1. Semantic Interoperability Deployment & Research Roadmap i2010 Subgroup on eHealth meeting 21 February 2008, Brussels Veli Stroetmann, empirica with Alan Rector, UNIMAN Dipak Kalra, UCL Bedirhan Ustun, Pierre Lewalle, WHO Karl Stroetmann, Benjamin Jung, empirica Pieter Zanstra Jean Marie Rodrigues, UJM Martti Virtanen, UU Gyorgy Surjan, ESKI

2. 2 What are we talking about? Health system interoperability is the ability, facilitated by ICT applications and systems, –to exchange, understand and act on citizens/patient and other health-related data, information and knowledge –among linguistically and culturally disparate clinicians, patients and other actors –within and across health system jurisdictions in a collaborative manner Defining IOp:

3. 3 Why do we need Semantic IOp? Health system priorities and goals To support the goals of greater patient safety, better quality of care, chronic disease management, extended homecare or patient empowerment, clinical meaning (data, information, knowledge) must be expressed consistently –to enable the safe, meaningful sharing and combining of health record data between heterogeneous systems and actors / care providers; –to enable the integration and safe use of computerised protocols, alerts and care pathways by EHR systems; –to link EHR data to explanatory and educational materials to support patient and family engagement and professional development; –to ensure the necessary data quality and consistency to enable rigorous secondary uses of longitudinal and heterogeneous data for public health, research, health service management.

4. 4 Roadmap: Recommendations - General Principles Focus on concrete, immediate needs and real use cases with expected high benefits & lower costs Terminologies should have a well defined scope and purpose –be delivered against well defined, realistic time scales Separate: –Ontology - what you mean –Language - how you say it –Interface - how you find it Involve vendors/industry and human end users - clinicians, citizens –Be responsive –Be open, collaborative and participative Make it multilingual and multicultural Focus on Quality Assurance and Reproducibility Use today’s technology –modern ontology languages, Web 2.0, “Just in time”

5. 5 Some Recommendations on Structures and Process Governments to develop, implement and sustain longer-term visions, objectives and measures Establish national centres for multilingual, multicultural adaptation of international classifications including SNOMED Link them in a well-managed European network of Competence Centres Establish a European Network of Terminology Servers Assure sustainability and scalability –It must be maintained to be useful –Beware of silver bullets

6. 6 Socio-economic Assessment: Optimising Semantic IOp

7. 7 Terminologies: SNOMED-CT - Current Assessment Controlled vocabulary and identifiers –Well managed but slow response time Hierarchies and relations –Unusable Too unreliable to depend on to behave as documented Systematically flawed in principle Limited by software and logic limitations from early 1990s Cost of repair probably exceeds cost of rebuilding - but still modest Multilingual / Multicultural support –Minimal Neither understood nor a priority for the IHTSDO –Spanish and Canadian-French versions might appear Openness and accessibility to Social Computing –Unusable - remains effectively closed Not generally available on the Web Opportunity cost of participation prohibitive Influencing policy difficult

8. 8 Terminologies: Selected Recommendations Support for specific initiatives between ICD/WHO ISO and SNOMED to develop ICD-11 along with mappings to/from SN Support feasibility study (select subset of ca. 25,000 terms / use case) of reformulation of SNOMED to –build reliable hierarchies & relations –develop multilingual support –introduce social computing tools –empirically assess individual, organisational and societal benefits & costs Support open tools for terminologies that link up to SNOMED Support social computing efforts (Web 2.0) on ICD-11 Develop language technologies –Text extraction to build new terms and encode natural language –Text generation to present and for QA User involvement & ownership, a series of centres & initiatives Support training at all levels

9. 9 Sustainable framework with EU Industry for effective standards development European Centres of Excellence Collaboration with EBI and NBCO Intern. Biobanking collaboration Sustainable Centres for Selected Ontologies Toolset for Feasibility Study Large Scale Environment Multilingual -cultural adaptation Research on consequences of different commitments Tools for Terminfo test Social Computing based Terminology Service Central Reference Services Local mappings to UMLS Toolkit for HL7 messages & archetypes binding Ongoing consultations Actions arising from consultations Feasibility Study & reformulation of subset Multilingual -cultural subsets Formal QA of subset Statistical extension of QA Policy with MS on future use of hierarchies & relations Roadmap for SIOp Deployment & Research - Ontologies 2009 2010 2011 2012 2014 2016 2021 2008 SNOMEDLOINC, DICOM Terminolo- gies & EHRs Genomics Transl. Medicine Socio-Econ. Issues Ontologies

10. 10 Roadmap: Ontologies Action Plan Year ContentProcessTools 2008  Open ICD 11 with SNOMED Mappings  Reformulation of SNOMED  Establish Open collaborative framework for ICD11  Begin to establish mechanisms for industrial involvement  Open tools for ontology development  Open Web 2.0 tools to support ICD 11 2009  Quality assurance metrics for SNOMED Fragment  First translations of SNOMED Fragment  Extend industrial involvement  Establish formal collaboration with European BioBanking and EBI  Develop tools for linking and binding terminologies and archetypes  Establish open social site for clinical terminology 2010  Continue  Establish mechanisms for reformulation of SNOMED Fragment  Extend and test open tools for terminology and Archetypes, possibly with inclusion of HL7 2011  Reassess and create long term plan for selected terminologies including limits on scope  Establish European Network of Terminology Servers 2012- 2013  Review and reassess interoperability

