Implementation of a CEN/ISO 13606 Platform for Medicines Reconciliation
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Transcript of Implementation of a CEN/ISO 13606 Platform for Medicines Reconciliation
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Implementation of a CEN/ISO 13606
Platform for Medicines Reconciliation
David Moner1, Marta Terrón2, Carlos Angulo1, Luis Lechuga2, Pablo Serrano2, José A. Maldonado1, Francisco J. Farfán2, and
Montserrat Robles1
1 ITACA Institute, Universitat Politècnica de València, Spain2 Hospital de Fuenlabrada, Madrid, Spain
Contact: David Moner ([email protected])
MIE2011
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Project description
• Semantic interoperability must exist between all data sources.
– The CEN/ISO 13606 norm and archetypes were used together
with SNOMED CT and the Spanish National Medication
Database.
– The infrastructure is based on the use of the LinkEHR
Normalization Platform.
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Objective: To define and use a methodology and tools to guarantee
medicines reconciliation between the Hospital de Fuenlabrada in
Madrid and the primary care centres of its health area.
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Medicines reconciliation
• Medicines reconciliation is the process of evaluating the
complete list of past and current medications of a patient to
avoid medication errors.
• It should be done at every transition of care in which new
medications are ordered or existing orders are rewritten.
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• Up to 67% of patients' prescriptions histories have
one or more errors.
• Up to 46% of medication errors take place when new
orders are written at transition points.
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The CEN/ISO 13606 norm
• The CEN/ISO 13606 norm for the Communication of
the Electronic Health Record is the basis for health
information systems semantic interoperability.
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• It distinguishes two different models:
- The Reference Model contains basic and generic entities to represent
any kind of health information, together with context information.
- Archetypes are formal definitions of domain concepts whose purpose is
to provide a powerful, reusable and interoperable mechanism for the
creation, description, validation and query of EHR information.
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LinkEHR® Normalization Platform
• The LinkEHR Normalization Platform facilitates the
creation of normalized and federated views of clinical
information which is distributed among heterogeneous
health information systems.
• LinkEHR is the only existing tool capable of handling
archetypes as a data normalization mechanism.
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www.linkehr.com
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Architecture of the solution
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LinkEHR Platform
DATA NORMALIZATION
DATA INTEGRATION
NOMENCLATORDIGITALIS
LOGS
ARCHETYPES
INDEPENDENT
WEB VIEWER
HOSPITAL EHR
(SELENE)
Web Service
The integrated and normalized view is offered through a web service interface to be used directly or to be integrated into other systems
Primary care
OMI-AP
Hospital de Fuenlabrada
FARMATOOLS SELENE
Three basic steps:
1. Data integration
2. Archetype definition
3. Data normalization
1
2
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Data integration
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OMI-AP
The primary care
information system
The hospital
electronic health
record system
The hospital
pharmacy information
system
Spanish National
Medication Database
SELENE
FARMATOOLS
Nomenclator
The LinkEHR Integration Engine builds a
virtual integrated XML view of all data of a
patient existing in heterogeneous and
distributed systems.
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Archetype definition
Knowledge sources
Patient Summary
specifications
CKM archetypes
Medication
specifications
Existing systems and
clinical knowledge
Defined archetypes
Several CEN/ISO 13606 archetypes were
defined using the LinkEHR Editor
Medications Problems
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Normalization
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The tool generates an XQuery
script that is able to transform
the legacy data into CEN/ISO
13606 EHR extracts
The LinkEHR Editor allows
the specification of mappings
and transformation rules
between archetypes and data
sources.
MAP
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Deployment
• The LinkEHR Extract Server retrieves the integrated data, applies
the normalization XQuery to it and offers the normalized XML
documents through a web service interface.
• This service was integrated into the hospital EHR system (Siemens
Selene), providing access to the patient summary, including the
medication list from both the hospital and the primary care centres.
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Conclusions
• We have demonstrated that CEN/ISO 13606 and the
archetype methodology can be used in real environments.
– Medicines reconciliation is a clear example that semantic
interoperability technologies can highly improve the quality of
care and patient security.
• This project served as an introduction for several clinicians of
a new way of using standards and semantic technologies.
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This project has been financed in part by the Spanish Ministry Science and Innovation
under Grant TIN2010-21388-C02-01, and by the Health Institute Carlos III through the
RETICS Combiomed, RD07/0067/2001.
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More info
• You can see this technology working at
MIE 2011 Workshop 14:
“CEN/ISO 13606 Implementation and
Communication of Health Information”
• Tuesday, 30th August, 13:45
• Room N4 Christiania