aktuelles von hl7 internationale projekte · sop instance observation study act ... nucc health...
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Aktuelles von HL7 – Nationale und
internationale Projekte
Alexander Mense & Stefan Sabutsch
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Berichte
Österreichisches Interoperabilitätsforum
ELGA CDA Online-Validator
Österreichischer Terminologieserver für e-Health
Internationale Anwendung von CDA
Neue HL7.at-Website
eLearning
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Österr. Interoperabilitätsforum
Ziel: Förderung der Interoperabilität und der Anwendung von
Kommunikationsstandards Offene Kommunikationsplattform für eHealth-Projekte:
Informations-, Berichts- und Diskussionsplattform Ist kein neuer Verein, beschließt keine Standards, Tätigkeit
freiwillig und ehrenamtlich Initiiert von HL7 Austria für die e-Health-Community
Rahmen: „Memorandum of Understanding“ der Standardsorganisationen:
Austrian Standards, IHE, GS1, ProRec, HL7
Meetings Vierteljährlich Moderation: Sauermann/Sabutsch Bisher 3 Meetings, 30 Tln. Nächstes Meeting: 21.5.2014 Anmeldung: [email protected]
Website: http://www.hl7.at/?p=737
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Österr. Interoperabilitätsforum
Arbeitsweise Projekte werden vorgestellt und analysiert Analyse auf Anknüpfungspunkte und
Überschneidungen mit anderen Projekten Mögliche Synergien, Optimierung, Standardisierung
Themen / Projekte „PROP“ (Datentransfer der präoperativen
Untersuchung) CDA, XDW? „Krebsstatistik-Meldung“ CDA „Biosignale“ Fördern eines neuen Standards „Online-Versicherungszuständigkeitserklärung“
Anwendung von HL7 Messaging eGovernment – GS1 GLN …
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CDA Online-Validator
Ziel: CDA Dokumente können auf Konformität zu den ELGA Implementierungsleitfäden getestet werden
Funktion: Upload einzelner CDA-Dateien Status (Fehler, Warnungen) werden zurückgegeben
Zur Verfügung gestellt von ELGA GmbH
Eine Kooperation der HL7 Community: Entwickelt von Medshare, CH Schematron-Rules sind mit ART-DECOR generiert
(HL7 Template-Standard, Heitmann)
Link https://cda-tools.elga.gv.at/
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https://cda-tools.elga.gv.at/online-validator
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Terminology Server
Beispiele für CTS2-Terminologieserver:
France Phast STS (Standard Terminology Server) (http://wiki.phast.fr)
Mayo Clinic (http://informatics.mayo.edu/cts2)
Austria (https://termpub.gesundheit.gv.at/TermBrowser/)
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Terminologieserver & HL7
HL7 fordert und fördert den Einsatz von Semantikstandards
HL7 CTS2: Ein Standard zur Verwaltung von Terminologien (Definition von Datenmodell und Webservices)
Prototyp eines vollständig CTS2-basierten Open-Source Terminologieservers durch FH Dortmund (Prof. Peter Haas)
Weiterentwicklung zur eHealth-Infrastruktur in Österreich (BMG, ELGA, FH Technikum)
Funktionen Enthält alle Terminologien für eHealth in Österreich
(Codelisten, Value Sets) Standardisierter Download auf Website (auch per
Webservice) Kollaborationsplattform (Anmeldung notwendig)
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Terminologieserver (www.gesundheit.gv.at)
https://termpub.gesundheit.gv.at/TermBrowser/
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Relaunch der Website www.hl7.at
Online seit Jänner 2014 im „responsive Design“
Funktionen News
Twitter-Integration https://twitter.com/HL7_Austria
Veranstaltungskalender
Glossar
Liste der zertifizierten Experten
Mitgliederbereich
Download von Standards Zugang zum Standardsrepository von HL7 International
Backend: Mitgliederverwaltung
Geplant: offenes eHealth-Diskussionsforum
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Relaunch der Website (Jänner 2014)
Im „responsive Design“
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HL7 in Europe: 19+1 affiliates, EU office
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ROMANIA
ROMANIA
TURKYE
TURKE
Y
CROATIA
CROATI
A
CZECH
REPUBLI
C
CZECH
REPUBLI
C
BOSNIA &
HERZEGOVINA
BOSNIA &
HERZEGOVINA
HL7 affiliate
membership 957
orgs (2011)
Cath
erine
Chro
naki: “
HL7 E
uro
pean O
ffic
e R
eport
“ (2
014-0
1)
+Slovenia
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Content and Exchange Standards Adoption - National/Regional eHealth Projects
