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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 l.jpg

Concept and Terminology in Denmark

Arne Kverneland and Ulrich Andersen

National Board of Health

Denmark


Different scenarios in it in denmark l.jpg
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


Analysis of it in a major university hospital l.jpg
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


Starting point l.jpg
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


Central starting point l.jpg
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


Percentage of total possible messages dk l.jpg
Percentage of total (possible) messages (DK)

National Board of Health

Source: MedCom


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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


Initiatives of the strategy l.jpg
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


Major initiatives of the 2003 2007 strategy l.jpg
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


Slide10 l.jpg

Result

Goal

Problem

Diagnosis

Intervention

National Board of Health



Standards for ehr l.jpg

Clinical Terminology

Concept Model

Standards for EHR

National Board of Health



Healthterm developement l.jpg

Guidelines

EHR system

EHR-model

Terminologi

Healthterm - developement

xml

subsets

text

….

Defence

qualitymodel

Viborg

H:S

subsets

synonyms

National Board of Health


Why the snomed terminology l.jpg
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


Snomed ct l.jpg
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


The danish ehr project l.jpg
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


Research quality management ehr l.jpg

clinical proces

User interface

BEHR

Guidelines

Terminology

research – quality – management - EHR?

Guide-

lines

EHR-

model

Clinical

Terminologi

National Board of Health



Slide20 l.jpg

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


Slide21 l.jpg

Copenhagen 20. februar 2001

National Board of Health


What did they sign in 2001 l.jpg
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


The architecture of a clinical terminology l.jpg

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



It takes 5 10 years before the benefit begins to materialise l.jpg

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


Goals for ec healthcare l.jpg
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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