Thanks to Pr Christian Lovis, MD, MPHI Head, Unit of Clinical ......Electronic Health Records and...

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Slide Slide 11Electronic Health Records and Supply Chain Data Standards

GS1 Healthcare, Hong Kong, October 7GS1 Healthcare, Hong Kong, October 7thth, 2009, 2009

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Thanks to Pr Christian Lovis, MD, MPHI

Head, Unit of Clinical Informatics

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EHR EHR fromfrom US US DoDDoD* / 1 (* / 1 (encounterencounter / location)/ location)Additional Selection Criteria


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Previous Encounters

Location

*DoD:

US Department of Defense

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EHR EHR fromfrom US US DoDDoD / 2 (/ 2 (encounterencounter / location)/ location)


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Previous Encounters

Location

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EHR EHR fromfrom US US DoDDoD / 3 (document)/ 3 (document)


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Documengt History

Discharge Letter

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EHR EHR fromfrom US US DoDDoD / 4 (/ 4 (structuredstructured document)document)


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Documents History

Location

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EHR EHR fromfrom US US DoDDoD / 5 (/ 5 (medsmeds historyhistory))

Medications dispensed by DoD, VA* & retail pharmacies© Medinorma LLC Switzerland

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Slide 6Medications dispensed by DoD, VA* & retail pharmacies

VA:

Veteran Affairs, the US federal

hospital for military staff

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EHR…. Connecting the dotsEHR…. Connecting the dotsSupplySupply Chain … Chain … connectingconnecting to EHRto EHR

EHR differs from paper-based filesData are stored electronically,Preferrently in a structured formatPreferrently by referring to common agreed semantics, including images, lab results, etc.


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EHR belongs to the clinical IT

Supply Chain data belong to an other “silo”?

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SupplySupply Chain data in Chain data in HospitalHospital ITIT


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SupplySupply Chain meeting Chain meeting ClinicalClinical ITIT


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Drugs, laboratory samples, etc, …Care, acts, actions, …

SupplySupply Chain and Chain and ClinicalClinical ITIT

University hospitals of GenevaPediatry Dept, mai – october 2007 – 6’786 episodes, 93’294 medical acts

Medication25%


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Medication

Nursing acts

Medication

Medications

Care

Laboratory

Radiology

Consultations

Other

93’294 medical acts

2’900’000 nursing acts

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Supply chain as bridging processes Supply chain as bridging processes and silosand silos

Supply ChainCare

Accounting

From Product to Patient


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EHR

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Supply Chain and EHR:Supply Chain and EHR:different time scales ?different time scales ?

1971

1978© Medinorma LLC Switzerland

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…over …over generationsgenerations


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2009

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SupplySupply Chain Data … in Chain Data … in clinicalclinical ITIT

Supply Chain Data... As identification keys...attributes for traceabilitySmooth linkage between two environments

HL7 and GS1 collaborating to make this as © Medinorma LLC Switzerland

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HL7 and GS1 collaborating to make this as interoperable as possible

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HL7’s MissionHL7’s Mission

HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. HL7 promotes the use of such standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all.


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healthcare delivery for the benefit of all.HL7’s strategy is innovation – both by ourselves and by our users

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SupplySupply Chain Data … Chain Data … intointo ClinicalClinical ITIT

GLN 7601001370500

GS1 xml message


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Location

Identifier Authority: EAN.UCC

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SupplySupply Chain Data … Chain Data … intointo ClinicalClinical ITIT

HL7 CDA messageGLN 7601001370500

OID : 1.3.88


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Location

•IS_A

•Cardioselective beta-blocker

•IS_A

•Beta-blocker drug

•etc etc

•IS_A

•Snomed CT drug core

Dm+d and SNOMED CT

•Atenolol 50mg

•Tablet

•(Cox)

•X28

•(AMPP)

•Atenolol

•50mg

•Tablet x28

•(VMPP)

•Atenolol 50mg

•Tablet

•(COX)

•(AMP)

•Atenolol 50mg

•Tablet

•(VMP)

•Atenolol

•(drug product)

•(VTM)

