Jean marie Rodrigues Dpt of public health and medical informatics, University of Saint Etienne USE, France

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1 Workshop on semantic interoperability prerequisites for efficient e-health systems. How to support convergence of ontology, standards in health informatics for clinical terminologies,classifications, coding systems and e health records. A strategy for a top down approach Brussels 14-15/02/05 Jean marie Rodrigues rodrigues@univ-st-etienne.fr

2 WHY A TOP TOP DOWN APPROACH 1 BETWEEN 2 OPPOSITE POSSIBLE ERRORS IDEAL SOLUTIONS No No chances before we we are are all all dead dead PRAGMATIC RESIGNATION So So difficult let let us us go go our our old old traditional way way (ex (ex procedures coding systems) 2 DIVERGENT BOTTOM UP UP INITIATIVES See See before 3 SEMANTIC INTEROPERABILITY PERCEIVED AS AS A RISING PRIORITY BUT BUT No No clear understanding by by decision makers Underestimation of of the the complexity of of the the whole and and of of some parts Mixing not not optimal between industry and and academic

3 WHERE WE WE ARE The The different aspects of of interoperability (Electronic Health Records, messages, security, terminology and and languages, data data types, information models, architectures, archetypes, standards,etc.) are are addressed by by divergent initiatives aiming at at exchanging not not only only data data or or information, but but also also at at transferring meaning: in in healthcare, such a practice is is related to to risk. risk.

4 WHERE WE WE ARE Advanced technologies in in computer and and other disciplines, such as as artificial intelligence, allow for for much more complex problems solving in in routine: this this is is possible through the the use use of of such tools as as ontologies and and formal representations, hidden within the the computer for for terminology, or or personal microprocessor cards for for security.

5 Bridges/roles in semantic Natural language Clinical Terminologies UMLS SNOMED CT interoperability MeSH ARCHITECTURE AND ARCHETYPES STANDARDS ONTOLOGY Decision support Claims casemix SDMG Continuity of care Coding & Classifications CCI ICD-9 ICD-10 CCAM TERMINOLOGY STANDARDS Patient information ICPC

6 1 Information Model (RIM HL7) 2 Architecture: pren EHRcom,CDA 3 Archetypes : pren EHRcom,Templates HL7 set of minimal ontology and context structure constraints 4 Terminology standards EN1828 Categorial structure for surgical procedures EN ISO Integration of a reference terminology model for nursing pren12264 Categorial structure :reference terminology model x pren medical devices,clinical laboratory,medicinal products,claml Ontology Formal knowledge representation with editing,reasoning and nlp software tools as OPEN SOURCE to share acquisition, validation,use USE Department between of countries,centres public health and languages and medical informatics

7 l Relations ontology:nlp Classifications craniotomy, cranial incision, incision of the skull Set of sensible_statements(cl_incising, rel_actsspecificallyon, cl_hollowbodystructure). And annotations(22.1, cl_generalisedprocess, rel_actson, cl_bodystructure, [en([adj,cpl,nprem]), fr([adj,cpl]), it([adj,cpl])], [en([adj,partperf(affected,by)]), ] ). FOR COMPUTERS AND NOT FOR HUMANS NOT EASILY PERFECT AND EXHAUSTIVE 1 st Generation 2nd Generation 3 rd Generation ICD 10 ICF GALEN ICD 9 CM CCAM SNOMED RT CPT 4 SNOMED intern. FMA USE Department of public health and medical informatics

8 ONTOLOGY CONFUSING FACTORS Consensus process between professionals Inter rater reliability Assessing quality of of the the whole process? A new identifyer End End users

9 Macro view Road map for decision makers - understanding complexity and issues - implementation platforms at different levels (EU,nation,region,organisation) - coordination(member states,eu,so, Who,industry,academia) - action plan USE Department of public health and medical informatics

10 METHODOLOGY To To identify the the needs of of target beneficiaries, To To keep keep in in mind the the context (( levels of of development, cultural and and linguistic sensitivities), To To assess impact (benefits) over over time time and and to to prioritise,, To To identify missing links links (R&D (R&D)in )in qualitative terms To To assess implications in in quantitative terms (planning and and resource).

11 Micro approaches :targeted topics Disease Anatomy Procedures Medicinal products USE Department of public health and medical informatics

12 to towhat extent existing applications and and tools can can be be improved and and at atwhat cost cost to to come useful for for specific purposes. OR OR to to what extent ideal solutions can can be be operationalized and andat at what cost costto to be bepractically implemented to to be be useful for forspecific purposes.

13 END USE Department of public health and medical informatics

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