Semantic Interoperability Deployment & Research Roadmap i2010 Subgroup on eHealth meeting 21 February 2008, Brussels Veli Stroetmann, empirica with Alan.

Semantic Interoperability Deployment & Research Roadmap

i2010 Subgroup on eHealth meeting21 February 2008, Brussels

Veli Stroetmann, empiricawith

Alan Rector, UNIMANDipak Kalra, UCL

Bedirhan Ustun, Pierre Lewalle, WHO Karl Stroetmann, Benjamin Jung, empirica

Pieter ZanstraJean Marie Rodrigues, UJM

Martti Virtanen, UUGyorgy Surjan, ESKI

2

What are we talking about?

Health system interoperability is the ability, facilitated by ICT applications and systems,

– to exchange, understand and act on citizens/patient and other health-related data, information and knowledge

– among linguistically and culturally disparate clinicians, patients and other actors

– within and across health system jurisdictions in a collaborative manner

Defining IOp:

3

Why do we need Semantic IOp?

Health system priorities and goals

To support the goals of greater patient safety, better quality of care, chronic disease management, extended homecare or patient

empowerment, clinical meaning (data, information, knowledge)

must be expressed consistently – to enable the safe, meaningful sharing and combining of

health record data between heterogeneous systems and actors / care providers;

– to enable the integration and safe use of computerised protocols, alerts and care pathways by EHR systems;

– to link EHR data to explanatory and educational materials to support patient and family engagement and professional development;

– to ensure the necessary data quality and consistency to enable rigorous secondary uses of longitudinal and heterogeneous data for public health, research, health service management.

4

Roadmap: Recommendations - General Principles

• Focus on concrete, immediate needs and real use cases with expected high benefits & lower costs

• Terminologies should have a well defined scope and purpose– be delivered against well defined, realistic time scales

• Separate: – Ontology - what you mean– Language - how you say it– Interface - how you find it

• Involve vendors/industry and human end users - clinicians, citizens– Be responsive– Be open, collaborative and participative

• Make it multilingual and multicultural• Focus on Quality Assurance and Reproducibility• Use today’s technology

– modern ontology languages, Web 2.0, “Just in time”

5

Some Recommendations on Structures and Process

• Governments to develop, implement and sustain longer-term visions, objectives and measures

• Establish national centres for multilingual, multicultural adaptation of international classifications including SNOMED

• Link them in a well-managed European network of Competence Centres

• Establish a European Network of Terminology Servers • Assure sustainability and scalability

– It must be maintained to be useful– Beware of silver bullets

6

Socio-economic Assessment: Optimising Semantic IOp

DxDegrees D0 D100

Degree ofInteroperability

BenefitCost

medium

low

high

Δmax

optimal: Dopt

Cost

Benefit

DxDegrees D0 D100

Degree ofInteroperability

BenefitCost

medium

low

high

Δmax

optimal: Dopt

Cost

Benefit

7

Terminologies: SNOMED-CT - Current Assessment

• Controlled vocabulary and identifiers– Well managed but slow response time

• Hierarchies and relations– Unusable

• Too unreliable to depend on to behave as documented• Systematically flawed in principle• Limited by software and logic limitations from early 1990s• Cost of repair probably exceeds cost of rebuilding - but still modest

• Multilingual / Multicultural support– Minimal

• Neither understood nor a priority for the IHTSDO– Spanish and Canadian-French versions might appear

• Openness and accessibility to Social Computing– Unusable - remains effectively closed

• Not generally available on the Web• Opportunity cost of participation prohibitive• Influencing policy difficult

8

Terminologies: Selected Recommendations

• Support for specific initiatives between ICD/WHO ISO and SNOMED to develop ICD-11 along with mappings to/from SN

• Support feasibility study (select subset of ca. 25,000 terms / use case) of reformulation of SNOMED to– build reliable hierarchies & relations– develop multilingual support– introduce social computing tools– empirically assess individual, organisational and societal benefits & costs

