Finland Use Case Presentation: Semantic Standardisation for a … · 2016-05-26 · Finland Use...

Finland Use Case Presentation: Semantic Standardisation for a Shared eHealth Infrastructure

Dr. Päivi Hämäläinen, Director of Department for Information, THL

THL Päivi Hämäläinen conhIT 1

Patient Care Records in Finland In Finland most health care is public, we have • Public health care providers (munincipal) (~200)

• Hospital districts (21) • Health centers (~192)

• Private Health care providers (~4000) • Nation wide companies • Local (small) companies • Private GP:s and Specialists

Each Healthcare Provider has an own • Electric Patient Record systems (EPR) in daily use

• Pharmacies (~800) – Have own pharmacy-systems

2 THL Päivi Hämäläinen - Heikki Virkkunen

EPR adaptation on the local and regional level has been high for a long time and in health care. There is a long experience on regional data exchange/sharing also in Finland

3

Winblad et al. 2012, Hämäläinen et al. 2013

THL Päivi Hämäläinen

FINNISH E-HEALTH SURVEYS (2001) 2003, 2005, 2008, 2011 HÄMÄLÄINEN P, REPONEN J, WINBLAD I

5.3.2014

)

20/21 Hospital districts have had regional data sharing systems (depositories) fore some time But they differ - The patient index model - The web distribution model - The regional EPR system model - Few mixed models There is experience of 10 years on patient data

exchange on the regional level. (Mostly primary care hospital)

When KanTa, the new national health information system is in full operation, patient data exchange becomes nationally possible including private care services

4 Päivi Hämäläinen MD, PhD, MA, Specialist of Public Health

Finland participates in the epSOS project. Piloting on ePrescriptions has started with Sweden

European/international Also in mind

The national Kanta-Service for electronic records

Kanta is for use • by other health care providers with patients consent

– Each health care provider mainly uses their own “Copies of Patient records for daily use” in their own data warehouse

– National services are accessed through existing (EPR) systems • Also a Web- / Mobile-based National User interface service for

direct access is under preparation

• by Citizens – There is a Web-based National User interface service “Omakanta” (My

Kanta pages in English) • By law for 18 year old persons and under construction an access to the data

of own children

*


NATIONAL KANTA SERVICES KanTa-service

Electronic prescription service

ePrescriptions and eDispensations Archive

Pharmacies (800)

Hospital districts (21)

Health centres (192)

Private health care providers (4000)

Patients (> 5 000 000)

Patient health record service

Repository Registry

Patient summary service

Diagnoses

Lab tests

Imaging results

Procedures

Risks Health and care plan eA

cces

s

Consent and will management service

Opt-in / opt-out

Organ donation wills Living wills ep

SOS

NCP

Foreign epSOS NCPs (22)

THL Päivi Hämäläinen 6

HL7

Med

ical

Rec

ords

inte

rfac

es

– “eArchive” First Hospital District joined in November 2013

– “epSOS” (EU) ePrescription (first between Finland and Sweden has started)

Joining Kanta needs standardization

NATIONAL KANTA SERVICES Other national ICT-services (2013)

Electronic prescription service

ePrescriptions and eDispensations Archive

Patient health record service

Repository Registry

Patient summary service

Diagnoses

Lab tests

Imaging results

Procedures

Risks Health and care plan eA

cces

s

Consent and will management service

Opt-in / opt-out

Organ donation wills Living wills ep

SOS

NCP

THL Päivi Hämäläinen - Heikki Virkkunen 7

HL7

Med

ical

Rec

ords

inte

rfac

es

Nationally there is also (among others):

• The National Code Server, that includes

– National codes – Patient

Document contents and structures

• The National Drug database

OTHER NATIONAL SERVICES

National code server

Code lists Terminologies

Document ´contents & structures

Health care professionals register

Certification services

Drug database

Main standards

• HL7 V3: CDA R2 Level 3 and Medical Records

• W3C XML Signature • WS Addressing, WS-I • TLS, X.509

Patient Records in the National eArchive • Patient Records are stored in the National Repository “eArchive”

as documents – That include (“all” patient data)

• Structured data (entries) • “Semi structured data” (by Labels) • Narrative text

– The most important Structured data is also stored in a separate

database: – ”Patients Information Management Service”

• for more advanced use of data such as Patient Summaries



Making and saving an entry in a clinical document from the code set perspective.

