1. Health Care Process Modelling: How to develop semantic interoperability in health care? The steps before IT implementation Karl-Henrik Lundell Medical dir. Swedish National Board of health and welfare EHTEL board of directors (SALAR)

2. How to achieve clinical semantic interoperability? The steps before IT implementation  The overall aim with IT should be to support the production of services to the main customers  These services are produced in the core processes of health and social care  Interoperability must include and focus on the content and context of the core processes  To achieve that; Do we need a common description and shared understanding of what we aim to support??  If yes – how to do it?

3. Why a common description of the core processes?  Base for Interoperability Concept models Information models of meaning and use Specialisations of generic concepts for different contexts  Needed for extended use of e-health/EHR when it comes to Core process management Quality management systems Continuous improvements

4. Disposition  Processes in general  Health care processes  Clinical processes  Models and model architecture  The Swedish approach  Break out session/use case - the generic process model in the Swedish National information structure project

5. Processes in general Activities Transforming the input InputOutput Activities adding value to an object

6. Processes in health care organisations Core processes in health care organisations Educational processes Clinical processes Research processes Subjects of care Health care professionals

7. Clinical processes Activities to identify the condition and treat the problem Health state Health care activities adding value to the health state of a subject of care Needs and goal

8. Clinical processes Leadership/management and support processes Activities to identify the condition and treat the problem for a subject of care Health state Leadership/management Business plan, Policy, Objectives, Basic values, Restrictions, Quality management system etc Support Personnel, material, knowledge support (e.g. guidelines) etc

9. Generic models of process and concepts  Descriptions of the real operations (dynamic models)  Theoretical constructions  High level of abstraction  Often primarily difficult for clinicians to see the relevance of  Necessary (?) as a ground for information models, development of e-health/EHR and quality management  Theory before practice!!

10. Process models  A process model is a description of; the value adding to an input and the type of activities performed to add that value  Different methods/languages/notations are used to describe  A well defined and precise language is needed to create unambiguous models – experts  In health care the value adding can be described as conditions and the activities out from their different aims  A process model is not a flow model with fixed sequences and does not include actors/responsibilities  Flow-, concept- and information models should be based on an explicit process model

11. Information systems and Process orientation in health care services  The core processes are the clinical processes  Quality management systems should focus the clinical processes  Information systems should support the management of the clinical processes  The information structure should be founded on the content and context of the clinical processes  The content (activities) and the context (value adding) of the clinical processes should be identified in an explicit generic model of the clinical processes

12. Why clinical process models?  Identifies and describes the important concepts of the reality: context and content Value adding and health conditions Types of activities that can contribute to value adding  Information models and information systems not based on explicit process models risk to miss the targets of supporting the core processes achieve unambiguous interoperability  Process oriented clinical quality management systems and clinical process management are dependent on process oriented information systems  “Clinical oriented” is not enough – should be “clinical process oriented”.

13. Generic models and specialisations  Generic – possible to apply for all occurrences in a certain domain  Specialisation – Applied model for a specific part/area within the generic domain  All specialisation can be contained and recognised in the generic model

14. Generic – specialised balance  Generic for coverage of all business areas who need to share information  Specialised as much as possible – the more specialised the better support for effective processes  Generic but nor more generic than absolutely needed for coverage

15. Model architecture; process-, flow-, concept- and information models  Process – values added and activities  Flow – time sequences, actors and cooperation  Concept – definitions of and relations between concepts in process and flow models  Information – classes and characteristics (attributes) for information regarding the concepts in the concept model

16. Health care process-, flow-, concept- and information models  All are needed to build sustainable, effective and comprehensive information systems for Leadership/management Performance/operation Support to the clinical processes

17. Information systems in health services  Focus on the core processes  Founded on and supporting the content and the context of the “real thing”  Model of the clinical process needed for the ability of the information system to contribute to good quality  European Generic model of the clinical process? Within the scope of Contsys 2 Of interest for joint initiatives in global standardisation?

18. Basic values, legislation, regulations, requirements QMS etc. Health services in the “real and complex” world Logical information model National information structure Generic process and flow models Generic Concept model Generic semantic Information model The Swedish approach Good Quality Health Services Applied information systems Information systems and IT-solutions Archetype specifications Support process management and quality management systems

19. Health state Health-related request/ consultation Health problem – treatment needed No needs for treatment Health condition/ Health issue Health state (treated) Activities to treat health problems Activities to identify health conditions/-problems

20. Asses needs Plan Perform Evaluate Types of activities for the two main aims End of process

22. Treat health problem Health state Health issue/condition Health consultation Health problem Needs for treatment Activity plan Output/ health state Assessed health condition No needs for activities Identify Health condition Assessment of needs for activities Activity planning Perform activities Evaluate effect End process The generic health service process – under development – Swedish national Information structure project Health problem not needed to treat Tillst- Id- behov Aktivitets- plan Utfall/ resultat Upprätta aktivitetspla n Utföra aktivitet Identifiera och bedöma hälsotillstånd Hälso- problem Ej aktuellt hälsopr oblem ”aim 1” ”aim 2” Identify health condition Needs of activiti es Activity plan Result Assess needs of identifying condition Activity planning Perform activities Identify and assess health condition Health problem No current health problem Health needs and health goal

23. Open EHR; clinical problem solving

24. Asses needs Plan Perform Evaluate Open EHR and the Swedish generic process model End of process Health condition Observation Observation, Opinion Plan/instruction ActionObservation, assessment, opinion

25. Health condition Observation Health consultation Observation Assessment of needs Opinion Draw up plan for activities Instruction Perform activities Action Evaluate and analyse Observation and opinion No needs for further activities End process Health state Blue= open EHR Swedish generic process pattern for the two main aims related to open EHR problem solving model Knowledge based process management

26. Discussion points  The role of clinical process model for development of Information models Information structures Interoperability between information systems Clinical process management and improvements Leadership and quality management systems?