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 Laboratory Committee

Integrating the Healthcare Enterprise 2 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. April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability « Connectathon results »

Information exchanges related to microbiology The intra-hospital diagnostic workflow April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability3 CIS Clinical Information System LIS Laboratory Information System Middle ware Microbio analyzer Orders for in vitro diagnostic services Results & reports HIS Patient admissions & movements Patient demographic data  Treatment of the patients  Prevention and control of nosocomial infections Microbio analyzer Hospital Information System

Information exchanges related to microbiology Interactions with Public Health April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability4 CIS LIS Middle ware Microbio analyzer HIS Public Health System  Health alerts, outbreaks Microbio analyzer  Surveillance of resistant clones (e.g. MRSA)  Notification of infections (e.g. HIV, salmonella...)  Surveillance of antibiotic-resistant infections

Information exchanges related to microbiology Interactions with Care Coordination April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability5 CIS LIS Middle ware Microbio analyzer HIS National shared electronic health record  Discharge summary (tracking acquired and treated infections)  Selected lab reports  Follow up sheet for multiresistant bacterium carriers GP Microbio analyzer DMP in France, ELGA in Austria epSOS in Europe DMP in France, ELGA in Austria epSOS in Europe

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. April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability6

The need for coded data April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability7 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 … IT solutions can take actions and support clinical decisions of their users, based on the recognition of codes Global interpretation by the microbiologist

The need for international standards April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability8 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.

International standards for interoperability in healthcare IT are available... Standard terminologies for the coding of healthcare information  Systematized NOmenclature of MEDicine (SNOMED CT) o > 300,000 coded concepts covering the whole field of medicine  Logical Observation Identifiers, Names and Codes (LOINC) o > 1,500 codes for antimicrobial susceptibility tests o >10,000 codes for other microbiology tests (direct examination, stain, culture,...) April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability9 eHealth Projects IHTSDO Base Standards IETF... However, they don’t say how one should combine them into an e-health project

IHE combines standards and guides their implementation to cover a specific use case April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability10 Some profiles built by IHE Laboratory :  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 Base Standards IHTSDO IETF eHealth Projects An profile An profile Use case Adopted nation-wide by France (DMP) and Austria (ELGA)

Information exchanges related to microbiology Interactions with Care Coordination April 2, 2012ECCMID Interest of IT solutions to improve patient management – Systems interoperability11 CIS LIS Middle ware Microbio analyzer HIS National shared EHR GP Microbio analyzer Public Health System Electronic laboratory reports XD-LAB LTW LAW Continuity of care Patient Administration Management (PAM)

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