semantic interoperability deployment & research roadmap i2010 subgroup on ehealth meeting 21...
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Semantic Interoperability Deployment & Research Roadmap
i2010 Subgroup on eHealth meeting21 February 2008, Brussels
Veli Stroetmann, empiricawith
Alan Rector, UNIMANDipak Kalra, UCL
Bedirhan Ustun, Pierre Lewalle, WHO Karl Stroetmann, Benjamin Jung, empirica
Pieter ZanstraJean Marie Rodrigues, UJM
Martti Virtanen, UUGyorgy Surjan, ESKI
2
What are we talking about?
Health system interoperability is the ability, facilitated by ICT applications and systems,
– to exchange, understand and act on citizens/patient and other health-related data, information and knowledge
– among linguistically and culturally disparate clinicians, patients and other actors
– within and across health system jurisdictions in a collaborative manner
Defining IOp:
3
Why do we need Semantic IOp?
Health system priorities and goals
To support the goals of greater patient safety, better quality of care, chronic disease management, extended homecare or patient
empowerment, clinical meaning (data, information, knowledge)
must be expressed consistently – to enable the safe, meaningful sharing and combining of
health record data between heterogeneous systems and actors / care providers;
– to enable the integration and safe use of computerised protocols, alerts and care pathways by EHR systems;
– to link EHR data to explanatory and educational materials to support patient and family engagement and professional development;
– to ensure the necessary data quality and consistency to enable rigorous secondary uses of longitudinal and heterogeneous data for public health, research, health service management.
4
Roadmap: Recommendations - General Principles
• Focus on concrete, immediate needs and real use cases with expected high benefits & lower costs
• Terminologies should have a well defined scope and purpose– be delivered against well defined, realistic time scales
• Separate: – Ontology - what you mean– Language - how you say it– Interface - how you find it
• Involve vendors/industry and human end users - clinicians, citizens– Be responsive– Be open, collaborative and participative
• Make it multilingual and multicultural• Focus on Quality Assurance and Reproducibility• Use today’s technology
– modern ontology languages, Web 2.0, “Just in time”
5
Some Recommendations on Structures and Process
• Governments to develop, implement and sustain longer-term visions, objectives and measures
• Establish national centres for multilingual, multicultural adaptation of international classifications including SNOMED
• Link them in a well-managed European network of Competence Centres
• Establish a European Network of Terminology Servers • Assure sustainability and scalability
– It must be maintained to be useful– Beware of silver bullets
6
Socio-economic Assessment: Optimising Semantic IOp
DxDegrees D0 D100
Degree ofInteroperability
BenefitCost
medium
low
high
Δmax
optimal: Dopt
Cost
Benefit
DxDegrees D0 D100
Degree ofInteroperability
BenefitCost
medium
low
high
Δmax
optimal: Dopt
Cost
Benefit
7
Terminologies: SNOMED-CT - Current Assessment
• Controlled vocabulary and identifiers– Well managed but slow response time
• Hierarchies and relations– Unusable
• Too unreliable to depend on to behave as documented• Systematically flawed in principle• Limited by software and logic limitations from early 1990s• Cost of repair probably exceeds cost of rebuilding - but still modest
• Multilingual / Multicultural support– Minimal
• Neither understood nor a priority for the IHTSDO– Spanish and Canadian-French versions might appear
• Openness and accessibility to Social Computing– Unusable - remains effectively closed
• Not generally available on the Web• Opportunity cost of participation prohibitive• Influencing policy difficult
8
Terminologies: Selected Recommendations
• Support for specific initiatives between ICD/WHO ISO and SNOMED to develop ICD-11 along with mappings to/from SN
