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A clinical challenge:
To lead or be led by health-IT?
Learn more 9-10 November 2015 in Linköping, Sweden
Speakers: Silje Ljosland Bakke (Norway), Rong Chen, Daniel Karlsson,
Heather Leslie (Australia), Mikael Nyström, Erik Sundvall
The amount of information relevant
(and irrelevant) to clinical decisions
is increasing, often above human
cognitive capacity. IT-solutions in
healthcare designed to guide and
lead clinicians are increasingly
needed to perform best practice
care. But who and what guide the
design of such systems?
Too often IT-solutions are slow to keep
up with the constantly changing needs
of healthcare, but guiding systems
based on outdated processes and
knowledge are not desirable.
The focus of these educational days in
Linköping is on how clinicians, and
healthcare organizations, can get
more control of the development of
electronic health record systems and
as a result, faster changes. With the
right knowledge and tools, clinicians
can cooperate better to agree on shared
needs and be more directly involved in
keeping the system up to date, without
losing easy access to older patient data.
We’ll discuss how electronic healthcare
record (EHR) systems can share
detailed
information
structures,
terminology systems and decision rules
– all designed and actively maintained
by cooperating skilled clinicians and
directly usable in systems (reducing the
need of time- and resource-consuming
reinterpretation and implementation
by IT-staff).
Invitation version 1.4
Updated versions may be available at
http://bit.ly/lead-or-be-led-by-IT
November 9 – Introduction, overview and Context
Suitable for decision makers, interested clinicians, researchers and,
health-IT-department staff.
Example content: (for detailed program and times see page 2)
 Clinician-led e-health records, How the control and
development direction of clinical information systems can be
turned back into the hands of skilled clinicians using
information structures called “archetypes” and “templates”
 SNOMED CT. What it is, content, usage, learning
 Local, national and international development and
governance of archetypes and templates, international and
Norwegian examples.
 Clinical Decision Support (exemplified by Cambio CDS)
 Terminology, clinical models and queries combined
 Detailed models in CIMI, CEN/ISO, openEHR and HL7
November 10 – Hands-on archetype/template training
Suitable for those wanting deeper knowledge and skills in editing
openEHR archetypes and templates, for example:
 clinicians wanting to engage in international archetype
authoring or local prototyping.
 IT- and information-governance staff at organizations
preparing to use archetype based systems.
Costs and registration
Nov 9 only:
500 kr, subject to availability (limited seats)
Nov 9+10:
3700 kr
Now fully booked, if you register for this now you will instead be put
on a waiting list and not charged for Nov 10 unless you later accept a
a possible extra invitation by email.
Costs include lunch and coffee-breaks etc. but exclude v.a.t. (moms).
Info & registration shortcut: http://bit.ly/lead-or-be-led-by-IT
Registration questions: [email protected]
Course content questions: [email protected]
Related events:
November 23, SFMI Termkonferens
10:00-17:00 Läkaresällskapet, Stockholm, see http://sfmi.se/
Clinician-led bottom-up detailed EHR content modeling in Sweden?
Including speech by CEN/ISO & openEHR veteran Prof. Dipak Kalra,
UCL, and chairman of the European Institute for Health Records.
December 3-4, Medicinska riksstämman
Several IT-related sessions, e.g. 3 Dec 13:45 - 14:45 “ehälsa behöver
en användbar, standardiserad och strukturerad dokumentation –
hur?” See http://www.sls.se/Riksstamman/
http://bit.ly/lead-or-be-led-by-IT
Jointly arranged by: Centrum för hälso- och vårdutveckling (CHV) & Centrum för medicinsk teknik och IT (CMIT), Region Östergötland
November 9 – Overview and Context
Arriving by train to Linköping at 9:00 should get you to the meeting venue in time with some minutes for coffee. Timing and ordering may
change slightly. Location: Scandic Frimurarhotellet, S:t Larsgatan 14.
9:00
9:30
9:50
10:50
11:00
11:45
12:30
13:15
13:35
14:10
14:45
15:00
15:15
15:40
Coffee, sandwich etc.
