a sustainable european roadmap for semantic interoperability
TRANSCRIPT
A sustainable European roadmap for semantic interoperability
Dipak Kalra!on behalf of the SHN Consortium
SHN$CIMI$Workshop,$13215$March$2014
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
Many incompatible standards and specifications
Source: The Vision of the eHealth European Interoperability Framework (2013), Deloitte and DG Connect
The challenge of semantic interoperability
• A global and singular representation for each distinct clinical expression is not realistic, and may not be desirable!– different representations might be optimal for different use cases!– different levels of detail, different levels of granularity, different kinds of data
entry options might be suitable for different clinical settings!– clinical practice is too diverse, and evolving, for such fine grained standards
to be set or adopted!– different cultures, and natural languages, may need to represent clinical
meaning differently!– patients and carers might need to enter and read a different level of jargon
from health care professionals
SemanticHealthNet
• European Commission sponsored Network of Excellence on Semantic Interoperability!– 2011 to 2015!– 3m Euro!– 17 Partners !– > 40 internationally recognised experts
SemanticHealthNet concept and objectives• Leverage a clinically-driven work-plan!
• heart failure, exemplifying chronic disease management, evidence based care and shared care: focus on individuals who are patients!
• cardiovascular prevention, exemplifying public health and national / global strategies: focus on populations who are citizens!
• Bring together the globally best of breed semantic resource producers including commitment from the top SDOs!
• Draw on a rich body of expertise including past EU projects in the EHR, semantics, semantic interoperability, wide-scale record sharing and eHealth governance + the new projects!
• Maximise stakeholder engagement and resourced commitment to ensure we focus on usable and useful and affordable solutions!
• Robust business approach: people, processes, products, platforms!• Develop a scalable, sustainable, well-governed European Virtual
Organisation for semantic interoperability
• Inpatient Mortality 11.1%!– Cardiology ward 7.8%!– General medical 13.2%!– Other ward 17.4%
Mortality for patients hospitalised with HF
Source: John Cleland, Suzanna Hardman, SHN WP1
The HF Information Landscape
Pa#ent'Core'Data
Hospital'Admissions,'Discharge'planning
Medical'History'First'visit'only
Medica#on'
Death'Adjudica#on'(Only'if'pa#ent'
dies)
Ques#onnaire
Visits:''One'per'contact'
per'pa#ent
Physical'Exam Blood'Test'
resultsECG'Report Echocardiograph
Source: John Cleland, Suzanna Hardman, SHN WP1
Is it heart failure? Key information for diagnosis
Is It Heart Failure?
Key information to support or refute the diagnosis John Cleland edit Suzanna Hardman
Suspected Heart Failure
Heart Failure Symptoms &
Signs
Cardiac Biomarker
Cardiac Imaging
Heart Failure Treatment
Orthopnoea / PND (no/yes/NK if yes - mild/mod/severe/NK)
Breathlessness when Walking (no/yes/can’t walk NK if yes - mild/mod/severe/NK)
Breathlessness at Rest (no/yes/NK if yes - mild/mod/severe/NK)
Swelling of Ankles or Legs (no/yes/NK if yes - mild/mod/severe/NK)
BNP - Value
NT-pro BNP - Value
MR-pro ANP - Value
Echo
Other ECG CXR
Left Ventricular Systolic Dysfunction Qualitative - (none/mild/mod/severe/ NK) or LVEF value
Additional Information Age Sex Height / Weight Heart Rhythm – SR, SR with freq ES, AF, AFl, V.Pace, Haemoglobin Serum Creatinine
Left Atrial Dilatation Qualitative - (none/mild/mod/severe/ NK) Or LA dimension Or LA volume
Valve Disease Qualitative - (none/mild/mod/severe/NK)
Other Right/Left Heart Dysfunction Qualitative - (none/mild/mod/severe/can’t walk, NK)
Loop Diuretic
ACE Inh.
ARB
Beta-Blocker
MRA
Warfarin
Thiazide Diuretic
NYHA Class (I/II/III/IV/NK)
Current Diagnosis
Heart Failure Excluded Heart Failure Confirmed
Heart Failure Uncertain
Clinician completing HER (name and role)
Physical signs
!
Source: John Cleland, Suzanna Hardman, SHN WP1
SHN standards, specification and profiling expertise
• Continua Health Alliance!• EN13606 Association!• HL7!• IHE !• IHTSDO!• openEHR Foundation!• WHO!!
• Academic expertise: ontology, guideline representation!• Industry expertise: EHR system vendors!• Adoption, quality labelling, dissemination: EuroRec, ESC, public health!• Sustainability: EuroRec, eHGI, Ministry experts, health insurers
Interoperable representations for diagnosis: archetype, OWL DL
shn:DiagnosisRecord/subClassOf! (D1) ///////shn:Informa3onItem/and $$$$$$$$$$$$$$$$$and$shn:hasInforma4onObjectA:ribute$some$shn:CertaintyA8ributeC/$$$$$$$$$$$$$$$$$and$btl:outcomeOf$some$shn:Diagnos3cProcedureD/$$$$$$$$$$$$$$$$$and$btl:outcomeOf$some$(shn:Interpre3ng$and$btl:haspar4cipant$some$shn:EvidenceE)$$$$$$$$$$$$$$$$$$$and$shn:isAboutSitua4on>only$ $$$$$$$$$$$$$$$$$$$$$$$$$(shn:ClinicalSitua3onX/and$ $$$$$$$$$$$$$$$$$$$$$$$$$$ $ and$btl:temporallyRelatedTo>some$shn:TimeT/////////////////////////// / and/btl:causedBy/some/shn:ClinicalSitua3onXY)$
Example clinical screen - to assist with clinician feedback
Source: Tony Austin, Shanghua Sun, WP1
Industry “soundbites”
• Slowly but steadily industry is realising the importance of semantic interoperability, although many don't understand fully what this involves.!
• SI will ... increase the Business Intel capabilities and make our systems more competitive.!
• Industry lacks a clear growth path and guidance on the implementation of semantic interoperability.!
• As long as industry is not actively involved in engineering the solution, the whole effort is deemed to fail. !
• SI will benefit the user much more than the vendor but in the long run it will increase competition and therefore improve the quality and competitiveness of the systems.
SHNet sustainability activities
• Work with the clinical, public health and patient stakeholders to define a formal process for the governance of semantic interoperability resources!
• Design an overall infostructure (a virtual platform and services) that can publish or reference resource “bundles” and manage their maintenance!
• Specify how EHR systems, public health systems, CRO systems etc. should ensure consistent and verifiable adoption of semantic interoperability resources!
• Develop a business plan for certifying semantically interoperable systems!
• Liaise with industry, professional bodies, ministries, insurers, SDOs on business drivers and incentives to foster rapid adoption of semantic interoperability resources and certification of such systems
