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© 2009 HL7 Anwendergruppe Österreich – www.hl7.atwww.hl7.at An implementation guide for CDA laboratory reports in the Austrian electronic health record (“ELGA”) IHIC, 08.05.2009 Mense, Sabutsch, Sauermann
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Agenda The Austrian EHR: „ELGA“ CDA Standardization – the laboratory report Problems Q&A
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at The Austrian EHR: „ELGA“
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at What is ELGA? ELGA (Elektronische Gesundheitsakte = EHR) ELGA contains relevant multimedia-based and health related data and information referring to a precisely identified person. Data und information originate from different health service providers and from the patient himself/herself and are stored in one or several different information systems (virtual health record). Data are available independently of place and time (cost-saving) at the place of treatment for all authorized persons according to the tasks and needs of these persons and in compliance with data protection rules
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at History 2004 E-health action plan by European Commission Each member has to develop an eHealth roadmap 2005 eHealth initiative with 150 experts in 6 groups 2006 Feasiblility study for a nationwide EHR Operational unit ARGE ELGA founded 2007 Masterplan, Architecture, Standards for the first implementation phase 2008 Start of development of CDA documents
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at International Standards IHE IT Infrastructure (ATNA, XDS, PIX, …) Patient Care Coordination HL7 RIM CDA Rel.2 DICOM WADO (Web Access to DICOM Persistent Objects) LOINC (Laboratory domain)
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Projects
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at ELGA Infrastructure zentraler Pat-Index GDA-Index Dokumenten Register Gateway (CCB) Protokoll- System Berechtigungs System lokaler Patienten-Index Dokumenten- Register Gateway (CCB) Berechtigungs- Verwaltung Protokoll- System aggregiert GDA System ConsumerSource GDA System Consumer Source Datenspeicher Service-Provider Datenspeicher zentraler Patienten- Index Protokoll- System Portal Consumer Source Information Berechtigungs- System Gateway (CCB) Grundversorgungsbereich ELGA lokaler Patienten- Index RLS Service-Provider Datenspeicher Externe Verbund- Ebene GDA- Ebene
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at CDA Standardization – the laboratory report
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Report Standardization Delegated to expert groups 10-50 members covering all involved occupational groups (medical experts and technicians) Basic CDA implementation guide + addenda
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Laboratory Experts group of about 50 persons mainly specialists in laboratory medicine (private or hospital laboratory), but also laboratory IT vendors, experts for medical informatics, and HL7 experts Goal: develop a nationwide harmonized report definition for laboratory and microbiological studies CDA document with fully defined level 2 and level 3 Two phases Harmonizing medical content based on requirements of Austrian Society for Laboratory Medicine January 2008 – May 2008 Finish definition of harmonized medical content + microbiology studies, technical implementation December 2008 – March 2009
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Laboratory report (medical content)
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Special requirements medical content Report structure Report sections (are not batteries) Advanced handling of specimen information Condition, comment, responsible persons, … Chief complaint or admission diagnosis Taken from order Multiple reference ranges with different preconditions for one test Subcontracting laboratory Tests have to be marked Complex comment structure specimen, test, report section, whole report
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Evaluation … Evaluated international work on CDA lab reports Germany (VHitG / HL7) Italy Finland IHE … Decision for IHE XD-Lab (Lab TF – Vol. 3) VHitG model was firstly preferred but does not fulfill the Austrian requirements IHE covers most of Austrian use cases Multinational solution Also includes microbiology studies
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Vocabulary LOINC Test codes, laboratory specialities, antibiotics HL7 Specimen type: “SpecimenType” - German translation Specimen Collection: “SpecimenCollectionMethod” - German translation Anatomical locations: “ActSite” - German translation Specimen Condition: “SpecimenCondition” - German translation Interpretation of test results: “ObservationInterpretation” - constrained and translated to German Unified Code for Units of Measure (UCUM)
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Constraining level 2 IHE XD-LAB contains only a number of recommendations Acc. to IHE sections are “DRIV” rules for mapping level 3 to level 2 required To get a similar structure and layout for the laboratory report all over Austria it was necessary to strictly constrain the level 2 coding and the associated display of the medical content. Type of elements (e.g. specimen information) Fields (order, coding) Order of elements …
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Problems …
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Observation Observation range (normal range) depends on preconditions for some tests Sex, age, hormonal status, … IHE enhances model based on HL7 lab domain Not longer CDA 2 conformant Correct solution?
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Chief complaint & admission diagnosis Not covered by IHE – implemented according to definitions in Germany as a own section
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Further challenges … Coding and order of report sections List of specialities not fitting the requirements Microbiology studies Coding “same” isolate with different cultures (ongoing discussion) Rendering footnotes: unclear definition of and in the CDA definition. No appropriate example could be found Hard to fulfill IHE requirements e.g. on address and telecom
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Problems Vocabulary LOINC and other code lists: Quality assurance for translation and adoption process for Austria is neither fully defined nor finished Coding of microorganisms (isolates) no candidate vocabulary for the coding of microorganisms, since SNOMED CT is not available in a German version and in addition: Austria is not a member of the IHTSDO Semantics of interpretation codes
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Example … Example …
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at
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© 2007 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at © 2009 HL7 Anwendergruppe Österreich – www.hl7.at www.hl7.at Thanks for your attention
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