Health Care Process Modelling: How to develop semantic interoperability in health care?

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Health Care Process Modelling How to develop
semantic interoperability in health care?  The
steps before IT implementation

• Karl-Henrik Lundell
• Medical dir.
• Swedish National Board of health and welfare
• EHTEL board of directors (SALAR)

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How to achieve clinical semantic
interoperability?  The steps before IT
implementation

• The overall aim with IT should be to support the
  production of services to the main customers
• These services are produced in the core processes
  of health and social care
• Interoperability must include and focus on the
  content and context of the core processes
• To achieve that Do we need a common description
  and shared understanding of what we aim to
  support??
• If yes how to do it?

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Why a common description of the core processes?

• Base for
• Interoperability
• Concept models
• Information models of meaning and use
• Specialisations of generic concepts for different
  contexts
• Needed for extended use of e-health/EHR when it
  comes to
• Core process management
• Quality management systems
• Continuous improvements

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Disposition

• Processes in general
• Health care processes
• Clinical processes
• Models and model architecture
• The Swedish approach
• Break out session/use case - the generic process
  model in the Swedish National information
  structure project

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Processes in general
Activities adding value to an object
Activities Transforming the input
Input
Output
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Processes in health care organisations
Core processes in health care organisations
Research processes
Educational processes
Clinical processes
Subjects of care
Health care professionals
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Clinical processes
Health care activities adding value to the health
state of a subject of care
Activities to identify the condition and treat
the problem
Health state
Health state
Needs and goal
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Clinical processes Leadership/management and
support processes
Leadership/management Business plan, Policy,
Objectives, Basic values, Restrictions, Quality
management system etc
Activities to identify the condition and treat
the problem for a subject of care
Health state
Health state
Support Personnel, material, knowledge support
(e.g. guidelines) etc
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Generic models of process and concepts

• Descriptions of the real operations (dynamic
  models)
• Theoretical constructions
• High level of abstraction
• Often primarily difficult for clinicians to see
  the relevance of
• Necessary (?) as a ground for information models,
  development of e-health/EHR and quality
  management
• Theory before practice!!

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Process models

• A process model is a description of
• the value adding to an input and
• the type of activities performed to add that
  value
• Different methods/languages/notations are used to
  describe
• A well defined and precise language is needed to
  create unambiguous models experts
• In health care the value adding can be described
  as conditions and the activities out from their
  different aims
• A process model is not a flow model with fixed
  sequences and does not include actors/responsibili
  ties
• Flow-, concept- and information models should be
  based on an explicit process model

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Information systems and Process orientation in
health care services

• The core processes are the clinical processes
• Quality management systems should focus the
  clinical processes
• Information systems should support the management
  of the clinical processes
• The information structure should be founded on
  the content and context of the clinical processes
• The content (activities) and the context (value
  adding) of the clinical processes should be
  identified in an explicit generic model of the
  clinical processes

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Why clinical process models?

• Identifies and describes the important concepts
  of the reality context and content
• Value adding and health conditions
• Types of activities that can contribute to value
  adding
• Information models and information systems not
  based on explicit process models risk to miss the
  targets of
• supporting the core processes
• achieve unambiguous interoperability
• Process oriented clinical quality management
  systems and clinical process management are
  dependent on process oriented information systems
• Clinical oriented is not enough should be
  clinical process oriented.

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Generic models and specialisations

• Generic possible to apply for all occurrences
  in a certain domain
• Specialisation Applied model for a specific
  part/area within the generic domain
• All specialisation can be contained and
  recognised in the generic model

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Generic specialised balance

• Generic for coverage of all business areas who
  need to share information
• Specialised as much as possible the more
  specialised the better support for effective
  processes
• Generic but nor more generic than absolutely
  needed for coverage

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Model architecture process-, flow-, concept- and
information models

• Process values added and activities
• Flow time sequences, actors and cooperation
• Concept definitions of and relations between
  concepts in process and flow models
• Information classes and characteristics
  (attributes) for information regarding the
  concepts in the concept model

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Health care process-, flow-, concept- and
information models

• All are needed to build sustainable, effective
  and comprehensive information systems for
• Leadership/management
• Performance/operation
• Support
• to the clinical processes

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Information systems in health services

• Focus on the core processes
• Founded on and supporting the content and the
  context of the real thing
• Model of the clinical process needed for the
  ability of the information system to contribute
  to good quality
• European Generic model of the clinical process?
• Within the scope of Contsys 2
• Of interest for joint initiatives in global
  standardisation?

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The Swedish approach
Basic values, legislation, regulations, requiremen
ts QMS etc.
Health services in the real and complex world
Generic process and flow models
Generic Concept model
Generic semantic Information model
National information structure
Logical information model
Information systems and IT-solutions
Archetype specifications
Applied information systems
Support process management and quality
management systems
Good Quality Health Services
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Health state
Health condition/ Health issue
Health-related request/ consultation
Activities to identify health conditions/-problem
s
No needs for treatment
Health problem treatment needed
Activities to treat health problems
Health state (treated)
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Types of activities for the two main aims
Plan
Asses needs
Perform
Evaluate
End of process
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The generic health service process under
development Swedish national Information
structure project
Health state
Health issue/condition
Health consultation
Assessed health condition
Health needs and health goal
Treat health problem
Output/ health state
Assessment of needs for activities
Identify Health condition
Needs for treatment
Activity plan
Activity planning
Perform activities
Evaluate effect
Health problem
No needs for activities
aim 2
Health problem not needed to treat
End process
aim 1
Identify health condition
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Open EHR clinical problem solving
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Open EHR and the Swedish generic process model
Health condition
Observation
Plan
Plan/instruction
Observation, Opinion
Asses needs
Perform
Action
Observation, assessment, opinion
Evaluate
End of process
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Swedish generic process pattern for the two main
aims related to open EHR problem solving model
Health state
Health condition Observation
Evaluate and analyse Observation and opinion
Health consultation Observation
Perform activities Action
Assessment of needs Opinion
No needs for further activities End process
Draw up plan for activities Instruction
Knowledge based process management
Blue open EHR
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Discussion points

• The role of clinical process model for
  development of
• Information models
• Information structures
• Interoperability between information systems
• Clinical process management and improvements
• Leadership and quality management systems?