standards und projekte zur ehealth-interoperabilität ... · interoperability & innovation...
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Workshop 4: Telematik-Plattform für eine verzahnte Versorgung auf derBasis von Interoperabilitätsstandards – Ist das bIT4health-Projekt state-of-the-art?
Standards und Projekte zur eHealth-Interoperabilität
einschließlich EHR aus HL7, ISO, CEN und anderen
Standardisierungsgremien Bernd Blobel
Fraunhofer-Institut für Integrierte Schaltungen, ErlangenLeiter der Projektgruppe Gesundheitstelematik
Leiter der GMDS AG “Standards für Kommunikation und Interoperabilität”
Vorsitzender der HL7-Benutzergruppe in Deutschland
HL7 specificationsNouns
Things or entities thatare being communicated.
AdjectivesDescriptors and relationships of the nouns.
VerbsActions being requestedor communicated.
What must be specified for communication?
The semantics of the communicationThe semantics convey the actual "meaning" of the message. The semantics is conveyed via a set of symbols contained within the communication. An external dictionary", thesaurus, or terminology explains the meaning of the symbols.
A syntax for communicationThe syntax defines the structure and layout of the communication. Common syntax representations include ASN.1, XML, X.12, HL7, IDL, etc.
Services to accomplish the communicationExamples include the post office, a telephone switchboard, SMTP, FTP, Telnet, RPC, ORB services, etc.
A channel to carry the communicationExamples of channels include written documents, telephones, network connections, satellite links, etc.
Interoperability & Innovation
Semanticinteroperability
Functionalinteroperability
• Main Entry: in·ter·op·er·a·bil·i·tyFunction: nounDate: 1977: ability of a system (as a weapons system) to use the parts or equipment of another system
Source: Merriam-Webster web site
• interoperability: ability of two or more systems or components to exchange information and to use the information that has been exchanged.
Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]
Basic and Infrastructural Services
Electronic Health Record
A2
An-1An
A1
A3
Available Models:CEN EN 13606
“EHR Communication”
Part 1: Electronic Health Record Architecture
EHRcom Reference Model Class Packages
EN13606-A
EXTRACT DEMOGRAPHICS Package
MESSAGE
ACCESS TERMINOLOGY
EN13606 Extract Reference Model
Inheriting CEN DataTypes go here
Version 4b 2003-06-30DL/DK/TB
EXTRACTPackage
DATA_VALUE
ELEMENTnull_flavour[0..1] : CS
0..10..1val ue
CLUSTER
structure_type[1] : CS
ITEM
emphasis[0..1 ] : TEXTobs_time[0..1] : IVL<TS>0 .. *0 .. *
parts
RELATED_PARTYparty[0..1 ] : IIrel at ionship[1] : CV
SECTION
ENTRYinfo_provider[0..1] : FUNCTIONAL_ROLEannotat io ns[0..1 ] : LIST<CS>act_ id [0..1] : S tringact_status[0..1] : CV
1..*1..*
data
0..10..1
protocol
11
subject_of information
LINK
nature[1] : CVtarget_rc_id[1] : IIrole[0..1] : CVfollow_link[1] : BL
CONTENT
orig_parent_ref[0 ..1] : String
0..*0..*
members
CLINICAL_SESSIONsession_time[1] : IVL<TS>hca_legally_responsible_for_care[0..1] : IIhealthcare_facility[0..1] : ORG_IDservice_setting[0..1] : CVterritory[0..1] : CS
EHR_MESSAGE(from MESSAGE)
TERMINOLOGY_EXTRACT(from TERMINOLOGY)
FOLDER
0..*0..*
sub_folders
DEMOGRAPHIC_EXTRACTparties : SET<EX_PARTY>
FUNCTIONAL_ROLE
function[0..1] : CEperform er[1] : I Imode[0 ..1] : CV
0..*0..*
