Ma présentation au séminaire 12 du Congrès EAHP de Genève le 24 mars 2006

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11th
Congress of the EAHP
Palexpo Congress Centre, Geneva, Switzerland,
22-24 March 2006
Simon Letellier,
Hospital pharmacist, medical informatics MD
CHS de la Sarthe, Le Mans, France
simon.letellier@phast.fr
Context :Context :
11stst
aspect :aspect : International PlayersInternational Players
in Health Care Standardsin Health Care Standards
22ndnd
aspect :aspect : Communication processCommunication process
for interoperabilityfor interoperability

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International PlayersInternational Players
in Health Care Standardsin Health Care Standards
11stst
aspect :aspect :

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Who are the InternationalWho are the International
Players in Health CarePlayers in Health Care
Standards?Standards?
Technical
committee 215
Health Informatics
Technical
committee 251
Health Informatics
Health Care
Messaging
Standards
Health Level Seven
European
Committee for
Standardization

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Making World Health CareHealth Care
Standards
TC 215
AFNORDIN
National levelNational level
European levelEuropean level
Worldwide levelWorldwide level

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• WG1 :WG1 : Health RecordsHealth Records
• WG2 :WG2 : Messaging and CommunicationMessaging and Communication
ArchitectureArchitecture
• WG3 :WG3 : TerminologyTerminology
• WG4 :WG4 : SecuritySecurity
• WG5 :WG5 : Smart CardsSmart Cards
• WG6 :WG6 : e-pharmacye-pharmacy
Technical Committee 215

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//
• cen : « academic » view
 work on standard as norm
• HL7 : « pragmatic » view
 work on functional standard

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• Technical Board of CEN decided in 1990 that
many of the issues that needed standards for
health informatics would best be solved on a
European scaleEuropean scale rather than national and
created the TC 251.
• That position now seems to be changing with
the creation of ISO TC 215
and the emergence of HL7 as an international
standard.
• CEN has moved to a position of sharingsharing and
cooperationcooperation in the international community.

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• WG1 :WG1 : Information models
• WG2 :WG2 : Terminologies
• WG3 :WG3 : Security, safety, and quality
• WG4 :WG4 : Technology for interoperability
 Nothing specially dedicated to
Pharmacy.

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BSI
SAI
ON
IBN
BASMP
ABNT
CSSN
DPS
ANSI
CSNI
IRAM
INTECO
ICONTEC
KATS
AFNOR
SFS
EOS
INEN
DS
DZNM
MSZT
BSN
NSAI
STIR
BIS
IDHKSAR
KEBS
JISC
UNI
SIIELOT
DIN
BPS
INDECOPI
DGSM
NSF
SNZ
NNI
SNIMA
MOLDST
DGN
DSM
SEE LST
AENOR
SMIS
UNMS
PSB
SASO
GOST-R
IPQ
FONDONORMA
TCVN
UNIT
SSUAE
TSE
TTBS
TISI
SNV
SIS
SLSI
SCC
EVS
CSM
LVS
MSA
PKN
SZS
DSTU
ASRO
DIN National Standardization Bodies
NEN
SIST
SUTN
ASRO
IST
CNI
CYS

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International AffiliatesInternational Affiliates
• JapanJapan
• KoreaKorea
• LithuaniaLithuania
• New ZealandNew Zealand
• South AfricaSouth Africa
• SwitzerlandSwitzerland
• TaiwanTaiwan
• The NetherlandsThe Netherlands
• TurkeyTurkey
• United KingdomUnited Kingdom
• and more ...and more ...
• ArgentinaArgentina
• AustraliaAustralia
• BrazilBrazil
• CanadaCanada
• ChinaChina
• Czech RepublicCzech Republic
• DenmarkDenmark
• FinlandFinland
• FranceFrance
• GermanyGermany
• IndiaIndia

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France
2004
Italy
2003
Spain
2003
Denmark
2003
Germany
1995
Netherland
s 1996
Ireland
2003
UK
2000
Bulgaria
2005
Poland
2003
Finland
1996
Croatia
2001
Portugal
2006 ?
Switzerland
2000
Austria
2006 ?
Czech Republic
2001
Lithuania
2002
Latvia
2006 ?
Sweden
2006 ?
affiliates in Europeaffiliates in Europe

