The document discusses experiences implementing the CEN EN13606 normalization framework for semantic interoperability of clinical data across three hospitals in Spain. It describes defining clinical archetypes, normalizing legacy data according to archetypes, and communicating electronic health record extracts between hospitals using CEN EN13606 standards. The experiences show that archetypes can be developed in a few hours and legacy data normalized to standardized documents in a day using available tools. Both strengths and weaknesses of CEN EN13606 are discussed.

1. 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

2. Contents
• Semantic interoperability of clinical data
• The LinkEHR Normalisation Platform
• Implementation experiences
• Discussion and conclusions
EN13606 experiences 2

3. EN13606 experiences 3
Semantic interoperability of
clinical data
• Our objective: the semantic interoperability of
clinical information.
Alerts
Current history
Past history
Medications
And all the information
we would like to include

4. 4
Semantic interoperability of
clinical data
• Semantic interoperability requires:
A standard
labelling and
structure for data
A high-level definition
of clinical concepts
A semantic
description of
clinical concepts
Reference Model Archetype model
Terminologies
and Ontologies
ISO/CEN EN13606
The standard for the communication and
semantic interoperability of health information
EN13606 experiences

5. 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.
EN13606 experiences 5

6. EN13606 experiences 6
EFMI STC 2010
LinkEHR-Ed: A tool for the description and normalization
of legacy clinical data
EFMI STC 2010
Standardized and flexible health data management
with an archetype driven EHR system (EHRflex)

7. 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.
EN13606 experiences 7

8. EN13606 experiences 8
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

9. 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.
EN13606 experiences 9

10. Implementation experiences
1. Definition of archetypes
EN13606 experiences 10

11. EN13606 experiences 11
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.

12. EN13606 experiences 12
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.

13. EN13606 experiences 13
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.

14. EN13606 experiences 14
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

15. EN13606 experiences 15
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.
XML
Existing
EHR systems

16. EN13606 experiences 16
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
EHR
Server
XML
EN13606
Standard
Information
Mapped
Archetype
CHGUV
HIS
HF
HIS
EHR
Server
Mapped
Archetype

17. EN13606 experiences 17

18. EN13606 experiences 18
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.

19. 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.
EN13606 experiences 19

20. Discussion and conclusions
• EN13606 weaknesses:
– Lack of previous implementation experiences.
– Lack of methodologies for developing
archetypes.
– Lack of support from a community of users.
EN13606 experiences 20

21. 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.
EN13606 experiences 21

22. Thank you for your attention!
CEN EN13606 Normalisation Framework
Implementation Experiences
David Moner
damoca@upv.es
22EN13606 experiences