other_participations
0..*0..* other_participations
RECORD_COMPONENTname[1] : TEXT_OR_CODEarchetype_id[0..1] : Stringrc_id[1] : IIsensitivi ty[0..1] : INTmeaning[0..1] : CVis_archetype_root[1] : BLsynthesised[1] : BL
0.. *0.. *
l inks
COMPOSITIONcomposer[1] : II 0..*0..*
content
0..10..1
clinical_session
rc_id0 .. *0 .. * rc_id
compositions
AUDIT_INFO
ehr_node[1] : OIDtime_committed[1] : TScommitter[1] : IIrevision_status[0..1] : CSreason_for_revision[0..1] : CVprevious_version[0..1] : OIDcontribution_id[0..1] : EXTERNAL_ID
0..10..1
feeder_audit
EHR_EXTRACT
ehr_node[1] : IIehr_id[1] : IIsubject_of_care[1] : IItime_created[1] : TShca_authorising[0..1] : IIincluded_multimedia[1] : BLrm_id[1] : String
11
message_details
0..*0..*terminologies
0..10..1
directo ry
0 .. *0 .. *
demographic_entities
ATTESTATION_INFO
time[1] : TSproof[0..1] : EDlegal_image[0..1] : ED
11
attester
rc_id
1..*1..*
rc_id
target
VERSION
11
data
11
audit_trail
0..*0..*
all_versions
0..*0..*
attestations
Extract
HL7 D-MIM Representation of 13606
Correspondence with HL7 & CDAEHR
Folder
Composition
Section
Cluster
Element
All of the 13606 containerclasses now have a correspondingAct classCode
Correspondence with HL7 & CDAEHR
Folder
Composition
Section
Cluster
Element
(Act: classCode = EHR)
(Act: classCode = Folder)
Clinical Document
Section
choice of Entries: e.g. Observation, Encounter,
SubstanceAdministration
attributes of Entries
Correspondence with HL7 & CDA (2)
EHR_EXTRACTehr_node[1] : IIehr_id[1] : IIsubject_of_care[1] : IItime_created[1] : TShca_authorising[0..1] : IIincluded_multimedia[1] : BLrm_id[1] : String
AUDIT_INFOehr_node[1] : OIDtime_committed[1] : TScommitter[1] : IIrevision_status[0..1] : CSreason_for_revision[0..1] : CVprevious_version[0..1] : OIDcontribution_id[0..1] : EXTERNAL_IDFUNCTIONAL_ROLE
function[0..1] : CEperformer[1] : IImode[0..1] : CVCOMPOSITIONcomposer[1] : II
CLINICAL_SESSIONsession_time[1] : IVL<TS>hca_legally_responsible_for_care[0..1] : IIhealthcare_facility[0..1] : ORG_IDservice_setting[0..1] : CVterritory[0..1] : CS
RELATED_PARTYparty[0..1] : IIrelationship[1] : CV
(Participation)
recordTargetinformant
dataEnterer
encounterPerformer
author
legalAuthenticator
participant,legalAuthenticator
Correspondence with CDA (3)
• Correspondence has also been mapped for:– dates and times– version management, unique identifiers
• some changes to the RIM are being proposed
– clinical context (negation, certainty etc.)– (data type mapping via CEN data types -> ISO)
• But, the scope of 13606 is broader than CDA (i.e. not just documents)
• CDA documents can be represented in 13606• most of a 13606 Composition can be represented in CDA
The HISA StandardCEN EN 12967
CEN EN 12967
• Part 1: Enterprise viewpoint• Part 2: Information viewpoint• Part 3: Computational viewpoint
• Parts 1, 2 and 3 are jointly replacing the European prestandard ENV 12967-1: 1997 Medical informatics – Healthcare Information System Architecture (HISA) -Part 1: Healthcare middleware layer
HISA in relation to other standards and models
Common, neutral, HISA model
(e.g. RIM, DICOM, GPICs, etc.)
Integrated and consistent heritage of all common enterprise data end common business logic
Common, neutral, organisation-wide HISA model
Specific models & communication interfaces
Common, neutral, HISA model
(e.g. RIM, DICOM, GPICs, etc.)
