Transcript Document

Draft Policy Brief on
Semantic Interoperability
Editors
Dipak Kalra and Mark Musen
ARGOS and Semantic Interoperability
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The ARGOS Transatlantic Observatory for Meeting Global
Health Policy Challenges through ICT Enabled Solutions is an
international platform for dialogue and collaboration on
health policy issues that surround making Health ICT a success
Co-ordinated by EuroRec, in partnership with AMIA
Semantic interoperability is one of the priority themes
Experts from the EU and US have met during 2010-11 and
shared understanding of the problem space, solutions found
and priority areas to be tackled
This presentation summarises the strategies proposed
Drivers for integrated EHRs
• manage increasingly complex clinical care
• connect multiple locations of care delivery
• support team-based care
• deliver evidence-based health care
• improve safety through mechanisms that:
– reduce errors and inequalities
– reduce duplication and delay
• improve cost effectiveness of health services
• enrich population health management and prevention
• empower and involve citizens
• protect patient privacy
• better inform and exploit biomedical research
Health information flows needing semantic interoperability
Wellness
Fitness
Complementary health
Citizen in the
community
rapid bench to bed translation
Social care
Occupational health
School health
real-time knowledge directed care
Point of care
delivery
Teaching
Research
Clinical trials
explicit consent
implied consent
Disease registries
Screening recall
systems
Continuing care
(within the institution)
Education
Research
Epidemiology
Data mining
de-identified
implied consent
+/- consent
Long-term shared care
(regional national, global)
Public health
Health care
management
Clinical audit
Essential needs
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Guideline and decision support systems, notification and
alerting components, and analytic tools need to process
integrated health data drawn from multiple EHR systems in a
consistent manner
Intelligent personal health guidelines interoperating with
PHRs and EHRs need to support the centring of care on
patients
New generation personalised medicine, underpinned by
‘omics sciences and translational research such as the VPH,
needs to integrate EHRs with data from research:
fundamental biomedical science, clinical and population
health research, and clinical trials
architecture
identifiers for people
policy models
structural roles
functional roles
purposes of use
care settings
pseudonymisation
privacy
record structure
and context
Resources needed to support rich semantic interoperability
reference models
data types
near-patient device interoperability
archetypes
templates
Consistent
representation, access
and interpretation
workflow
clinical terminology systems
classification systems
terminology sub-sets
value sets and micro-vocabularies
post-co-ordination
multi-lingual mappings
semantic context model
categorial structures
terminology
systems
guidelines
care pathways
decision support
algorithms
Semantic interoperability resource priorities
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Widespread and dependable access to maintained collections
of coherent and quality-assured semantic resources
– clinical models, such as archetypes and templates
– rules for decision making and monitoring
– workflow logic
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which are
– mapped to EHR interoperability standards
– bound to well specified multi-lingual terminology value sets
– indexed and correlated with each other via ontologies
– referenced from modular (re-usable) care pathway components
Practical issues
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These resources need to be developed by communities of
practice, reflecting real needs
This development must include patients, emphasising citizen
engagement in self management and health maintenance
They need to be embedded within EHR systems, and within
other systems and services that will analyse and interpret EHR
data
Nine key recommendations
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Nine strategic actions that now need to be championed,
as a global mission
1. Establish good practice
2. Scale this up
3. Support translations
4. Track natural language technologies
5. Align and harmonise standardisation efforts
6. Support education
7. Develop business models
1. Establish good practice
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Establish projects to develop good practice in the definition
and validation of clinical models bound to terminologies and
ontologies and guideline-based pathway models
that have a well-grounded and practical relevance to the
management of clinical conditions of national and
international priority
– e.g. chronic conditions, like heart failure
– e.g. population health issues, like childhood obesity
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BUT: still adopting a holistic - not a piecemeal - approach
2. Scale this up
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Develop a sustainable approach to scaling this up across
disease areas and stakeholders, importantly with patients
Ensure wide-scale clinical engagement during the design and
piloting of clinical models and terminology
Involve other stakeholders who will create or use health data
Address wider health system needs and support future
research
3. Support translations
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Resources need to be multi-lingual to support cross border
shared care, cross border health planning and global scale
research
Specifically consider the challenges of supporting multiple
levels of “clinical jargon” for different stakeholders including
patients and caregivers
4. Track natural language technologies
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Monitor the evolving capability and potential uses of naturallanguage technologies,
including the reliability of such approaches for populationlevel and patient-level decision making
5. Align and harmonise standardisation efforts
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Having understood the clinical modelling that is really
needed...
conduct a gap analysis of
– interoperability standards
– informatics tools
– knowledge representation formalisms
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clinical content
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– embedding such resources within EHR systems
– providing formal recommendations to SDOs on the scope and level of
detail that is needed and would be usable
6. Support education
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Invest in education that enables clinical and patient/citizen
acceptance, creation and use of knowledge-rich EHRs
– to create good quality (faithful, accurate) and re-usable information
– to better trust and use information from external sources
– to take better advantage of semantically interoperable systems and
services
7. Develop business models
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Develop and align with business models to justify strategic
investments in this field
Understand the value propositions (ROI) for key stakeholder
groups and decision makers, including
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clinicians, patients, citizens
EHR system vendors
healthcare provider organisations
health authorities
insurers
academic, bio-science and pharma research
standards developers
Find win-wins and relevant incentives
Continue this Transatlantic Observatory
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Support Transatlantic research efforts on
– what parts of, and how much of, a health record is useful to
structure/code/make interoperable: focus on benefits versus effort
– the quality assurance of semantic resources when used together:
clinical and technical validation
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Collaborate across countries on
– common conformance criteria for systems and system components
– practical methods for testing interoperability
(e.g. for vocabularies, ontologies)
– validating the correctness and consistent usability of solutions
(including human factors)
Leadership and governance are needed
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Strong leadership within and across all relevant stakeholders
will be essential to drive these actions and oversee benefits
realisation
In the longer term a governance organisation is needed
– to support, co-ordinate and quality manage the future development of
semantic interoperability resources for health
– to develop an action plan for future research and educational
investments