The Spanish experience BEYOND TECHNICAL INTEROPERABILITY Javier Etreros / Icíar Abad Sanitary Information Institute Quality agency Ministtry of Health and Social Policy
Interoperability in a Highly Decentralised Country- Lessons Learned
Feb 18, 2017
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The Spanish experience
BEYOND TECHNICAL
INTEROPERABILITY
Javier Etreros / Icíar Abad
Sanitary Information Institute
Quality agency
Ministtry of Health and Social Policy
THE SPANISH NHS
17 Autonomous
Communities
2 Autonomous
Cities (Ceuta y
Melilla)
Languages:
Spanish plus 3
more languages,
co-oficial
languages.
DECENTRALISED: transfer of care 1981-2001
Start point
THE SPANISH NHS
Each region includes its users in their regional DB. All Regional DBs are connected at a national level.
There is a single national code for each user
NHS DB
(Within
NCP)
Region
al DB2
Region
al DB1
Region
al DB3
UNEQUIVOCAL IDENTIFICATION
THE SPANISH NHS
THE PRAGMATIC APPROACH: First step
To Access to the full Electronic
Health RecordNOT
Sets of relevant clinical data to be
share: > 30 scientific societies +
autonomous communities
YES
THE SPANISH NHS
Discharge report
Specialised surgery report
Emergency Room report
Primary care report
Laboratory report
Imaging report & Imaging
Nurse care report
PATIENT SUMMARY
TREATMENT
IMMUNIZATIONSCURRENT PROBLEMS
ELECTRONIC
HEALTH RECORD
ALLERGIES
Patient Summary
(PS)
PATIENT SUMMARY
¿ ?
INTEROPERABILITY STRATEGY
Semantic dimension: to make information
understandable by any organization and in
any language with the level needed to take
clinical decisions that affects people’s health
EXPERT GROUP
Interoperability
strategy
EXPERT GROUP
Semantic interoperability
Technical interoperability
PILOT
Decision
Consultancy
Execution
DECISION
TERRITORIAL
BOARD
CURRENT WORK
A 3 year specific ROADMAP was define to reach the
objectivesROADMAP
SNOMED-CT terminology for variables without
standardization in the Patient Summary and as a
necessary step to reach complete interoperability in the
long term scenario.
Follow up of reference models (EHRNHS).
Main
Agreements
INTEROPERABILITY STRATEGY
Seek for short-term solutions regarding semantic
interoperability of the Patient Summary.
Recommendations about the standards that should be
adopted as a long-term solution to reach semantic
interoperability in the EHRNHS project.
Objectives
Lo
ng
-te
rmS
ho
rt-t
erm
Report on the
EHRNHS
requirements
TRAINING
2
OID´s
3
Inventory of Health Terminology
1
Reference model
4
Me
diu
m-t
erm
IDENTIFICATION
OF FUNCTIONAL NEEDS
TO CREATE A NATIONAL
SEMANTIC SERVICES SYSTEM
7
Coordination of different national extensions
8
Mapping and translation tools
5
Subset priority
6
INTEROPERABILITY STRATEGY
NEW STRATEGIES in the EHR within NHS
CURRENT WORK
MAPPING AND TRANSLATION TOOLS
Spain joins IHTSDO in 2009, to develop SNOMED-CT as the clinical
terminology of reference within the health records.
PATIENT SUMMARY SUBSETS:
Snomed CT
NURSE CAREMEDICINESPROBLEM LISTALLERGIESVACCINATIONS
308.000 active concept
791.000 descriptions
951.000 relaciones
CROSS-MAPPING WITH THE EXISTING TERMINOLOGIES: ICD,
ICPC, NANADA-NIC-NOC, Snomed for Anatomic pathology.
INTEROPERABILITY STRATEGY
Sospecha de hipertensión
417312002
SNOMED CT: a multilingual terminology
Sospecha de hipertensión. 417312002
Sospecha de hipertensión
Sospita d´hipertensióNacional
Version of
Snomed CTHipertesioz goganbehartzen
Sospeita de hipertensión
Suspected hypertension
417312002
Misstänkt hypertoni
417312002
Sospecha de hipertensión
417312002
Sospita d´hipertensió
417312002
Sospeita de hipertensión
417312002
CURRENT WORK
CURRENT WORK
International
Core (Snomed)
Tiempo estimado de trabajo del Grupo:
2 ó 3 meses
Subconjunto alergias
VALIDADO
(extensión es-ES)
Especialista/s en
Dermatología
Subconjunto
ALERGIAS
Médico de familia
con ejercicio en
Atención Primaria
Especialista/s en
Farmacología ClínicaMedicina de Urgencias
Especialista/s en
Alergología
PERFILES PROFESIONALES
Revisión
Discusión
Validación
Herramienta de
trabajo en grupo
Tiempo estimado de trabajo del Grupo:
2 ó 3 meses
Subconjunto alergias
VALIDADO
(extensión es-ES)
Especialista/s en
Dermatología
Subconjunto
ALERGIAS
Médico de familia
con ejercicio en
Atención Primaria
Especialista/s en
Farmacología ClínicaMedicina de Urgencias
Especialista/s en
Alergología
PERFILES PROFESIONALES
Revisión
Discusión
Validación
Herramienta de
trabajo en grupo
Herramienta de
trabajo en grupo
CURRENT WORK
THANKS
FOR YOUR
ATTENTION
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