•IS_A

•NHS dm+d

Source: Paul Frosdick, Bpharm, NHS, 2005

VTMVirtual

Therapeutic

Moiety

SCT_id GTIN* 1719111000001106 05010605005114 1365411000001104 05012617009616 3243411000001108 07640134320013* 4376911000001104 07680382100258*

Added value in NCRS and

systems

VMPVirtual

Medicinal

Product

VMPPVirtual

Medicinal

Product Pack

AMPPActual

Medicinal

Product Pack

AMPActual

Medicinal

Product

Adapted* from: Paul Frosdick Bpharm, NHS, 2005

07640134320013*

07680382100258*

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A tentative to visualise GS1 in HL7’s A tentative to visualise GS1 in HL7’s Model Model shapeshape

Entity(GTIN, GLN, etc. )

Participation(attributes as

serial #, dates,)

Entity(Value, Transaction,

involved parties)© Medinorma LLC Switzerland

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Referral

authorized_visits_qty : REAL

Observation

value : ANY

interpretation_cd : SET<CE>

method_cd : SET<CE>

target_site_cd : SET<CD>

derivation_expr : ST

Substance_administration

route_cd : CE

approach_si te_cd : SET<CD>

dose_qty : IVL<PQ>

rate_qty : IVL<PQ>

dose_check_qty : SET<RTO>

max_dose_qty : SET<RTO>

potency_qty : PQ

substitution_cd : CE

Procedure

method_cd : SET<CE>

approach_site_cd : SET<CD>

target_site_cd : SET<CD>

Supply

qty : PQ

expected_use_time : IVL<TS>

Diet

energy_qty : PQ

carbohydrate_qty : PQ

Container

capacity_qty : PQ

height_qty : PQ

diameter_qty : PQ

cap_type_cd : CE

separator_type_cd : CE

barrier_delta_qty : PQ

bottom_delta_qty : PQ

Access

approach_site_cd : CD

target_site_cd : CD

gauge_qty : PQDevice

manufacturer_model_nm : ST

software_nm : ST

local_remote_control_state_cd : CE

alert_level_cd : CE

last_calibration_time : TS

Employee

job_cd : CE

job_title_nm : ST

job_class_cd : CE

salary_type_cd : CE

salary_qty : MO

hazard_exposure_txt : ED

protective_equipment_txt : ED

Living_subject

administrative_gender_cd : CE

birth_time : TS

deceased_ind : BL

deceased_time : TS

multiple_birth_ind : BL

birth_order_nbr : INT

organ_donor_ind : BL

Material

form_cd : CE

Assigned_entity

position_cd : CE

primary_care_ind : BL

Certified_entity

recertification_time : TS

Place

mobile_ind : BL

addr : AD

directions_txt : ED

position_txt : ED

gps_txt : ST

Manufactured_material

lot_nm : ST

expiration_time : TS

stability_time : IVL<TS>

Non_Person_living_subject

taxonomic_classification_cd : CE

breed_cd : CE

strain_txt : ED

gender_status_cd : CE

euthanasia_ind : BL

Patient

confidentiality_cd : CE

very_important_person_cd : CE

Organization

addr : BAG<AD>

standard_industry_class_cd : CE

Account

nm : ST

currency_cd : CE

i nterest_rate_qty : RTO<MO,PQ>

al lowed_balance_qty : IVL<MO>

Financial_act

net_amt : MO

Person

addr : BAG<AD>

marital_status_cd : CE

education_level_cd : CE

ambulatory_status_cd : CE

disability_cd : CE

living_arrangement_cd : CE

religious_affiliation_cd : CE

special_accommodation_cd : SET<CE>

race_cd : SET<CE>

ethnic_group_cd : SET<CE>

Working_list

ownership_level_cd : CE

Public_health_case

detection_method_cd : CE

transmission_mode_cd : CE

disease_imported_cd : CE

Patient_encounter

acuity_level_cd : CE

admission_source_cd : CE

birth_encounter_ind : BL

discharge_disposition_cd : CE

length_of_stay_qty : PQ

pre_admit_test_ind : BL

referral_source_cd : CE

special_courtesies_cd : SET<CE>

urgency_cd : CE

valuables_desc : ED

valuables_location_desc : ED

Schedulable_resource

slot_size_increment_qty : PQ

Infrastructure (Structured documents)

