1. What CareComcan do by CEO Jacob Boye Hansen &Project Manager Annika Sonne Hansen

2. Overview Syntactic and Semantic Interoperability –Example (Alexander Graham Bell) HealthTerm product The epSOS project Advantages Security Quality Cost Savings

3. Syntactic but not Semantic Interoperability ラドクリフ、マラソン五輪代表に1万m出場にも含み Bonjour mademoiselle. Ça va bien?

4. Syntactic AND Semantic Interoperability Jes thnak vi, kaj kiel vi fartas? Bonan matenon maltrafas, vin estas bone? One common language is necessary – here it is Esperanto

5. How do your terminologies & classifications work today? SNOMED CT® Export SNOMED CT ® server HealthCare system HealthCare system Web interface ICD-10 ICD-10 server Export HealthCare system Web interface ICF ICF server Export Web interface Other classifications Other classification servers HealthCare system Export X numbers of terminologies and classifications X numbers of servers, database licences & software applications X numbers of exports & web interfaces X numbers of HealthCare systems

6. How should your terminologies & classifications work: SNOMED CT® HealthTerm® terminology & classification server HealthCare system HealthCare system ICD-10 HealthCare system Web interface ICF Other classifications HealthCare system X numbers of terminologies and classifications 1 server, 1 database licence & 1 software application 1 web interface X numbers of HealthCare systems

7. What is HealthTerm about: One repository for all terminologies and classifications. A one-stop ontology service Web application with: Concept Browser Request & Editing module Mapping module Subset module Qualification module Translation module Distribution module Workflow mechanism History mechanism

8. Web application: User controlled access through the internet No local installation All data in real time No data exchange

9. Concept Browser: Access to different terminologies and classifications is controlled by user setup

10. Concept Browser: Show all terminologies and classifications in the same browser window Concepts and terms shown in their context.

11. Concept Browser: Display of user interface and content is based on language setup Local language of terminologies & classifications requires translation

12. Request & Editing: Maintenance of terminologies and classifications Suggest new or missing concepts and terms in the request module User controlled access

13. Request & Editing: Create new concepts or terms Edit existing concepts Edit or create descriptions Edit or create relations Edit existing terms Edit or create properties Validate Publish

14. Request & Editing: Since it is a web application new or edited concepts and terms will be available for all other users the same second they have been published No data exchange All terminologies and classifications can be maintained on the same database with the same application User controlled access

15. Mapping: Mapping between different terminologies & classifications Mapping between clinical and accounting classifications can prevent double entries and ensure more correct financial settlements

16. Mapping: Mapping between local and international classifications for exchange of clinical & statistical data Quick map feature Workflow mechanism to ensure quality

17. Subset: Create subsets in order to get a manageable amount of concepts or terms to work with: Subsets for editing Subsets for mapping Subsets for qualification Subsets for translation Clinical subsets for distribution purposes Workflow mechanism to ensure quality

18. Qualification: Qualification to validate clinical use of concepts and terms Qualification to add synonyms, clinical dialects and layman’s language This can be done at different levels, and allows distribution of clinical subsets for use in different contexts to ensure semantic interoperability Workflow mechanism to ensure quality

19. Translation: Translate to local language based on the context Get help from previous translations in same translation project or other translation project Apply term references or web links that supports the translation Workflow mechanism to ensure quality

20. Translation: Monitor progress

21. Distribution: Distribute at realm or context level: Full export Delta export Custom Export Distribute different formats

22. Workflow mechanisms: Different workflows in different modules Ensuring quality in data enrichment Subset Selection Translation Service Provider Batch creation (Concept Manager) Translation Translation Review Subject Matter Expert Editorial Board Internal Review Concept Published

23. History mechanisms: History for the different workflow steps History for terminologies and classifications

24. Data at different levels: All data can be shown and maintained at different levels in order to cope with different use of data at different levels: International level National level Regional level Local level Specialist level General level Public level

25. Perspective: Subject Matter Expert Translation Service Provider IT Suppliers EHR IHTSDO National Authorities WHO-FIC Local Authorities CCI/OQLF Regional Authorities Hospital General Practitioner Community Care

26. The maintenance covers e.g. the translation and transcoding (mapping) process where each MS translates to local language and transcodes from local classification(s) to epSOSclasifications Page 26 Terminology maintenance Valueset selection Service Provider Batch creation (Concept Manager) Translation / transcoding Review Subject Matter Expert Maintenance workflow Subsets Terminology Repository Editorial Board Internal Review Central codingsystems Local codingsystems Published

27. Terminology Maintenance Tool Subject Matter Expert Translation Service Provider IT Suppliers WHO (ATC) National Authorities WHO (ICD 10) LOINC Mapping expert Classification Centre #1 Classification Centre #2 Classification Centre #3

30. Advantages – CostSavings All classifications are maintained and further developed in ONE place only Many external consultancy hours may be saved by having ONE system only that does much of the work for you You can save on hardware and software, as thefunctionality is in ONE place only Internal time savings by keeping data up-to-date in ONE place only Error corrections and manual updates are minimised No longer any reason to keep track of several copies of (almost) identical classifications. Previously this work had to be repeated for every new system to be integrated Medicine lists are identical at all hospitals. Centrally managed, which drugs are used/recommended (price/quality)

31. Classification broker PAS EMR Labsys Patho-logy Ambu-lance Micro-biology Clinical and administrative staff can access HT directly through the user interface All administrative and clinical systems retrieves codified information from one place only Health-Term® All terminologies, classifications and local code books are maintained one place only All hospitals draw upon the same service Regional org. classif., ICD-10, SNOMED CT, IUPAC, ATC, local code books, etc. etc.