• Support feasibility study (select subset of ca. 25,000 terms / use case) of reformulation of SNOMED to– build reliable hierarchies & relations– develop multilingual support– introduce social computing tools– empirically assess individual, organisational and societal benefits & costs
• Support open tools for terminologies that link up to SNOMED• Support social computing efforts (Web 2.0) on ICD-11• Develop language technologies
– Text extraction to build new terms and encode natural language– Text generation to present and for QA
• User involvement & ownership, a series of centres & initiatives• Support training at all levels
9
Sustainable framework
with EU Industry for
effective standards
development
European Centres of Excellence
Collaboration with EBI and
NBCO
Intern. Biobanking
collaboration
Sustainable Centres for
Selected Ontologies
Toolset forFeasibility Study
Large Scale Environment
Multilingual-cultural
adaptation
Research on consequences
of different commitments
Tools for Terminfo
test
Social Computing
based Terminology
Service
Central Reference Services
Local mappings to UMLS
Toolkit for HL7
messages & archetypes
binding
Ongoing consultations
Actions arising from
consultations
Feasibility Study & reformulation
of subset
Multilingual-cultural subsets
Formal QA of subset
Statistical extension of
QA
Policy with MS on future
use of hierarchies & relations
Roadmap for SIOp Deployment & Research - Ontologies
2009
2010
2011
2012
2014
2016
2021
2008
SNOMED LOINC, DICOM
Terminolo-gies & EHRs
GenomicsTransl. Medicine
Socio-Econ. Issues
Ontologies
10
Roadmap: Ontologies Action Plan
YearContent Process Tools
2008 Open ICD 11 with SNOMED Mappings
Reformulation of SNOMED
Establish Open collaborative framework for ICD11
Begin to establish mechanisms for industrial involvement
Open tools for ontology development
Open Web 2.0 tools to support ICD 11
2009 Quality assurance metrics for SNOMED Fragment
First translations of SNOMED Fragment
Extend industrial involvement
Establish formal collaboration with European BioBanking and EBI
Develop tools for linking and binding terminologies and archetypes
Establish open social site for clinical terminology
2010 Continue Establish mechanisms for reformulation of SNOMED Fragment
Extend and test open tools for terminology and Archetypes, possibly with inclusion of HL7
2011 Reassess and create long term plan for selected terminologies including limits on scope
Establish European Network of Terminology Servers
2012-2013
Review and reassess interoperability
11
Roadmap EHR: Basic elements and short term actions
• Effective, functional EHR systems need:1. Generic reference models for representing clinical (EHR)
data e.g. EN 13606, HL7 CDA, openEHR Reference Model
2. Agreed clinical data structure definitions e.g. openEHR archetypes, HL7 templates, generic templates and data sets
3. Clinical terminology systems e.g. LOINC, SNOMED-CT
• Areas needing adoption (short term):– Agree on a generic model for EHR communications: consider EN13606 – Adopt a standardised approach for representing and sharing of clinical
data structure specifications: agree to use archetypes / templates – Collaborate on key use cases for shared care & patient safety, and on
defining & tidying up the corresponding terminology/SNOMED-CT sub-sets – Seed clinical fora to develop care pathways and archetypes to meet the
needs of safe and evidence based care in different medical domains and disciplines
– Strengthen clinical user training in the use of EHRs, terminology and structured records
12
Roadmap EHR: Medium term actions
• Areas needing wide-scale evaluations:– Develop best practice in archetype design– Establish useful exemplars of SNOMED-CT sub-sets being adopted
within EHR systems and delivered in meaningful ways to clinical users
– Develop the business rules and validation processes– Identify and evaluate the benefits for various stakeholders & health
systems
• Areas needing investments: • Industry sponsored or nationally supported open source approaches
for:– Archetype & template authoring and validation tools– Terminology servers, term browsers for SNOMED CT, support for
term coordination– Global multi-cultural dimension - not just term translation but
internationalisation across health care paradigms and cultural differences
