What can and should be agreed upon? Standardized? (EHR = Electronic - - PowerPoint PPT Presentation

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What can and should be agreed upon? Standardized? (EHR = Electronic - - PowerPoint PPT Presentation

Jan 12, 2023 336 likes •839 views

Scandinavian openEHR and ISO13606 workshop The event is part of SHI2011 co-hosted with MIE2011. Welcome everybody! Agenda Intro (5 min) Briefings from Norway, Sweden & Denmark (40 min) Open discussion (40+ min) Focus

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SLIDE 1

Scandinavian openEHR and ISO13606 workshop

The event is part of SHI2011 co-hosted with MIE2011. Welcome everybody!

  • Agenda
  • Intro (5 min)
  • Briefings from Norway, Sweden & Denmark (40 min)
  • Open discussion (40+ min)
  • Focus themes
  • Semantic challenges (clinical content)
  • Tooling & software challenges
  • Architectural challenges

(system integration, national frameworks etc)

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SLIDE 2

Scandinavian openEHR and ISO13606 workshop

The event is part of SHI2011 co-hosted with MIE2011. Welcome everybody!

  • Agenda
  • Intro (5 min, by Erik Sundvall)
  • Briefings from Norway, Sweden & Denmark (40 min)
  • Open discussion (40+ min)
  • Focus themes
  • Semantic challenges (clinical content)
  • Tooling & software challenges
  • Architectural challenges

(system integration, national frameworks etc)

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SLIDE 3

What can and should be agreed upon? Standardized?

(EHR = Electronic Health Record)

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EHR system A EHR system B

export/import export/import

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SLIDE 4

Conversion problems 1

Same kind of information, but captured in different ways

Resolvable by computer computer (non-changing patterns)

Weight at birth: 3300g Weight: 3.3 kg

Resolvable by medically competent human but not computer

Example: Medical history in two different systems Chief Complaint History of the present illness Past medical history Family diseases Social history Substance use (tobacco, alcohol, drugs) Diet Exercise Chief Complaint Medical History Social History

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Conversion problems 2

Same kind of information, but captured in different ways

Not resolvable even by medically competent human (but maybe useful for a human anyway)

Example: Aggregations using different intervals (cigarettes/week) 0, 1-5, 5-10, 11-15, 16-30, 31-50, 51-100, 101+ 0, 1-3, 4-7, 8-14, 15-28, 29-56, 57+

Different kinds of information or missing information

Not resolvable even by medically competent human (not reusable for certain purposes)

Example: Alcohol yes/no Tobbaco yes/no Cigarettes yes/no Snuff (snus) yes/no

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What is possible...

For a computer system? For a human? For an organization? For multiple organizations?

Does it scale? Is it manageable? Man-hours? (Costs & competence) Is data quality effected?

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EHR system A EHR system B

export/import export/import

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SLIDE 7

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Domain Content Models templates Information Representation Models reference model

  • Implemented as software

(in Java, .NET etc.)

  • By IT system vendors etc.

Computer Science knowledge?

  • Storage, transactions etc.
  • Rather stable
  • Change when new

clinical needs arise.

  • By Clinicians

Medical (Informatics) knowledge?

Domain Content Models archetypes

Layers of modeling

  • penEHR
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SLIDE 8

09/10/2008 Linköpings universitet Sid

Archetypes

(chaining points)

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Why?

Document - Traditions, clinical context, authorship etc. matter.

EHR > Compositions > Sections > Entries > Data structures > Values

Tree - Paths are convenient for queries, processing etc.

ehr://1234567/87284370-2D4B-4e3d-A3F3-F303D2F4F34B@latest_trunk_version/ content[openEHR-EHR-SECTION.vital_signs.v1]/items[openEHR-EHR-OBSERVATION.heart_rate-pulse.v1]/ data/events[at0006]/data/items[at0004]/value/magnitude

Objects - Easily implementable in IT systems (somewhat consistently)

