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Challenges and Solutions in Semantic Framework Collaboration Paths

Explore potential collaboration paths and challenges in interoperability, patient access, and standards adoption in the healthcare sector. Discover how semantic frameworks can address legal, organizational, and technical interoperability challenges.

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Challenges and Solutions in Semantic Framework Collaboration Paths

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  1. The epSOS Semantic Framework Potential collaboration paths Poznana, 24-25/10/2013 Giorgio Cangioli / Marcello Melgara Lombardy Region

  2. Challenges • Basic Use Cases: • Patient Summary interoperability • ePrescription/ eDispensation • Patient Access • Different languages • Different eHealth processes • Different grade of development • Different Legislation • Different Standards adopted • Challenges to get there (based on the EIF (European Interoperability Framework)): • Legal Interoperability • Organisational Interoperability • Semantic Interoperability (human & machine) • Technical Interoperability

  3. …a TurkishPatientSummary….. Allergies Blood Group Active Problems This is an extract from a Turkish Patient Summary, taken during the last Project-a-thon in Bern May 24th 2012

  4. ..as can be seen by an ItalianPhysician….. Allergies Blood Group Active Problems This is an extract from a Patient Summary display device, taken during the last Project-a-thon in Bern May 24th 2012

  5. epSOS NCPs evolution National Infrastructure(s)

  6. OpenNCP Architecture • Identified components either jointly developed or under PNs responsibility • Clustered components in MiniProjects • Defined the Integration MiniProjects • Identified MiniProject Leaders & Allocated resources to MiniProjects • Defined stringent concurrent design planning and verification

  7. Adoption of IHE profiles

  8. OpenNCP Architecture SEMANTIC ASSETS eCRTS MVC/MTC CTS-2 • Components based on SRDC implementation are released on GPLv3 • Component based on FET OSS or newly developed are on ASLv2

  9. The epSOS Semantic Framework 10 • The epSOS Semantic Framework keywords: • The Semantic Services • The Semantic Signifiers • MVC (Master Value set Catalogue) / MTC (Master Translation/Transcoding Catalogue) MVC/MTC Semantic Signifier

  10. The epSOS Semantic Framework • The epSOS Service Functional model separate between the behavioural aspects of interfaces and the “semantic signifiers” used to capture the exchanged resources and data structures. Semantic Signifier Service & Functional model

  11. The epSOS Semantic Framework 12 • epSOS is a “pilot” project • Legislations, workflows and standards that are used for sharing data within an epSOS Participating Nation (PN) MUST NOT be influenced by epSOS • Support both human and computational semantic interoperability • terms need to be understandable by humans and available in the language of the receiving Health Professionals (HP) • For liability and patient safety reasons: • Original “concepts” and the mappings/translations applied have to be tracked within the exchanged data • No NLP-based translation techniques

  12. The epSOS Semantic Framework • The MVC/MTC • MVC (Master Value set Catalogue) is the collection of all the value sets selected in epSOS for representing the coded information to be exchanged in the agreed signifiers (e.g. the Patient Summary). • MTC (Master Translation/Transcoding Catalogue) is the collections of • MVC value sets translated by the PN Terminology Responsible • Mapping tables between the National and epSOS Value Sets [if any] • The MVC and MTC are developed, validated, FORMALLY APPROVED , archived and downloaded to the National Contact Points of every Member State by using the Central Terminology Services implemented by the epSOS Central Reference Terminology Server (eCRTS)

  13. The epSOS Semantic Framework • The Semantic Services. It includes • The Transformation (transcoding/translation) services. They allow for : • mapping the original coded concepts into the common epSOS ones • Adding epSOS and target language translations. • The Central Terminology Services • Enable for terminologies (and related mapping) QA control and sharing

  14. epSOS Semantic Interoperability Translated /Transcoded epSOS “Pivot” Structured Data National Data CDA epSOS Domain epSOS “PDF” PDF OriginalContent 15

  15. The process in “a nutshell” Business Architecture Legal Framework Conceptual Information Model Processes Use Cases Feedbacksanalysis Ontologies/MVC Implementation and Testing MTC Formal QA, ChangeMgmt and ApprovalProcess Implementation Guides End to End Functional Test

  16. The process in “a nutshell” Business Architecture Legal Framework Conceptual Information Model Processes Use Cases Feedbacksanalysis Ontologies/MVC Implementation and Testing MTC Formal QA, ChangeMgmt and ApprovalProcess Implementation Guides End to End Functional Test

  17. The epSOS Semantic Framework 18 • The process “in a nutshell” [use case already consolidated]: • Clinical/Functional experts agree about concepts and identify the information needs of each use case taking into account the common legal framework. (conceptual information model) • Identified the concept domains to deal with (e.g. administrative Gender, Illnesses, Surgical Procedures) • Terminology and Clinical/Functional experts identify the set of (coded) concepts that fulfill the information needs [MVC] • Defined the Value Sets binding for each concept domain within a specified context (e.g. Patient Summary). • National experts define - where needed - the mappings between the locally used vocabularies and the epSOS Value Sets and the translations for the concepts designations [MTC]

  18. The epSOS Semantic Framework 19 • The process “in a nutshell”: • Technicians, including industry experts, serialize the conceptual/logical models and define the implementable specification (including the vocabulary bindings) based on existing standard and profiles • All these steps are subject to a formal revision, approval (QA) and publication process including the Member States representatives and Industry and Members States experts • Semantic signifiers and services are tested in a Lab (project-a-thon) and in a Pre Pilot test environment, including end to end functional tests, before going into the pilot phase.

