Systems interoperability for a better treatment and surveillance of infections

1. Systems interoperability for a better treatment and surveillance of infections ECCMID Symposium Interest of IT solutions to improve patient management Monday April 2, 2012 François Macary cochair of IHE International LaboratoryCommittee

2. Integrating the Healthcare Enterprise An international organisation joining healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE builds specifications, and organises anually interoperability sessions to let IT vendors test their connectivity with their peers. « Connectathonresults » ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

3. Information exchanges related to microbiologyThe intra-hospital diagnostic workflow • Treatment of the patients • Prevention and control of nosocomial infections Orders for in vitro diagnostic services Results & reports CIS LIS Middleware Microbio analyzer Patient demographic data Clinical Information System Laboratory Information System Microbio analyzer Microbio analyzer HIS Hospital Information System Patient admissions & movements ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

4. Information exchanges related to microbiologyInteractions with Public Health Public Health System • Health alerts, outbreaks • Surveillance of resistant clones (e.g. MRSA) • Notification of infections (e.g. HIV, salmonella ...) • Surveillance of antibiotic-resistant infections CIS LIS Middleware Microbio analyzer Microbio analyzer Microbio analyzer HIS ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

5. Information exchanges related to microbiologyInteractions with Care Coordination DMP in France, ELGA in Austria epSOS in Europe National shared electronic health record GP • Discharge summary (tracking acquired and treated infections) • Selected lab reports • Follow up sheet for multiresistant bacterium carriers CIS LIS Middleware Microbio analyzer Microbio analyzer Microbio analyzer HIS ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

6. The need for interoperability • All actors and organisations involved in these workflows use IT systems and applications. Therefore, most of these information exchanges are (or aim to be) paperless to shorten delays, suppress the burden of manual copy and avoid its inherent risks of errors: • Intra-hospital: Event triggered electronic messages convey the atomic data exchanged in real time between HIS, CIS, LIS, middleware & IVD devices. • Hospital to public health systems: Electronic reports and datasheets consolidate microbiology information related to a case or to a period, and are sent by LIS to public health systems • Patient care coordination: Electronic reports documenting the findings and conclusions on a patient microbiology study, are authored, digitally signed, and then made available in shared repositories. ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

7. IT solutions can take actions and support clinical decisions of their users, based on the recognition of codes The need for coded data patient current clinical status order of microbiology services specimen: type, source site, collection method, risk … microscopic examination observations culture observations isolate: Genus species, strain antibiotic susceptibilities other observations: ESBL, serotype, genotype … Global interpretation by the microbiologist ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

8. The need for international standards • Most IVD devices are sold on the global market. This becomes also more and more the case with Healthcare IT solutions (HIS, CIS, LIS, midlleware ...) • Public health disease control and surveillance data needs to be consolidated at the continental level (e.g., ECDC in Europe), and at the planet level (WHO). • Care coordination and continuity crosses the borders with the people e.g., the “European Patient Smart Open Services” (epSOS) project joining 23 countries. • Hence, electronic messages, documents and services must leverage international standards. ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

9. IHTSDO International standards for interoperability in healthcare IT are available ... • Standard terminologies for the coding of healthcare information • Systematized NOmenclature of MEDicine (SNOMED CT) • > 300,000 coded concepts covering the whole field of medicine • Logical Observation Identifiers, Names and Codes (LOINC) • > 1,500 codes for antimicrobial susceptibility tests • >10,000 codes for other microbiology tests (direct examination, stain, culture, ...) ... However, they don’t say how one should combine them into an e-health project eHealth Projects IETF Base Standards ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

10. IHTSDO IHE combines standards and guides their implementation to cover a specific use case Use case An profile eHealth Projects IETF Base Standards Some profiles built by IHELaboratory : • Laboratory Testing Workflow (LTW): ordering/reporting (CIS <-> LIS <-> middleware). • Laboratory Analytical Workflow (LAW): (LIS <-> middleware <-> IVD analyzer) • Sharing electronic laboratory reports (XD-LAB):  public health, care coordination Adopted nation-wide by France (DMP) and Austria (ELGA) ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

11. Information exchanges related to microbiologyInteractions with Care Coordination Public Health System National shared EHR Continuity of care GP Electronic laboratory reports XD-LAB LAW CIS LIS Middleware LTW LTW Microbio analyzer LAW Microbio analyzer Patient Administration Management (PAM) LAW Microbio analyzer HIS ECCMID 2012 - Interest of IT solutions to improve patient management – Systems interoperability

12. Thank you www.ihe.net Overview of IHE profiles for the Laboratorydomain: wiki.ihe.net/index.php?title=Profiles#IHE_Laboratory_Profiles