Integrated and consistent heritage of all common enterprise data end common business logic
Common, neutral, organisation-wide HISA model
Specific models & communication interfaces
The process is shown in three parallel processes, where the clinical process is on top, the management process in the middle and the communication process in the bottom.
Investigate demand for care
Communication process
Core process
Management process
Demand forcare
Notedemandfor care
Noteddemand forcare
Decide on evaluatingdemand for care
Identify andmatch
Identifytype ofhealthissue
Identified typeof heath issue
Matchagainstservicerepository
Suggested listof services
Decide andagree onhealthcarecommitment
Agreedhealthcarecommitment
Reject
Communicatedecision
Communicateddecision
Continueprocess
Demanderof care
Patient HCIS
Activity HCIS
Clinical HCIS
Ressource HCIS
Authoris. HCIS
Access service catalogue
Concept HCIS
Register demand
Register decision
Access possibly ear-lier clinical data
Healthcare
information
services (explicit)
Healthcare
information
services (implicit)
Healthcare processes and services
Investigate demand for care
Communication process
Core process
Management process
Demand forcare
Notedemandfor care
Noteddemand forcare
Decide on evaluatingdemand for care
Identify andmatch
Identifytype ofhealthissue
Identified typeof heath issue
Matchagainstservicerepository
Suggested listof services
Decide andagree onhealthcarecommitment
Agreedhealthcarecommitment
Reject
Communicatedecision
Communicateddecision
Continueprocess
Demanderof care
Patient HCIS
Activity HCIS
Clinical HCIS
Ressource HCIS
Authoris. HCIS
Access service catalogue
Concept HCIS
Register demand
Register decision
Access possibly ear-lier clinical data
Healthcare
information
services (explicit)
Healthcare
information
services (implicit)
Healthcare processes and services
Agreedhealthcarecommitment
Realise healthcare commitment
Kärnprocess
Styrprocess
Kommunikationsprocess
Formulatehealthproblemsand goals
Formulatedhealthproblemsand goals
Decide tomatch againstservicerepository
Match foravailableactivities
Communicatedecision
Communicateddecision
Decide andplanactivities
Plannedactivities
Fetch availableactivities accordingto formulated healthproblems and goals
List of activities
Carry outactivity
Condition
Analyse anddecide oncontinuation
Continueprocess
Terminateprocess
Condition
Notehealthcarecommitment
Notedhealthcarecommitment
Decide onproblem andgoalformulation
Formulatehealthproblemsand goals
Orderexternalservice
Seviceprov ider
Demandfor care
Realisedhealthcarecommitment
Condition
Patient HCIS
Activity HCIS
Clinical HCIS
Ressource HCIS
Authoris. HCIS
Access catalogue of activities
Concept HCIS
Register commitment
Register decision
Access clinical data
Healthcare
information
services (explicit)
Healthcare
information
services (implicit)
Healthcare processes and services
Plan, execute, order activities
Register results Access clinical data
Agreedhealthcarecommitment
Realise healthcare commitment
Kärnprocess
Styrprocess
Kommunikationsprocess
Formulatehealthproblemsand goals
Formulatedhealthproblemsand goals
Decide tomatch againstservicerepository
Match foravailableactivities
Communicatedecision
Communicateddecision
Decide andplanactivities
Plannedactivities
Fetch availableactivities accordingto formulated healthproblems and goals
List of activities
Carry outactivity
Condition
Analyse anddecide oncontinuation
Continueprocess
Terminateprocess
Condition
Notehealthcarecommitment
Notedhealthcarecommitment
Decide onproblem andgoalformulation
Formulatehealthproblemsand goals
Orderexternalservice
Seviceprov ider
Demandfor care
Realisedhealthcarecommitment
Condition
Patient HCIS
Activity HCIS
Clinical HCIS
Ressource HCIS
Authoris. HCIS
Access catalogue of activities
Concept HCIS
Register commitment
Register decision
Access clinical data
Healthcare
information
services (explicit)
Healthcare
information
services (implicit)
Healthcare processes and services
Plan, execute, order activities