10

• Will be shown patient centrically

• * In Phase 2 (2016)

Patient Summary for professionals - Content of the Patient Summary

Summary documents

• Diagnosis • Risk factors (alerts) • Procedures • Radiology (only text) • Laboratory • Physiological

measurements* • Immunization* • Medication*

Updating documents • Health and care plan

THL Päivi Hämäläinen - Heikki Virkkunen

The National Institute for Health and Welfare (THL) maintains the National Code Service • The Code Service manages the preparation, distribution and maintenance

of nationally uniform social and health care code sets, classifications, terminologies, form structures and coded data specifications.

• The Code Service maintains the code sets and other data structures used in the customer and patient information systems in social and health care.

• The structured data are also utilised for statistics and registers. • Structured data can also be utilised in the organisations’ own enterprise

resource planning (ERP) systems.


Code Service partners, interest groups and customers • Ministry of Social Affairs and

Health (STM) • Ministry of Finance (VM) • Social Insurance Institution of

Finland (Kela) • National Supervisory Authority

for Welfare and Health (Valvira) • Association of Finnish Local

and Regional Authorities (Kuntaliitto)

• Finnish Medicines Agency (Fimea)

• Population Register Centre (VRK)

• Statistics Finland (TK)

• HL7 Finland Association (HL7) • Finnish Standards Association

(SFS) (ISO/CEN) • WHO • Nordic Center for Classifications • Social and health care

professionals (and their NGO´s) • Social and health care customers

(and their NGO´s) • Data system providers (vendors)

for social and health care • Action Programme on eServices and

eDemocracy (SADe) • Smart Open Services for European

Patients (epSOS) • PARENT, Joint Action • EXPAND, EHR4CRm, Antilope ….


Legislation • The Act on the electronic processing of customer data in

social and health care (159/2007) • Act on the National Institute for Health and Welfare

(668/2008) • The Decree on patient documentation (298/2009)

• The Health Care Act (1326/2010)

• Act on the steering of data management in public

administration (634/2011)15

• Ministry of Social Affairs and Health Decree on national health care IT system services, 165/2012


The code service process • The preparation of code sets • Publishing of codes + supporting material • Updating published code sets and data structures.


Code set life cycle

Supporting material such as Guidebook to Structured Documenting of Patient Information by Lehtovirta et al, to be published in 2014).


The administration process related to the preparation of a code set.

An official decision making point; if consensus can not be reached the code set is returned for more preparative work

The final official decision to publish


Over 200 experts in WG:s

About 10-15 experts at THL in code service work

Code server platform • The code sets can be downloaded from the code server. • The software platform of the code server is the CodeServer of

the shelf software developed by Datawell Oy • The CodeServer product contains many interfaces for other

IT systems to be integrated with the CodeServer. • Each code has its own basic information, such as an unique

Identifier • The code server is physically located and technically

managed by the National Social Security Institute (Kela) and the code service function of publishing and keeping the content of the code server is the responsibility of THL.


Teksti .txt Excel: .xls Sas (*): .sas Ecomed (*): XML (*): XML

18 THL Päivi Hämäläinen

Collaboration with the ICT- product providers • All can take the national standarised code/classification sets

in to their products free of charge from the code server • Are invited to open work shops where national data structure

suggestion are discussed and can participate in public consultations also with written feedback

• Influence via the Finnish HL7 –Association, that is a member

of the code serve board and technical groups

• Have given positive feedback on the possibility to use the common structures from the code server

• Are active in reporting quality issues to the quality assurance function


How to work towards a standardized eHealth infrastructure with all the different local EPR-systems provided by different vendors?

• Policy and legislation • Agreement on the standards, structures and codes/

classifications • A system to manage to commonly agreed semantic

standards, information structures, codes and classifications

• A system to deliver the structures to the EPR/systems

(vendors)



http://urn.fi/URN:ISBN:978-952-302-042-9

Thank you! Päivi Hämäläinen [email protected]










Finland Use Case Presentation: Semantic Standardisation for a … · 2016-05-26 · Finland Use...

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