eurorec (eurorec )

EuroRec: current standing on EHR certification in Europe

22/10/2007Georges De Moor, MD, PhD – President EuroRec

EuroRec (http://www.eurorec.org )

• The « European Institute for Health Records »

• A not-for-profit organisation, established April 16, 2003

• Mission: the promotion of high quality Electronic Health Record systems (EHRs) in Europe

• Federation of national ProRec centres in Europe



ProRec CentersCentres

Belgium

Bulgaria

Denmark

France

Italy

Germany

Ireland

Romania

Slovenia

Spain

Slovakia

Applicants

United Kingdom

Serbia

The Netherlands

Poland

Norway

Greece

Hungary

Portugal

Sweden

“ Differences in languages, cultures and HC-delivery/funding systems ”



EHRs: TRENDS

• transmural, virtual• multidisciplinary and interactive• longitudinal and intelligent

AdministrativeRecords

Personal Patient Records

MedicalRecords

NursingRecords

! Integration with other eHealth applications ...!

EHRs start to become:



Q-REC

European Quality Labelling and Certification of Electronic Health Record systems (EHRs)

Duration: 2006 - 2008Contract No: IST-27370-SSACoordinator: Prof. Georges De Moor http://www.eurorec.org/

EHR-Implement

National policies for EHR implementation in the European area: social and organisational issues

Duration: 2007 - 2010Contract No: IST-27370-SSACoordinator: Dr. Laurence Esterle http://www.ehr-implement.eu/

RIDE

A Roadmap for Interoperability of eHealth Systems in Support of COM 356 with Special Emphasis on Semantic Interoperability

Duration: 2006 - 2007Contract No: IST-027065Coordinator: Prof. Asuman Dogac http://www.srdc.metu.edu.tr/



QREC’s Objective

To develop formal methods and to create a mechanism for the quality labelling and certification of EHR systemsin Europe, in primary- and in acute hospital-care settings

EuroRec Institute is coordinating partner QREC has 12 partners and 2 subcontractorsProject duration is 30 months (1/1/2006-30/6/2008)



QREC: ORIGIN

Several EU-member states (Belgium, Denmark, UK, Ireland, …) have already proceeded since years with (EHRs-) quality labelling and/or certification (more often in primary care) but these differ in scope, in legal framework under which they operate, in policies and organisation, and perhaps most importantly in the quality and conformance criteria used for benchmarking …

These differences represent a richness but also a risk: harmonisation efforts should help to avoid further market fragmentation in Europe



Central Repository

EuroRec will install a central repository of validated quality criteria and other relevant materials that can be used to harmonise European testing, quality labelling and procurement specification of EHR systems.

It will not impose particular certification models or specific criteria on any member country but will foster, via ProRec centres and other channels, the progressive adoption of consistent and comparable approaches to EHR system quality labelling.



Q-REC Rationale –Certification is Essential

To assure the quality of EHR systems, e.g., patient safety may be at risk due to:• system design, specification and functional inadequacies,• poor or confusing presentation of clinical relevant information.

Sharing of information requires a quality assessment of EHR products with a view to ensuring interoperability with other systems because:

• healthcare information, in particular clinical information, is often scattered over a number of informatics systems

• the structures of these EHRs may significantly differ from one system to the other, depending on the creator and the purpose.

• more and more incentives are being given to share patients’ medical data to support high quality care and “continuity of care” in a seamless way.

Certification of EHRs is essential for purchasers and suppliers• to ensure that EHR systems are robust enough to deliver the anticipated

benefits as EHR systems and related product quality (data portability and interoperability are difficult to judge).

• To reduce the risk for purchasers and therefore accelerate the adoption of high quality and more interoperable EHRs.