Country HL7 CDA HL7 V3
Messages OpenEHR/13606
Transport
or Sharing
Austria Yes Some No IHE XDS/XCA
Denmark No, but planned No No - Local Std Local WS- IHE-XDS
England Yes Yes No HL7 V3
Finland Yes No (transport only) No HL7 V3
France Yes No (Pt ID only) No IHE-XDS
Germany Some Regions No No Some IHE-XDS
Italy Yes No No IHE-XDS and other
Luxemburg Yes No No IHE-XDS
Netherlands Yes Yes No HL7 V3 & IHE-XDS
Poland Yes No No --
Slovenia No No CDR Internal design --
Spain Some No Some --
Sweden No (Analyzed) No Yes --
Switzerland Yes No No IHE-XDS/XCA
Australia Yes No Some (only Models) IHE-XDS-Pt-Pt
Brazil Some Pilots Pt ID only Some Pilots --
Canada Some Yes No HL7V3/XDS
China Yes No No --
Japan Yes No No Some IHE-XDS
Korea Yes No No XDS Pilot
New Zealand Yes No Some (only Models) Various
Russia Yes (Nation-wide) No Only a part of Moscow IHE-XDS
Taiwan Yes No No --
USA Yes Limited to Pt ID No E-Mail/IHE-XDS-XCA
Cath
erine
Chro
naki: “
HL7 E
uro
pean O
ffic
e R
eport
“ (2
014-0
1)
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USA – Consolidated CDA
Clinical Interop in Stage 2 Meaningful Use
Basic C-CDA
Technical Name:
HL7 Implementation Guides for CDA Release 2: IHE Health Story
Consolidation, DSTU Release 1.1 - US Realm
Called: Consolidated CDA, C-CDA …
The C-CDA contains a library of CDA templates.
Updates 11 CDA document types, including CCD
Harmonizes previous HL7, IHE, HITSP efforts
It consolidated previous document templates into a single library,
resolving conflicts, ambiguities as needed!
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HL7’s CDA vs. C-CDA
CDA
The HL7 Clinical Document Architecture (CDA) is a
document markup standard that specifies the structure
and semantics of "clinical documents" for the purpose of
exchange.
C-CDA
The HL7 Consolidated CDA is an implementation guide
which specifies a library of templates and proscribes
their use for a set of specific document types.
defines a set of CDA documents!
the schema for those documents!
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Consolidated CDA (C-CDA)
C-CDA
History and Physical
Discharge Summary
Consultation Notes
Diagnostic Imaging Rpt
Procedure Note
Operative Note
Progress Note
Unstructured Documents HL7 Health Story Implementation Guides
C
C
D
ONC - CEHRT
HITSP - C32, C80, C83
IHE – PCC
HL7 – CCD
HL7 – CDA
Continuity of Care Document
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Consolidated CDA
The guide contains a library of CDA templates,
incorporating and harmonizing previous efforts from:
Health Level Seven (HL7)
Integrating the Healthcare Enterprise (IHE)
Health Information Technology Standards Panel (HITSP)
It includes harmonized HL7 Health Story guides,
HITSP C32, related components of IHE Patient Care
Coordination, and the Continuity of Care (CCD). It
includes all required CDA templates in Final Rules for
Stage 1 Meaningful Use and can support Stage 2
Meaningful Use requirements.*
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Consolidated
CDA Documents
H&P Diagnostic
Imaging Consult
Surgical
Operation
Progress Procedure Discharge
Summary
Unstructure
d (Non-XML Body)
CCD
9 Document Types
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74 C-CDA Sections
Advance Directives Section (entries optional) Advance Directives Section (entries required) Allergies Section (entries optional) Allergies Section (entries required) Anesthesia Section Assessment and Plan Section Assessment Section Chief Complaint and Reason for Visit Section Chief Complaint Section Complications Section DICOM Object Catalog Section - DCM 121181 Discharge Diet Section Encounters Section (entries optional) Encounters Section (entries required) Family History Section Fetus Subject Context Findings Section (DIR) Functional Status Section General Status Section History of Past Illness Section History of Present Illness Section Hospital Admission Diagnosis Section Hospital Admission Medications Section (entries optional) Hospital Consultations Section Hospital Course Section Hospital Discharge Diagnosis Section Hospital Discharge Instructions Section Hospital Discharge Medications Section (entries optional) Hospital Discharge Medications Section (entries required) Hospital Discharge Physical Section Hospital Discharge Studies Summary Section Immunizations Section (entries optional) Immunizations Section (entries required) Implants Section Instructions Section Interventions Section Medical (General) History Section