• Support open tools for terminologies that link up to SNOMED• Support social computing efforts (Web 2.0) on ICD-11• Develop language technologies

– Text extraction to build new terms and encode natural language– Text generation to present and for QA

• User involvement & ownership, a series of centres & initiatives• Support training at all levels

9

Sustainable framework

with EU Industry for

effective standards

development

European Centres of Excellence

Collaboration with EBI and

NBCO

Intern. Biobanking

collaboration

Sustainable Centres for

Selected Ontologies

Toolset forFeasibility Study

Large Scale Environment

Multilingual-cultural

adaptation

Research on consequences

of different commitments

Tools for Terminfo

test

Social Computing

based Terminology

Service

Central Reference Services

Local mappings to UMLS

Toolkit for HL7

messages & archetypes

binding

Ongoing consultations

Actions arising from

consultations

Feasibility Study & reformulation

of subset

Multilingual-cultural subsets

Formal QA of subset

Statistical extension of

QA

Policy with MS on future

use of hierarchies & relations

Roadmap for SIOp Deployment & Research - Ontologies

2009

2010

2011

2012

2014

2016

2021

2008

SNOMED LOINC, DICOM

Terminolo-gies & EHRs

GenomicsTransl. Medicine

Socio-Econ. Issues

Ontologies

10

Roadmap: Ontologies Action Plan

YearContent Process Tools

2008 Open ICD 11 with SNOMED Mappings

Reformulation of SNOMED

Establish Open collaborative framework for ICD11

Begin to establish mechanisms for industrial involvement

Open tools for ontology development

Open Web 2.0 tools to support ICD 11

2009 Quality assurance metrics for SNOMED Fragment

First translations of SNOMED Fragment

Extend industrial involvement

Establish formal collaboration with European BioBanking and EBI

Develop tools for linking and binding terminologies and archetypes

Establish open social site for clinical terminology

2010 Continue Establish mechanisms for reformulation of SNOMED Fragment

Extend and test open tools for terminology and Archetypes, possibly with inclusion of HL7

2011 Reassess and create long term plan for selected terminologies including limits on scope

Establish European Network of Terminology Servers

2012-2013

Review and reassess interoperability

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Roadmap EHR: Basic elements and short term actions

• Effective, functional EHR systems need:1. Generic reference models for representing clinical (EHR)

data e.g. EN 13606, HL7 CDA, openEHR Reference Model

2. Agreed clinical data structure definitions e.g. openEHR archetypes, HL7 templates, generic templates and data sets

3. Clinical terminology systems e.g. LOINC, SNOMED-CT

• Areas needing adoption (short term):– Agree on a generic model for EHR communications: consider EN13606 – Adopt a standardised approach for representing and sharing of clinical

data structure specifications: agree to use archetypes / templates – Collaborate on key use cases for shared care & patient safety, and on

defining & tidying up the corresponding terminology/SNOMED-CT sub-sets – Seed clinical fora to develop care pathways and archetypes to meet the

needs of safe and evidence based care in different medical domains and disciplines

– Strengthen clinical user training in the use of EHRs, terminology and structured records

12

Roadmap EHR: Medium term actions

• Areas needing wide-scale evaluations:– Develop best practice in archetype design– Establish useful exemplars of SNOMED-CT sub-sets being adopted

within EHR systems and delivered in meaningful ways to clinical users

– Develop the business rules and validation processes– Identify and evaluate the benefits for various stakeholders & health

systems

• Areas needing investments: • Industry sponsored or nationally supported open source approaches

for:– Archetype & template authoring and validation tools– Terminology servers, term browsers for SNOMED CT, support for

term coordination– Global multi-cultural dimension - not just term translation but

internationalisation across health care paradigms and cultural differences

13Reference

ModelArchetypes Terminology

SNOMED-CTApplications Socio-

economic Issues

Generic Model for EHR

Communication

Standardised Represention

Clinical Data Structures

Care Pathways

Best PracticeA. Design

QA & Certification

Repositories

Term Binding

Authoring/Validation

Tools

Key Use Cases

Policies on SN Term Coordination

(TC)

