an alliance among HL7, CEN and OpenEHR ? Inventory of patient summaries and clinical data sets for transfer of care Angelo Rossi Mori, 2005-05-05

interoperability vs. cooperability interoperability ability of information systems to interoperate cooperability ability of healthcare professionals and citizens to cooperate (health level 8 ?)

objective of cooperability EHR solutions should assure “the consistent capture, communication and availability along the care pathway, to clinicians and patients, of key data required to provide and manage direct care” Colin Gordon, UK NHSIA Disease Management Systems Programme

1. non-clinical situations standards and implementation guidelines developed so far e.g. by HL7, ISO, DICOM, CEN, IHE are suitable for stereotypical situations and predictable workflows, as in administrative and organizational contexts, e.g. for orders and reports.

1. non-clinical situations ongoing standards do allow to obtain “basic semantic interoperability” among applications, based on detailed data structures and on coded values.

2. generic situations involving transfer of care generic situations involving transfer of care are poorly predictable: no general model is possible about which particular clinical data must be transferred for a specific task

2. generic situations involving transfer of care Progress in cooperability may be supported by generic standards with basic clinical structures, independent from any particular clinical issue, as CEN-EHRcom EN 13606 in, HL7-CDA ASTM-CCR, and their generic implementation guides measures to share such generic documents, e.g. by IHE-XDS

2. generic transfer of care: challenges systematize document names and section names; describe the expected generic clinical content of relevant kinds of "generic" clinical documents (e.g. discharge summary, clinical letter); define how to organize documents in folders within multi-source registries; define a set of “patient baseline profiles” (aka of patient summary) for several specialties and (chronic) problems

3. intermediate solutions: context-based clinical data sets collect and harmonize clinical data sets derived from evidence-based clinical pathways to assure that the required information is properly captured and made timely available to each professional for transfer of care and for his/her critical decisions to synchronize the items in the patient record and the knowledge sources for decision support

3. clinical data sets: challenges a methodology to understand which clinical pathways and which decisions are suitable to reach the adequate level of cooperability; harmonization of clinical data sets across various clinical and organizational contexts; exploration of the interaction between terminology models and information models; setting up of safe ways to express the clinical and organizational context for decisions

policy factors large jurisdictions must promote a balanced deployment of solutions for cooperability in clinical information systems with the technical and informational infrastructures and the appropriate level of quality in data recording

policy factors Therefore attention should focus on the educational, regulatory, economic, organizational policies for change management programs of unusual size and on the obstacles in the full deployment of cooperability

policy factors At the same time, there is a need to develop the criteria to define the optimal level of cooperability for each kind of clinical situation, and the appropriate strategies to reach them in large-scale programs

CNR - Istituto Tecnologie Biomediche Angelo Rossi Mori 10/03/2004 thank you Angelo Rossi Mori rossimori@itb.cnr.it CNR - Istituto Tecnologie Biomediche 22/11/2018