xiii international hl7 interoperability conference 2012
DESCRIPTION
TRANSCRIPT
Testing a New CDA Development Strategy in a Standardized Infrastructure for Continuity of Care in
Chronic Kidney Disease Patients Alberto Moreno, Alicia Martínez, Francisco Núñez, Carlos Parra
IHIC Conference
28th September 2012
Research partly funded by the Instituto de Salud Carlos III within RETICS Innovation in
Healthcare Technology call (code RD09/0077/00025), Corporación Tecnológica de Andalucia
and REDSA S.A.
Haemodialysis Scenario
Hospital provides care for more than 500 Patients diagnosed with CKD
When the patients are stable they are transferred to 8 outsourced external HD centres
Although the hospital is responsible of the patient and also pays the patient treatment the evaluation of the patients once they are transferred is not exhaustive enough
The communication was previously paper based
Referral
Prescription
Lab results
External HD
Private Center
Haemodialysis Scenario
Patients transferred back to the hospital
The information is urgently required when:
• Their health condition become unstable
• When an organ is available for patients that are included in the transplant list
?
External HD
Private Center
Project Objectives
As research project we aim to develop and test new interoperability approaches in a real scenario.
Develop a platform for our Nephrology department able to provide the means for continuity of care in CKD patients.
Requirements
– Integrated with the regional architecture of the Andalusian Health Service
– Interoperable with external nephrology
systems based on defined specifications.
Integration with regional infrastructure
Nephrology platform is integrated with the Andalusian Public Health Regional SOA infrastructure through the following services:
• UDB. User Data Base. This is a central patient management system that includes their demographic data.
• OCAM. Operator Centralised Access Module. This system manages professional roles and passwords in order to allow other applications set different access levels.
• CCD. Centralised Clinical Data. This system is a registry that contains identifiers and pointers to clinical reports and general information about the patients (encounters, allergies, problems and treatments, etc.).
Interoperability with External Private Centres
Definition of specifications based on IHE profiles for coordinating document and patient management tasks within the different systems in an Affinity Domain.
- Cross-Enterprise Clinical Documents Share Profile (XDS.b)
- Patient Identifier Cross-referencing for MPI Profile (PIX)
.
Interoperability with External Private Centres
External HD
Private Center
External HD
Private Center External HD
Private Center
Health IT
Provider
External HD
Private Center
External HD
Private Center
Business
Model A
Business Model B
ESB
LIS
Nephrology Platform
OCAM
UDB
CCD
Services from
the regional
infrastructure
Documents shared with HD centers
• Referral CDA a patient summary and patient evolution through previous HD sessions.
• Prescription CDA. In this document the nephrology professionals specify the patient treatment plan including number of dialysis sessions, dialysis settings and medication list. This document guides nurses in preparation tasks of the sessions.
• Session CDA. This document contains the patient evolution through the session including vital sign evolution, weight, dialysis catheter, others accesses. Nurses must record patient vital sign every hour.
• Lab Results NP receives all the lab results from the Laboratory Information System (LIS) as HL7 v2.5 messages. Once the patient is transferred to an external private HD centre, NP sends notifications of all previous Lab Results from this patient to the system of the external HD centre which could request these documents at any time based on XDS profile.
Referral CDA
Prescription CDA
Sessions CDA
Lab results (HL7v2)
External HD
Private Center
CDA development
CDA Archetype (Template
in ADL format)
XML instance CDA instance
Legacy data schema (XSD)
XQuery Engine
LinkEHR Tool
Export Mappings
(XQuery format)
LinkEHR tool that is able to map information from any XML format to the most
common EHR standards such as CDA, HL7v2 and ISO13606. This tool
defines these mapping relationships as a XQuery file and this can be executed
by any XQuery engine.
Source Target
Interoperability with External Private Centres
External HD
Private Center
External HD
Private Center External HD
Private Center
Health IT
Provider
External HD
Private Center
External HD
Private Center
Business
Model A
Business Model B
ESB
LIS
Nephrology Platform
Xquery Engine
OCAM
UDB
CCD
Services from
the regional
infrastructure
Validated with Lantana CDA Validator
With the large amount of information required by
the clinicians, we tried to maximise the reusability
of the CDA structures
Generic CDA archetypes defined the constrains
and semantics required in the CDA model for a
local organisation or IT infrastructure specific
system
CDA development
Generic Header
CDA development
Generic Observation
CDA development
Generic SubstanceAdministration
CDA development Generic Organiser
CDA development
Secondly we defined specialised archetypes, which are conformant to the resultant
CDA and include the clinical concepts specified by our nephrology department.
Specialised Observation Specialised Header
CDA development
CDA Document CDAHeader Substance Administration
Organiser Observation
Referral 1 1 0 16
Prescription 1 1 29 121
Session 1 1 75 389
Successfully defined highly complex CDA structures and that are able to be
created from legacy data
Conclusions
• The platform piloted by the nephrology
department and the 8 external HD private
centres through an IT Health provider.
• Perform a cost-effectivity study about the
impact that this new infrastructure has on
clinical practice.
• The defined specifications have successfully
opened a market for different health and
technical providers.
Conclusions
• Promising results of using CDA templates,
provides better management and audit of the
semantic structures, aligned with CIMI
• These archetypes are expected to be the
source for a new implementation guide for
CDA in the nephrology domain which has
just started within the HL7 Spain
Technical Committee.
Thank you for your kind attention [email protected]