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: bbl@iis.fraunhofer.deTel.: +49-9131-776-5830Fax (Department Office): +49-9131-776-588