Published on February 23, 2014
Getting Clinical Information Right Emerging Medication Standards Koray Atalag, MD, PhD, FACHI email@example.com HISO Member HL7 New Zealand Vice-Chair openEHR Programme Lead The National Institute for Health Innovation
Agenda • The problem • What‟s out there? • Medication Example • Methods & Standards • Recommendations & Discussion
What’s the problem? • Healthcare is hard! – Breadth, depth, complexity, variability etc. • So is dealing with health information... – What is a Heart Attack? – Is there such a disease as hypertension? – Is Diabetes a single disease? • Burning issue: getting a core dataset ASAP – Who will be responsible to govern definitions? – How to coordinate and support dataset teams? – How to get clinicians/experts on the same page? • An obvious gap in current approach • Start with Medication (+ Allergies & ADR)
So what’s actually out there? • PMS: each vendor has own data model • GP2GP: great start for structure • NZePS: started with a propriety XML payload, now waiting for standard CDA – PMS vendors implementing Toolkit based Adapter • • • • Shared Care / Maternity / St John? Hospitals? Labs & Pharmacies? Others? Can you really trust incoming data? (without human control)
Unified Medication Definition • Essential to get it right – first in patient safety! – Needs to be clinically valid, computable and support multiple use • Reused in many places, including: – – – – – – ePrescribing, eReferrals My List of Medicines Shared Care systems Patient and clinician portals Health (status & event) summary Public Health / Research • New HISO Connected Care suite of standards – HISO 10043 CDA Common Templates – 10041.1 CDA Templates for Medications, Allergies and Adverse Reactions just passed public consultation – coming soon • NZMT / NZULM & Formulary > great start!
Why bother? (with a standard structured Medication model) “If you think about the seemingly simple concept of communicating the timing of a medication, it readily becomes apparent that it is more complex than most expect…” “Most systems can cater for recording „1 tablet 3 times a day after meals‟, but not many of the rest of the following examples, ...yet these represent the way clinicians need to prescribe for patients...” Dr. Sam Heard
Example: Medication timing Acknowledgement: Sam Heard
Medication timing – and more!! Acknowledgement: Sam Heard
Medication timing cont. Acknowledgement: Sam Heard
Medication timing – cont. Acknowledgement: Sam Heard
Medication timing – even more! Acknowledgement: Sam Heard
HISO 10040 Interoperability Reference Architecture 10040.1 R-CDRs XDS 10040.2 CCR SNOMED CT openEHR 10040.3 CDA Acknowledge Alastair Kenworthy
The Principles 1. 2. 3. 4. 5. 6. 7. Align to national strategy: as per national and regional plans Invest in information: use a technology agnostic common content model, and use standard terminologies Use single content model: information for exchange will be defined and represented in a single consistent way Align to business needs: prioritise the Reference Architecture in line with regional and national programmes Work with sector: respect the needs of all stakeholders Use proven standards: adopt suitable and consistent national and international standards wherever they exist (in preference to inventing new specifications) Use a services approach: move the sector from a messaging style of interaction to one based on web services
It’s REFERENCE LIBRARY (of reusable clinical information models) Data & meta-data definitions (data dictionary) Relationships & clinical terminology
Usage of the Content Model
Health Information Exchange & More Single Content Model Automated Transforms PAYLOAD CDA System A Map To Content Model FHIR HL7 v2/3 EHR Extract System B Map To Content Model UML XSD/XMI PDF Mindmap Data Source A Data Source B No Mapping Secondary Use Native CDR / Datamart
Creating CDA Payload
Draft HISO Medication Standard
Peer review of models
Resulting Models (using CKM Tool)
Who else is doing it?
Other upcoming HISO standards • • • • 10041.4 CDA Templates for Referral Requests 10040.4 Clinical Document Metadata Standard 10050.1 Maternity Data Set Standard 10050.2 CDA Templates for Maternity Care Summary • 10052 Ambulance Data Set Standard They all share common clinical concepts; certainly the Medication Definition – Who’s responsible for making sure they are aligned? – What mechanism exist to assist dataset developers / clinical domain experts? – How do you keep them aligned over time / governance?
Options / Recommendations Who can be responsible for making sure datasets are aligned and interoperable? MoH, NHITB, HISO, HIGEAG, NICLG, other? What mechanisms to assist dataset developers / clinical domain experts? Policy, principles, guides, examples HISO 10040.2 Exchange Content Model Tools? CKM but also Word, Excel, mindmaps, UML How do you keep them aligned over time / support governance? CKM – Not Data dictionary, meta-data registry, Excel
Bottom line • Content is „clinician‟s stuff‟ – not techy; – yet most standards are meaningless for clinicians • We need to invest in information – Whatever technology will be • Method defined in HISO standard – Worked well for Medications • Let‟s build rest of it as we go! – NIHI is keen to facilitate clinical content development and governance + tooling support – This will also fulfil MoH “Data Dictionary” need
Thank you Questions? firstname.lastname@example.org The National Institute for Health Innovation
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