~samhandling for helse og velferd The use of eHealth standards in Norway Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Why do we need standardsWhy do we need standards? Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd The Norwegian Centre for Informatics in Health and Social Care Limited company Not for profit Owned by –The Ministry of Health –The Ministry of Social Affairs –The Norwegian Association of Local and Regional Authorities (KS) Established in 1990 Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Company Goals Contribute to coordinated and cost-efficient application of secure information technology in the health sector Establish necessary standards for safe communication within the Health sector and between the health sector and outside sectors Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Norwegian standardisation policy Adapt European or international standards, when possible National standards are developed when international standards are missing Keep standards as stable as possible when disseminated –Health care organisations and vendors need to be confident that they get return on investment when implementing standard Long overlap period is necessary when replacing standards Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Standard Norge Norwegian Standardisation Body KITH defines eHealth Standards on behalf of Standard Norge Standardisation activities are financed by Directorate of Health Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd European Standardisation CEN/TC251: European Health Informatics Committee was also established in 1990 Included 6 Working Groups and related Task Forces that drafted standards Norwegian delegates participated actively Few existing systems that could be used as basis or pilots Draft were produced and tried out. Feedback was used as basis for revised standards Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Examples of CEN pre-standards ENV 1613 (1995) Messages for exchange of laboratory information ENV (1997) Messages for patient referral and discharge ENV (1999) Electronic healthcare record communication ENV (2001) System of concepts to support continuity of care Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd International classifications in Norwegian use ICD 10, International Classification of Diseases ICF, International Classification of Functioning, Disability and Health ATC, Anatomical, Therapeutic, Chemical classification of therapeutic drugs ICPC 2, International Classification of Primary Care SNOMED RT, The Systematized Nomenclature of Human and Veterinary Medicine, Reference Terminology (national profile, pathology) KS Fagråd for IKT i helse- og omsorg , Vigdis Heimly

~samhandling for helse og velferd Find code Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Other standards HL7 version 2.x message standards are used for hospital internal communication Some services based on HL7 v3 RIM have been developed and used by a few hospitals from 2009 DICOM (Digital Imaging and Communication in Medicine) is used in radiology Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Generation 1: EDIFACT CEN/TC251 developed syntax independant information models The expert group EEG9 of the CEN workshop eBES (European Board for EDI/EC Standardization) defined EDIFACT message syntax National profiles were developed in the 90ties. Laboratory messages are in widely use. Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd 2nd generation: XML Extensible Markup Language (XML) is a text format derived from ISO SGML. XML standards have been developed by many groups at local, regional or national level. Norwegian XML schemas was inpired by the early work of HL7 and used HL7 datatypes. Dissemination has been slow. Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd European and international standards Implementation and dissemination of existing messages has high priority and will continue for many years Likely that number of message standards will be more than 50 before new standards overtake Cross-border semantic ad syntactic interoperability is a goal, but not likely Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Test and certification A test server facility was established by KITH in 2005 Certification and testing is free of charge In 2010, the server handles about 30 eHealth messages Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Norwegian Collaboration Architecture all messaging traffic should use the national broadband network, the Norwegian Health Net only standardized messages should be used the vendor’s message implementations should be approved by the Norwegian Testing and Approval Service at the Norwegian Centre for Informatics in Health and Social Care (KITH) the ebXML framework should be used application receipts should be sent for all messages. KS Fagråd for IKT i helse- og omsorg , Vigdis Heimly

~samhandling for helse og velferd Collaboration Architecture Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd EHR in Norway All (28) cathegories of authorised health care professionals are obliged by law to record relevant information Need to know principle by law Traditional role based access control is not sufficient The patient may refuse to give som actors access to their record Makes it challenging to develop EHR systems KS Fagråd for IKT i helse- og omsorg , Vigdis Heimly

~samhandling for helse og velferd EHR standards First national standard in 2001 National standard was revised in 2007 Based on pre-standard ENV (architecture) Includes in addition: –Access control –Patient consent –Archieving –Editing, corrections and deletions Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd What about legislation? Norwegian legislation does not allow shared data repositories containing health information Requests for health information have to be considered individually by a health professional Only health information relevant and necessary for the purpose of the request can be distributed The patient has the right to refuse the distribution of health information –The patient's explicit consent is not mandatory when it comes to distribution of health information, but such a consent is normally sufficient to make distribution legal

~samhandling for helse og velferd National EHR standard Does not include any specification of content Specifies how standards for content should be defined Based on the standard, a number of national content scpecifications have been developed –Corresponds to Archetypes as defined in EN :2007 –Clinical content specified by these archetypes are also referenced from new message standards –Makes communication of EHR content easier Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd EHR standards, future Partly overlapping initiatives: ISO EN EHR com and HL7 v3 RIM European decision should be taken regarding which way to go International standards for clinical content should be considered Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Where do we need new standards? Study was done in 2009 in order to get an overview of the status of electronic collaboration in the Norwegian health sector today Report for Innovation Norway Solutions that should support shared care and empower the patient are to a large extent lacking. Vigdis Heimly , TDT4213 Kliniske informasjonssystemer

~samhandling for helse og velferd Vigdis Heimly , TDT4213 Kliniske informasjonssystemer Non relevant 1Standards Are missing. Few systems with collaboration support implemented. 2Some standards available Few systems with collaboration support implemented. 3The most essential standards are available and several systems that can be used for collaboration are implemented. 4Certified and standardized collaboration solution is commonly available.

~samhandling for helse og velferd References Standardisering og samhandlingsarkitektur The use of eHealth standards in Norway - A brief history Electronic Cooperation in the Health and Social Electronic Cooperation in the Health and Social Sector Health Informatics and Telemedicine in Norway Health and Social Sectors with an "e" Information technology strategies for health and social care in NorwayInformation technology strategies for health and social care in Norway PACS in Norway EHR and Archetypes See also: KITHs publication pageKITHs publication page Vigdis Heimly , TDT4213 Kliniske informasjonssystemer