Welcome, introduction to the field and today’s program [Erik]
Clinician-led e-health records
How the control and development direction of clinical information systems can be turned back into the hands of
skilled clinicians – the role of archetypes and templates. Introduction to openEHR archetypes and templates, their
use and context.[Heather]
Break
Local, national and international development and governance of archetypes and templates – exemplified by
Norway’s archetype governance and openEHR’s international repository [Heather & Silje]
SNOMED CT. What SNOMED CT is, what it contains and how it may be used. How clinicians and others can get
involved and improve content. +How to get (free) Snomed CT training [Mikael] This part will be in Swedish.
Buffet Lunch
You can start today! - Demo: How to “adopt an archetype” and take part in international review and translation.
+How to find (free) video/text guides to get you started [Heather &Silje]
Terminology, clinical models and queries combined. Boundary problems. “Terminology binding” in archetype based
systems. Archetype- and terminology based queries for patient specific and epidemiological/statistical use.
[Heather, Daniel & Erik]
Clinical Decision Support (CDS) Decision support using decision rules, information models and terminology systems Exemplified by Cambio CDS using GDL, openEHR archetypes and SNOMED CT
[Rong]
CIMI, CEN/ISO and HL7 – more international modeling collaboration & conversion partly using archetypes. CIMI now
becoming a working group within the HL7 organization. Relation to HL7 FHIR.
+Info about SFMI event with Dipak Kalra in Stockholm November 23 [Daniel]
Break
Questions & Answers (primarily about archetypes, terminology and CDS)
Discussion (wider scope and Swedish context)
First discussion questions: Some Swedish regions will start using archetypes in their EHR systems soon. Can the their detailed clinical modeling and
translations of international efforts be used in clever ways also in non-archetype based EHR systems? Would it be clever to do like in Norway and
have a vendor neutral nationwide collaboration and governance? Who? How? Health Professional organizations, authorities, others?
16:20
End #1 = Break + bye-bye to those needing to catch early trains etc.
16:30
Deeper introduction to archetype/template thinking and tooling (Necessary for those attending day 2. Also open to
curious attendees of day 1) [Heather & Silje]
17:30
19:00
End#2
Possibility to meet for dinner at some restaurant for those that want to (not included in fee).
November 10 – Hands-on archetype/template training
Tutors during Nov 10 will be Heather Leslie and Silje Ljosland Bakke, partly assisted by Erik Sundvall. The number of possible participants is
limited. Participants are expected to bring their own computers with Archetype- and Template-tools already installed. Instructions have been
sent to participants. Location: Region Östergötland, Klostergatan 19c
8:00
8:15
16:20
16:30
17:30
Meet, set up computers etc (Times for lunch and breaks will be specified later)
Hands-on archetype/template training with real examples mixed with theory and demos. Main content: Archetypes,
Templates, Practical online reviewing. Modelling lessons learned (by years of experience)
End #1 = Break + bye-bye to those needing to catch early trains etc.
Last Q&A, reflections and end discussion. How would we like to continue? Tutoring help via web etc? Good example
starting/prototyping projects?
End #2, the end, really…
Filtering, defaults,
terminology binding
via templates etc.
adapt the usage of
shared models to
clinical use case.
Archetype examples
Entry screen example
Heather Leslie, MD (Australia)
As Clinical Program Lead at openEHR, Heather is one
of the world’s most experienced archetype and
template authors. She has worked as a clinician for
15 years and transitioned to health informatics in
2000. Heather joined Ocean Informatics in 2005
where she is now Director of Clinical Modeling. She
has worked with national health IT programs in
Australia, UK, Norway, Sweden, Brazil and Slovenia
and run training courses on clinical modelling in the EU, USA, South America
and Australia. In her openEHR role she oversees the development, quality
assurance and governance of clinical archetypes through an active online
community of clinicians and other domain experts from over 80 countries.
Färre bromsar i vårdens lärande kretslopp?
Läkekonstens och vårdens kretslopp för innovation
och förnyelse fanns långt innan datorerna. Bra IToch eHälso-lösningar kan snabba upp iterationerna
och föra oss snabbare från data, via information, till
kunskap, men då krävs tillräcklig struktur,
samordning och samarbete i de olika stegen.
