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2. Conceptual Framework for eHealth Interoperability Pieter E Zanstra, Veli Stroetmann, Jean-Marie Rodrigues Radboud University Nijmegen Medical Center; Empirica Bonn, University St Etienne EU SemanticHEALTH Specific Support Action: Semantic Interoperability Deployment and Research Roadmap World of Health IT, SEMANTIC INTEROPERABILITY, Geneva, 20061011

3. 3 The SemanticHEALTH task Short term (R)TD recommendations to improve Semantic Interoperability (SIOp) Medium term R(TD) recommendations on SIOp Recommendations to EU and MS on: Consistent use of language Assure high quality data on different abstraction levels Improve quality of information retrieval / data mining Merge genomics, proteomics etc into health services Deploy semantic WEB for sophisticated information processing

4. 4 Acknowledgements Specific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMME Communication & Technology Research, Germany Radboud University Nijmegen Medical Center Department of Medical Informatics (Co-ordinator) World Health Organization Dept. Measurements and 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 and Multiprofessional Education (CHIME), UK

5. 5 Interoperability: WHY IS IT SO HARD? Technology –Drive (solution gap?) Social / Economic –‘dividend’ (BPR?) Regulations / Legislation –Cross Organisational/Border Needs Multifactored Global Approach

6. 6 Comprehensive approach

7. 7 What is the context Aging population Pressures to reduce cost Empowered knowledgeable consumer Increase Quality of Life Increase Quality of services Sustainable quality care for all Continuous (costly) advances in Medicine Economic/Social changes

8. 8 What is the quick solution/dream? Massive development of advanced terminologies meaningful data structures Needing 5%+ extra ICT budgets But What is the ROI ? Consumers willingness/ability to pay ? Vendors have not fulfilled expectations

9. 9 What is the meaning of Interoperability Interoperability means the ability of information and communication technology (ICT) systems and of the business processes they support to exchange data and to enable the sharing of information and knowledge. Interoperability is a state which exists between two application entities when, with regard to a specific task, one application entity can accept data from the other and perform that task in an appropriate and satisfactory manner without the need for extra operator intervention. (CEN/ISSS 2005) …..

10. 10 What is the meaning of Semantic Interoperability [Semantic interoperability] is concerned with ensuring that the precise meaning of exchanged information is understandable by any other application that was not initially developed for this purpose.” (IDABC 2004). CEN/ISSS 2005 stresses that semantic interoperability is not an “all-or nothing” concept. That is “the degree of semantic interoperability depends on the level of agreement between sender and receiver regarding the terminology, and the content of archetypes and templates to be used”. ……

11. 11 A multilayer approach to interoperability (I2Health) Action layer and approachIssues Health policy layer: cooperation Vision & strategies Structures, processes & measures, incentives for actors Sustainable socio-economic and legal framework Privacy and confidentiality Certification of systems and devices Health service provider (organisational) layer: collaboration Organisational structures and culture Intra & inter-jurisdictional service processes Change management, behavioural change Systems thinking, business process re-engineering Semantic layer: interoperation Terminologies, classifications, ontologies Translation Sustainable development and implementation infrastructures, application support Technical / functional layer: interoperation Technical standards Hardware and software connectivity User interfaces

12. 12 Why bother about Semantic Interoperability? For Direct care: e.g. –to coordinate patient care between multiple care institutions/professionals (Stroke Services) –to support cross border care for EU citizens –to improve usefulness of automatic decision support –to help comply with best practice For Organisation: e.g. –to support exchanges across jurisdictions and to support cross border and multilingual and multicultural issues in public health –to incorporate primary care and community based care

13. 13 Why bother about Semantic Interoperability? For Costs: e.g. –improve productivity –eliminate redundant testing and investigation For Population: e.g. –unify clinical data in time and space for disease surveillance area of vital concern on a global scale –better cope with emerging pathogens and bioterrorism

14. 14 What is problematic? Interoperability efforts are too fragmented Developments still in relative isolation –E.g. Electronic Health Records (EHRs), terminology & ontologies, messages, care pathways, data types, security, and system architectures. Member states driven by different needs and agenda’s …

15. 15 Next steps on the Framework development Update Framework with feedback from a.o. RIDE partners, NEHTA, WHO network, Infoterm Publication of framework for public debate –http://www.semantichealth.org Ultimately use the framework for: –Mapping EU and Member State Initiatives –Identify emerging issues and gaps in our understanding

16. 16 Thank you for your attention! Further information: www.semanticHEALTH.org semantichealth@eski.hu Pieter E Zanstra Radboud University Nijmegen Medical Center P.Zanstra.mi@xs4all.nl