SNOMED-CT Subsets

Business Rules for TC

Terminology Servers

Term Browsers

Consistency Test HL7 Terminfo

Global Experience

Test

EHR Visualisation Applications

Adaptable Clinical

Applications

Improve Inter-nationalisation

Agree on SIOP Goals for PHR

Link EHR to Educational

Material

Acceptance Evaluation

EHR/TerminologyUser Training

Roadmap for SIOp Deployment & Research - EHR

2008

2009

2010

2011

2012

2014

2016

2021

14

Roadmap Public Health: Long term goals

• Consistent use of EHRs as person-based health records in clinical settings

• Interconnecting health service providers so health information can be exchanged through interoperable digital means in a standard fashion

• Research to prove the comparability of digital information with analog traditional measures used for monitoring and evaluation in various health inf. systems

Time

Data, Norms,Standards

KnowledgeOrganization

LegalRequirements

EHR Common Standards

Exchange

EHR Common Standards

Content

LiabilitySecurityPrivacy

OwnershipIntellectualProperty

3 years 5 years 7 years 10 years

Population

Services

Environment

Metadata

Multilevel Ontologies

Mandate Organization

Multiple LanguagesLinguisticRepresentations

Interoperability Levels

FULL Semantic Interoperability

Some Semantic Interoperability

Technical Interoperability

NO Interoperability

Time

Data, Norms,Standards

KnowledgeOrganization

LegalRequirements

EHR Common Standards

Exchange

EHR Common Standards

Content

LiabilitySecurityPrivacy

OwnershipIntellectualProperty

3 years 5 years 7 years 10 years

Population

Services

Environment

Metadata

Multilevel Ontologies

Mandate Organization

Multiple LanguagesLinguisticRepresentations

Interoperability Levels

FULL Semantic Interoperability

Some Semantic Interoperability

Technical Interoperability

NO Interoperability

15

Roadmap Public Health: Actions

Requirements for SIOp:• Interconnection tools• Identification management• Common web services• Security technologies• Mechanisms for ensuring the sustainable operation of these

components on a widespread and publicly available basis

Action points:• Enable common standards to allow data exchange on predefined

key variables & compilation of content• Compile data across populations and across health care providers• Link data across multiple care settings• Compare data across regions, time or populations• Set up organizational and legal regulations in a sustainable

fashion• Develop global registries of standardized information models and

related metadata

16

Legal Requirements:

Liability, Security, Privacy

IPR, Ownership

Mandate the organisation

of PH information gathering

Common Standards

for Exchange

Common Standardsfor Content

Metadata for populations, settings and

GIS

Predefined Reportable Diseases

International Health

Regulations

Online Epidemiology on selected conditions

BioBanking

Linkage toPopulation Registries

Electronic Death

Certifiation

Patient Flow/ Statistics

Case-MixGrouping

Roadmap for SIOp Deployment & Research – Public Health

2009

2010

2011

2012

2014

2016

2021

2008

Classifications Demography Biosurveillance Public Health Infrastructure

Socio-economic Issues

17

Final Report: Roadmap Matrices & Action Plans

ContentTools

ProcessesToDo

Time Actors

PrereqsShort Term

Medium Term

Long term

Policy Makers

Health professionals

Researchers

SDOs

Industry

C1

Content SNOMED

Feasibility study and semantically sound reformulation hierarchies and relations for a of subset of SOMED

x x x x x T1

C2Multilingual multicultural versions of semantically sound subset

x x X x

C3Formal QA of Subset of SNOMED X x x X

C4Statistical extension of QA to all of SNOMED x X X x

C5Policy in conjunction with member states on future of use of SNOMED hierarchies and relations

x X

C6

Content Other

Consultation on issues related to LOINC & DICOM

x x x x

C7Consultation on issues related to Adverse reaction reporting and Drug Reporting

x x x X[1]