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AQL

SELECT e/data[at0001]/items[at0002.1]/value/defining_code/code_string FROM EHR [uid = 121212-1212] CONTAINS COMPOSITION c [openEHR-EHR-COMPOSITION.epicrisis.v1] CONTAINS EVALUATION e [openEHR-EHR-EVALUATION.problem-diagnosis.v1] SELECT c FROM EHR [uid=$ehrUid] CONTAINS COMPOSITION c CONTAINS INSTRUCTION i[openEHR-EHR-INSTRUCTION.medication.v1] CONTAINS ITEM_TREE it[openEHR-EHR-ITEM_TREE.medication.v1] WHERE (it/items[at0012]/value/defining_code/terminology_id = "SNOMED" AND it/items[at0012]/value/defining_code/code_string matches {'350162003', '350162003'})

More info: http://www.openehr.org/wiki/display/spec/Archetype+Query+Language+Description

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Archetype Query Language Variables in green Paths in yellow

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SLIDE 11

Briefings from Norway, Sweden & Denmark

40 minutes ≈10 quick reports

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Norway Archetypes for EHR information in Norway. Johan Gustav Bellika Master thesis topic: Enabling research on routinely collected EHR data by exporting data to an archetype based systems. Johan Gustav Bellika & Leykun Gebeyehu Archetype integration by DIPS (EHR vendor) ???

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What is happening in Norway?

Gustav Bellika, Leykun Melkamu Gebeyehu Department of Computer Science, University of Tromsø

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Something is finally happening! 

  • Government level:

– Action 41: Terminology binding of Archetypes with existing terminologies and SNOMED CT

  • Academic: A master thesis project at CS dept

at University of Tromsø

  • Industry: DIPS, a Norwegian EMR vendor, will

use OpenEHR archetypes in their new version

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SLIDE 15

Government initiated activity

  • “National ICT” (NIKT)

– The medical specialist service arena for integrated care using ICT. – Funded by Dept. of Health

  • Objectives:

– Develop a catalog of clinical information models (archetypes) with corresponding terminology for medical chart systems (curve) and clinical quality registries based on archetypes.

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Deployment

User scenarios Contents in archetypes/templates

Registries Terminology binding

1 year 2-3 year 3-5 year

Only project participants Smoking, Hart disease in family BP, pulse, weight Chemical lab ECG Diagnosis Medication? Physiological data, incl. respiratory/ventilator equipment Procedures and results GCS, MMS, MADRS Adverse reaction ? Treatment goals (lab values) Translate 20, adapt 10, develop 5 archetypes. Norwegian intensive care registry Norwegian diabetes registry for adults Norwegian cardiac arrest registry (should be considered) ICD-10, NCMP, NCSP, ATC, FEST, SNOMED CT, DATAMS, NORAKO, national contents standards ICF, NEKLAB, radiology classifications PAS-data. Demographics, contact details (persons) Information from anamnesis (etnisity, heredity , food, physical activity) Clinical, non quantifiable findings, example: vibration sensing Infusjon, cytostatika, transfusjon Xray picture interpretation, other reports More treatment goals/effect/result Organ donation status Scoring systems Other critical information Registry owners and health personnel in hospital / outpatient clinics Pilot with EPR-vendors and registries Library with archetypes Guide for implementation
  • f archetypes and
templates Inform Hospitals and developers

Archetypes and terminology in EMR and registries

Potential information contents

ICD-11
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SLIDE 17

Academic

  • A master thesis project: Extracting and

extending EMR data from the gastro surgical department at UNN using archetypes.

  • Objective: Enable research/secondary use of

15 years production of clinically data

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SLIDE 18

Industry

  • DIPS ASA has announced that they will use

archetypes in their next version of the DIPS EMR system.

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SLIDE 19

Norway Archetypes for EHR information in Norway. Johan Gustav Bellika Master thesis topic: Enabling research on routinely collected EHR data by exporting data to an archetype based systems. Johan Gustav Bellika & Leykun Gebeyehu Archetype integration by DIPS (EHR vendor) ???

