Workshop on semantic interoperability

Transcription

1 Workshop on semantic interoperability Thoughts from the HIS perspective Dr. Sven Tiffe GWI Research GmbH, Vienna Clinical Decision Support Systems Head of Section 14./ Workshop on semantic interoperability

2 Aims of IT in healthcare y IT addresses various roles (medical, care, administration) y Overall, IT has to decrease work load of the hospital staff y Direct benefits for users, e.g. 4 Availability of reliable information 4 Unambiguously documented information 4 Reusability of (structured) information y Indirect benefits for users, e.g. 4 Increase the quality of treatment 4 Cost reduction/transparency y Optimal support of the users cannot be reached by unstructured documentation only 14./ Workshop on semantic interoperability slide 2

3 Acceptance of coded documentation y Acceptance by physicians varies 4 Information systems per se are usually accepted as long as they support the clinical staff 4 Additional documentation tasks are usually not well accepted (e.g. use of a separate coding system) y In Germany, parts of the documentation have to be formally documented 4 DRG related information: Diagnoses, procedures 4 Before DRG, quality of coded ICDs varied y Some information are coded by nature 4 Lab, medication y Other information are usually not coded 14./ Workshop on semantic interoperability slide 3

4 User acceptance as first step for semantic interoperability y As long as information is not entered in formalized way, architectures for semantic interoperability have no information to work on y Formalized information required for automated support 4 Error prevention, computer assisted diagnoses, pathways, etc. y Acceptance of information systems can be increased by 4 Help to reducing the amount of boring work (e.g. by automatically creating discharge letters from data stored in the EPR) 4 Save user s time, optimize organizational structures (processes) 4 Increase quality of medical treatment 4 Let the user benefit from the data entered into the system 14./ Workshop on semantic interoperability slide 4

5 Semantic interoperability within HIS IS IS 1 IS IS 2 IS IS 3 External IS IS HIS/EPR knowledge bases (CDSS) 14./ Workshop on semantic interoperability slide 5

6 Semantic interoperability within HIS y Exchange of information not limited to patient data y Reusability & standardization of knowledge bases for CDSS 4 Interoperability of rules, process definitions, etc. 4 Interoperability of data models 4 Interoperability of terminologies y Reusability of clinical documentation 4 Machine-processable for clinical decision support 4 Clinical documentation is the starting point for semantic interoperability 14./ Workshop on semantic interoperability slide 6

7 Passive coding as part of documentation pre-structured free text y Free text: content has to be coded during runtime, type can be pre-classified y Pre-structured: content and type can be pre-classified during application development 14./ Workshop on semantic interoperability slide 7

8 Influence of terminology y Once the data is entered and coded 4 Is the selected terminology suitable for the given tasks? 4 In routine, more than one terminology will be used 4 If different terminologies are used within the same system, can concepts be mapped? y Coding will be imprecise, users may look up wrong codes 4 What if coding was too precise? (e.g. user entered heavy smoker, 2 pk/day while rule author used heavy smoker ) 4 What precision is required? 4 How to deal with concepts that are almost semantically equivalent y While knowledge and concepts are fuzzy in general, every explicit coding step leads to a crisp set of knowledge representation 4 Two fuzzy minds could mean the same thing but model two different, crisp concepts 14./ Workshop on semantic interoperability slide 8

9 Research opportunities 1. Hide the coding from the user 4 Coding from free text or semi-structured documentation as external (free or commercial) service 4 Define API and message exchange format for coding request 4 Coding may be asynchronous 2. Deal with imprecise, over-precise, semantically equivalent coded concepts 4 Deal with terminology 2 terminology mappings 4 Deal with fuzziness of human thinking 14./ Workshop on semantic interoperability slide 9

10 Thank you 14./ Workshop on semantic interoperability