Copyright HEALTHone Global – October 2006
The Relevance of EHR Standards and of EHR Quality labelling for SMEs Alain Maskens
Copyright HEALTHone Global – October 2006 HEALTH HEALTH one TM Clinical Management, for life The Relevance of EHR Standards and of EHR Quality labelling for SMEs Alain Maskens
Copyright HEALTHone Global – October 2006 Contents Certification requirements: examples –Generic requirements –Specific requirements Certification > Standards Advantages for SMEs Issues for SMEs What should SMEs do?
Copyright HEALTHone Global – October 2006 U.S.A.: certification criteria: excerpt
Copyright HEALTHone Global – October The system shall record the identity of the user finalizing each note and the date and time of finalization. … 7. The system shall provide the ability to addend and/or correct notes that have been finalized. 8. The system shall record and display the identity of the user who addended or corrected a note, as well as other attributes of the addenda or correction, such as the date and time of the change. U.S.A.: certification criteria: excerpt
Copyright HEALTHone Global – October 2006 Belgium: certification criteria: excerpt
Copyright HEALTHone Global – October « Le système doit pouvoir reconstituer l'historique des versions successives d'une donnée, gérées selon les règles suivantes : - Chaque version de donnée est associée à un auteur et un moment (date, heure) d'enregistrement. - Chaque modification d'une donnée (à l'exception des notes personnelles du médecin) en génère une nouvelle version. Dans ce cas, la suppression d'une donnée doit être considérée comme une modification et ne peut entraîner la perte physique de cette donnée. Belgium: certification criteria: excerpt
Copyright HEALTHone Global – October 2006 CEN TC251 prEN
Copyright HEALTHone Global – October 2006 CEN TC251 EN13606
Copyright HEALTHone Global – October 2006 pr EN – 1: Requirements basis for this EHR communication standard Many investigations of user and enterprise requirements for the EHR have taken place over this period, which have sought to span the information needs of diverse specialties across primary, secondary and tertiary care, between professions and across countries. These requirements have been distilled and analysed by expert groups, mainly within Europe, in order to identify the basic information that must be accommodated within an EHR information architecture
Copyright HEALTHone Global – October 2006 This work includes the GEHR, EHCR-SupA, Synapses, I4C and Nora projects and work by SPRI. These key requirements publications are listed in the bibliography in Annex F. These requirements have recently been consolidated on the international stage within an ISO Technical Specification, ISO TS pr EN – 1: Requirements basis for this EHR communication standard
Copyright HEALTHone Global – October 2006 The GEHR (Good European Electronic Healthcare Record) Architecture
Copyright HEALTHone Global – October 2006 GEHR: requirements for clinical comprehensiveness « Author Responsibility It is widely recognised that every entry in the record must be attributed to an author. What is displayed in the record should be a true account of events as recorded by the author. If changes need to be made, it must be possible to step through and account for those changes individually within a rigorous audit trail. »
Copyright HEALTHone Global – October 2006 « Recording a Transaction A new Transaction will incorporate the identifier of the responsible clinician, the date/time of the Transaction, and the type of the Transaction. If an amendment has occurred, then the amendment version, the identifier of the amending clinician and the date/time of the amendment will also be documented. » GEHR: functional specifications
Copyright HEALTHone Global – October 2006 Specific requirements
Copyright HEALTHone Global – October 2006 Specific requirements CCHIT : The system shall associate standard codes with discrete data elements in a note. Examples include but are not limited to SNOMED-CT, ICD-9CM, DSM-IV, CPT-4, MEDCIN, and LOINC. This would allow symptoms to be associated with SNOMED terms, labs with LOINC codes, etc.
Copyright HEALTHone Global – October 2006 Specific requirements CCHIT : The system shall associate standard codes with discrete data elements in a note. Examples include but are not limited to SNOMED-CT, ICD-9CM, DSM-IV, CPT-4, MEDCIN, and LOINC. This would allow symptoms to be associated with SNOMED terms, labs with LOINC codes, etc. Belgium: Les codes associés au contenu sont issus soit de la classification CISP-2 et/ou ICD-10 (voir les critères 54 et 55), soit d'un système de codification de référence ou propriétaire. En cas de codage propriétaire, le logiciel offre en plus une correspondance vers la classification CISP-2 et/ou ICD-10.
Copyright HEALTHone Global – October 2006 GEHR: requirements for clinical comprehensiveness There are many classification systems used in medicine, and a shared healthcare record must allow use of any one or all of these systems. They are usually designed for a specific purpose and may be used in specific or general settings.
Copyright HEALTHone Global – October 2006
Quality labelling (certification) and standards
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification User requirements generic specific
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification User requirements generic specific Standards
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification User requirements generic specific Standards
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification User requirements generic specific Standards Research and development
Copyright HEALTHone Global – October 2006 Quality labelling (certification) and standards certification User requirements generic specific Standards Research and development
Copyright HEALTHone Global – October 2006 Advantages: Certification and standards
Copyright HEALTHone Global – October 2006 Advantages: Certification and standards Offer a rigorous analysis of market requirements
Copyright HEALTHone Global – October 2006 Advantages: Certification and standards Offer a rigorous analysis of market requirements Offer the results of extensive, multidisciplinary R&D work (architectures, specifications)
Copyright HEALTHone Global – October 2006 Advantages: Certification and standards Offer a rigorous analysis of market requirements Offer the results of extensive, multidisciplinary R&D work (architectures, specifications) Offer protection against the imposition of « de facto standards » by big industrial players
Copyright HEALTHone Global – October 2006 Advantages: Certification and standards Offer a rigorous analysis of market requirements Offer the results of extensive, multidisciplinary R&D work (architectures, specifications) Offer protection against the imposition of « de facto standards » by big industrial players Offer the same level of visibility for small and large players
Copyright HEALTHone Global – October 2006 Difficulties
Copyright HEALTHone Global – October 2006 Difficulties Discrepancy between market demand / maturity and standards sophistication
Copyright HEALTHone Global – October 2006 Difficulties Discrepancy between market demand / maturity and standards sophistication Instability of the standards
Copyright HEALTHone Global – October 2006 Difficulties Discrepancy between market demand / maturity and standards sophistication Instability of the standards Multiplicity of the standards
Copyright HEALTHone Global – October 2006 Difficulties Discrepancy between market demand / maturity and standards sophistication Instability of the standards Multiplicity of the standards Ongoing cohorts of customers..
Copyright HEALTHone Global – October 2006 Main issue: Ongoing cohorts of existing customers..
Copyright HEALTHone Global – October 2006 SME strategy Take advantage of requirements analysis provided by GEHR and complementary projects –Comprehensiveness –Communication capacity –Portability and independence Take advantage of GEHR generic architecture concepts
Copyright HEALTHone Global – October 2006 SME strategy –Comprehensiveness and expandability of the data architecture – the constraints must be at a higher level –Terminology independence –Standards compatibility / standards independence –Internal inter-operability HEALTH one Global:
Copyright HEALTHone Global – October 2006 South Africa The AIDS team, AngloPlatinum healthcare services, South Africa
Copyright HEALTHone Global – October 2006 USA The Madrona Clinic, Whashington State, USA
Copyright HEALTHone Global – October 2006 Europe Clinique Sainte-Anne Saint-Remy, Brussels
Copyright HEALTHone Global – October 2006 Shanghai
Copyright HEALTHone Global – October 2006