13Reference
ModelArchetypes Terminology
SNOMED-CTApplications Socio-
economic Issues
Generic Model for EHR
Communication
Standardised Represention
Clinical Data Structures
Care Pathways
Best PracticeA. Design
QA & Certification
Repositories
Term Binding
Authoring/Validation
Tools
Key Use Cases
Policies on SN Term Coordination
(TC)
SNOMED-CT Subsets
Business Rules for TC
Terminology Servers
Term Browsers
Consistency Test HL7 Terminfo
Global Experience
Test
EHR Visualisation Applications
Adaptable Clinical
Applications
Improve Inter-nationalisation
Agree on SIOP Goals for PHR
Link EHR to Educational
Material
Acceptance Evaluation
EHR/TerminologyUser Training
Roadmap for SIOp Deployment & Research - EHR
2008
2009
2010
2011
2012
2014
2016
2021
14
Roadmap Public Health: Long term goals
• Consistent use of EHRs as person-based health records in clinical settings
• Interconnecting health service providers so health information can be exchanged through interoperable digital means in a standard fashion
• Research to prove the comparability of digital information with analog traditional measures used for monitoring and evaluation in various health inf. systems
Time
Data, Norms,Standards
KnowledgeOrganization
LegalRequirements
EHR Common Standards
Exchange
EHR Common Standards
Content
LiabilitySecurityPrivacy
OwnershipIntellectualProperty
3 years 5 years 7 years 10 years
Population
Services
Environment
Metadata
Multilevel Ontologies
Mandate Organization
Multiple LanguagesLinguisticRepresentations
Interoperability Levels
FULL Semantic Interoperability
Some Semantic Interoperability
Technical Interoperability
NO Interoperability
Time
Data, Norms,Standards
KnowledgeOrganization
LegalRequirements
EHR Common Standards
Exchange
EHR Common Standards
Content
LiabilitySecurityPrivacy
OwnershipIntellectualProperty
3 years 5 years 7 years 10 years
Population
Services
Environment
Metadata
Multilevel Ontologies
Mandate Organization
Multiple LanguagesLinguisticRepresentations
Interoperability Levels
FULL Semantic Interoperability
Some Semantic Interoperability
Technical Interoperability
NO Interoperability
15
Roadmap Public Health: Actions
Requirements for SIOp:• Interconnection tools• Identification management• Common web services• Security technologies• Mechanisms for ensuring the sustainable operation of these
components on a widespread and publicly available basis
Action points:• Enable common standards to allow data exchange on predefined
key variables & compilation of content• Compile data across populations and across health care providers• Link data across multiple care settings• Compare data across regions, time or populations• Set up organizational and legal regulations in a sustainable
fashion• Develop global registries of standardized information models and
related metadata
16
Legal Requirements:
Liability, Security, Privacy
IPR, Ownership
Mandate the organisation
of PH information gathering
Common Standards
for Exchange
Common Standardsfor Content
Metadata for populations, settings and
GIS
Predefined Reportable Diseases
International Health
Regulations
Online Epidemiology on selected conditions
BioBanking
Linkage toPopulation Registries
Electronic Death
Certifiation
Patient Flow/ Statistics
Case-MixGrouping
Roadmap for SIOp Deployment & Research – Public Health
2009
2010
2011
2012
2014
2016
2021
2008
Classifications Demography Biosurveillance Public Health Infrastructure
Socio-economic Issues
17
Final Report: Roadmap Matrices & Action Plans
ContentTools
ProcessesToDo
Time Actors
PrereqsShort Term
Medium Term
Long term
Policy Makers
Health professionals
Researchers
SDOs
Industry
C1
Content SNOMED
Feasibility study and semantically sound reformulation hierarchies and relations for a of subset of SOMED
x x x x x T1
C2Multilingual multicultural versions of semantically sound subset
x x X x
C3Formal QA of Subset of SNOMED X x x X
C4Statistical extension of QA to all of SNOMED x X X x
C5Policy in conjunction with member states on future of use of SNOMED hierarchies and relations
x X
C6
Content Other
Consultation on issues related to LOINC & DICOM
x x x x
C7Consultation on issues related to Adverse reaction reporting and Drug Reporting
