Interoperability and biology: the technical and functional foundations have been laid

Telemedicine | 07 Feb 2011
The view of Jean-François Parguet and Professor Eric Lepage.
By Jean-François Parguet, ASIP Santé’s Director of Reference Frameworks, Architecture and Security, and Professor Eric Lepage, Director of the the Paris hospitals authority (AP-HP) Centre of Competences and Services for Patient Information Systems.
Professeur Eric LepageIn France, hundreds of thousands of biology test reports are produced every day. In the context of the computerization and exchange of health data, the challenge is to provide healthcare professionals with simple, reliable IT tools that enable them to view this medical data, with the objective of optimizing patient treatment. The establishment of ASIP Santé in 2009, with its specific roles to consolidate interoperability between information systems in the health sector, gave a new boost to the work that was already being conducted by various healthcare stakeholders.

For the last few years, the AP-HP has been using the LOINC [1] international nomenclature, with the aim of standardizing a catalogue of biology analyses across all of its hospitals and clinics. This has considerably enhanced the international nomenclature, and a systematic translation of all of its names has been produced. Thanks to this catalogue, the AP-HP is able to use the nomenclature in its treatment processes, whenever biology analyses and test results are requested.
In parallel, and in keeping with its missions to promote the development and evolution of medical laboratory analysis software, the French aboratory informatics agency (SFIL)[2]  has generated a French translation of the LOINC reference framework names and codes most commonly used in analyses in France..

In late 2009, under the aegis of ASIP Santé, the AP-HP and the SFIL took the decision to merge their translations, in order to produce a LOINC reference standard in French for presenting biology test results [3] . This reference framework is now an integral part of the health information systems interoperability framework; it was approved by ndustry representatives in October 2009, and has been published by SIP Santé in the national Reference Frameworks Repository. All of the ranslations of the LOINC names and codes are currently being ntegrated into this reference framework.
In parallel, the AP-HP and the SFIL have both directly contributed to ASIP Santé’s drafting of the HL7 CDA model for electronic biology reports, then the approval process for that model in April 2010, alongside industry representatives; the model is now available in the health information systems interoperability framework.

With the advent of these two reference frameworks – LOINC and the CDA report model – biology test results can now be exchanged among healthcare professionals, and shared within the electronic health record (DMP), a service that commenced nationally on 5 January 2011. The format and semantics of these test results are standardized, enabling doctors receiving or consulting them to integrate them into their own local patient files, no matter which laboratory issued them. Doctors can thus now incorporate their patients’ biology test histories into their own local patient files, and monitor (including in graphic format) the development of a particular parameter over time (for example, they can monitor the prothrombin levels of a patient receiving anticoagulant treatment).

In this field, the AP-HP is something of a forerunner, because it has been using Integrating the Healthcare Enterprise (IHE) profiles, including the HL7 standards, for several years in its biology activities, long before the health information systems interoperability framework was published. The AP-HP now uses these IHE biology profiles in its institutions to support biology test request and result workflows between its clinical units and laboratories, and to circulate its unified catalogue of analyses, ensuring that it is available in any of its ystems that may be utilized to prescribe biology tests.

The AP-HP has chosen to add data into DMPs from its own omputerized patient files, which will be the single point of interface between the hospital information system and the DMP. In the short term, the AP-HP will be able to enter medical documents into the DMP, such as pathology reports and reports from other specialist fields, in CDA format with minimum structuring (level 1). Then, as the new computerized patient records are rolled out, its hospitals and clinics will switch to the highly structured (level 3) health information systems interoperability framework report model.

[1] Logical Observation Identifiers Names and Codes (LOINC®)
[2] Set up in 1985, the French laboratory informatics agency (SFIL) is a scientific association under the terms of the French Law of 1901, whose members include private and hospital biologists, and industry representatives.
[3] Cf Press Release of 19 July 2010 (in french) entitled “Coordinating healthcare professionals”: Biology leads the way in structuring health data.