Register results Access clinical data
HISA overall and main objects / classes and their relation
Contact
PeriodOfCare SubjectOfCare
ACTIVITY
HealthCareProvider
ClinicalInformationHealthIssue
Resource
AccessSubjectIndividualUser
ClinicalGuidelines&Protocols
ClinicalPlan
PatientPlan
Authorisation profile
Is subject to >
< Belongs to
< Is responsible for
Belongs to >
Is generated by / relevant for >
< Has
< Has
< Is instantiated for
Executed regarding >
< Is related to
Is used by >
< Is derived from
Is requsting / performing >
Groups
< Is delineated by
HISA Information Model
Activity part of the Activity Management Information Reference Model
Planning part of the Activity Management Information Reference
Model
Healthcare enterprise information model
geographicnetworklocal network
Patients HC data Activities ResourcesConcepts Authorisations
Integrated and consistent heritage of enterprise data
Healthcarespecific
part
Genericpart
Common services not specifically related to
the healthcare
domain
Providing services for managing
common, fundamental data
of the healthcare organisation
Bitways (technological platform)
Providing facilities for the physical connection of
heterogeneous technological environments
(e.g. Corba, TCP-IP, etc)
Wards
Imaging
Materials
Management
..............User Front-ends
• Providing specialised supports to the specific user activities in the various sectors
• Comprise:•presentation layer•presentation logic
Middleware of common services
“complex”,high-level service
(e.g. HCR services)
view/aggregate
“complex”,high-level service
(e.g. authorization)
“complex”,high-level service(e.g. act life cycle)
Formalisedby
HISA Task HISA Task ForceForce
from the enterprise, information
and computational viewpoints
geographicnetworklocal network
Patients HC data Activities ResourcesConcepts Authorisations
Integrated and consistent heritage of enterprise data
Healthcarespecific
part
Genericpart
Common services not specifically related to
the healthcare
domain
Providing services for managing
common, fundamental data
of the healthcare organisation
Bitways (technological platform)
Providing facilities for the physical connection of
heterogeneous technological environments
(e.g. Corba, TCP-IP, etc)
Wards
ImagingImaging
MaterialsMaterials
ManagementManagement
............................User Front-ends
• Providing specialised supports to the specific user activities in the various sectors
• Comprise:•presentation layer•presentation logic
Middleware of common services
“complex”,high-level service
(e.g. HCR services)
view/aggregate
“complex”,high-level service
(e.g. authorization)
“complex”,high-level service(e.g. act life cycle)
Formalisedby
HISA Task HISA Task ForceForce
from the enterprise, information
and computational viewpoints
EN 12967 and the CV
Patients HC data Activities ResourcesConcepts Authorisations
Integrated and consistent asset of enterprise data
Application Application Application Application
Basic services for entering/retrieving common data
common HISA data model
Complex services implementing common business functions
1 “basic” services
2 “complex” services
General principles for all interfacesXML Structure of the input/output
parameters
• The HISA interface input structure organisation
• The HISA interface output structure organization
Summary
• There are many projects and initiatives at national but also at international level for designing and implementing semantically interoperable EHR systems based on a future-proof EHR architecture.
• Different established approaches such as HL7 Version 3, HL7 CDA, HL7 EHR, CEN EHRcom, CEN HISA, openEHR, NHII, etc. offer convergent paths to a component-based, service-oriented, flexible, scalable, secure, model driven EHR architecture.
Questions?
Contact details:
Bernd Blobel Ph.D.Associate ProfessorHead of the Health Telematics GroupFraunhofer Institut Integrierte SchaltungenAm Wolfsmantel 3391058 ErlangenEmail: [email protected].: +49-9131-776-5830Fax (Department Office): +49-9131-776-588