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Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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SLIDE 23

Work on reference archetypes

 Based on openEHR RM and a model of a

generic clinical process

 Adds classes corresponding to steps in the

generic process model

 Borrows attributes from SNOMED CT concept

model

 http://sllocean.karolinska.se/ckm/

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SLIDE 24

Work on reference archetypes

 Process model is used to elicit recording

requirements

 Reference archetypes used for representing

Heart Failure clinical documenting requirements

 Ongoing project, three more domains will follow this

fall

 Quality registry data items will be inferred from

clinical data

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SLIDE 25

Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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SLIDE 26

Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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SLIDE 27

EEE

An Educational EHR Environment

  • r Extendable EHR Ecosystem?

REST = "representational state transfer"

design principles presented in 2000 in the doctoral dissertation of Roy Fielding, one of the principal authors of the Hypertext Transfer Protocol (HTTP) specification.

EEE = openEHR sliced to more digestable pieces using REST + ...

Presented by: Erik Sundvall erik.sundvall@liu.se http://www.imt.liu.se/~erisu/ Department of Biomedical Engineering Linköpings Universitet, Sweden

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SLIDE 28

Query

(DB native QL)

Validators & Converters

EEE main components

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EHR Database basic DB read Native DB calls basic DB write

Versioned objects (compositions etc) Contributions EHR Access control settings

Versioned

  • bject

AQL-Query

Log

Trigger handler

(on commit)

Log extractor Log

Contribution builder Decision support Export

(e.g. replication)

Trigger handler

(during entry)

Decision support Query translators Custom resources Custom resources Custom resources

Contribution builder Validators & Converters

Query

(DB native QLs)

Instance builder Bulk loader Admin (users etc)

Contribution Client Client Client Client Single record access router Multi record access router

Tools & utilities:

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SLIDE 29 Source http://bonnier.com/en/content/digital-magazines-bonnier-mag-prototype

”Skapa en kreativ plattform med senaste tekniken för att praktiskt implementera tvärvetenskaplig forskning inom informationsvisualisering för vård och omsorg.”

AIV

http://www.advancedinfovis.org/

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SLIDE 30

County Council of Östergötland Med Tech R&D Organisation

R&D Coordinator

Magnus Stridsman

Research Development Testning Research and development unit Innovation

http://www.advancedinfovis.org/

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SLIDE 31

AIV + EEE

EHR overviews

Medication history, review & perscription

http://www.nepi.net/110208-Foerstudie-ordinationsorsak.htm http://www.nepi.net/res/dokument/Bilaga-B-Anvandarutvardering-av-Ordinationsorsak.pdf

General EHR overviews

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SLIDE 32

Cooperative Prototyping, a form of participatory design

Let the user/domain expert have power over the prototyping tools and shared "ownership" of prototype. a) idéa-generation & exploration b) "work-like evaluation"

Susanne Bodker, Kaj Gronbaek, Cooperative prototyping: users and designers in mutual activity, International Journal of Man-Machine Studies, Volume 34, Issue 3, Computer-supported Cooperative Work and Groupware. Part 2, March 1991, Pages 453-478, ISSN 0020-7373, DOI: 10.1016/0020-7373(91)90030-B. Grønbæk, K. Prototyping and Active User Involvement in System Development: Towards a Cooperative Prototyping Approach. Computer Science Department, Aarhus University, Ph.D. Thesis, September 1991 http://www.daimi.au.dk/~kgronbak/Thesis/ThesisOverview.html (Schuler, D. & Namioka, A. (1993). Participatory design: Principles and practices. Hillsdale, NJ: Erlbaum) (Bødker, S. and Grønbæk, K. (1989). Cooperative Prototyping Ex-periments - Users and Designers Envision a Dental Case Record System. In J. Bowers and S. Benford (eds.), Proceedings of the first EC-CSCW '89, UK. Computer Sciences Company (pp. 343-357).)