x x x X[1]
C8Actions arising from consultations X X X X X X
[1] Incl. Pharma
Roadmap Matrix on Ontologies (excerpt)
18
Final Report: Roadmap Matrices & Action Plans
Roadmap for Semantic Interoperability Deployment and Research
Tools-Contents-Processes
2008 2009 2010 2011 2012 2014 2016 2021
Reference Model
Archetypes
Terminology Systems
Technology/ Visualisation
EH
R
Socio Economic Issues
SNOMED
LOINC, DICOM
Terminologies and EHRs
Ontologies
Genomics/ Translational
Medicine
On
tolo
gie
s
Socio Economic Issues
Classifications
Demography
Biosurveillance
Public Health Infrastructure
P
ub
lic
Hea
lth
Socio Economic Issues
Generic Model for EHR Communication
Standardised Represention/ Sharing of clinical data structures
Care Pathways and Archetypes
Best Practise Archetype Design
Quality Assurance and Certification
Archetype Repositories
Term Binding to Archetypes
Archetype/Template Authoring/Validation Tools
Key Use Cases
Policies on SNOMED-CT Term coordination
SNOMED-CT subsets
Business Rules to support term coordination
Terminology Server/Term Browser for SNOMED-CT
Consistency Test HL7 Terminfo Trial Standard
SNOMED-CT global Experience Test
EHR Visualisation Applications
Adaptable Clinical Applications
Electronic Death Certifiation
Patient Flow/ Statistics
Case-Mix Grouping
Linkage to Population Registries
Predefined Reportable Diseases
International Health Regulations
Online Epidemiology on selected conditions
Bio Banking
Common Standards for Exchange
Common Standards for Content
Metadata for populations, settings and GIS
Legal Requirements on Liability, Security, Privacy
Legal Requirements on Intellectual Property, Ownership
Mandate the organisation of PH information gathering
Consultations on issues related to LOINC & DICOM
Actions arising from consultations
Tools/methods for Terminfo guidelines test implementation
Generic Toolkit for HL7 messages and Archetypes binding to Terminologies
Establish sustainable framework with European Industry for effective standards and terminology/ontology development
Establish local European CoE on NCI technologies
Establish collaboration with EBI and US NBCO
Establish international Biobanking collaboration on terminologies
Toolset for Feasibility Study
Social Computing based Terminology Service
Large Scale Collaborative Ontology Environment
Central Reference Terminology Services
Ontology Mapping Research
Sustainable Centres for Selected Ontologies
Multilingual/-cultural classification adaptation
Policy: Local terminologies map to UMLS CUI & LUI
Research: Consequences of different ontological patterns and commitments
Feasibility Study and re-formulation of SNOMED subset
Multilingual/ -cultural SNOMED subset
FORMAL QA of SNOMED subset
Statistical extension of QA to all SNOMED
Policy in conjunction with MS on future use of SNOMED hierarchies and relations
Improve Internationalisation across HC paradigm and cultural differences
Agree on Semantic Inter-operability Goals for PHR
Link EHR data to educational material
Acceptance Evaluation
EHR/Terminology User Training
19
Proposal: Building a European Semantic IOp Knowledge Base
• Semantically linked set of documents• Collaborative environment (discussion page open for everybody)• Extensibility
SemanticHEALTH Wiki
20
Acknowledgements
Specific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMME
Communication & Technology Research Germany
Radboud University NijmegenMedical CenterThe Netherlands
World Health Organisation Dept. Measurements & Health Information Systems, Switzerland
Uppsala UniversityNordic Centre for Classifications in Health Care, Sweden
University of St. EtienneDepartment of Public Health & Medical Informatics, France
National Institute for Strategic Health ResearchHungary
University of Manchester Health and Bioinformatics Group, UK
University College LondonCentre for Health Informatics, UK
21
Thank you for your attention!
Further information:
www.SemanticHEALTH.orgsemantichealth@eski.hu
Veli Stroetmannfor the SemanticHEALTH consortium
Communications & Technology ResearchBonn, Germany
veli.stroetmann@empirica.com
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