Towards semantic interoperability solutions Dipak Kalra

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

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

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

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

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