The EuroRec Repository: Introduction

• The Q-Rec repository will comprise several kinds of artefacts relating to the quality labelling and benchmarking of EHR systems:

• EHR system requirements• EHR system conformance criteria• EHR system test plan items• An inventory of quality labelled (certified) EHR systems• An inventory of EHR related standards• An inventory of terminology and coding schemes• A directory of certified EHR archetype repositories• A directory of reviewed open source specifications and

components

The year 1 priority



EHRs Criteria: Business Cases

• A purchaser wishing to procure an EHR system module• An e-Health programme wishing to ensure consistent EHR system

functionality nationally• A vendor wishing to (re-)develop an EHR system module• Developers wishing to interface to a given EHR system module

across multi-vendor systems• All may be:

– seeking design guidance– wishing to obtain quality labelling certification– searching for trustworthy products



EuroRec Repository

Repository Workflow



Typology of EHR System Statements

• Source Statements– faithfully extracted from original EHR system specifications

and test plans– translated if necessary

• Fine Grained Statements (FGS)– usually derived from source statements– made more generic, decomposed, reworded, corrected

• Good Practice Requirements (GPR)– recomposed from FGS into the more common useful building

blocks– may enhance or extend the scope of FGS: “push the boat out

a bit”• Generic Test Criteria

– derived from FGS and/or GPR– formally worded as testable functions



EuroRec Repository

Repository Workflow



Indexing the statements (1)

• Multiple indexing of each statement– to maximise the likelihood of finding all relevant statements

when searching via the indices

1. Business Function (50 in 8 subcategories)2. Care Setting (18 in 3 subcategories)3. Component Type (18 in 4 subcategories)



Business Function (1)

• A0 EHR data (record) management• A00 EHR data entry• A01 EHR data analysis• A02 EHR data content• A03 EHR data structure• A04 EHR data display• A05 EHR data export/import• A09 EHR generic data attributes• A1 Clinical functions• A10 Clinical: medication management• A11 Clinical: long-term illness

management• A12 Clinical: health needs assessment• A13 Clinical: care planning and care

pathways• A14 shared care• A15 Clinical: alerts, reminders and

decision support• A16 Clinical: workflow and task

management• A17 Clinical: patient screening and

preventive care services

• A2 Administrative services• A20 Appointments and scheduling• A21 Patient consents, authorisations,

directives• A22 Patient demographic services• A23 Certificates and related reporting

services• A24 Patient financial and insurance

services• A3 Care Supportive services• A30 Supportive care service requests

(orders)• A31 Supportive care service reporting

(results)• A32 Laboratory services• A33 Imaging services• A34 Diagnostic and therapeutic

services (other): ECG/EEG etc.• A35 Pharmacy services• A4 Analysis and reporting• A40 Screening and preventive health• A41 Care setting reports



• A5 Population health• A50 Screening and preventive health• A51 Disease registries• A52 Public health• A53 Epidemiology• A6 Health system services• A60 Healthcare organisation

management• A61 System maintenance and

technical support• A62 Education, training, support• A63 System configuration of the

application• A64 Individual configuration of the

application

• A7 Security: privacy and accountability• A70 Security: authentication• A71 Security: authorisation• A72 Security: access control• A73 Security: confidentiality and

consents• A74 Security: version management• A75 Security: de-identification services

and processes• A8 Security: technical• A80 Security: backup and integrity

validation• A81 Security: data retention,

availability and destruction• A82 Security: audit and override

monitoring• A83 Security: attestation and non-

repudiation

Business Function (2)



Care Setting

• B0 Generic or ubiquitous• B01 Regional healthcare network

(specific distribution)• B02 Virtual or telehealth• B03 Personal health• B04 Community and home care• B05 Health, wellness and prevention• B06 Occupational health• B07 Public health

• B1 Health care enterprises• B10 Long-term care (institution)• B11 General practice• B12 Secondary care (hospital)• B13 Tertiary care centre (specialist

hospital)• B14 Domain specific• B15 Profession specific

• B2 Secondary uses• B20 Research and knowledge

discovery• B21 Education• B22 Health service and planning



Component Type

• C0 EHRS functional component• C1 EHRS infrastructure component• C10 EHRS Interoperability component• C11 Security management component• C2 Knowledge resources• C20 Knowledge: terminology• C21 Knowledge: ontology• C22 Knowledge: archetype• C23 Knowledge: template• C24 Knowledge: data set• C25 Knowledge: guideline• C26 Knowledge: algorithm

• C3 Directory services• C30 Directory: patients• C31 Directory: personnel• C32 Directory: equipment• C33 Directory: health service

directories• C34 Directory: service resources• C35 Third parties• C4 Profiling or authoring tool• C5 Documentation, support etc.• C6 EHR system functional component