Trögändrade IT-lösningar kan å andra sidan försena
önskade förändringar.
Silje Ljosland Bakke, RN (Norway)
Informatician and registered nurse, with clinical
background in surgery as well as clinical research from
the University Hospital of Northern Norway. She has
worked in health IT for more than five years, first in
the Bergen Hospital Trust and she’s now an
information architect in the National ICT health trust
for strategic IT cooperation in the Norwegian hospital
system. She has been a leading figure in Norway’s
national archetype governance since the start in 2013. She has joined
Heather as Clinical Program Lead at openEHR.
Mikael Nyström, PhD (Sweden)
Lecturer in Medical Informatics at IMT, Linköping
University. One of Sweden’s top technical experts
regarding clinical terminology systems, including
SNOMED CT. He has served in many roles at IHTSDO
(the organization governing SNOMED CT) where one of
his current tasks is focused on providing education and
training. His research interests include: Ontology
engineering with special focus of SNOMED CT,
ontology and terminology use in electronic health records, electronic health
record architecture and information reuse.
Daniel Karlsson, PhD (Sweden)
Senior Lecturer in Medical Informatics at IMT,
Linköping University. Chairman of the Swedish
Association for Medical Informatics (SFMI). He has
served in many roles at IHTSDO and has also been
actively participating in CIMI (Clinical Information
Modeling Initiative). Daniel’s research spans over
terminologies/ontologies, documentation models and
decision support systems, and includes the
intersections and boundaries between those domains.
Rong Chen, MD, PhD (Sweden)
Rong Chen is the Chief Medical Informatics Officer
and the head of Medical Informatics Group at Cambio
Healthcare Systems, Sweden, where he is responsible
for the research and development in clinical decision
support and knowledge management. Rong’s PhD
from Linköping University was focused on EHR
semantic interoperability. He is now an associated
researcher at the Health Informatics Centre at
Karolinska Institutet, where he lectures and
supervises PhD and master students.Rong has contributed to several core
openEHR design specifications, and has for many years led the Java
Reference Implementation of openEHR. Rong is the lead author of
Guideline Definition Language (GDL), which is designed to express clinical
logic for scalable decision support with openEHR underpinning. Within
openEHR he is member of the Management Board and the Specifications
Editorial Committee
Erik Sundvall, PhD (Sweden)
Information Architect at Region Östergötland working
with future directions of clinical IT systems he is also
Act. Lecturer in Medical Informatics at IMT, Linköping
University. Within openEHR he is Software Program
Lead and member of the Specifications Editorial
Committee. Erik has researched archetype based EHR
systems, REST based openEHR component designs
making it easier to deploy EHR systems by putting
together components from different projects/vendors/platforms. Erik has
also designed archetype editing tools and SNOMED CT browsers.
Figur 1. Delar av vårdens lärande kretslopp
Att få till bra stödjande IT-system innebär mycket
arbete, därför bör det arbetet delas och
återanvändas. I möjligaste mån vill man även
minimera antalet led (och tillhörande omtolkningar)
från vårdpersonalens behovsbeskrivning till
implementerade IT-system.
Bristande kunskap om vikten av nationellt och
internationellt
samarbete
kring
konkreta
detaljerade kliniska modeller inuti system (mallar,
”arketyper” etc.) bromsar också. Ett syfte med de
arbetssätt som presenteras under utbildningsdagen
är att hälso- och sjukvårdsverksamheter i samverkan
ska kunna påverka systemen och uppleva färre
eller kortvarigare bromsar av typen ”det nya
arbetssättet ni vill ha matchar inte hur IT-systemet
funkar ” eller ”vi får se om det kanske kommer i nästa
systemversion”.
Om flera aktörer kan arbeta med samma öppna
informationsstrukturer, beslutsregler m.m. istället
för att sådant arbete blir inlåst i enskilda system så
kan leverantörernas ”inlåsningseffekter” minska och
en mer levande marknad för journalsystem
gynnas. Ett sådant ”ekosystem” öppnar även upp
för innovation hos mindre aktörer som kan
använda de öppna standarderna. De kan t.ex.
fokusera på behoven hos mindre kunder (t.ex.
kommunala) och ändå erbjuda system som är
kompatibla med de större vårdgivarnas system.
