation, access interoperability and interpretation 6 Initiatives striving for harmonisation • Clinical Information Modeling Initiative (CIMI) • SemanticHealthNet 7 Clinical Information Modeling Initiative (CIMI) • International collaboration of several SDO’s, national eHealth programmes, and large providers e.g. IHC, VA, Kaiser – providing a common format for the specification of clinical models – so that semantically interoperable information may be created and shared in health records, messages and documents • Building on the openEHR archetype approach as its starting point • Specifications will be openly accessible, freely usable 8 • European Commission sponsored Network of Excellence in Semantic Interoperability – Dec 2011 to Nov 2014 – 3m Euro – 17 Partners – > 40 internationally recognised experts 9 SemanticHealthNet concept and objectives • Leverage a clinically-driven work-plan – heart failure, exemplifying chronic disease management, evidence based care and shared care – cardiovascular prevention, exemplifying public health and national / global strategies • Bring together the globally best of breed semantic resource producers including commitment from the top SDOs – to develop harmonised resources meeting the clinical needs, adapting their standards as necessary • Engage stakeholders: patients, clinicians, industry, ministry, insurance, on priorities, scope, governance, adoption • Establish a scalable, sustainable, well-governed European Virtual Organisation for semantic interoperability 10