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Prof. Christian Lovis, MD MPH
STANDARDS AND INTEROPERABILITY INHEALTHCARE SUPPLY CHAIN PROCESSES
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2©2010 University hospitals of Geneva ©2010 University of Geneva
governance• dashboards• billing• R&D• image
patient care• bedside• mobility• decision support
logistic of care• people• items, devices• locations, rooms• etc.
track – trace - match
building a consistant world
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3©2010 University hospitals of Geneva ©2010 University of Geneva
governance• white boards• billing• R&D• image
patient care• bedside• mobility• decision support
logistic of care• human resources• devices and items• locations, rooms• etc.
optimizing human resources, means and time
bridge that gap
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4©2010 University hospitals of Geneva ©2010 University of Geneva
1971
1978
Ariadne's thread – the challenge of time
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5©2010 University hospitals of Geneva ©2010 University of Geneva
Ariadne's thread – the challenge of time
2003
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6©2010 University hospitals of Geneva ©2010 University of Geneva
2009
Ariadne's thread – the challenge of time
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7©2010 University hospitals of Geneva ©2010 University of Geneva
multi-dimensional net of traceability
• time• location• things• transformation• actors• actions• information• …
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8©2010 University hospitals of Geneva ©2010 University of Geneva
across numerous boundaries
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9©2010 University hospitals of Geneva ©2010 University of Geneva
protocol based order entry
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10©2010 University hospitals of Geneva ©2010 University of Geneva
production – control – storage – delivery – …
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11©2010 University hospitals of Geneva ©2010 University of Geneva
administration, bedside traceability
• drug• location• patient• provider• action• date-time
operator
infusion
date, location, action
patient
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12©2010 University hospitals of Geneva ©2010 University of Geneva
not just drugs – professional clothes
• who is using which/how much clothes, where ?• clothes resistance evaluation, turn-over tracing• decreased clothes in use• decentralized• over-the clock
• decreased costs• increased availability
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13©2010 University hospitals of Geneva ©2010 University of Geneva
biomedical devices and instruments
• equipments• monitoring, endoscopes, …
• medical gazes• surgery instruments
• 120’000 instruments• 18 months• GS1 laser encoding
• who ?• when ?• patient …• where ?
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14©2010 University hospitals of Geneva ©2010 University of Geneva
supply chain
• order of goods• offer, bids, stocks• …
• receipt of goods• identify goods• link order – goods• …
• storage• location• …
• delivery to end users• identify goods, users, location• …
• usage• post market surveillance• valorisation
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15©2010 University hospitals of Geneva ©2010 University of Geneva
transport
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16©2010 University hospitals of Geneva ©2010 University of Geneva
delivery
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17©2010 University hospitals of Geneva ©2010 University of Geneva
reception
Benefits
• direct link between supply chain and intern market
• massive decrease in “lost&founds”, inquiries, time spent to “track&trace”
• almost real-time information about location, delivery, etc…
• global increase in customers satisfaction
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18©2010 University hospitals of Geneva ©2010 University of Geneva
interoperability – what does it require ?
• hospital 1• OBX| 1| NM| XY32^Serum Na^L999| 1| 138| mmol/L|
• hospital 2• OBX| 1| NM| 3567^Na, Serum^L973| 1| 6| petits sachets|
• yet another lab 3• OBX| 1| NM| NAS^Ser Sodium^L357| 1| 20| grammes|
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19©2010 University hospitals of Geneva ©2010 University of Geneva
interoperability – what does it require ?
• hospital 1• OBX| 1| NM| 2951-2^Serum Na^LN| 1| 138| mmol/L|
• hospital 2• OBX| 1| NM| 2951-2^Na, Serum^LN| 1| 138| mmol/L|
• yet another lab 3• OBX| 1| NM| 2951-2^Ser Sodium^LN| 1| 138| mmol/L
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20©2010 University hospitals of Geneva ©2010 University of Geneva
almost interoperable is not interoperable !
• protocols
• meaning, semantics
• carriers
• readers
a chain is only as strong as its weakest link
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21©2010 University hospitals of Geneva ©2010 University of Geneva
the need for a shared semantic
• numerous answers• Snomed CT for clinical terms
In Switzerland: drugs master data pool with added value: HospIndexSwiss version of LOINC: CUMUL
• many open questions• allergies ?
• bacteriology ?
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22©2010 University hospitals of Geneva ©2010 University of Geneva
example of … weak link !
1. Match between genders and species
2. Match between genders only
3. No match found
Staph. aureus
Staphylococcus aureus
Citrobacter sp.
Citrobacter
Aerobia bacteria
NEWT
LAB
NEWT
LAB
NEWT
LAB
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23©2010 University hospitals of Geneva ©2010 University of Geneva
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24©2010 University hospitals of Geneva ©2010 University of Geneva
commerce électronique
sécuritélogistique
gouvernance
EANCOM - ebXML
GTIN(Identification of an Item)
SSCC(Identification of logistics units)
GSRN(i.e. patient id)
GLN(i.e. physical entity identification and staff identification)
UCC/EAN-128
EAN-13 ITF-14
EPC/RFID
RSS/CS Datamatrix
GS1 – a system of information representation
GRAI’s and GIAI’s(i.e. asset identification)
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25©2010 University hospitals of Geneva ©2010 University of Geneva
GS1 – an ontology ? HL7 color set
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26©2010 University hospitals of Geneva ©2010 University of Geneva
entities ….
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27©2010 University hospitals of Geneva ©2010 University of Geneva
importance of carrier
• code
• barcode
• datamatrix
• rfid
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28©2010 University hospitals of Geneva ©2010 University of Geneva
and readers
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29©2010 University hospitals of Geneva ©2010 University of Geneva
the importance of human
+
GS1 inherited benefits- traceability- global standard not institution specific- all data of the production
batch number, locations, production and validity dates, …- numerous readers available- ….
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30©2010 University hospitals of Geneva ©2010 University of Geneva
HUG – Pediatry : May to October, 2007
6’786 inpatients, 93'294 order entry
2'900'000 care interventions
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“ The future has been created to be changed”Paulo Coelho