Semantic interoperability of EHR systems is a vital prerequisite for enabling patient-centred care and advancing clinical and biomedical research. Furthermore, to deliver benefits in these areas the information about patients within EHR systems needs to be interoperable with the information and knowledge within many other eHealth infrastructure components and services such as decision support systems, care pathway and planning tools, alerts and notifications, patient safety detection and adverse event reporting, quality and governance systems, resource utilisation and optimisation and public health surveillance systems. SemanticHealthNet is developing a scalable and sustainable pan-European organisational and governance process to help advance this necessary semantic interoperability across the eHealth landscape.
A clinical focus on chronic heart failure and cardiovascular prevention in the work plan has focused efforts on the semantic resources (assets) to be developed, and permitted an understanding of good practices that will subsequently be propagated and scaled up. The exemplars in cardiology and public health have proved specific enough to permit the development and validation of a wide range of interoperability assets, and yet typical enough for wider generalisation of the methodology and its governance. SemanticHealthNet has captured the needs articulated by clinicians and public health experts for evidence-based, patient-centred integrated care in these domains. Existing European consensus in the management of chronic heart failure and cardiovascular prevention has been represented within clinical data structures, terminologies and ontology by leading international standards developers, supported by other informatics experts.
Figure 1: infostructure for semantic interoperability resources
Figure 1 illustrates the diversity of health informatics specification types (interoperability assets) that are variously – and variably - used to represent the information needed within eHealth architectural components. The problem faced by the sector is that these different kinds of asset are poorly aligned with each other, and therefore are populated and used inconsistently, resulting in poor interoperability and the risk of error when mapping data between heterogeneous systems. The project has investigated how best to align, combine and adapt these informatics assets to better support semantic interoperability, and how these can be developed and supported at scale. Results of this investigation have been generalised and formalised. The involvement of health authorities, clinical professionals, insurers, ministries of health, vendors, and purchasers, with the eHealth Governance Initiative and with epSOS, ensured that the project approach and results will be considered realistically adoptable and viable.
SemanticHealthNet has analysed the information recommended by best practice clinical guidelines to support shared clinical care in the management of heart failure in order to propose a heart failure patient summary, and studied examples of public health interventions relevant to the prevention of cardiovascular disease. These clinically-driven specifications have been formally modelled using multiple interoperability standards and specifications, and formalisms have been developed to enable semantic brokering between these different specifications. The project has produced recommendations on how healthcare professional societies should become more engaged in the specification of semantic interoperability assets, and defined best practice guidance on how clinical models and term value sets should be developed, and assessed for their quality. Importantly, recognising the value of a Network of Excellence but also the time and scale limitations of the project, a strategy for sustaining this effort has been established following multi-stakeholder engagement, as a not for profit Institute: the European Institute for Innovation through Health Data.