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Is there anything about
pharmaceutical standards ?
• cen : [ENV« EuroNorm Vornorm » draft standard]
– ENV 13607:2000  messages on medicine prescriptions
– ENV 12610:1997  pharmaceutical product identification
• HL7 v3 : [From Draft Standard to Normative state]
– Pharmacy domain  process and messages
– Medication domain  pharmaceutical product identification

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Communication processCommunication process
for computer interoperabilityfor computer interoperability
2nd aspect :2nd aspect :

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Semantic
interoperability
Functional
interoperability
What is computerWhat is computer
interoperability?interoperability?
• Although an intuitive answer is easy,
a specific response is more complex
“The ability of two or more systems or components
to exchange information and to use the information
that has been exchanged.”
[IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990]

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The Semiotic TriangleThe Semiotic Triangle
C.K Ogden and I. A. Richards. The Meaning of Meaning.
“Drug”
Concept
Referent Symbol
SymbolizesRefers to
Stands for

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From humans to computersFrom humans to computers
I dispense
a drug

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The Communication ProcessThe Communication Process
Concept
Referent
Refers to Symbolizes
Stands for
Refers toSymbolizes
Stands for
Concept
Symbol Symbol
Semantics
I dispense
a drug Referent“Drug” “Drug”

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The Communication ProcessThe Communication Process
Concept
Referent
Refers to Symbolizes
Stands for
Refers toSymbolizes
Stands for
Concept
Symbol Symbol
Semantics
I dispense
a drug Referent
Syntax
“Drug” “Drug”

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The Communication ProcessThe Communication Process
Concept
Referent
Refers to Symbolizes
Stands for
“Drug”
Refers toSymbolizes
Stands for
“Drug”
Concept
Symbol Symbol
Semantics
I dispense
a drug Referent
Syntax
Shared Context
ContextContext ContextContext

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From humans to computersFrom humans to computers
Je dispense
un
médicament
I dispense
a drug
Translator

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Je dispense
un
médicament
EAI: «translator» server
No brain , no cognition.
I dispense
a drug
From humans to computersFrom humans to computers
[EAI: Enterprise Application Integration, the integration of data between applications in a company.]

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?
I dispense
a drug
No brain , no cognition.
From humans to computersFrom humans to computers

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The Communication Process
Information Model
/ Data Model
Shared Context
Concept
Refers to Symbolizes
Stands for
“Drug”
Refers toSymbolizes
Stands for
“Drug”
Concept
Symbol Symbol
I dispense
a drug
Lexicon
(dictionary)
ContextContext ContextContext
Referent Referent

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The Communication Process
Information Model
/ Data Model
Concept
Refers to Symbolizes
Stands for
Refers toSymboliszs
Stands for
Concept
Symbol Symbol
I dispense
a drug
Lexicon
(dictionary)
ContextContext ContextContext
Formal Shared
Context
Terminologies Terminologies
Referent
“Drug” “Drug”
Referent

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How to improve
communication ?
Define 2 elements :
– Semantics / Vocabulary : definition from a dictionary
• Ex: dispense blue pharmacist tablet
– Syntax / Grammar : structure for the
message/sentence
• Ex: subject-verb-complement-adjectivesubject-verb-complement-adjective
Define the [global english] globish language for
pharmaceutical softwares (Formal Shared Context) :
HL7-speak
 “Pharmacist” “dispense” “blue” “tablet”

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Messages : communication
and information
• Vocabulary for content : CIOsp (Fr) / DM+D (UK) /
G-standaard (NL)
– Description of medication content (and model)
• Grammar for structure: XML & PN13/HL7v2
– Born with WebPages (HTML), XML defines (only)
structure inside messages.
– Description of messages in pharmaceutical process

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Story-boards
of our pharmaceutical
practices
European
best practices
Seamless
computer
communication
In conclusion …
Shared Context