  19. The epSOS Semantic Framework 20 • The process “in a nutshell”: • Issues and feedbacks from the pre pilot (above all from the end to end functional test) and from the pilot phases are collected and analyzed as inputs for the semantic signifiers and MVC/MTC maintenance process. • A change management process has been identified for handling change request for MVC/MTC and semantic signifiers including : • Inputs from pilot and SMEs • Harmonization for new use cases

  20. OpenNCP Architecture SEMANTIC ASSETS eCRTS MVC/MTC CTS-2 • Components based on SRDC implementation are released on GPLv3 • Component based on FET OSS or newly developed are on ASLv2

  21. The epSOS Semantic Assets 22 • Transformation Manager (TM): syntactically transform the document generated by a Country into the HL7 CDA Pivot format, to be exchanged between to Countries • Terminology Service Access Manager (TSAM): is called by the TM to mapeveryTerm from an Input Coding System to the Output Coding System used in the International document exchange) and/or translate the Term into thedesignation language. • Local Terminology Reposity (LTR): is the data base of the terminologies within the NCP. It contains the Master Translation Transcoding Catalogue (MTC) specific for the Country, which contains the Translations of the Master ValueSet Catalogue (MVC) used in that Country and the Transcoding between the Coding Systems used in the Country and the one adopted by epSOS for cross-border communication SEMANTIC ASSETS eCRTS MVC/MTC CTS-2

  22. The epSOS Semantic Assets 23 • TSAM Synchronizer: (TSAM Sync): the component to download in the LTR the MVC/MTC generated / managed in the epSOS Central Terminology Server (eCRTS). The interfae of the TSAM Sync will be changed to be compliant to HL7 CTS-2 • epSOS Central Terminology Server (eCRTS): HealthTerm from CareCom is the Central Terminology Server where the MVC terminologies are developed, validated, approved and where each Country generates / uploads the specificMTC, according to a strictly control process of editing, revision approval. In future, the eCRTS services to create MTCs could be performed on National TerminologyServices • The info and the SW of the OpenNCP (the Open Source National Connector) can be accessed on:https://openncp.atlassian.net/wiki/display/ncp/OpenNCP+HomeIn particular, the Semantic Components are described in:https://openncp.atlassian.net/wiki/display/TM/Semantic+Services+-+Transformation+Management SEMANTIC ASSETS eCRTS MVC/MTC CTS-2

  23. Document transformation The documentistrasformedinto Pivot HL7 CDA L3, trascoded and translated epSOS Central Reference Terminology Service: Master Value Set Catalogue: [MVC,] Subset of International Coding Systems (WHO ICD10, ATC; SNOMED-CT, EDQM, UCUM, HL7, IHE, ISCO)+ Master Translation/Transcoding Catalogue [MTC]

  24. Pivot Document In Country A Country A Data Pivot Document In Country B C-A Code C-A Code C-A Code C-A Display name C-A Display name C-A Display name epSOS Code epSOS English Display name 25 Redundant Coded Data Elements for Safety epSOS Code @ epSOS English Display name epSOS C-B lang. Display name Transcoding @ Translating Translating Local Terminology Repository (based on epSOS Reference Terminology [MVC, MTC]) Subset of International Coding Systems (WHO ICD10, ATC; SNOMED-CT, EDQM, UCUM, HL7, IHE, ISCO + National Translation

  25. CTS-2 Conceptual Model

  26. Alternative Terminology Server Architectures NCP-y eCRTS NCP-z eCRTS Service Interface eCRTS NCP-z eCRTSSrvs Interface NCP-x eCRTS Service Interface NI-x NCP-y ….. PN-x Standardized Interfaces (CTS-2) NTS-x NCP-x NCP-x NI-x NI-x PN-x NTS-x PN-x NTS-x NTS: National Terminology Service See notes…

  27. Alternative Terminology Server Architectures NCP-z NCP-y ….. NCP-x eCRTS SDOs NI-x SDOs PN-x NTS-x SDOs

  28. Alternative Terminology Server Architectures (Some) Open Issues • Terminology Services • Which Architecture (Business, Technical) for the EU Semantic Infrastructure ? (aka “centralized vs. distributed” issue) • It is NOT a technical decision: • EU Policy • PN Policies • PN Readiness

