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Semantic Interoperability Deployment & Research Roadmap. Veli Stroetmann, empirica with Alan Rector, UNIMAN Dipak Kalra, UCL Bedirhan Ustun, Pierre Lewalle, WHO Karl Stroetmann, Benjamin Jung, empirica Pieter Zanstra Jean Marie Rodrigues, UJM Martti Virtanen, UU Gyorgy Surjan, ESKI.

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semantic interoperability deployment research roadmap

Semantic Interoperability Deployment & Research Roadmap

Veli Stroetmann, empirica


Alan Rector, UNIMANDipak Kalra, UCLBedirhan Ustun, Pierre Lewalle, WHO Karl Stroetmann, Benjamin Jung, empirica Pieter ZanstraJean Marie Rodrigues, UJMMartti Virtanen, UUGyorgy Surjan, ESKI

i2010 Subgroup on eHealth meeting21 February 2008, Brussels

what are we talking about
What are we talking about?

Defining IOp:

Health system interoperability is the ability, facilitated by ICT applications and systems,

  • to exchange, understand and act on citizens/patient and other health-related data, information and knowledge
  • among linguistically and culturally disparate clinicians, patients and other actors
  • within and across health system jurisdictions in a collaborative manner
why do we need semantic iop health system priorities and goals
Why do we need Semantic IOp? Health system priorities and goals

To support the goals of greater patient safety, better quality of care, chronic disease management, extended homecare or patient empowerment,

clinical meaning (data, information, knowledge) must be expressed consistently

  • to enable the safe, meaningful sharing and combining of health record data between heterogeneous systems and actors / care providers;
  • to enable the integration and safe use of computerised protocols, alerts and care pathways by EHR systems;
  • to link EHR data to explanatory and educational materials to support patient and family engagement and professional development;
  • to ensure the necessary data quality and consistency to enable rigorous secondary uses of longitudinal and heterogeneous data for public health, research, health service management.
roadmap recommendations general principles
Roadmap: Recommendations - General Principles
  • Focus on concrete, immediate needs and real use cases with expected high benefits & lower costs
  • Terminologies should have a well defined scope and purpose
    • be delivered against well defined, realistic time scales
  • Separate:
    • Ontology - what you mean
    • Language - how you say it
    • Interface - how you find it
  • Involve vendors/industry and human end users - clinicians, citizens
    • Be responsive
    • Be open, collaborative and participative
  • Make it multilingual and multicultural
  • Focus on Quality Assurance and Reproducibility
  • Use today’s technology
    • modern ontology languages, Web 2.0, “Just in time”
some recommendations on structures and process
Some Recommendationson Structures and Process
  • Governments to develop, implement and sustain longer-term visions, objectives and measures
  • Establish national centres for multilingual, multicultural adaptation of international classifications including SNOMED
  • Link them in a well-managed European network of Competence Centres
  • Establish a European Network of Terminology Servers
  • Assure sustainability and scalability
    • It must be maintained to be useful
    • Beware of silver bullets
terminologies snomed ct current assessment
Terminologies:SNOMED-CT- Current Assessment
  • Controlled vocabulary and identifiers
    • Well managed but slow response time
  • Hierarchies and relations
    • Unusable
      • Too unreliable to depend on to behave as documented
      • Systematically flawed in principle
      • Limited by software and logic limitations from early 1990s
      • Cost of repair probably exceeds cost of rebuilding - but still modest
  • Multilingual / Multicultural support
    • Minimal
      • Neither understood nor a priority for the IHTSDO
        • Spanish and Canadian-French versions might appear
  • Openness and accessibility to Social Computing
    • Unusable - remains effectively closed
      • Not generally available on the Web
      • Opportunity cost of participation prohibitive
      • Influencing policy difficult
terminologies selected recommendations
Terminologies: Selected Recommendations
  • Support for specific initiatives between ICD/WHO ISO and SNOMED to develop ICD-11 along with mappings to/from SN
  • Support feasibility study (select subset of ca. 25,000 terms / use case) of reformulation of SNOMED to
    • build reliable hierarchies & relations
    • develop multilingual support
    • introduce social computing tools
    • empirically assess individual, organisational and societal benefits & costs
  • Support open tools for terminologies that link up to SNOMED
  • Support social computingefforts (Web 2.0) on ICD-11
  • Develop language technologies
    • Text extraction to build new terms and encode natural language
    • Text generation to present and for QA
  • User involvement & ownership, a series of centres & initiatives
  • Support training at all levels
Roadmap for SIOp Deployment & Research - Ontologies


Central Reference Services

Sustainable Centres for Selected Ontologies

Policy with MS on future use of hierarchies & relations



for HL7 messages & archetypes binding


Large Scale Environment


Sustainable framework with EU Industry for effective standards development

Statistical extension of QA

Intern. Biobanking collaboration

Multilingual-cultural adaptation

Local mappings to UMLS


Formal QA of subset


Actions arising from consultations

Collaboration with EBI and NBCO

Social Computing based Terminology Service

Research on consequences of different commitments

Multilingual-cultural subsets


European Centres of Excellence

Feasibility Study & reformulation of subset

Ongoing consultations

Tools for Terminfotest


Toolset forFeasibility Study



Terminolo-gies & EHRs


GenomicsTransl. Medicine

Socio-Econ. Issues

roadmap ehr basic elements and short term actions
Roadmap EHR: Basic elements and short term actions
  • Effective, functional EHR systems need:

