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Achieving Interoperability of EHR Systems through Functional Harmonisation

Learn about the importance of interoperability in healthcare systems, the role of functional criteria, and the EuroRec Institute's efforts in promoting high-quality EHR systems. Discover how to ensure functional quality and harmonisation for efficient care delivery.

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Achieving Interoperability of EHR Systems through Functional Harmonisation

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  1. Through functional harmonisation to Interoperability of EHR systems ISHEP Zagreb, September 16, 2010 Dr. Jos Devlies, EuroRec

  2. Topics addressed • The EuroRec Institute • Interoperability and Quality…. • Functionality as prerequisite for Quality • EuroRec Functional Criteria • EuroRec Seal • HITCH project • Conclusions

  3. The EuroRec Institute • Not-for-profit • Federation of National Centres • To promote the use of high quality EHR systems • Main activities: • Research • Product Conformance

  4. Why do we need interoperability? • Efficiency in care: • sharing available patient information with authorised ‘users’ • knowledge explosion  more decentralised care decisions on more centralised data • Patient-focused information management • complete record = patient lifetime (at least) • beyond life the HC Professionals • applications ‘disappear’

  5. What is Interoperability? • So many definitions: just one of IEEE “The ability of two or more systems or components to exchange information and to use the information that has been exchanged” • Focus on the “use” • More than exchangeability More than being “human understandable”  exchangeability is a “low level of interoperability”. • Remark: We are only addressing “clinical systems”

  6. (Re)use is the issue • Interoperability means the ability to (re)use content • by different applications • outside the context of origin • without new / complementary encoding • Is exchangeability / understandability enough for (re)use? • Everything depends on the quality…

  7. Garbage in... Garbage out

  8. Exchangeable Garbage is stillGarbage

  9. Health data need to be • Correct at “conception” • Comprehensive regarding context: • Who, when, circumstances and role of the author regarding the patient (on duty service, regular GP consult, multidisciplinary conclusion of a hospital stay)… • Co-morbidity / absence of co-morbidity • Precise and granular • “Other disease of genito-urinary tractus” • Staging and severity • Certainty

  10. Quality problems ? • Enormous “quality” gap at data entry • professional inconsistency in labelling clinical conditions using “standards” (if used…) • functionalities of systems insufficiently used • systems with poor functionality • Lack of domain-validated “info-structure”: • what are now the correct attributes in order to capture a complete description of a type II diabetes, of blood pressure, a medication administration? • where are the standard expressions for some of these attributes? • Even more regarding environmental, behavioural, hereditary and professional context

  11. Also at application level Systems need to be able to produce / to collect and to share those “high quality data” with authorised Healthcare Professionals. Examples: • Staging of diseases • Complex dosing schemes for medicinal products • Distinguish a confirmed diagnosis from a nursing diagnosis or from a hypothesis • Monitor real-time alerts for allergies or specific health conditions • Manage prevention and immunisations • Implement Good Practice Guidelines and specialised Care Protocols • Device connectivity… Defining the needs is defining EHR functional requirements.

  12. Functional Requirements • Without functionalities no content, nothing to exchange… • Systems with the same / similar functionalities will produce roughly the same data (more specifically when using the same standards or based on the same requirements). • There are hundreds, thousands of requirements to be met • Some by all the systems • Some (domain specific) only by some applications • The actual EuroRec repository of functional descriptive statements contains over 1.600 statements / criteria. • Partially translated in 19 languages.

  13. The EuroRec Functional Requirements

  14. Countries of origin • Belgium (1999-2006-2010) • CCHIT (USA) • Alberta (Canada) • Ireland • France (LAP) • Denmark • Meaningful use (USA) • Clinicalresearch (eClinical Forum) • Austria (Labresults)

  15. Medicinal decision support related statements….

  16. In Croatian

  17. How to reach functional quality? • Someone defines an agreed “quality” level. What and how a system should behave. Who? • The users… surely, ideally a professional consensus • Also the authorities, as they: • have different / additional priorities • want consistency between the systems • Translated in system / functional requirements • Issuing requirements is not enough, they should be “verified”  conformance testing • Will result in systems with similar (not identical!) functionality  harmonisation

  18. Two ways to favour functional harmonisation? • National / Regulatory way: • Can be very detailed / comprehensive. • May address one specific user group. • Cross-Border: needs to be more generic • EuroRec issued two “Seals” • Seal Level 1 : 20 mainly generic statements • Seal Level 2 : 50 criteria also addressing security and confidentiality management. • http://www.eurorec.org/consortium_intern/seal/index.cfm • Available in all the languages

  19. Composition of the seal

  20. Is that enough to guarantee quality? • Having good systems is one step. This includes the function of sharing / exchanging patient information. • Getting them used properly is another issue • Using the rod or whip does not work • Let the market do his job… • Incentives….for using those systems (meaningful use in the USA) • Education and training are essential as well… 25 years after the first PCs still…

  21. How to match Functional Testing (EuroRec,…)andInteroperability Testing (IHE Europe) ?

  22. Support Action within 7Th Framework. • Aim of the project is to define “A roadmap to establish a foundation for the Interoperability Conformance Testing of information systems in Healthcare” • Partners: INRIA, IHE Europe, OFFIS, ETSI, MEDCOM and EuroRec.

  23. Overlap functionality and interoperability testing

  24. Conclusions • Quality of the content is a prerequisite to interoperability. • Quality of the content depends on functional ability of the system to produce those data and on the effective use by the HC Professional. • Systems meeting the same / similar functional criteria evolve to a degree of functional harmonisation, favouring interoperability. • Conformance testing is an important step to realise quality as well as interoperability.

  25. Thank you www.eurorec.org jos.devlies@eurorec.org

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