EHR Qualities Semantic Interoperability Privacy - Gerard Freriks
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EHR Qualities Semantic Interoperability Privacy - Gerard Freriks
- 1. EHR-Qᵀᴺ Polska 2012 EHR Qualities Semantic Interoperability Privacy (Lodz, 29 November 2012) Gerard Freriks Gerard Freriks. ERS B.V. © ERS 2012
- 2. "It's the economy, stupid" • Slight variation of the phrase "The economy, stupid" which James Carville had coined as a campaign strategist of Bill Clinton's successful 1992 presidential campaign against sitting president George H. W. Bush. • Carville's original phrase was meant for the internal audience of Clinton's campaign workers as one of the three messages to focus on, the other two messages being: • "Change vs. more of the same" and • "Don't forget health care" 2 © ERS 2012
- 3. MIE2012-Village of the Future 3 © ERS 2012
- 4. MIE2012-Village of the Future • Point on the horizon –All must communicate –Now and in the future –How? It is the semantics stupid! Blue Line 4 © ERS 2012
- 5. Topics - What is the EHR? - Semantic Interoperability the Semantic Interoperability Stack - Data and Information: Interoperability Privacy - Standards for Semantic Interoperability - International Developments - National/regional Governance Quality Assurance - Conclusions © ERS 2012
- 6. © ERS 2012
- 7. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines 7 © ERS B.V.
- 8. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines Rules Information Presentation Software Hardware EHR 8 © ERS B.V.
- 9. I- Bakery Kitchen Instructions Ingredients Moulds Oven Pastry machines Rules Information Presentation Software Hardware EHR 9 © ERS B.V.
- 10. Instruction Ingredients Moulds Kitchen tools Oven Pastry Rules Information Presentation Software Hardware EHR 10 © ERS 2012
- 11. EHR SemanticHealthNet Dipak Kalra © ERS 2012
- 12. EHR SemanticHealthNet Dipak Kalra © ERS 2012
- 13. EHR and Privacy ACL Trust ACL Flexibility It is the Semantics stupid! ACL Patient Mandate ACL ACL ACL Author and Patient controlled 13 © ERS 2012
- 14. Health Information Security 450.000 records not secured Names, Date of Birth, addresses, telephone numbers, Patient ID, Governmental ID 14 © ERS B.V.
- 15. Health Information Security What is needed: –Deploy top to bottom in each organisation – ISO 27799:2008 Health informatics Information security management in health using ISO/IEC 27002 –Treat health software and the development of it as a medical device –Deploy 13606 EHR Communication 15 © ERS B.V.
- 16. Health Information Security CEN/ISO 13606 EHR Communication –No patient identifiable data in the Record –Each data object carries the Patient Mandate (who has access to what kind of data) 16 © ERS B.V.
- 17. 13606-4 Patient Mandate CEN/ISO 13606-4 TS: Security –is a profile of the • ISO 22600 • Privilege Management and Access Control 17 © ERS B.V.
- 18. 13606-4 Patient Mandate 18 © ERS B.V.
- 19. 13606-4 Patient Mandate 19 © ERS B.V.
- 20. 13606-4 Patient Mandate 20 © ERS B.V.
- 21. 13606-4 Patient Mandate 21 © ERS B.V.
- 22. 13606-4 Patient Mandate 22 © ERS B.V.
- 23. 13606-4 Patient Mandate 23 © ERS B.V.
