1. an alliance among HL7, CEN and OpenEHR ?
Inventory of patient summaries and clinical data sets for transfer of care
Angelo Rossi Mori,

2. interoperability vs. cooperability
interoperability ability of information systems to interoperate
cooperability ability of healthcare professionals and citizens to cooperate (health level 8 ?)

3. objective of cooperability
EHR solutions should assure
“the consistent capture,
communication and availability
along the care pathway,
to clinicians and patients,
of key data required
to provide and manage direct care”
Colin Gordon, UK NHSIA Disease Management Systems Programme

4. 1. non-clinical situations
standards and implementation guidelines developed so far e.g. by HL7, ISO, DICOM, CEN, IHE are suitable for stereotypical situations and predictable workflows, as in administrative and organizational contexts, e.g. for orders and reports.

5. 1. non-clinical situations
ongoing standards do allow to obtain
“basic semantic interoperability”
among applications, based on detailed data structures and on coded values.

6. 2. generic situations involving transfer of care
generic situations involving transfer of care are poorly predictable:
no general model is possible about which particular clinical data must be transferred for a specific task

7. 2. generic situations involving transfer of care
Progress in cooperability may be supported by
generic standards with basic clinical structures, independent from any particular clinical issue, as CEN-EHRcom EN in, HL7-CDA ASTM-CCR, and their generic implementation guides
measures to share such generic documents, e.g. by IHE-XDS

8. 2. generic transfer of care: challenges
systematize document names and section names;
describe the expected generic clinical content of relevant kinds of "generic" clinical documents (e.g. discharge summary, clinical letter);
define how to organize documents in folders within multi-source registries;
define a set of “patient baseline profiles” (aka of patient summary) for several specialties and (chronic) problems

9. 3. intermediate solutions: context-based clinical data sets
collect and harmonize clinical data sets
derived from evidence-based clinical pathways
to assure that the required information is properly captured and made timely available to each professional for transfer of care and for his/her critical decisions
to synchronize the items in the patient record and the knowledge sources for decision support

10. 3. clinical data sets: challenges
a methodology to understand which clinical pathways and which decisions are suitable to reach the adequate level of cooperability;
harmonization of clinical data sets across various clinical and organizational contexts;
exploration of the interaction between terminology models and information models;
setting up of safe ways to express the clinical and organizational context for decisions

11. policy factors large jurisdictions must promote a balanced deployment
of solutions for cooperability
in clinical information systems
with the technical and informational infrastructures
and the appropriate level of quality in data recording

12. policy factors Therefore attention should focus on the
educational, regulatory,
economic, organizational policies
for change management programs of unusual size
and on the obstacles
in the full deployment of cooperability

13. policy factors At the same time, there is a need to develop
the criteria to define
the optimal level of cooperability
for each kind of clinical situation,
and the appropriate strategies
to reach them in large-scale programs

14. CNR - Istituto Tecnologie Biomediche
Angelo Rossi Mori
10/03/2004
thank you
Angelo Rossi Mori
CNR - Istituto Tecnologie Biomediche
22/11/2018