IHE QRPH – Maternal and Child HealthIHE QRPH – Maternal and Child Health

Detailed Profile Proposal for 2008/09Detailed Profile Proposal for 2008/09presented to thepresented to the

QRPH Infrastructure Planning Committee for QRPH Infrastructure Planning Committee for November 18 to November 19 at the face to face meetingNovember 18 to November 19 at the face to face meeting

Charles Rica, Ana EstelrichCharles Rica, Ana EstelrichNovember 19, 2008November 19, 2008

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Proposed Editors

Principal Editors: Principal Editors: Charles RICA, MD, PhD (GIP-DMP) – Ana ESTELRICH (GIP-DMP)Charles RICA, MD, PhD (GIP-DMP) – Ana ESTELRICH (GIP-DMP)

Co-editors:Co-editors:

Pr. Didier LEMERY, MD, PhD (Dept of pediatrics, Clermont)Pr. Didier LEMERY, MD, PhD (Dept of pediatrics, Clermont)Pr Paul LANDAIS, MD, PhD (Dept of biostatistics, and Public Health, AP-HP)Pr Paul LANDAIS, MD, PhD (Dept of biostatistics, and Public Health, AP-HP)Dr. Bernard GIUSANO, MD (Dept of pediatrics, Dept of Public Health, CHU Nice)Dr. Bernard GIUSANO, MD (Dept of pediatrics, Dept of Public Health, CHU Nice)Dr. Catherine CRENN-HEBERT, MD (Dept. of pediatrics, AP-HP)Dr. Catherine CRENN-HEBERT, MD (Dept. of pediatrics, AP-HP)Brigitte LEFEUVRE (Ministry of Health - Direction Genérale de la santé)Brigitte LEFEUVRE (Ministry of Health - Direction Genérale de la santé)Christophe BROYER (Ministry of Health - Direction Genérale de la santé) Christophe BROYER (Ministry of Health - Direction Genérale de la santé)

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Summary

Existing ProblemExisting Problem

1.1. Medical information related to mother’s and child health is dispersed between the Medical information related to mother’s and child health is dispersed between the different healthcare providers involved in the pregnancy/delivery/child growth periodsdifferent healthcare providers involved in the pregnancy/delivery/child growth periods

1.1. Existing standards (US, UE initiatives) need to be harmonizedExisting standards (US, UE initiatives) need to be harmonized

2.2. Documents that binds this information have to be defined (standard used, contents)Documents that binds this information have to be defined (standard used, contents)

5.5. Public Health & Clinical Research need to have Public Health & Clinical Research need to have coherent and exhaustive coherent and exhaustive .databases to .databases to work on general statistical survey, epidemiological studies, and to make evaluations on work on general statistical survey, epidemiological studies, and to make evaluations on the medical (child growth, immunization, epidemic illness,…) state of the country the medical (child growth, immunization, epidemic illness,…) state of the country

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Summary

Relevant standards Relevant standards • XDS.FolderXDS.Folder• XDS Document RegistryXDS Document Registry• SVS profile SVS profile • PCC Medical Summary Implementation Profiles, especiallyPCC Medical Summary Implementation Profiles, especially

– Antepartum recordAntepartum record– Immunization ContentImmunization Content

• HL7 CDA-R2HL7 CDA-R2• DICOMDICOM• PERISTATPERISTAT

Summarize how the problem could be solvedSummarize how the problem could be solved• EU works on perinatality health indicators (PERISTAT) or can be use as a basis to EU works on perinatality health indicators (PERISTAT) or can be use as a basis to

establish a common vocabulary and data sets, establish a common vocabulary and data sets, • French CDA-R2 document on health certificate can be used as a basis to establish the French CDA-R2 document on health certificate can be used as a basis to establish the

format of the document which could bind such information format of the document which could bind such information • Documents can be put into an XDS folder, shared within the affinity domain Documents can be put into an XDS folder, shared within the affinity domain

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Use Case - Public Health - Current

• Physicians have to manually fill these three health certificates at the age of 8 days, 9 Physicians have to manually fill these three health certificates at the age of 8 days, 9 months, and 24 months old, and then send them to the social services (PMI).months, and 24 months old, and then send them to the social services (PMI).

• Information sent to PMI can trigger intervention from its servicesInformation sent to PMI can trigger intervention from its services • The information must be pseudonimized by thePMI, then recopied into on statistics The information must be pseudonimized by thePMI, then recopied into on statistics

institutions servers, in order to process it. Also, if the child changes physician and the institutions servers, in order to process it. Also, if the child changes physician and the certificates are lost, the data is lost as well. Erroneous conclusions are drawn at a certificates are lost, the data is lost as well. Erroneous conclusions are drawn at a national level.national level.