- 24. Semantic Interoperability Stack Common Trusted Facilities Semantic Interoperability © ERS 2012
- 25. Semantic Interoperability Stack HL7 EHR v3, CDA Extract RIM Common Facilities Documentation Documentation Archiving Archiving Semantic Interoperability 25 © ERS 2012
- 26. Semantic Interoperability Stack Semantic Interoperability Levels Semantic Stack 26 © ERS 2012
- 27. Semantic Interoperability Stack Semantic Interoperability Levels FP7-SemanticHealth Project 27 © ERS 2012
- 28. Standards Enterprise CEN/tc251 System of Concepts for EHR-systems viewpoint Continuity of Care using Information HL7 CEN/tc251 viewpoint EN13606 EHRcom Information Bus All viewpoints Computation programmed in viewpoint CEN/tc251 Health one system or Health Information Services Architecture message Engineering viewpoint Technical viewpoint © ERS 2012
- 29. Standards Message based Archetype based EHR-systems EHR-systems Production of 1-3 years Minutes message IHE process 1-2 years nil Programming 1-2 years nil Roll Out 1 year nil Total YEARS MINUTES © ERS 2012
- 30. CEN/ISO13606 Standard Reference Model Archetype Object Model Term List Patient Mandate EHR-extract exchange © ERS 2012
- 31. CEN/ISO13606 Standard Coding systems Archetypes Templates Rules Patient mandates EN13606-2 Tools Software EN13606-1 Tools Services © ERS 2012
- 32. CEN/ISO13606 Standard © ERS 2012
- 33. Semantic Interoperability Stack Model for Knowledge Encyclopedia SNOMED WHO Loinc Model of Meaning Dictionary SIAMS Models of General Use Generic Phrases CEN/ISO 13606-3 Models of Specific Use Specific Phrases CEN/ISO 13606-2 CEN/ISO 13606-1 Models of Archiving ‘Syntax’ Models of Storage Database Schema 33 © ERS 2012
- 34. International Developments - Renewal CEN/ISO 13606 - Integration of 13606 with: - System of Concepts for Continuity of Care (ContSys CEN/ISO 13940) - Health Information Services Architecture (HISA CEN/ISO 12967) - Harmonisation with HL7 CDA - FP7 SemanticHealthNet (make 13606, CDA, coding systems and ontologies work together) http://www.eurorec.org/RD/SemanticHealthNet.cfm - Clinical Information Modeling Initiative http://informatics.mayo.edu/CIMI/index.php/Main_Page - New FP7 2013 call: - epSOS EU-USA, Semantic Interoperability EU-USA, ... © ERS 2012
- 35. International Developments © ERS 2012
- 36. International Developments © ERS 2012
- 37. International Developments © ERS 2012
- 38. International Developments © ERS 2012
- 39. (Inter-)National Governance INFOstructure Direction Healthcare Patients Stanardisation organisations Ontology / Coding systems Clinical Information Models Providers (Inter-) National Project Government Local Communities Insurers Re-Users of data IT- Vendors Quality Assurance © ERS 2012
- 40. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance • Essential elements –All actors co-operating in their natural role –Direction based on expertise, knowledge and authority. Not too much money. –One standing (virtual) organisation) –With ongoing secured funding. The INFOstructure is not a one time project. © ERS 2012
- 41. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance INFOSTRUCTURE –Production, Maintenance, Publication of all semantic interoperability artefacts is very resource intensive (money and expertise) –Even big countries can not create a full Semantic Stack on their own –European countries (and more) had better co-operate and provide jointly the resources needed © ERS 2012
- 42. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance INFOSTRUCTURE Ongoing projects –SemanticHealthNet (SHN) –Clinical Information Modeling Initiative (CIMI) –... © ERS 2012
- 43. (Inter-)National Governance Direction (Inter-) National Project Healthcare Clinical Information Patients Ontology / Coding Providers Stanardisation organisations Government systems Insurers Local Communities Models Re-Users of data IT- Vendors Quality Assurance © ERS 2012
- 44. Conclusions 1. No semantic interoperability without the Semantic Stack 2. Base standards, Coding systems and Ontologies constitute the Semantic Stack 3. Using Base Standards profiles/archetypes/templates define the clinical statements 4. The Patient Mandate is an integral part of Interoperability © ERS 2012
- 45. Conclusions 5. International co-operation is shaping up 6. International, European and National/Regional Governance structures will be set up © ERS 2012