Implementation of a CEN/ISO 13606

Platform for Medicines Reconciliation

David Moner1, Marta Terrón2, Carlos Angulo1, Luis Lechuga2, Pablo Serrano2, José A. Maldonado1, Francisco J. Farfán2, and

Montserrat Robles1

1 ITACA Institute, Universitat Politècnica de València, Spain2 Hospital de Fuenlabrada, Madrid, Spain

Contact: David Moner (damoca@upv.es)

MIE2011

Project description

• Semantic interoperability must exist between all data sources.

– The CEN/ISO 13606 norm and archetypes were used together

with SNOMED CT and the Spanish National Medication

Database.

– The infrastructure is based on the use of the LinkEHR

Normalization Platform.

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Objective: To define and use a methodology and tools to guarantee

medicines reconciliation between the Hospital de Fuenlabrada in

Madrid and the primary care centres of its health area.

Medicines reconciliation

• Medicines reconciliation is the process of evaluating the

complete list of past and current medications of a patient to

avoid medication errors.

• It should be done at every transition of care in which new

medications are ordered or existing orders are rewritten.

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• Up to 67% of patients' prescriptions histories have

one or more errors.

• Up to 46% of medication errors take place when new

orders are written at transition points.

The CEN/ISO 13606 norm

• The CEN/ISO 13606 norm for the Communication of

the Electronic Health Record is the basis for health

information systems semantic interoperability.

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• It distinguishes two different models:

- The Reference Model contains basic and generic entities to represent

any kind of health information, together with context information.

- Archetypes are formal definitions of domain concepts whose purpose is

to provide a powerful, reusable and interoperable mechanism for the

creation, description, validation and query of EHR information.

LinkEHR® Normalization Platform

• The LinkEHR Normalization Platform facilitates the

creation of normalized and federated views of clinical

information which is distributed among heterogeneous

health information systems.

• LinkEHR is the only existing tool capable of handling

archetypes as a data normalization mechanism.

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www.linkehr.com

Architecture of the solution

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LinkEHR Platform

DATA NORMALIZATION

DATA INTEGRATION

NOMENCLATORDIGITALIS

LOGS

ARCHETYPES

INDEPENDENT

WEB VIEWER

HOSPITAL EHR

(SELENE)

Web Service

The integrated and normalized view is offered through a web service interface to be used directly or to be integrated into other systems

Primary care

OMI-AP

Hospital de Fuenlabrada

FARMATOOLS SELENE

Three basic steps:

1. Data integration

2. Archetype definition

3. Data normalization

1

2

3

Data integration

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OMI-AP

The primary care

information system

The hospital

electronic health

record system

The hospital

pharmacy information

system

Spanish National

Medication Database

SELENE

FARMATOOLS

Nomenclator

The LinkEHR Integration Engine builds a

virtual integrated XML view of all data of a

patient existing in heterogeneous and

distributed systems.

Archetype definition

Knowledge sources

Patient Summary

specifications

CKM archetypes

Medication

specifications

Existing systems and

clinical knowledge

Defined archetypes

Several CEN/ISO 13606 archetypes were

defined using the LinkEHR Editor

Medications Problems

Normalization

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The tool generates an XQuery

script that is able to transform

the legacy data into CEN/ISO

13606 EHR extracts

The LinkEHR Editor allows

the specification of mappings

and transformation rules

between archetypes and data

sources.

MAP

Deployment

• The LinkEHR Extract Server retrieves the integrated data, applies

the normalization XQuery to it and offers the normalized XML

documents through a web service interface.

• This service was integrated into the hospital EHR system (Siemens

Selene), providing access to the patient summary, including the

medication list from both the hospital and the primary care centres.

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Conclusions

• We have demonstrated that CEN/ISO 13606 and the

archetype methodology can be used in real environments.

– Medicines reconciliation is a clear example that semantic

interoperability technologies can highly improve the quality of

care and patient security.

• This project served as an introduction for several clinicians of

a new way of using standards and semantic technologies.

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This project has been financed in part by the Spanish Ministry Science and Innovation

under Grant TIN2010-21388-C02-01, and by the Health Institute Carlos III through the

RETICS Combiomed, RD07/0067/2001.

More info

• You can see this technology working at

MIE 2011 Workshop 14:

“CEN/ISO 13606 Implementation and

Communication of Health Information”

• Tuesday, 30th August, 13:45

• Room N4 Christiania