Medical Equipment Section Medications Administered Section Medications Section (entries optional) Medications Section (entries required) Objective Section Observer Context Operative Note Fluids Section Operative Note Surgical Procedure Section Payers Section Physical Exam Section Plan of Care Section Planned Procedure Section Postoperative Diagnosis Section Postprocedure Diagnosis Section Preoperative Diagnosis Section Problem Section (entries optional) Problem Section (entries required) Procedure Description Section Procedure Disposition Section Procedure Estimated Blood Loss Section Procedure Findings Section Procedure Implants Section Procedure Indications Section Procedure Specimens Taken Section Procedures Section (entries optional) Procedures Section (entries required) Reason for Referral Section Reason for Visit Section Results Section (entries optional) Results Section (entries required) Review of Systems Section Social History Section Subjective Section Surgery Description Section Surgical Drains Section Vital Signs Section (entries optional) Vital Signs Section (entries required)
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65 C-CDA Entries
Admission Medication Advance Directive Observation Age Observation Allergy Observation Allergy Problem Act Allergy Status Observation Boundary Observation Code Observations Comment Activity Coverage Activity Discharge Medication Drug Vehicle Encounter Activities Estimated Date of Delivery Family History Death Observation Family History Observation Family History Organizer Health Status Observation Hospital Admission Diagnosis Hospital Discharge Diagnosis Immunization Activity Immunization Medication Information Immunization Refusal Reason Indication Instructions Medication Activity Medication Dispense Medication Information Medication Supply Order Medication Use - None Known (deprecated) Non-Medicinal Supply Activity Plan of Care Activity Act Plan of Care Activity Encounter
Plan of Care Activity Observation Plan of Care Activity Procedure Plan of Care Activity Substance Administration Plan of Care Activity Supply Policy Activity Postprocedure Diagnosis Precondition for Substance Administration Pregnancy Observation Preoperative Diagnosis Problem Concern Act (Condition) Problem Observation Problem Status Procedure Activity Act Procedure Activity Observation Procedure Activity Procedure Procedure Context Product Instance Purpose of Reference Observation Quantity Measurement Observation Reaction Observation Referenced Frames Observation Result Observation Result Organizer Series Act Service Delivery Location Severity Observation Social History Observation Sop Instance Observation Study Act Text Observation Vital Sign Observation Vital Signs Organizer
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38 C-CDA Code Systems
ISO 3166-1 Country Codes DCM Internet Society Language Vaccines administered (CVX) Adminstrative Gender ActMood Religious Affiliation RoleClass RoleCode AddressUse ActStatus MaritalStatus LOINC NUCC Health Care Provider Taxonomy ICD9 CM Procedures CPT-4 Confidentiality Code National Cancer Institute (NCI) Thesaurus US Postal Codes
Race and Ethnicity - CDC HealthcareServiceLocation ActCode EntityNamePartQualifier EntityNameUse ASC X12 LanguageAbilityMode LanguageAbilityProficiency NDF-RT ActPriority Unique Ingredient Identifier (UNII) ActReason ObservationInterpretation ParticipationFunction Participationsignature Unified Code for Units of Measure (UCUM) RXNorm FIPS 5-2 (State) SNOMED CT
S&I Companion Guide references (links) on CEHRT Vocabularies: CDT – Dental Codes ICD – 10 CM / PCS
CPT – AMA Procedure Codes ISO 639-2 Language Codes
HCPCS – Procedure Codes LOINC – Lab Codes
CVX – HL7 table 0292 OMB Race / Ethnicity Codes
RxNorm – Medication Codes SNOMED CT – via UMLS
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Data Segmentation for Privacy (DS4P)
Implementation Guide for CDA R2 US Realm
IG about segmenting clinical records so that
personally identified information (PII) can be
appropriately shared as may be permitted by privacy
policies or regulations.
based on artifacts and the findings of pilot
implementers of the Data Segmentation for Privacy
S&I Initiative, specifically on the Use Cases
developed by the stakeholder community.
