Towards semantic interoperability solutions

1. Towards semantic interoperability solutions • Dipak Kalra

2. Health information flows needing semantic interoperability rapid bench to bed translation real-time knowledge directed care Education Research Epidemiology Data mining Public health Health care management Clinical audit Wellness Fitness Complementary health implied consent implied consent de-identified Teaching Research Clinical trials Social care Occupational health School health Disease registries Screening recall systems Long-term shared care (regional national, global) explicit consent Citizen in the community Point of care delivery Continuing care (within the institution) +/- consent

3. 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

4. The EHR landscape - for archetypes Hypotheses, health issues (problems and diagnoses), risks Chronic disease management Prevention and screening, population health measures Treatment Conventional medical summary Medication and prescriptions Care planning Advice and education Symptoms and history Self management and home monitoring Well-being and fitness, rehabilitation after illness Body physical examination findings Tests and investigations Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Protocols, guidelines, care pathways Communication, team-based collaboration Consent, permissions, disclosures, complaints

5. Hospital admission Chronic disease management Hypotheses, health issues (problems and diagnoses), risks Prevention and screening, population health measures Mental health Treatment Conventional medical summary Medication and prescriptions Cardiovascular medicine Care planning Advice and education Symptoms and history Self management and home monitoring Well-being and fitness, rehabilitation after illness High priority, often used re-used fragments Body physical examination findings Tests and investigations Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Protocols, guidelines, care pathways Communication, team-based collaboration Consent, permissions, disclosures, complaints

6. Resources needed to support rich semantic interoperability guidelines care pathways decision support algorithms architecture identifiers for people policy models structural roles functional roles purposes of use care settings pseudonymisation Rich EHR interoperability Consistent representation, access and interpretation privacy workflow record structure and context clinical terminology reference models data types archetypes templates near-patient device interoperability clinical terminology systems classification systems terminology sub-sets value sets and micro-vocabularies post-co-ordination multi-lingual mappings semantic context model categorial structures

7. Initiatives striving for harmonisation • Clinical Information Modeling Initiative (CIMI) • SemanticHealthNet

8. 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

9. European Commission sponsored Network of Excellence in Semantic Interoperability • Dec 2011 to Nov 2014 • 3m Euro • 17 Partners • > 40 internationally recognised experts

10. 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