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iEHR.eu IHIC 2013 Presentation
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Transcript of iEHR.eu IHIC 2013 Presentation
![Page 1: iEHR.eu IHIC 2013 Presentation](https://reader033.fdocuments.in/reader033/viewer/2022060201/55999c941a28ab730d8b47db/html5/thumbnails/1.jpg)
2014-03-06 1
14th International HL7 Interoperability Conference
Extensions to HL7 V3 Standards Designed for the First Polish Nationwide Implementation:
Reasoning and Modelling
Roman Radomski, Sebastian Bojanowski
iEHR.eu, Warsaw, Poland
October 29, 2013
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14th International HL7 Interoperability Conference
eHealth in Poland
• The main project of Polish eHealth aims at building the central information system supporting common exchange of electronic medical documents.
• Three types of documents: eReferral, ePrescription and eOrder of Supply are to be uploaded to the central repository to be accessed by the potential service providers.
• Other documents are to be stored locally, but their metadata will be sent to the same central system and published in the form of document registry.
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14th International HL7 Interoperability Conference
HL7 v3 Implementation Guide
• HL7 CDA and V3 have been chosen as the standards for documents and messages to be exchanged with the central system.
• Due to the official project timeline, the large scale amendments of the current regulations and printed document forms were excluded.
• Draft CDA implementation guide for all 3 document types has been developed by iEHR.eu and distributed by the official government agency CSIOZ for review.
• The message template for other documents metadata exchange has been designed on the basis of the HL7 Medical Records R-MIM.
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14th International HL7 Interoperability Conference
Local extensions
• Most of the clinical concepts represented in the documents have been successfully mapped to the CDA, although 8 local extensions had to be defined.
• One extension has been defined for the HL7 v3 message beingsent to the central repository.
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14th International HL7 Interoperability Conference
Entitlement document
• The clinical document may contain information on non-clinicaldocument allowing patient’s entitlement to the particularmedical service coverage plan.
• The information consists of the document type and the document number (identifier).
– The special entitlement resulting from the document is not explicit in the document.
– The entitlement is subject to the operational context (planned service, local conditions, region) and may vary in time, but it does not changethe document information.
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14th International HL7 Interoperability Conference
Entitlement document
id.root = OID nodes for entitlement documents identifierscode.codeSystem = OID node for entitlement documents types value set
Constraint: Document id and code
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14th International HL7 Interoperability Conference
Special entitlement
• There are special entitlements (e.g to the drug refundcoverage plans) that should be indicated in the prescriptiondocument.
– The value sets of those coverage plans are regulated by law.
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14th International HL7 Interoperability Conference
Special entitlement
code.code = "PUBLICPOL"code.codeSystem = "2.16.840.1.113883.11.19350” (ActInsurancePolicyCode)code.qualifier.name.code = "RLEKUD" (drug refund based on special entitlement)code.qualifier.name.codeSystem = OID node for coverage plans value setcode.qualifier.value.codeSystem = OID node for special entitlements value set
Constraint: CoveragePlan.code
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14th International HL7 Interoperability Conference
Coverage eligibility confirmation
• There is a procedure for online confirmation of patienteligibility to the national health insurance.
• The confirmation has a form of a string and needs to be included in the clinical document issued when refundedservice is performed.
– The confimation string is not an identifier of an insurance policy or anyother entitlement document.
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14th International HL7 Interoperability Conference
Coverage eligibility confirmation
id.root= OID node for coverage eligibility confirmation identifierscode.code = "ELG " (eligible)code.codeSystem = "2.16.840.1.113883.11.17488" (ActCoverageEligibilityConfirmationCode)
Constraint: CoverageEligibilityConfirmation id and code
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14th International HL7 Interoperability Conference
Multiple birth indicator and order number
• Newborns are identified by their mother identifier and the birth date.
• Multiple birth newborns are identified by their motheridentifier, the birth date and the birth order number.
– All those identifying data needs to be included in every clinicaldocument until the proper national identifier is given - usually it takescouple of weeks.
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14th International HL7 Interoperability Conference
Multiple birth indicator and order number
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14th International HL7 Interoperability Conference
Close person
• There are specific document forms in Poland which require providing given names of patient’s parents as an additional patient identifying information.
– This is not an information about patient’s guardian.
– This is not a participation in the act of clinical document or in any act being documented.
– The document does not contain any other information about patient’s parents.
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14th International HL7 Interoperability Conference
Close person
code.codeSystem = "2.16.840.1.113883.11.19563" (PersonalRelationshipRoleType)
Constraint: PersonalRelationship.code
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14th International HL7 Interoperability Conference
Physician speciality
• Prescriptions for specific drugs and medical equipment supply require to be issued by physicians of particular specialities.
• Common practice is to include all medical specialities of document authenticator in every clinical document issued.
– The document content and context may not be relevant to the physician’s medical speciality.
– The value set of medical specialities is regulated by law.
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14th International HL7 Interoperability Conference
Physician speciality
code.codeSystem = OID node for physician specialities value set
Constraint: Qualification.code
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14th International HL7 Interoperability Conference
Drug payment level
• Drug may be refunded on various levels according to the public insurance/coverage plan.
• The same drug may be refunded on different levels dependingon clinical context.
– Physician is expected to determine the patient’s payment level for the drug being prescribed.
– The value set of drug payment levels is regulated by law.
– The national health fund conducts continous fraud detection to ensureproper drug refund processes.
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14th International HL7 Interoperability Conference
Drug payment level
code.code = "PUBLICPOL"code.codeSystem = "2.16.840.1.113883.11.19350” (ActInsurancePolicyCode)code.qualifier.name.code = "POLEKR" (refunded drugs payment levels)code.qualifier.name.codeSystem = OID node for coverage plans value setcode.qualifier.value.codeSystem = OID node for refunded drugs payment levels value set
Constraint: CoveragePlan.code
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14th International HL7 Interoperability Conference
Drug substitution
• The default rule is that pharmacist can substitute the prescribed drug with its equivalent, unless the drugprescription contains „no substitution” remark.
– The problem of drug substitution is rather sensitive, due to business competition between pharmaceutical companies and its potentialinfluence on the medical professionals.
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14th International HL7 Interoperability Conference
Drug substitution
code.code = "N" (none)code.codeSystem = "2.16.840.1.113883.11.16621" (ActSubstanceAdminSubstitutionCode)
Constraint: Substitution.code
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14th International HL7 Interoperability Conference
Supporting Clinical Statement
• The message containing metadata of clinical document beingissued is sent to the central repository.
– This message has to contain information about diagnosis placed in the context of the document.
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14th International HL7 Interoperability Conference
Supporting Clinical Statement
Clinical StatementMedical Records
code.codeSystem = OID node for official Polish translation of ICD-10
Constraint: Observation.code
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14th International HL7 Interoperability Conference
New Timeline for the Polish eHealth Agenda
• The central system (P1) to be ready by mid 2014
• First production use of P1 at beginning of 2015
• The electronic drug prescription obligatory for all healthcareproviders in 2015 or 2016
• Other documents will be obligatory gradually from 2016