C8Actions arising from consultations X X X X X X

[1] Incl. Pharma

Roadmap Matrix on Ontologies (excerpt)

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Final Report: Roadmap Matrices & Action Plans

Roadmap for Semantic Interoperability Deployment and Research

Tools-Contents-Processes

2008 2009 2010 2011 2012 2014 2016 2021

Reference Model

Archetypes

Terminology Systems

Technology/ Visualisation

EH

R

Socio Economic Issues

SNOMED

LOINC, DICOM

Terminologies and EHRs

Ontologies

Genomics/ Translational

Medicine

On

tolo

gie

s

Socio Economic Issues

Classifications

Demography

Biosurveillance

Public Health Infrastructure

P

ub

lic

Hea

lth

Socio Economic Issues

Generic Model for EHR Communication

Standardised Represention/ Sharing of clinical data structures

Care Pathways and Archetypes

Best Practise Archetype Design

Quality Assurance and Certification

Archetype Repositories

Term Binding to Archetypes

Archetype/Template Authoring/Validation Tools

Key Use Cases

Policies on SNOMED-CT Term coordination

SNOMED-CT subsets

Business Rules to support term coordination

Terminology Server/Term Browser for SNOMED-CT

Consistency Test HL7 Terminfo Trial Standard

SNOMED-CT global Experience Test

EHR Visualisation Applications

Adaptable Clinical Applications

Electronic Death Certifiation

Patient Flow/ Statistics

Case-Mix Grouping

Linkage to Population Registries

Predefined Reportable Diseases

International Health Regulations

Online Epidemiology on selected conditions

Bio Banking

Common Standards for Exchange

Common Standards for Content

Metadata for populations, settings and GIS

Legal Requirements on Liability, Security, Privacy

Legal Requirements on Intellectual Property, Ownership

Mandate the organisation of PH information gathering

Consultations on issues related to LOINC & DICOM

Actions arising from consultations

Tools/methods for Terminfo guidelines test implementation

Generic Toolkit for HL7 messages and Archetypes binding to Terminologies

Establish sustainable framework with European Industry for effective standards and terminology/ontology development

Establish local European CoE on NCI technologies

Establish collaboration with EBI and US NBCO

Establish international Biobanking collaboration on terminologies

Toolset for Feasibility Study

Social Computing based Terminology Service

Large Scale Collaborative Ontology Environment

Central Reference Terminology Services

Ontology Mapping Research

Sustainable Centres for Selected Ontologies

Multilingual/-cultural classification adaptation

Policy: Local terminologies map to UMLS CUI & LUI

Research: Consequences of different ontological patterns and commitments

Feasibility Study and re-formulation of SNOMED subset

Multilingual/ -cultural SNOMED subset

FORMAL QA of SNOMED subset

Statistical extension of QA to all SNOMED

Policy in conjunction with MS on future use of SNOMED hierarchies and relations

Improve Internationalisation across HC paradigm and cultural differences

Agree on Semantic Inter-operability Goals for PHR

Link EHR data to educational material

Acceptance Evaluation

EHR/Terminology User Training

19

Proposal: Building a European Semantic IOp Knowledge Base

• Semantically linked set of documents• Collaborative environment (discussion page open for everybody)• Extensibility

SemanticHEALTH Wiki

20

Acknowledgements

Specific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMME

Communication & Technology Research Germany

Radboud University NijmegenMedical CenterThe Netherlands

World Health Organisation Dept. Measurements & Health Information Systems, Switzerland

Uppsala UniversityNordic Centre for Classifications in Health Care, Sweden

University of St. EtienneDepartment of Public Health & Medical Informatics, France

National Institute for Strategic Health ResearchHungary

University of Manchester Health and Bioinformatics Group, UK

University College LondonCentre for Health Informatics, UK

21

Thank you for your attention!

Further information:

[email protected]

Veli Stroetmannfor the SemanticHEALTH consortium

Communications & Technology ResearchBonn, Germany

[email protected]