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Sweden

Commercial projects by Cambio Healthcare Systems. Rong Chen National openEHR/13606-related eHealth projects, current situation, challenges Daniel Karlsson Using openEHR to exchange data between an overview application for intensive care and an EHR application (Cambio Cosmic). Nadim's PhD project, which just started and looks at possibilities of EBM practice support and clinical process support through openEHR. The first results of Nadim's PhD, in which European stroke guidelines are formally represented with consideration of openEHR concepts Nadim Anani Archetype based prototyping projects by academy and healthcare: AIV & EEE Erik Sundvall Archetype based decision support systems for dental care & openEHR experiences by Chalmers (Hajar Kashfi et al in Gothenburg) Olof Torgersson

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Denmark National Patient Index and Shared Medication Record. Louise Bilenberg Pape-Haugaard National archetype project – a cooperation between the national authorities, regions, and vendors Knut Bernstein

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Denmark National Patient Index and Shared Medication Record. Louise Bilenberg Pape-Haugaard National archetype project – a cooperation between the national authorities, regions, and vendors Knut Bernstein

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Denmark National Patient Index and Shared Medication Record. Louise Bilenberg Pape-Haugaard National archetype project – a cooperation between the national authorities, regions, and vendors Knut Bernstein

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Danish research contribution and perspectives

Focus on Shared Medication Record

Presented by Louise Pape-Haugaard

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National Patient Index & Shared Medication Record

  • In DK – several smaller ongoing projects

– Conducted by vendors, researchers and governmental staff

  • Research in eHealth conducted at AAU is:

– Terminologies (SCT) – Architectures – Clinical content – Electronic Health Records (from different perspectives)

  • Basicly, Interoperability in eHealth
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Shared Medication Record

3

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Standardization used to support SMR

4

Webservice standards Security standards

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Future ideas and collaboration

  • Shared Medication Record is quick and dirty

but….

– Can we reuse the model in a different domain? – Can we internationalize the model? – Could such services be based on international profiles and standards? – Can we in any way create a collaboration?

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SLIDE 42

Open Discussion

Scandinavian openEHR and ISO13606 workshop

Semantic challenges

clinical content

Tooling & software challenges Architectural challenges

system integration, national frameworks etc

Questions in Scandinavian languages are also welcome and will be translated to English.

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SLIDE 43

Open Discussion

Scandinavian openEHR and ISO13606 workshop

  • A. Using openEHR for quality registers? Will distributed queries in

archetyped EHRs be able to replace registers in the future? Will the expert roles change?

  • B. How can Scandinavian cooperation in openEHR-related research and

education be improved?

  • C. Can common semantic platform support Scandinavian participatory

design of reusable parts for end user solutions?

  • D. Can different it-architectures and strategies across national borders

make Scandinavian collaboration harder? Do Danish SOA approaches and archetype-based approaches address the same or different kinds of problems? Can experiences from one approach be reused in the

  • ther?
  • E. How can CDS applications and distributed care process support

benefit from a common semantic platform and shared clinical content?

Questions in Scandinavian languages are also welcome and will be translated to English.

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The End?

Slides & contact info will be uploaded to http://www.imt.liu.se/~erisu/2011/MIE/

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SLIDE 45

Bonus track...

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Borders… Systems of Systems...

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Terminology systems Information models and structures Decision Support Systems (DSS) Process & flow models

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SLIDE 47

Borders… Systems of Systems...

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Terminology systems Information models and structures Decision Support Systems (DSS) Process & flow models

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SLIDE 48

Borders… Systems of Systems...

About Engineering Complex Systems: Multiscale Analysis and Evolutionary Engineering [Bar-Yam-2004]

limits of decomposition based engineering (bandwidth in hierarchies) Instead, competitive parallel design - mimics complex biological and social systems or free market competition, Some key concepts suggested:

A focus on environment and process rather than a product. Allow component changes in situ. Continually build on what already exists and allow systems to include multiple (possibly overlapping) versions of functional components. View complex systems as populations rather than rigid assemblies of unique components. Allow multiple parallel development processes, experiment in situ and gradually increase the usage of potentially more efficient solutions – testing is never complete and the operation needs to be continuous.

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  • Y. Bar-Yam: About Engineering Complex Systems: Multiscale Analysis and Evolutionary

Engineering, in Engineering Self Organising Systems: Methodologies and Applications, S. Brueckner, G. Di Marzo Serugendo, A. Karageorgos, R. Nagpal (Eds.), ESOA 2004, LNCS 3464, Springer-Verlag, 16-31, 2005.Available from: http://necsi.org/projects/yaneer/ESOA04.pdf