• Information is lost and cannot be retrieved for the Child EHR/PHRInformation is lost and cannot be retrieved for the Child EHR/PHR

• Information is often incomplete and only the first certificate is sent to PMI in most cases.Information is often incomplete and only the first certificate is sent to PMI in most cases...

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Use Case - Public Health - Desired

Creating an health certificateCreating an health certificate

• Health certificates should be electronic documents, created from data contained into the Health certificates should be electronic documents, created from data contained into the physician database. Missing data could be completed by the physician when creating physician database. Missing data could be completed by the physician when creating them.them.

• In the case of a child who has consulted several physicians, a health certificate should In the case of a child who has consulted several physicians, a health certificate should be created from the aggregation of data coming from disparate systems. This could be created from the aggregation of data coming from disparate systems. This could prevent data loss.prevent data loss.

Using a health certificate by the PMI and by Public HealthUsing a health certificate by the PMI and by Public Health

• As an aggregation of data of the same patient, the health certificate used by the PMI As an aggregation of data of the same patient, the health certificate used by the PMI should automatically provide other functionalities such as following links with other cases should automatically provide other functionalities such as following links with other cases of illness in the same location.of illness in the same location.

• Interventions from Social seServices can be tiggered by the health certificate contentsInterventions from Social seServices can be tiggered by the health certificate contents• Pseudonymization, then integration to national databases to provide national institute of Pseudonymization, then integration to national databases to provide national institute of

statistics (DRASS, INSERM, InVS) should be automated for the public health officials.statistics (DRASS, INSERM, InVS) should be automated for the public health officials.

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Use Case (I) pregnancy period

• After having confirmed she is pregnant by means of a biological test, Mrs X comes to see her After having confirmed she is pregnant by means of a biological test, Mrs X comes to see her gynecologist, for her first consultation for her pregnancy. gynecologist, for her first consultation for her pregnancy.

• The gynecologist, who works with a peri-natality network, The gynecologist, who works with a peri-natality network, creates a folder named “Maternal creates a folder named “Maternal and Child Health” (MCH) and Child Health” (MCH) within the mother’s EHR.  within the mother’s EHR.  

• He will send to it biological results he has ordered like determination of Human Chorionic He will send to it biological results he has ordered like determination of Human Chorionic Gonadotrophine (HCG) level, complete blood group, serology tests such as, HIV, syphilis or Gonadotrophine (HCG) level, complete blood group, serology tests such as, HIV, syphilis or hepatitis (B/C), or biological tests like urine albumin, and blood red, white, platelet cell counts, hepatitis (B/C), or biological tests like urine albumin, and blood red, white, platelet cell counts, etc.etc.

• The Gynecologist will send The Gynecologist will send a pregnancy diagnosis certificatea pregnancy diagnosis certificate, to this folder, as well as a , to this folder, as well as a notification of document availability to the authority in charge of pregnancy public health notification of document availability to the authority in charge of pregnancy public health statistics. statistics. 

• Also, consultations reports, and transabdominal ultrasound exams that are produced during the Also, consultations reports, and transabdominal ultrasound exams that are produced during the several consultations Mrs. X will have within her pregnancy, will be also sent to this folder.several consultations Mrs. X will have within her pregnancy, will be also sent to this folder.

 

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• During the labor and the delivery, healthcare providers could retrieve medical information During the labor and the delivery, healthcare providers could retrieve medical information related of her pregnancy by means of this MCH folder.related of her pregnancy by means of this MCH folder.

• At birth, the obstetrician or the midwife in charge of the delivery fills a At birth, the obstetrician or the midwife in charge of the delivery fills a report of deliveryreport of delivery. This . This report includes mother and child(ren) name(s), date and hour of birth, sex, weight, number of report includes mother and child(ren) name(s), date and hour of birth, sex, weight, number of gestational days, etcgestational days, etc. .

• AA notification of document availability notification of document availability will be sent to the authority in charge of pregnancy will be sent to the authority in charge of pregnancy public health statistics.public health statistics.  

• The physician also fills a The physician also fills a health report health report and sends it to Mrs. X MCH folder and sends it to Mrs. X MCH folder

• A notification of document availability A notification of document availability will be sent to the authority in charge of maternal and will be sent to the authority in charge of maternal and child protection (PMI)..  child protection (PMI)..  

• Information concerning Mrs. X social situation are also a part of this report, as well as the Information concerning Mrs. X social situation are also a part of this report, as well as the physician recommendations, about mobilizing social services for intervention, treatment or physician recommendations, about mobilizing social services for intervention, treatment or education. education.