  29. Med. Act.: Certify MTC Med. Act.: Certify MTC ICT Act.: Use MTC ICT Act.: Gen.Pivot Use MTC Medical activities connected to document transformation are performed off-line: they can be carefully checked. Only reference to certified tables are automatically performed real time Liability Assessment Liabilities in Document Life Cycle: PS /eP- No gaps between DC-A / DC-B liabilityData transformation Liabilities DC-B Liability DC-A Liability ICT Activity: Request/ Transmit PS/eP HCP Medical Activity: Create PS/eP ICT Activity: StorePS/eP Check Consent-A Retrieve PS/eP Medical Activity: Transform PS/eP ICT Activity: Request/ Transmit PS/eP Medical Activity: Translate Transform PS/eP ICT Activity: Request Transmit Display PS/eP HCP Medical Activity: Get Consent-B Use PS/eP Privacy & Security Privacy & Security 30

  30. epSOS transforms / translates / exchanges documents with clinical and legal validity for real patients Each Country has its own Coding Systems and (specific) agreements with SDOs In order to interoperate a mechanism of transforming documents (HL7 CDA 2 L3), transcoding and translating from Country of Affiliation to Country of Treatment was established The Master Value Set Catalogue (MVC), gathering all ValueSets from standard coding systems, was established, together with the controlled procedure to generate the Master Value Set Translation/Transcoding Catalogue (MTC) for each Country For Patient Summary and ePrescription services, liabilities were identified and safeguards were introduced However… Page 31 Major Issue Encountered: Semantic Sustainability / Liability (1)

  31. Maintaining MVC / MTC is potentially hardly sustainable Translation / transcoding procedures may introduce legal issues with SDOs and patient safety risks Maintaining a Central Terminology Server is not the task for a Project New epSOS services, like Patient Access (Country of Affiliation allows the patient to display his PS/eP in any EU language) has demonstrated new issues: Possibility to share translations among the Countries Liability on the shared / used translations Proposal: Move back to SDOs the task of maintaining, translating and provide certified transcoding Foresee the creation of a CTS-2 compliant EU CentralTerminology Service to allow appropriate access to the selected Coding Systems in EU languages Page 32 Major Issue Encountered: Semantic Sustainability / Liability (2)

  32. The Semantic Interoperability in epSOS….. lessons learned and inputs for discussions with other Domains

  33. Some Lesson Learned and Inputs for discussion 34 • Possible gaps between implementations and business needs • Formalization of the Business Architecture (including the Conceptual Information Models) • Not only the functional aspects: legal framework, liability aspects,.. • Exceptions managements • Impact of legalframeworks on the «implementation» of the semanticinteroperability • Notonly in term of class of information thatcould be exchanged. For example • epSOS requiresthattranslateddesignations are recorded in the exchangedsemanticsignifier. • There are REALMs in whichonly the concept code isexpected to be provided.

  34. Some Lesson Learned and Inputs for discussion 35 • Possible gaps between implementations and business needs • Business and not technology driven • … but “technology” is not the evil ! • Facilitates communication among Technicians / Terminology / Functional – Clinicians. • Formalization of the Business Architecture (including the Conceptual Information Models) • Not only the functional aspects: legal framework, liability aspects,.. • Exceptions managements

  35. Some Lesson Learned and Inputs for discussion • Impact of legal frameworks on the «implementation» of the semantic interoperability • Not only in term of class of information that could be exchanged • For example • epSOS requires that translated designations are recorded in the exchanged semantic signifier. • There are REALMs in which only the concept code is expected to be provided.

  36. Some Lesson Learned and Inputs for discussion 37 • Quality and availability of data: several semantic lacks experienced derive from the actual capability of countries of providing and/or mapping the coded concepts • Inability to extract structured information…. • Allergies data can be provided as a single piece of text • …and/or to have coded information…

  37. Some Lesson Learned and Inputs for discussion 38 • Quality and availability of data • Local eHealth policies to improve the collection of structured and coded information need to be considered. • The collection of coded and structured data has not to be in contrast with the care provisioning processes and needs to be acceptable for HPs • are the EHR systems able to collect those information seamlessly ? • Common EHR-S Functional Profiles may helps on this

  38. Some Lesson Learned and Inputs for discussion 39 • Mapping issues experienced (epSOS in this phase is based on linear N to 1 mappings) • Ambiguous and or missing mapping • Different levels of granularity among local and common value sets • One source concept mapped into multiple targets • Should be adopted more complex mapping rules ? • Should we suppose that countries will reduce the mapping discrepancies, e.g. converging progressively towards to the common concepts

  39. Lesson Learned and Inputs for discussion 40 • Centralized vs Distributed Terminology Services, • epSOS phase-I adopts a centralized model for enabling the QA control and the sharing of terminologies (and related mapping): • each member state is however responsible for its own mapping and translations • A decentralized approach has been suggested by the epSOS team responsible for analyzing the project Sustainability identified the need of decentralizing those services as much as possible. • A service federation may enable • The support for external terminology resources (e.g. SDOs) • The Cooperation with other operational context (like the Transatlantic eHealth)

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