11. 11 Roadmap EHR: Basic elements and short term actions Effective, functional EHR systems need: 1. Generic reference models for representing clinical (EHR) data e.g. EN 13606, HL7 CDA, openEHR Reference Model 2. Agreed clinical data structure definitions e.g. openEHR archetypes, HL7 templates, generic templates and data sets 3. Clinical terminology systems e.g. LOINC, SNOMED-CT Areas needing adoption (short term) : –Agree on a generic model for EHR communications: consider EN13606 –Adopt a standardised approach for representing and sharing of clinical data structure specifications: agree to use archetypes / templates –Collaborate on key use cases for shared care & patient safety, and on defining & tidying up the corresponding terminology/SNOMED-CT sub-sets –Seed clinical fora to develop care pathways and archetypes to meet the needs of safe and evidence based care in different medical domains and disciplines –Strengthen clinical user training in the use of EHRs, terminology and structured records

12. 12 Roadmap EHR: Medium term actions Areas needing wide-scale evaluations: –Develop best practice in archetype design –Establish useful exemplars of SNOMED-CT sub-sets being adopted within EHR systems and delivered in meaningful ways to clinical users –Develop the business rules and validation processes –Identify and evaluate the benefits for various stakeholders & health systems Areas needing investments: Industry sponsored or nationally supported open source approaches for: –Archetype & template authoring and validation tools –Terminology servers, term browsers for SNOMED CT, support for term coordination –Global multi-cultural dimension - not just term translation but internationalisation across health care paradigms and cultural differences

13. 13 Reference Model ArchetypesTerminology SNOMED-CT ApplicationsSocio-economic Issues Generic Model for EHR Communication Standardised Represention Clinical Data Structures Care Pathways Best Practice A. Design QA & Certification Repositories Term Binding Authoring/ Validation Tools Key Use Cases Policies on SN Term Coordination (TC) SNOMED-CT Subsets Business Rules for TC Terminology Servers Term Browsers Consistency Test HL7 Terminfo Global Experience Test EHR Visualisation Applications Adaptable Clinical Applications Improve Inter- nationalisation Agree on SIOP Goals for PHR Link EHR to Educational Material Acceptance Evaluation EHR/Terminology User Training Roadmap for SIOp Deployment & Research - EHR 2008 2009 2010 2011 2012 2014 2016 2021

14. 14 Roadmap Public Health: Long term goals Consistent use of EHRs as person-based health records in clinical settings Interconnecting health service providers so health information can be exchanged through interoperable digital means in a standard fashion Research to prove the comparability of digital information with analog traditional measures used for monitoring and evaluation in various health inf. systems

15. 15 Roadmap Public Health: Actions Requirements for SIOp: Interconnection tools Identification management Common web services Security technologies Mechanisms for ensuring the sustainable operation of these components on a widespread and publicly available basis Action points: Enable common standards to allow data exchange on predefined key variables & compilation of content Compile data across populations and across health care providers Link data across multiple care settings Compare data across regions, time or populations Set up organizational and legal regulations in a sustainable fashion Develop global registries of standardized information models and related metadata

16. 16 Legal Requirements: Liability, Security, Privacy IPR, Ownership Mandate the organisation of PH information gathering Common Standards for Exchange Common Standards for Content Metadata for populations, settings and GIS Predefined Reportable Diseases International Health Regulations Online Epidemiology on selected conditions Bio Banking Linkage to Population Registries Electronic Death Certifiation Patient Flow/ Statistics Case-Mix Grouping Roadmap for SIOp Deployment & Research – Public Health 2009 2010 2011 2012 2014 2016 2021 2008 ClassificationsDemographyBiosurveillancePublic Health Infrastructure Socio-economic Issues

17. 17 Final Report: Roadmap Matrices & Action Plans Content Tools Processes ToDo TimeActors Prereqs Sh ort Ter m Me diu m Ter m Lo ng ter m Pol icy Ma ker s He alth pro fes sio nal s Re sea rch ers SD Os Ind ust ry C1 Content SNOMED Feasibility study and semantically sound reformulation hierarchies and relations for a of subset of SOMED xxxxxT1 C2 Multilingual multicultural versions of semantically sound subset xxXx C3 Formal QA of Subset of SNOMEDXxxX C4 Statistical extension of QA to all of SNOMEDxXXx C5 Policy in conjunction with member states on future of use of SNOMED hierarchies and relations xX C6 Content Other Consultation on issues related to LOINC & DICOM xxxx C7 Consultation on issues related to Adverse reaction reporting and Drug Reporting xxxX[1 ][1 ] C8 Actions arising from consultationsXXXXXX [1][1] Incl. Pharma Roadmap Matrix on Ontologies (excerpt)

18. 18 Final Report: Roadmap Matrices & Action Plans

19. 19 Proposal: Building a European Semantic IOp Knowledge Base Semantically linked set of documents Collaborative environment (discussion page open for everybody) Extensibility SemanticHEALTH Wiki

20. 20 Acknowledgements Specific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMME Communication & Technology Research Germany Radboud University Nijmegen Medical Center The Netherlands World Health Organisation Dept. Measurements & Health Information Systems, Switzerland Uppsala University Nordic Centre for Classifications in Health Care, Sweden University of St. Etienne Department of Public Health & Medical Informatics, France National Institute for Strategic Health Research Hungary University of Manchester Health and Bioinformatics Group, UK University College London Centre for Health Informatics, UK

21. 21 Thank you for your attention! Further information: www.SemanticHEALTH.org semantichealth@eski.hu Veli Stroetmann for the SemanticHEALTH consortium Communications & Technology Research Bonn, Germany veli.stroetmann@empirica.com