SILAM: integrating Laboratory Information Systems within the
Liguria Region Electronic Health Record
M. Giacomini1, A. Taglia11, V. Parodi2, S. Naso2 1DIBRIS – University of Genova – Italy
2Infinity Techology Solu1ons – Genova -‐ Italy
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
Introduc1on • During the last few years some important challenges have
been posed in the healthcare world in order to develop new standards that improve medical provision, workflow and efficiency in mee1ng the needs of pa1ents.
• To fulfill these requirements, analy1cal results should be automa1cally available directly from the data sources.
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Background • MEDINFO Laboratory cooperates with the Infinity Technology
Solu1ons Company in the project S.I.L.A.M. for the “Realiza1on of an informa1ve system for the adapta1on at the state-‐of-‐the-‐art standards reference sector in medical laboratory informa1on systems”
• The project is developed within the regional opera1ve programme POR CRO Regione Liguria 2007-‐2013 Line 1.2.2: “Industrial Research and experimental development ac1vi1es”
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Standards • The task is not only to provide informa1on to real people, but
also to make this data available to intelligent agents, for this reason standardiza1on and structure play a key role;
• Health Level Seven (HL7) is the reference standard for the infrastructure dedicated to the exchange and sharing of data;
• Logical Observa1on Iden1fiers Names and Codes (LOINC) is the best tool for the transla1on of informa1on related to laboratory studies;
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Why HL7v3 ?? • Created specifically for
sharing informa1on about a pa1ent
• It standardizes the en1re complex of a healthcare system at the level of clinical data
• It is widely extensible • It makes the various en11es
of the health-‐care world interoperable
Why LOINC ?? • It totally integrates with HL7 • It improves the management of
clinical data coming from the laboratories , which produce data on behalf of hospitals and clinicians
• It is adopted by TSE (Electronic-‐Health Chair shared by the Italian Ministry of Public Administra1on and Italian Regions) in the context of technical standards for the crea1on and development of the prescrip1on and report document
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
• Clinician’s Informa1on System
• Laboratory Informa1on System
• Central data repository, which links the en11es with
each other
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Materials & Methods • In the Visual Studio environment the following have been created:
Ø 1 Client for the interface simula1ng the clinician workflow Ø 1 Client for the interface simula1ng all the opera1ons that
occur in the LIS Ø 1 Web Server represen1ng the en1re health-‐care system of the Liguria region
• By means of SQL server the following have been created: Ø 1 Database that allows the management of data of the en1re processes and permits lifelong storage Ø 1 Database for the management of all the opera1ons in the Laboratory Domain
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
DB Schemas
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
TRANSLATION Descrip1on: • Collec1ng data from ASL2 • 260 Observa1ons available, sorted by name • Transla1on into Interna1onal Standard LOINC Language • 685 Observa1ons in LOINC form described by means of 18 parameters
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
STORYBOARD
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
• Describes a series of ac1ons which deals with a specific task in the healthcare domain; • Descrip1ons occur through a series of snapshots or chronological events; • Each snapshot shows the key par1cipants in the Storyboard and the interac1ons with the other “players”;
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Imports System.Data Imports System.Data.SqlClient <ServiceContract()> _ Public Interface IService <Opera1onContract()> _ Func1on PRPA_MT201303UV02_Pa1ent(ByVal pat_iden As PRPA_MT201307UV02, ByVal Auth_Iden As QUQI_MT021001UV01ControlActProcess, _ ByRef Aknowl As MCCI_MT000100UV01) As PRPA_MT201303UV02Pa1ent <Opera1onContract()> _ Func1on give_exemp1ons(ByVal fis_code As String) As String() <Opera1onContract()> _ Func1on give_LABS() As NewClasses <Opera1onContract()> _ Func1on give_OBS() As Observa1onClass <Opera1onContract()> _ Func1on GIVE_CDA2(ByVal pa1ent As Ana_Pa1ent, ByVal clinician As QUQI_MT021001UV01AuthorOrPerformer) As POCD_MT000040ClinicalDocument <Opera1onContract()> _ Func1on GIVE_CDA1(ByVal pa1ent As PRPA_MT201303UV02Pa1ent, ByVal observa1ons() As POCD_MT000040Observa1on, _ ByVal exemp1ons As POCD_MT000040Sec1on) As POCD_MT000040ClinicalDocument <Opera1onContract()> _ Func1on Test_for_Lab() As POCD_MT000040ClinicalDocument <Opera1onContract()> _ Func1on CLINICAL_DATA(ByVal pat_iden As PRPA_MT201307UV02Pa1entIden1fier) As COCS_MT100000UVEncounter() <Opera1onContract()> _ Func1on Encounter_DATA(ByVal visita As COCS_MT100000UVEncounter) As COCS_MT100000UVObserva1on
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
LABORATORY CLIENT
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
• Pa1ent Authen1ca1on (PRPA_MT201307UV02)
• Collec1on of Data (Recover of the CDA stored in DB) • Confirm Execu1on (POLB_TE004100 & POLB_TE004200) • Report crea1on (Wri1ng CDA according with TSE and HL7-‐Italia Standards)
• Submission of the report (Interac1on with WS, CDA Transmission and Storage)
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Conclusions & Future Developments • Currently the system is u1lized in a prototypal way, u1lizing test data, in order to simulate standard opera1ng condi1ons; • In the near future we will test the real poten1al involving two reali1es of medium dimension within the Liguria Region Healtcare System; • It is possible to integrate the en1re architecture with new scenario extents, by placing for example a complete Electronic Health Record, or realizing the en1re management system of the observa1on reserva1ons;
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
The use of technology • The present applica1on is not directly used by general people • This applica1on will feed the Electronic Health Record • Many Italian Regions have specific applica1ons for the use of these data • Liguria Region has the prototype of the «Conto Corrente Salute» = «Health Bank Account» • Main ideas of this prototype is the use of the tools of the typical online bank accounts, familiar to most of people
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
Advises • A useful Health Record applica1on should be based on analy1cal data • These data should be strictly individuated within a reliable context • Interna1onal vocabulary could improve this individua1on • Web services with standardized framework will also improve the plarorm free use of these analy1cal results
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
THANK YOU FOR YOUR ATTENTION!!
UNIVERSITY OF GENOVA – BIOENGINEERING AND MEDICAL INFORMATICS LABORATORY
MIE2012 – XXIV Conference of the European Federa1on for Medical Informa1cs
UNIVERSITY OF GENOVA – NANOBIOTECHNOLOGIY
AND MEDICAL INFORMATIC LABORATORY
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