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Concept and T erminology in Denmark

Concept and T erminology in Denmark. Arne Kverneland and Ulrich Andersen National Board of Health Denmark. Different scenarios in IT in Denmark. Effective use of IT, degree of ambition. Optimistic: Common concept model Common terminology reusable information. 4. 3. Pessimistic:

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Concept and T erminology in Denmark

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  1. Concept and Terminology in Denmark Arne Kverneland and Ulrich Andersen National Board of Health Denmark

  2. Different scenarios in IT in Denmark Effective use of IT, degree of ambition Optimistic: Common concept model Common terminology reusable information 4 3 Pessimistic: Different concept models Different terminology No reuse of data ? 2 1 0 1997 2002 2008 National Board of Health

  3. Analysis of IT in a major university hospital: Existing IT is ….. • An obstacle in the daily work • Complicating the key processes • Leads to redundant work • Is not coherent with external demands • booking • billing • reporting National Board of Health

  4. Starting point Professional needs….. • Supporting treatment and care • Ensure quality of data • Increase data re-usability • Easier communication • Make quality improvements possible National Board of Health

  5. Central starting point Patients need….. • Integrated care • seamless care between health care providers • shared care between healthcare providers • continuity of care within the organisation • multidisciplinary co-operation • Understandable information • Expectations/involvement (common goal) • Quality documentation National Board of Health

  6. Percentage of total (possible) messages (DK) National Board of Health Source: MedCom

  7. Background 1994: MEDCOM EDIFACT-messages (35 mill messages per year) 1996-97: Action Plan for EHR – decentralized, pilots Conclusion of the evaluation: “There is need for standards and common terminology” 1999: National Strategy for Information Technology in Hospitals “EHRs shall become the core of IT systems in hospitals” 2003: National Strategy for Information Technology in the Health Care System (2003-2007) “Shared information is the foundation for seamless care and patient involvement” National Board of Health

  8. Initiatives of the strategy Concepts / terminology(20) B-EHRsystems(1,2) Integration Platform(8) NQR QI Pilot DGMA B-EHR pilots(3-6) IQR(17) Classifications(22,23) NHCR(14) NPI (15) Pilot NHCR(14) Legal-safetyclarification (7) ”New-DRG” Basic EHRstandard ConvertionNew -> Old (14) XML-EPJmessages(25) HealthCare-portal(18) Old-DRGaccounting Medication-messagesin XML (4) SDN oninternet(26) Primary EHR(21) PKI forHealth professionals (24) GP-systems Medicatio-profile (16) User-management National Board of Health

  9. Major initiatives of the 2003-2007 strategy Move from messaging to shared information… • Development, test & implementation of EHRs • based on The National Basic Conceptual Model for EHR ”The Clinical Processes and its elements” • Common Terminology & Classifications • International & National classification (ICD, NCSP, ICPC, ICF, NANDA, IUPAC…) • SNOMED CT as a referenceterminology National Board of Health

  10. Result Goal Problem Diagnosis Intervention National Board of Health

  11. No integration without semantic interoperability National Board of Health

  12. Clinical Terminology Concept Model Standards for EHR National Board of Health

  13. National Board of Health

  14. Guidelines EHR system EHR-model Terminologi Healthterm - developement xml subsets text …. Defence qualitymodel Viborg H:S subsets synonyms National Board of Health

  15. Why the SNOMED Terminology? High cost and delays to develop alternative • Estimated cost to create an alternative: • 4-5 mill. euro to develop a terminology • ½-1 mill. euro per year to maintain and support • End-user costs increase as software vendors must support two competing terminology standards • And development would take 5-10 years, delaying national EHR adoption National Board of Health

  16. SNOMED CT • WHO may play a significant role • Terminology on the e-health agenda • SNOMED Standards Development Organisation [SDO] • All components needed for international conformance, interoperability & maintenance of the principles • National Extensions • All components needed for national, but not international conformance, interoperability & maintenance of the principles National Board of Health

  17. The Danish EHR-project • Modelling and documenting (NBH): • Information model (concepts and relations) • Data logic model (UML notation) • Communication model (XML schemes) • Health Terminologi • Translation of Snomed CT • Establishing National subsets • Mapping to existing classifications • Clinical guidelines • Textual description • Mapping to model & terminology • Building EHR’s (Regions, HC-Copenhagen) • Functonality • Performance • Integration Link: www.sst.dk/Gepj National Board of Health

  18. clinical proces User interface BEHR Guidelines Terminology research – quality – management - EHR? Guide- lines EHR- model Clinical Terminologi National Board of Health

  19. National Board of Health

  20. Det anvendelsesorientede Eksempler niveau Information til understøttelse af og dokumentation for sundhedsfaglige Brugerkrav arbejdsprocesser i relation til diagnostik, behandling og pleje Windows præsentation Det logiske niveau brugergrænseflade Definitioner og regler til Terminologi opnåelsen af éntydig indhold Forløbsdefinitioner information - sundheds- informatiske standarder EPJ-grund struktur Det teknologiske niveau EDIFACT teknisk format HTML, XML Tekniske standarder til sikring af udveksling af data imellem X.400 transmission forskellige edbsystemer TCP/IP Standardiseringsniveauer EPJ National Board of Health

  21. Copenhagen 20. februar 2001 National Board of Health

  22. What did they sign in 2001? • Episode of care based • Structured information • Report to clinical databases for quality • Standardized terminology & classifications • Shared responsibility for testing & pilots National Board of Health

  23. Disorder Tumor Throat disease Lung disease Inflammation Cancer Tonsillitis Pneumonia Lung cancer Throat cancer Benigne tumor in throat The architecture of a clinical terminology A concept based terminology National Board of Health

  24. National Board of Health

  25. PLANNING METHODOLOGY OBJECTIVE Stage 1 Inexperience ”Bottom-up”, experts Management understanding Stage 2 Inadequate business plan ”Top-down”, Management run Agreeing priorities Stage 3 Complexity apparent ”Bottom-up” ”Top-down”, prototyping Strategy plan Stage 4 Impatience for benefits ”Indside-out” management and users in control Finding opportunities Stage 5 Maturity Multiple methods accepted. Partnerskip Integrated IT and business strategy It takes 5 – 10 years before the benefit begins to materialise... National Board of Health

  26. Goals for EC Healthcare • Maintain sustainable health care for all • Improve safety of healthcare delivery and reduce the number of errors • Support secure authorised access to patients’ relevant health documentation anytime, anywhere • Support the mobile citizen in seeking high quality care throughout Europe Report from the CEN/ISSS e-Health Standardisation Focus GroupFinal version 2005-03-01 National Board of Health

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