1. CEN EN13606 Normalisation Framework Implementation Experiences David Moner 1, José A. Maldonado 1, Diego Boscá 1, Carlos Angulo 1,Montserrat Robles 1, Daniel Pérez 2 and Pablo Serrano 3 1 IBIME group, ITACA Institute, Universidad Politécnica de Valencia 2 Hospital General Universitario de Valencia, Valencia, Spain 3 Hospital de Fuenlabrada, Madrid, Spain

2. Contents Semantic interoperability of clinical data The LinkEHR Normalisation Platform Implementation experiences Discussion and conclusions EN13606 experiences2

3. 3 Semantic interoperability of clinical data Our objective: the semantic interoperability of clinical information. Alerts Current history Past history Medications And all the information we would like to include

4. 4 Semantic interoperability of clinical data Semantic interoperability requires: A standard labelling and structure for data A high-level definition of clinical concepts A semantic description of clinical concepts Reference ModelArchetype model Terminologies and Ontologies ISO/CEN EN13606 The standard for the communication and semantic interoperability of health information EN13606 experiences

5. The LinkEHR normalisation platform LinkEHR-Ed is a tool for: –Defining archetypes based on any reference model. –Normalise legacy data into standard documents. But LinkEHR-Ed is just one part of a bigger system: the LinkEHR Normalisation Platform. This platform allows to reach the semantic interoperability of the EHR of a patient whose data are distributed among heterogeneous HIS. EN13606 experiences5

6. 6 EFMI STC 2010 LinkEHR-Ed: A tool for the description and normalization of legacy clinical data EFMI STC 2010 LinkEHR-Ed: A tool for the description and normalization of legacy clinical data EFMI STC 2010 Standardized and flexible health data management with an archetype driven EHR system (EHRflex) EFMI STC 2010 Standardized and flexible health data management with an archetype driven EHR system (EHRflex)

7. Implementation experiences The LinkEHR Normalisation Platform is being used at the three steps towards the semantic interoperability of existing EHR systems: 1.Definition of clinical archetypes. 2.Normalisation of legacy EHR systems. 3.Communication of EHR extracts. EN13606 experiences7

8. 8 Implementation experiences 1. Definition of archetypes Hospital de Fuenlabrada (Madrid) –Use of EN13606 archetypes for pressure ulcer nursing control. The archetype creation methodology was evaluated. Both reference models were compared and tested. http://www.revistaesalud.com/index.php/revistaesalud/article/view/308/641

9. Implementation experiences 1. Definition of archetypes European Patient Smart Open Services (epSOS) –EN13606 implementation specifications have been developed following the agreed epSOS data sets: Patient Summary, ePrescription and eDispensation. –EN13606 archetypes have been implemented following those specifications. EN13606 experiences9

10. Implementation experiences 1. Definition of archetypes EN13606 experiences10

11. EN13606 experiences11 Implementation experiences 2. Normalisation of data Hospital General Universitario de Valencia –LinkEHR Integration Engine implementation for over 6 years Integration of distributed data sources (more than 20 databases). Virtual Federated EHR viewer for all the organisation (~1000 health professionals, ~500,000 patients) –Full migration to EN13606 EHR Extracts in development using the LinkEHR Normalisation Platform.

12. EN13606 experiences12 Implementation experiences 2. Normalisation of data Hospital de Fuenlabrada (Madrid) –Use of EN13606 for medication conciliation between primary and specialised care. Agreed definition of a primary-care patient summary archetype. Communication of normalised legacy data to support patient transitions between primary care and the hospital.

13. EN13606 experiences13 Implementation experiences 3. EHR extracts The semantic interoperability of the Patient Summary is being tested between the Hospital General Universitario in Valencia (HGUV) and the Hospital de Fuenlabrada in Madrid. –Based both on the Spanish and epSOS definition of the contents of the Patient Summary. –The information is communicated using the CEN EN13606 norm.

14. EN13606 experiences14 Implementation experiences 3. EHR extracts 1. Agree a concept definition and define the archetype We have used two different definitions –Spanish National Patient Summary –epSOS Patient Summary They can be easily edited or modified with open source archetype editors like LinkEHR-Ed http://www.linkehr.com

15. EN13606 experiences15 Implementation experiences 3. EHR extracts 2. Map the archetype to original/legacy data With these mappings we can automatically generate transformation programs for the EHR system. XML Existing EHR systems

16. EN13606 experiences16 Implementation experiences 3. EHR extracts 3. Deploy the transformation program in the EHR server Set up a standard EN13606 extract server in both hospitals to generate and communicate the standardized information –Transformation is applied on demand –Web-service based –Includes a standard EN13606 web viewer EHR Server XML EN13606StandardInformation Mapped Archetype CHGUV HIS HF HIS EHR Server Mapped Archetype

17. EN13606 experiences17

18. EN13606 experiences18 Implementation experiences 3. EHR extracts The project was developed in July 2009. The archetype definition took approx. 4h The archetype mapping and generation of EN13606 standardized data, just one day.

19. Discussion and conclusions EN13606 strengths: –Flexibility of the norm to represent all types of clinical data. It does not impose technical limitations for this. –Seamless transition of existing systems to the EN13606 norm. –Archetypes are easily developed and understood by health professionals. –There already exist tools that can help in this duty. EN13606 experiences19

20. Discussion and conclusions EN13606 weaknesses: –Lack of previous implementation experiences. –Lack of methodologies for developing archetypes. –Lack of support from a community of users. EN13606 experiences20

21. Discussion and conclusions We have launched an open web page for the community of developers and adopters of the EN13606 norm. http://www.en13606.eu In the next months an open international association for the management and evolution of the EN13606 will be created. EN13606 experiences21

22. Thank you for your attention! CEN EN13606 Normalisation Framework Implementation Experiences David Moner damoca@upv.es 22EN13606 experiences