Use-case (2) Labor and Delivery

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  • After leaving the hospital, Mrs. X comes to see her general practitioner, for the child medical After leaving the hospital, Mrs. X comes to see her general practitioner, for the child medical

consultations.consultations.

• The The GP retrieve information about her pregnancy by requesting her MCH folder GP retrieve information about her pregnancy by requesting her MCH folder (gynecologist, midwife, obstetrician reports, biological test results, first health record filled up by (gynecologist, midwife, obstetrician reports, biological test results, first health record filled up by the pediatrics specialist of the hospital). the pediatrics specialist of the hospital).

•   After the consultation, the GP fills up a After the consultation, the GP fills up a second health reportsecond health report, then send it to Mrs. X MCH , then send it to Mrs. X MCH folder while a notification of document availability is sent to the PMI.folder while a notification of document availability is sent to the PMI.

• Clinical examination, and immunization tests are reported in this report. Clinical examination, and immunization tests are reported in this report. 

• AA third health report third health report will be filled and send on the same way by the GP after the next will be filled and send on the same way by the GP after the next consultation.consultation.

• PMI can retrieve the three certificates by requesting them on the MCH folder, and after the data PMI can retrieve the three certificates by requesting them on the MCH folder, and after the data being being pseudonymizedpseudonymized, sends it to the Public Health Agencies and Organizations, or Research , sends it to the Public Health Agencies and Organizations, or Research Entities. This data is used to derive nation-wide statistical and epidemiologic reports, relating to Entities. This data is used to derive nation-wide statistical and epidemiologic reports, relating to the sanitary state of the country, on a pediatric level.the sanitary state of the country, on a pediatric level.

 

Use-case (3) Child growth

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Proposed Standards & Systems

• IHE Medical Summary Implementation ProfilesIHE Medical Summary Implementation Profiles• HL7 CDA-R2HL7 CDA-R2• W3C XFormsW3C XForms• IHE-ITI XDSIHE-ITI XDS• IHE-ITI SVSIHE-ITI SVS• DICOMDICOM• PERISTAT peri-natal health indicators for European PERISTAT peri-natal health indicators for European

CommunityCommunity• HITSP standards (selection)HITSP standards (selection)

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Technical Approach

• Sharing documents by means of an XDS folder would imply that Sharing documents by means of an XDS folder would imply that a common rule of a common rule of interoperability is adopted between those actors like format standards, value sets, interoperability is adopted between those actors like format standards, value sets, terminologiesterminologies as well as they all agree with a as well as they all agree with a common healthcare policy common healthcare policy that could that could insure that every actors are belonging to a same affinity domain. insure that every actors are belonging to a same affinity domain. 

• Technical approach then should be summarized on Technical approach then should be summarized on sharing specialized documents by sharing specialized documents by means of XDS transactions and actorsmeans of XDS transactions and actors..

• These documents have to be defined These documents have to be defined in order to address the needs of both US and in order to address the needs of both US and French Public Health systems.French Public Health systems.

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Impact on IHE

New actorsNew actors• MCH document providerMCH document provider• MCH document consumer MCH document consumer 

Existing actorsExisting actors• Value Set consumerValue Set consumer• XDS actors (registry, repository, folders) XDS actors (registry, repository, folders) 

New transactions (standards used)New transactions (standards used)• The same actors are used as in the XDS transactions. Please see the transaction diagram.The same actors are used as in the XDS transactions. Please see the transaction diagram.

Impact on existing integration profilesImpact on existing integration profiles• This is a stand-alone profile that might use the Publish and Subscribe profile and Sharing Value Sets This is a stand-alone profile that might use the Publish and Subscribe profile and Sharing Value Sets

profile. profile. 

New integration profiles neededNew integration profiles needed• NoneNone  

Breakdown of tasks that need to be accomplishedBreakdown of tasks that need to be accomplished• Evaluate the content of the necessary forms.Evaluate the content of the necessary forms.• Decide on the important data.Decide on the important data.• Transform the data in CDA format (there is already a French team dedicated to this task).Transform the data in CDA format (there is already a French team dedicated to this task).

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Impact on IHE

RisksRisks• If this profile is not taken by the committee this year it will lead to separate efforts in both If this profile is not taken by the committee this year it will lead to separate efforts in both

continents for an identical subject, leading to discrepancies and a non-harmonized approach.continents for an identical subject, leading to discrepancies and a non-harmonized approach.

  

Open IssuesOpen Issues• Must find a common reference of indicators for the content indicated. The European Must find a common reference of indicators for the content indicated. The European

Commission has already done some on this level (Peristat)Commission has already done some on this level (Peristat)• Transform the data in CDA format (there is already a French team dedicated to this task).Transform the data in CDA format (there is already a French team dedicated to this task).

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