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

Dr. Sabutsch 2

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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

Dr. Sabutsch 3

mailto:[email protected]





http://www.hl7.at/?p=737

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 …

Dr. Sabutsch 4

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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/

Dr. Sabutsch 5

https://cda-tools.elga.gv.at/




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https://cda-tools.elga.gv.at/online-validator

Dr. Sabutsch 6







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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/)

Dr. Sabutsch 7

http://wiki.phast.fr/

http://wiki.phast.fr/

http://informatics.mayo.edu/cts2

http://informatics.mayo.edu/cts2

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)

Dr. Sabutsch 8

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Terminologieserver (www.gesundheit.gv.at)


9 Dr. Sabutsch

http://www.gesundheit.gv.at/




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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

Dr. Sabutsch 10

http://www.hl7.at/

https://twitter.com/HL7_Austria

https://twitter.com/HL7_Austria

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Relaunch der Website (Jänner 2014)

Im „responsive Design“

Dr. Sabutsch 11

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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)

Dr. Sabutsch 13

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Some CDA related projects …

Dr. Sabutsch 14

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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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Standard EHR Interface

Dr. Sabutsch 17

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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.

Dr. Sabutsch 24

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Part 1: CDA R2 and Privacy Metadata Reusable

Content Profile document template, clinical statements templates,

and reusable building blocks

Dr. Sabutsch 25

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<observation classCode="OBS" moodCode="EVN">



<templateId root="2.16.840.1.113883.3.445.21"

assigningAuthorityName="HL7 CBCC"/>



<templateId root="2.16.840.1.113883.3.445.12"

assigningAuthorityName="HL7 CBCC"/>



<code code="SECCLASSOBS„ codeSystem="2.16.840.1.113883.1.11.20457"

displayName="Security Classification"

codeSystemName="HL7 SecurityObservationTypeCodeSystem"/>



<value xsi:type="CE" code="R"

codeSystem="2.16.840.1.113883.5.1063"

codeSystemName="SecurityObservationValueCodeSystem"

displayName="Restricted„>

<originalText>Restricted Confidentiality</originalText>

</value>

</observation>

Dr. Sabutsch 26

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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)

Dr. Sabutsch 27

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European Projects:

Trillium Bridge

19 January 2014

HL7 WGM January 2014, San Antonio, Catherine Chronaki, [email protected]

28

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

http://www.trilliumbridge.eu/

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29

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)

Dr. Sabutsch 32

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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

Dr. Sabutsch 35

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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

Dr. Sabutsch 36

Aktuelles von HL7 internationale Projekte · Sop Instance Observation Study Act ... NUCC Health...

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Transcript of Aktuelles von HL7 internationale Projekte · Sop Instance Observation Study Act ... NUCC Health...