The Spanish experience

BEYOND TECHNICAL

INTEROPERABILITY

Javier Etreros / Icíar Abad

Sanitary Information Institute

Quality agency

Ministtry of Health and Social Policy

THE SPANISH NHS

17 Autonomous

Communities

2 Autonomous

Cities (Ceuta y

Melilla)

Languages:

Spanish plus 3

more languages,

co-oficial

languages.

DECENTRALISED: transfer of care 1981-2001

Start point

THE SPANISH NHS

Each region includes its users in their regional DB. All Regional DBs are connected at a national level.

There is a single national code for each user

NHS DB

(Within

NCP)

Region

al DB2

Region

al DB1

Region

al DB3

UNEQUIVOCAL IDENTIFICATION

THE SPANISH NHS

THE PRAGMATIC APPROACH: First step

To Access to the full Electronic

Health RecordNOT

Sets of relevant clinical data to be

share: > 30 scientific societies +

autonomous communities

YES

THE SPANISH NHS

Discharge report

Specialised surgery report

Emergency Room report

Primary care report

Laboratory report

Imaging report & Imaging

Nurse care report

PATIENT SUMMARY

TREATMENT

IMMUNIZATIONSCURRENT PROBLEMS

ELECTRONIC

HEALTH RECORD

ALLERGIES

Patient Summary

(PS)

PATIENT SUMMARY

¿ ?

INTEROPERABILITY STRATEGY

Semantic dimension: to make information

understandable by any organization and in

any language with the level needed to take

clinical decisions that affects people’s health

EXPERT GROUP

Interoperability

strategy

EXPERT GROUP

Semantic interoperability

Technical interoperability

PILOT

Decision

Consultancy

Execution

DECISION

TERRITORIAL

BOARD

CURRENT WORK

A 3 year specific ROADMAP was define to reach the

objectivesROADMAP

SNOMED-CT terminology for variables without

standardization in the Patient Summary and as a

necessary step to reach complete interoperability in the

long term scenario.

Follow up of reference models (EHRNHS).

Main

Agreements

INTEROPERABILITY STRATEGY

Seek for short-term solutions regarding semantic

interoperability of the Patient Summary.

Recommendations about the standards that should be

adopted as a long-term solution to reach semantic

interoperability in the EHRNHS project.

Objectives

Lo

ng

-te

rmS

ho

rt-t

erm

Report on the

EHRNHS

requirements

TRAINING

2

OID´s

3

Inventory of Health Terminology

1

Reference model

4

Me

diu

m-t

erm

IDENTIFICATION

OF FUNCTIONAL NEEDS

TO CREATE A NATIONAL

SEMANTIC SERVICES SYSTEM

7

Coordination of different national extensions

8

Mapping and translation tools

5

Subset priority

6

INTEROPERABILITY STRATEGY

NEW STRATEGIES in the EHR within NHS

CURRENT WORK

MAPPING AND TRANSLATION TOOLS

Spain joins IHTSDO in 2009, to develop SNOMED-CT as the clinical

terminology of reference within the health records.

PATIENT SUMMARY SUBSETS:

Snomed CT

NURSE CAREMEDICINESPROBLEM LISTALLERGIESVACCINATIONS

308.000 active concept

791.000 descriptions

951.000 relaciones

CROSS-MAPPING WITH THE EXISTING TERMINOLOGIES: ICD,

ICPC, NANADA-NIC-NOC, Snomed for Anatomic pathology.

INTEROPERABILITY STRATEGY

Sospecha de hipertensión

417312002

SNOMED CT: a multilingual terminology

Sospecha de hipertensión. 417312002

Sospecha de hipertensión

Sospita d´hipertensióNacional

Version of

Snomed CTHipertesioz goganbehartzen

Sospeita de hipertensión

Suspected hypertension

417312002

Misstänkt hypertoni

417312002

Sospecha de hipertensión

417312002

Sospita d´hipertensió

417312002

Sospeita de hipertensión

417312002

CURRENT WORK

CURRENT WORK

International

Core (Snomed)

Tiempo estimado de trabajo del Grupo:

2 ó 3 meses

Subconjunto alergias

VALIDADO

(extensión es-ES)

Especialista/s en

Dermatología

Subconjunto

ALERGIAS

Médico de familia

con ejercicio en

Atención Primaria

Especialista/s en

Farmacología ClínicaMedicina de Urgencias

Especialista/s en

Alergología

PERFILES PROFESIONALES

Revisión

Discusión

Validación

Herramienta de

trabajo en grupo

Tiempo estimado de trabajo del Grupo:

2 ó 3 meses

Subconjunto alergias

VALIDADO

(extensión es-ES)

Especialista/s en

Dermatología

Subconjunto

ALERGIAS

Médico de familia

con ejercicio en

Atención Primaria

Especialista/s en

Farmacología ClínicaMedicina de Urgencias

Especialista/s en

Alergología

PERFILES PROFESIONALES

Revisión

Discusión

Validación

Herramienta de

trabajo en grupo

Herramienta de

trabajo en grupo

CURRENT WORK

THANKS

FOR YOUR

ATTENTION