Some statistics



EuroRec Repository Maintenance Tools

• Creation of Fine Grained Statements

• Creation of Good Practice Requirements

• Indexing statements

• Linking statements

• Maintenance and update of Fine Grained Statements

• Maintenance and update of Good Practice Requirements

• Translation functions

• Access management

• Versioning and audit functions

• Overviews and statistics



1. From Reference Statements to Fine Grained Statements: selecting the Reference Statement

Reference statements frequently include multiple functions. Extract of the Irish 2007 criteria for General Practitioners



2. From Reference Statements to Fine Grained Statements: editor and linkage and indexing FGS

Editor Linking anexisting FGS

Indexing



4. Fine Grained Statement: maintenance interface

Linked to 4 reference statements

Version and translation management

Editing area

Included in 1 Good Practice Requirement



5. Fine Grained Statement: similar view of attributes of a FGS

Linked to 4 reference statements

Included in 1 Good Practice Requirement

Applicable indexes

Area with comments from outside, if any



6. Fine Grained Statement

View of a Fine Grained Statement with link to the Source Statements and theGood Practice Requirements.



12. Overview of Good Practice Requirements

List of Good Practice Requirements, with • number of Fine Grained Statements included• number of EuroRec Baskets with this GPR selected• view icon on indexes• display icon of links and indexes• icon enabling the user to give comments• view icon on the translations• maintenance icon



13. Good Practice Requirement View

Five Fine Grained Statements included

The statement

The indexes for that Good Practice Requirement

Area with comments from outside, if any



16. Multilingual Good Practice Requirement

Example of Good Practice Requirement in English, Bulgarian, German, Danish, French, Dutch, Romanian and Slovenian



EuroRec Languages (non-exhaustive list)

• English (default language)

• Bulgarian

• Danish

• Dutch

• French

• German

• Romanian

• Slovenian



EuroRec Use Tools

The EuroRec Composer ™To compose user defined, re-usable and exchangeable baskets of Fine Grained Statements.

The EuroRec Certifier ™ To format a EuroRec Basket content to obtain the basic layer for the certification of EHR systems. This is done by adding structure and attributes to the selected Fine Grained Statements.

The EuroRec Documentor ™To document EHR systems and their functions, enhancing their understanding and comparability by using the EuroRec statements.

The EuroRec Procuror ™To list and describe, for purchase purposes, required functionalities and product characteristics using EuroRec statements.

The EuroRec Scriptor ™To produce and link Test Scenarios to EuroRec Baskets for Certification, Documentation and/or Procurement purposes.



TestProcedures

EuroRecBaskets

Certification Documentation Procurement

TestScenarios

Test CriteriaSets



EuroRec Services

1. An Inventory of Certification Criteria for EHR systems

2. An Inventory of Standards relevant for EHR systems

3. EHR Archetypes

4. Open Source Components and XML Schemas

5. EHR Tutorials

6. Register of Health Coding Systems in use in Europe

7. Events



Events at WHIT 2007Tuesday, 23 October13:30–14:30 Location: room 1 TL7 - Thought Leader SessionEHRs Certification: Global Issues Wednesday, 24 October11:30–12:30 Location: room 3ES34 – Integrating IT Leadership to Improve Healthcare Delivery and Performance Certification of EHRs: Criteria, Procedures and ToolsEuroRec will present an update on the development of its certification criteria repository, as well as on its recommended procedures, including the use of its EHR profiling tool. 17:15–18:00 Location: product tutorial theatre - booth 1021Demo of the EuroRec Tools EuroRec EHR certification and documentationNew era in certification - Real time demo

Thursday, 25 October09:00–10:00 Location: room 2 ES44 – Integrating IT Leadership to Improve Healthcare Delivery and PerformanceEHR in Europe: A new paradigm. Archetypes: a RevolutionThree new CEN European standards constitute a new paradigm. The Archetype paradigm enables 'plug-and-play' semantic interoperability between EHR systems. Via the process of 'creative destruction' new ICT vendors will enter the market using this new exciting paradigm. These European standards help fulfill the ambitious 2010 goals, as accepted by the European Commission.



www.eurorec.org [email protected]

Thank you for your attention!

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