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Data Segmentation for Privacy (DS4P)
Part 1: CDA R2 and Privacy Metadata Reusable
Content Profile document template, clinical statements templates,
and reusable building blocks
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Data Segmentation for Privacy (DS4P)
<observation classCode="OBS" moodCode="EVN">
<!-- Security Observation -->
<templateId root="2.16.840.1.113883.3.445.21"
assigningAuthorityName="HL7 CBCC"/>
<!-- Confidentiality Code template -->
<templateId root="2.16.840.1.113883.3.445.12"
assigningAuthorityName="HL7 CBCC"/>
<!-- Confidentiality Security Observation - the only mandatory
element of a Privacy Annotation -->
<code code="SECCLASSOBS„ codeSystem="2.16.840.1.113883.1.11.20457"
displayName="Security Classification"
codeSystemName="HL7 SecurityObservationTypeCodeSystem"/>
<!-- value set constrained to
"2.16.840.1.113883.1.11.16926" -->
<value xsi:type="CE" code="R"
codeSystem="2.16.840.1.113883.5.1063"
codeSystemName="SecurityObservationValueCodeSystem"
displayName="Restricted„>
<originalText>Restricted Confidentiality</originalText>
</value>
</observation>
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Data Segmentation for Privacy (DS4P)
Part 2: NwHIN DIRECT Transport Profile provides constraints a to the XDM Metadata based on the
Document Sharing Metadata specified in Volume 3 of the
IHE IT Infrastructure Technical Framework
Part 3: NwHIN Exchange Transport Profile The XDS privacy metadata constraints applies to ITI-18
(Registry Stored Query), ITI-42 (Register Document Set -
b), ITI-41 (Provide and Register Document Set - b), and
ITI-43 (Retrieve Document Set). These transactions
support the "push" and "pull" document exchange modes
required by the DS4P use cases. - Push (IHE IT XDR) :
ITI-41 (Provide and Register Document Set - b) - Pull
(IHE IT XDS, XCA): ITI-18 (Registry Stored Query), ITI-42
(Register Document Set - b), ITI-43 (Retrieve Document
Set)
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European Projects:
Trillium Bridge
19 January 2014
HL7 WGM January 2014, San Antonio, Catherine Chronaki, [email protected]
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Objective: Feasibility analysis of patient and provider-mediated
exchange of patient summaries across the Atlantic
Status: currently Working on
Detailed used case analysis
Gap Analysis epSOS CDA/ C-CDA (CCD)
Business Architecture
Demonstrator for eHealth Forum
Website: www.trilliumbridge.eu
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Selecting the Grounds:
• Pilot Use Cases
• Business Architecture
• Gap Analysis
Building the Bridge:
• Aligning Structure & Terminology
• Trust Agreements
Testing the Bridge:
• Testing Tools, Data Sets
• Validation Reports
Policy Alignment:
• eIdentification, Security & Privacy
• Legal / Regulatory Interoperability
• Feasibility Analysis
Trillium Bridge: Bridging
Patient Summaries across the
Atlantic
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Österreich …
Zwei Ballots Ende 2013 ELGA CDA Implementierungsleitfäden:
HL7 Implementation Guide for CDA® R2:
e-Medikation
HL7 Implementation Guide for CDA® R2:
Labormeldung an das Epidemiologische
Meldesystem (EMS)
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Ergebnis
Danke an alle die sich beteiligt haben!!!
Dr. Sabutsch 33
Abstimmungsergebnis Ballot EMS Ballot EMED
Anzahl Anzahl
Zustimmung 21 21
Ablehnung 0 0
Enthaltung 1 1
Quorum 29% 29%
Quorum (nur Organisationen) 35% 35%
Kommentare (Anzahl) Ballot EMS Ballot EMED
107 63
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11th International Conference on Wearable
Micro and Nano Technologies for Personalized
Health
11–13 June 2014
Vienna, Austria
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Topics
Wearable and implantable devices and systems
Solutions for personalized care
Interoperable ICT and Telemedicine
Data and Knowledge Management and
Methodologies
mHealth Applications
Security, Privacy, Safety and Ethics in pHealth
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Thanks for your attention!
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Dr. Sabutsch