ESCOS EHEALTH SEMANTIC AND CONTENT FOR SWITZERLAND 02.12.2011 CORRESPONDENCE Dr. Reinhold Sojer Prof. Henning Müller [email protected] [email protected] BlueCare AG HES‐SO Pflanzschulstrasse 3 TechnoArk 3 8400 Winterthur 3960 Sierre Dr. Dominik Aronsky Prof. Patrick Ruch [email protected] [email protected] II4SM AG HES‐SO Genève Bollwerk‐Promenade 5 7 route de Drize 4051 Basel 1227 Genève ACKNOWLEDGEMENTS We would like to thank the following people for their support: Judith Wagner, Prof. Claire‐Anne Siegrist, Stefan Wyss, Adrian Schmidt, Prof. Christian Lovis, Christian Hay, Tony Schaller, Philippe Schaller, Stéphane Spahni, Arnaud Gaudinat, Alain Périé, Karima Bourcquart, Eric Poiseau, Anne‐Gaëlle Berge, Anni Buhr, Christine Roth, Marcello Melgara, Stefan Schulz, Alberto Guardia. Die Analysen, Vorschläge und Empfehlungen in diesem Dokument sind das Resultat der Konzept- arbeiten des Mandatnehmers im Dialog mit der Co-Leitung des Teilprojekts „Standards und Architektur“. Sie richten sich an die Gremien von „eHealth Suisse“ und dienen dort als Grundlage für die Diskussion im Hinblick auf die Verabschiedung von weiteren Empfehlungen. Diese Vorschläge können von den konsolidierten und verabschiedeten Empfehlungen von „eHealth Suisse“ abweichen. 2 Table of Contents 1 Executive Summary ......................................................................................................................... 5 2 Introduction ..................................................................................................................................... 8 3 Basic Concepts and overview .......................................................................................................... 9 3.1 Definitions ............................................................................................................................... 9 3.2 Semantic Interoperability of Medical Content ...................................................................... 10 3.3 International Trends in Semantic Interoperability ................................................................ 13 3.3.1 Primary standard development efforts ......................................................................... 14 3.3.2 Other interest groups .................................................................................................... 17 3.3.3 Situation in Nordic countries ......................................................................................... 18 3.4 epSOS ..................................................................................................................................... 19 4 Situation and Requirements in Switzerland .................................................................................. 24 4.1 Selection of Current Projects ................................................................................................. 24 4.2 Terminological Landscape ..................................................................................................... 26 4.3 Locally Developed Standards ................................................................................................ 31 4.3.1 CHOP .............................................................................................................................. 31 4.3.2 Swiss Medical Exchange (SMEEX) Initiative ................................................................... 31 4.3.3 Swiss Medical Reference System (SMERF) .................................................................... 32 4.4 Positioning of Switzerland within the International Community .......................................... 33 4.5 Terminological Standards for the Encoding of Procedures ................................................... 35 5 Results and Discussion .................................................................................................................. 39 5.1 Quantitative Benchmarking of Terminologies and Information Models .............................. 39 5.1.1 Terminologies ................................................................................................................ 39 5.1.2 Description and Motivation of complex assessment criteria ........................................ 41 5.1.3 Clinical Information Models .......................................................................................... 43 5.2 Terminologies ........................................................................................................................ 48 5.2.1 SNOMED ........................................................................................................................ 48 5.2.2 LOINC ............................................................................................................................. 49 5.2.3 ICD10 ............................................................................................................................. 49 5.2.4 Alpha‐ID ......................................................................................................................... 49 5.2.5 ATC ................................................................................................................................. 50 5.2.6 SMERF ............................................................................................................................ 50 5.2.7 Tentative Conclusion ..................................................................................................... 51 5.3 Information Models ............................................................................................................... 51 3 5.3.1 CDA R2 ........................................................................................................................... 51 5.3.2 CCR/CCD ........................................................................................................................ 53 5.3.3 openEHR ........................................................................................................................ 53 5.3.4 DICOM ........................................................................................................................... 53 5.3.5 RadLex ........................................................................................................................... 54 5.3.6 Tentative Conclusion ..................................................................................................... 54 5.4 epSOS ..................................................................................................................................... 55 5.4.1 Evaluation ...................................................................................................................... 55 5.4.2 Tentative Recommendation regarding epSOS .............................................................. 57 5.5 Selected Use Cases ................................................................................................................ 59 5.5.1 Practical Deployment of Terminology in Healthcare .................................................... 59 5.5.2 Swiss Vaccination Record .............................................................................................. 60 5.5.3 Electronic Prescription .................................................................................................. 61 5.6 Selection and Prioritization of Information Models .............................................................. 63 5.7 Toward a Family of Swiss Terminologies ............................................................................... 63 6 Recommendation for Switzerland ................................................................................................. 67 6.1 Recommendation for Regulation (Predefinition) of Content Structures .............................. 67 6.2 Procedure ad Responsibilities ............................................................................................... 67 6.3 Licensing Aspects ................................................................................................................... 68 6.4 Implementation Plan ............................................................................................................. 70 6.5 Roadmap ............................................................................................................................... 73 7 Glossary ......................................................................................................................................... 75 8 References ..................................................................................................................................... 77 4 1 Executive Summary This report describes semantic standards and semantic interoperability in the medical field. The eHealth coordination body “eHealth Suisse” of the confederation and cantons (Koordinationsorgan eHealth Bund‐Kantone) that is responsible for the implementation of national eHealth strategy mandated this document that is being prepared by the HES‐SO (Haute Ecole Spécialisée de Suisse Occidental) and ii4sm (International Institute for the Safety of Medicines). The document starts with a short introduction to the domain of semantic interoperability to limit the vast field at least slightly, followed by an explanation of the terms employed and the main concepts used. This section is meant to explain the frequently used terms and their precise meaning as sometimes these terms are used with varying meaning. The main interest