Alternativt kan de satsa på att vara bättre än de
stora systemen inom speciella nischer och erbjuda
kompatibla tillägg till de stora systemen.
Dagens dokumentationsstöd är strukturerat i
varierande grad, det finns många skäl till att vilja
förbättra och strukturera information i klinisk
tillämpning (se figur. 1) t.ex. ökad användbarhet
och patientsäkerhet. Bättre struktur bidrar till
underlättad
journalföring
(bl.a.
mindre
dubbeldokumentation), sökfunktioner, översikter,
integrationer och även informationsflöden mellan
olika discipliner, verksamheter, system och
organisationer. Om strukturer tas fram och
underhålls utan tillräcklig möjlighet till engagemang
från aktiv vårdpersonal så kommer systemen gå i
otakt med verksamheten.
Att säga att forskning (se figur 1) underlättas av att
ha ordning på data är förhoppningsvis att slå in
öppna dörrar. Att få till en kontinuerlig utbildning
(se figur 1) och assisterande system i vårdvardagen
kan
underlättas
av
t.ex.
beslutsstödsystem.
Mängden
digitalt
lagrad
information
Figur 2
växer
exponentiellt
med ungefär en
fördubbling
vartannat
år.
Konkret innebär
det att mängden
beslutsgrundan
de information växer snabbt medan mänsklig
kognitionsförmåga inte utvecklas nämnvärt. Utan
aktiva stödfunktioner kommer gapet (se figur 2)
mellan vilken kunskap vi faktiskt baserar vården på
och vad vi skulle kunnat basera den på, att öka.
Noggrannhetskravet på aktiva stöd är dock mycket
högt för att de ska vara patientsäkerhetsmässigt och
arbetsmiljömässigt acceptabla. För att få hög
noggrannhet krävs god ordning på journalföringen
(dokumentationsmodellerna), vilket i sin tur kräver
bra funktionella uppdaterade strukturer/mallar att
journalföra i. Det krävs också bra begreppssystem
och klok tillämpning av de olika delarna. Beroenden
mellan modelltyper illustreras i figur 3 nedan (med
pilar mellan cirklarna).
Första dagen (9 Nov) ger en internationell överblick
av alla tre delarna i figur 3 och hur de påverkar
varandra. Andra dagen (10 Nov) ger en fördjupning i
en öppen internationell variant av dokumentationsmodeller som länge använts i en del andra länder
och succesivt nu börjar användas i t.ex. Norska
(DIPS) och Svenska (Cambio Cosmic) journalsystem.
Länktips
Kortfilm om ”arketyper” och tillhörande norskt arbete
https://youtu.be/JW8pBJvdsHQ
Om Snomed CT: http://www.ihtsdo.org/snomed-ct
Titta i Snomed CT: http://browser.ihtsdotools.org/
Om CIMI: http://www.opencimi.org
Om openEHR: http://openehr.org/
Titta på arketyper: http://www.openehr.org/ckm/ och
http://arketyper.no/ckm/
Exempel på norsk leverantör:
http://www.vitalis.nu/nyhetsbrev/nyhetsbrev1/Vitalis-2015--News-nr-18-mars/Oppen-plattform-framgangsfaktor-kringelektroniska-patientjournaler
Program or be programmed: https://youtu.be/imV3pPIUy1k
Figur 3. Illustrationen visar viktiga detaljerade delar som behövs inuti eHälso-system (t.ex. journalsystem) och nödvändiga samband mellan dem.
Dessutom finns meddelandemodeller/mekanismer (från t.ex. INERA/SKL, CEN, ISO, HL7 och IHE) för kommunikation mellan system.
WHO förvaltar ICD och ICF. Snomed CT förvaltas av IHTSDO. Dessa begreppssystem och klassifikationer förvaltas i Sverige av Socialstyrelsen.
Socialstyrelsens ”Gemensam Informationsstruktur” berör flera av bildens modellområden.