1. Generic reference models for representing clinical (EHR) data

e.g. EN 13606, HL7 CDA, openEHR Reference Model

2.Agreed clinical data structure definitions

e.g. openEHR archetypes, HL7 templates, generic templates and data sets

3.Clinical terminology systems


  • Areas needing adoption (short term):
    • Agree on a generic model for EHR communications: consider EN13606
    • Adopt a standardised approach for representing and sharing of clinical data structure specifications: agree to use archetypes / templates
    • Collaborate on key use cases for shared care & patient safety, and on defining & tidying up the corresponding terminology/SNOMED-CT sub-sets
    • Seed clinical fora to develop care pathways and archetypes to meet the needs of safe and evidence based care in different medical domains and disciplines
    • Strengthen clinical user training in the use of EHRs, terminology and structured records
roadmap ehr medium term actions
Roadmap EHR: Medium term actions
  • Areas needing wide-scale evaluations:
    • Develop best practice in archetype design
    • Establish useful exemplars of SNOMED-CT sub-sets being adopted within EHR systems and delivered in meaningful ways to clinical users
    • Develop the business rules and validation processes
    • Identify and evaluate the benefits for various stakeholders & health systems
  • Areas needing investments:
  • Industry sponsored or nationally supported open source approaches for:
    • Archetype & template authoring and validation tools
    • Terminology servers, term browsers for SNOMED CT, support for term coordination
    • Global multi-cultural dimension - not just term translation but internationalisation across health care paradigms and cultural differences
roadmap for siop deployment research ehr
Roadmap for SIOp Deployment & Research - EHR


Term Binding

GlobalExperience Test



Acceptance Evaluation

Consistency Test HL7 Terminfo

Adaptable Clinical Applications

QA & Certification


Link EHR to Educational Material

EHR Visualisation Applications

Terminology ServersTerm Browsers


Best PracticeA. Design

Business Rules for TC


Agree on SIOP Goals for PHR

Authoring/Validation Tools



Improve Inter-nationalisation

Care Pathways

Policies on SN Term Coordination (TC)


Standardised RepresentionClinical Data Structures

GenericModel for EHR Communication


EHR/TerminologyUser Training

Key Use Cases

Reference Model


Terminology SNOMED-CT


Socio-economic Issues

roadmap public health long term goals
Roadmap Public Health: Long term goals
  • Consistent use of EHRs as person-based health records in clinical settings
  • Interconnecting health service providers so health information can be exchanged through interoperable digital means in a standard fashion
  • Research to prove the comparability of digital information with analog traditional measures used for monitoring and evaluation in various health inf. systems
roadmap public health actions
Roadmap Public Health: Actions

Requirements for SIOp:

  • Interconnection tools
  • Identification management
  • Common web services
  • Security technologies
  • Mechanisms for ensuring the sustainable operation of these components on a widespread and publicly available basis

Action points:

  • Enable common standards to allow data exchange on predefined key variables & compilation of content
  • Compile data across populations and across health care providers
  • Link data across multiple care settings
  • Compare data across regions, time or populations
  • Set up organizational and legal regulations in a sustainable fashion
  • Develop global registries of standardized information models and related metadata
Roadmap for SIOp Deployment & Research – Public Health




Metadata for populations, settings and GIS


Mandate the organisation of PH information gathering



Online Epidemiology on selected conditions


Patient Flow/ Statistics

Common Standardsfor Content




International Health Regulations


Legal Requirements: Liability, Security, Privacy

Linkage toPopulation Registries

Common Standardsfor Exchange

Electronic Death Certifiation

Predefined Reportable Diseases





Public Health Infrastructure

Socio-economic Issues

final report roadmap matrices action plans
Final Report: Roadmap Matrices & Action Plans

Roadmap Matrix on Ontologies (excerpt)

[1] Incl. Pharma

proposal building a european semantic iop knowledge base
Proposal: Building a European Semantic IOp Knowledge Base

SemanticHEALTH Wiki

  • Semantically linked set of documents
  • Collaborative environment (discussion page open for everybody)
  • Extensibility
Specific Support Action co-funded by the European Commission SIXTH FRAMEWORK PROGRAMME


Communication & Technology ResearchGermany

University College LondonCentre for Health Informatics, UK

World Health Organisation Dept. Measurements & Health Information Systems, Switzerland

University of Manchester Health and Bioinformatics Group, UK

National Institute for Strategic Health ResearchHungary

Uppsala UniversityNordic Centre for Classifications in Health Care, Sweden

Radboud University NijmegenMedical Center

The Netherlands

University of St. EtienneDepartment of Public Health & Medical Informatics, France

thank you for your attention
Thank you for your attention!

Further information:

[email protected]

Veli Stroetmann

for the SemanticHEALTH consortium

Communications & Technology Research

Bonn, Germany

[email protected]