Guarantor

credit_rating_cd : CE

Diagnostic_image

subject_orientation_cd : CE

Imaging_modality

pixel_intensity_relationship_cd : CE

spacial _resolution_qty : PQ

pixel_padding_qty : PQ

Context_structure

local_id : ST

Message Control

Financial_transaction

credit_exchange_rate_qty : REAL

debit_exchange_rate_qty : REAL

interest_rate_qty : RTO

Invoice_element

modifier_cd : CE

unit_qty : PQ

unit_price_amt : RTO<MO,PQ>

factor_nbr : REAL

points_nbr : REALcoverage_source_cd : CE

notify_subject_ind : BL

Fi nancial_contract

payment_terms_cd : CE

Role_heirEntity_heir

Device_task

parameter_value : LIST<ANY>

Control_event

structure_type_id : II

response_cd : CS0..10..1

Act_relationship

type_cd : CS

inversion_ind : BL

context_control_cd : CS

sequence_nbr : INT

priority_nbr : INT

pause_qty : PQ

checkpoint_cd : CS

split_cd : CS

join_cd : CS

negation_ind : BL

conjunction_cd : CS

Act_context

level_cd : CE

Act

class_cd : CS

mood_cd : CS

id : SET<II>

cd : CD

negation_ind : BL

txt : ED

status_cd : SET<CS>

effective_time : GTS

activity_time : GTS

availability_time : TS

priority_cd : SET<CE>

confidentiality_cd : SET<CE>

repeat_nbr : IVL<INT>

interruptible_ind : BL

context_lock_ind : BL

independent_ind : BL

reason_cd : SET<CE>

language_cd : CE

0..n1

has_targ et

0..n

is_targ et_ fo r

1

0..n1

ha s_source

0..n

is_source_for

1

1..*

0..*

originates_in_context_of

1..*

provides_context_ for

0..*

Participation

type_cd : CS

function_cd : CD

context_control_cd : CS

sequence_nbr : INT

note_txt : ED

time : IVL<TS>

mode_cd : CE

awareness_cd : CE

signature_cd : CS

signature_txt : ED

0..n 1

for

0..n

has

1

Role_link

type_cd : CS

effective_time : IVL<TS>

Role

class_cd : CS

id : SET<II>

cd : CE

negation_ind : BL

addr : BAG<AD>

telecom : BAG<TEL>

status_cd : SET<CS>

effective_time : IVL<TS>

certificate_txt : ED

qty : RTO

position_nbr : LIST<INT>

0..n1

has_as_participant

0..n

participa tes_in

1

0..n1

has_source

0..n

is_source_for

1

0..n1

has_target

0..n

is_target_for

1

Language_communication

language_cd : CE

mode_cd : CE

proficiency_level_cd : CE

preference_ind : BL

Entity

class_cd : CS

determiner_cd : CS

id : SET<II>

cd : CE

qty : SET<PQ>

nm : BAG<EN>

desc : ED

status_cd : SET<CS>

existence_time : IVL<TS>

telecom : BAG<TEL>

risk_cd : CE

handling_cd : CE

importance_status_txt : ED

0..n0..1

is_played_by

0..n

plays

0..1

0..n0..1

is_scope d_by

0..n

scopes

0..1

10..n

communicates_ with

1

used_by

0..n

Communication_function

1..n

0..*

serves

1..n

0..*

Managed_participation

id : SET<II>

status_cd : SET<CS>

Act_heir

Entity Role

Participation

Clinical Acts

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Continue Continue workingworking in meeting Health in meeting Health IT IT requirementsrequirements

GSMP « Patient & Caregiver ID » :

gap analyse and searching solutions


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EHR and EHR and SupplySupply Chain Standards …Chain Standards …


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Christian Hay

Partner

Medinorma LLC

www.medinorma.net

[email protected]

Thanks to Pr Christian Lovis, MD, MPHI Head, Unit of Clinical ......Electronic Health Records and...

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Transcript of Thanks to Pr Christian Lovis, MD, MPHI Head, Unit of Clinical ......Electronic Health Records and...