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Il referto (ri)trovato
           Appunti per l'architettura dell'informazione di un Fascicolo Socio-Sanitario Elettronico


                                            Giampaolo Armellin, Dario Betti, Annamaria Chiasera
                                                      IV Italian IA Summit - Pisa, 7 maggio 2010

Sunday, May 16, 2010
Index
 2




        Houston, we have a problem

        Goals

        Under the hood: la cooperazione applicativa

        IAs at work

        Three lessons learned
Sunday, May 16, 2010
Houston, we have a problem
 3




Sunday, May 16, 2010
Houston, we have a problem
   4




WORLD POPULATION AGEING: 1950-2050 DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS POPULATION DIVISION, United Nations New York, 2001


Sunday, May 16, 2010
Houston, we have a problem
   5




         Spesa sanitaria totale pro-capite USD
         Anni 1960-2006




OECD HEALTH DATA 2008 – Indicatori del G7
Sunday, May 16, 2010
Houston, we have a problem
 6




                        age
Sunday, May 16, 2010
Houston, we have a problem
 7




                       health expenditure
Sunday, May 16, 2010
Houston, we have a problem
 8




                       huge data
Sunday, May 16, 2010
Houston, we have a problem
 9




                       data confidentiality
Sunday, May 16, 2010
Houston, we have a problem
 10




                       plurality of consumers
Sunday, May 16, 2010
Houston, we have a problem
 11




                       citizen as errand boy
Sunday, May 16, 2010
Houston, we have a problem
 12




                       operator as scriba
Sunday, May 16, 2010
Goals
 13




                       goals of FSSE
Sunday, May 16, 2010
Goals
 14




                       quality of assistance
Sunday, May 16, 2010
Goals
 15




                       Patient empowerment
Sunday, May 16, 2010
Goals
 16




                       dematerialization
Sunday, May 16, 2010
Goals
 17




                       privacy
Sunday, May 16, 2010
Goals
 18




                       information from data
Sunday, May 16, 2010
Under the hood
 19




Sunday, May 16, 2010
Under the hood
 20




                        EMR    EMR       EMR




                       Lab    MMG    Ospedale




                                     EHR

                                                  FSSE


Sunday, May 16, 2010
Under the hood
                        Producer
                       21                                Consumer
                                                                     Legacy
                               Legacy                                 app
                                app


                             Connector                          Connector


                            Evento                                Evento
                            socio-                                socio-
                          sanitario                               sanitario

           FSSE
                                      Service               bus




                            Gestore          Indice Regionale
                         regole visibilità   eventi socio-san   BPM engine


Sunday, May 16, 2010
IAs at work
 22




Sunday, May 16, 2010
IAs at work




      “
 23

                   L’FSE contiene diverse informazioni inerenti allo
                   stato di salute di un individuo relative ad eventi
                   clinici presenti e trascorsi (es.: referti,
                   documentazione relativa a ricoveri, accessi al pronto
                   soccorso), volte a documentarne la storia clinica.
                   I dati personali sono collegati tra loro con modalità
                   informatiche di vario tipo che ne rendono,
                   comunque, possibile un'agevole consultazione
                   unitaria da parte dei diversi professionisti o
                   organismi sanitari che prendono nel tempo in cura
                   l'interessato
                   (fonte: Garante privacy).



Sunday, May 16, 2010
IAs at work




      “
 24


                 L’FSE contiene diverse informazioni
                 inerenti allo stato di salute di un individuo relative
                 ad eventi clinici presenti e trascorsi (es.: referti,
                 documentazione relativa a ricoveri, accessi al pronto
                 soccorso), volte a documentarne la storia clinica.
                 I dati personali sono collegati tra loro con
                 modalità informatiche di vario tipo che ne rendono,
                               un'agevole
                 comunque, possibile
                 consultazione unitaria da parte dei
                 diversi professionisti o organismi sanitari che
                 prendono nel tempo in cura l'interessato
                 (fonte: Garante privacy).

Sunday, May 16, 2010
IAs at work
 25




                       process analysis
Sunday, May 16, 2010
IAs at work
 26




                       scenarios
Sunday, May 16, 2010
IAs at work
 27




                       formalism
Sunday, May 16, 2010
28




Sunday, May 16, 2010
29




Sunday, May 16, 2010
30




Sunday, May 16, 2010
IAs at work
 31




                       classification
Sunday, May 16, 2010
IAs at work
 32

        Classificazione degli eventi: un’analisi/1

           contenuti omogenei, appartenenti al dominio
            socio-sanitario specifico;

           numero crescente e potenzialmente elevato di
            items-eventi;




Sunday, May 16, 2010
IAs at work
 33




                       Tratto da: Mauro Moruzzi, eHealth e Fascicolo Sanitario Elettronico, Milano, 2009


Sunday, May 16, 2010
IAs at work
 34

        Classificazione degli eventi: un’analisi/2

           numerosità delle tipologie di producer,
            consumer e degli scenari di fruizione;

           probabilità di modificare/integrare nel corso
            del tempo i criteri di classificazione (aggiunta
            attributi semantici)



Sunday, May 16, 2010
IAs at work
 35




                       event
Sunday, May 16, 2010
IAs at work
 36




                       change of state
Sunday, May 16, 2010
IAs at work
 37




                       message
Sunday, May 16, 2010
IAs at work
 38

        L’evento-messaggio

                             Metadati descrittivi e anagrafici




                             Metadati semantici




                             Dati




Sunday, May 16, 2010
IAs at work
 39

        I metadati di un evento

           “descrittivi”: ospitano i contenuti propri/
            esclusivi di ciascun evento (es: ID, data,
            abstract,…);

           “semantici”: attributi significativi dal punto
            di vista semantico (classificazione)



Sunday, May 16, 2010
IAs at work
 40

        Una proposta: la classificazione multidimensionale

           catalogare uno stesso evento sotto più
            categorie (facets), ciascuna descrittiva di un
            aspetto particolare dell’evento.

           Individuare insieme di attributi/metadati
            mutuamente esclusivi rappresentanti un
            aspetto “persistente” dell’evento.

Sunday, May 16, 2010
IAs at work
 41

        Per i metadati descrittivi: subset del Dublin Core
           Title
           Creator
           Contributor
           Description
           Date
           Format
           Identifier
           Language
           Relation


Sunday, May 16, 2010
IAs at work
 42

        Per i metadati di tipo “semantico”
           Subject
           Publisher
           Type
           Source
           Coverage


        ipotizziamo alcune faccette:
           appoggiate allo standard CRG
           innestate nel metadato Subject del set Dublin Core


Sunday, May 16, 2010
IAs at work
 43

       Categoria CRG Faccetta dell’evento socio-sanitario
       Oggetto         evento socio-sanitario (default)
       Tipo            tipologia di evento (domanda, visita specialistica, ricovero, …)
       Parte           operazioni/attività interne all’evento
       Proprietà       costo, quota di compartecipazione, …
       Processo        prestazione a cui l’evento è correlato
       Operazione      azione svolta in occasione dell’evento
       Prodotto        referto, prescrizione, lettera dimissioni, …
       Paziente        destinatario dell’evento (solitamente il paziente)
       Agente          soggetto mediante cui si svolge l’operazione (U.O., ufficio, …)
       Spazio          comune in cui avviene l’evento
       Tempo           fascia d’età del Paziente

Sunday, May 16, 2010
IAs at work
 44

       Categoria CRG Faccetta dell’evento socio-sanitario
       Oggetto         Evento socio-sanitario
       Tipo            Chiamata telesoccorso
       Parte           Identificazione utente e telediagnosi parametri vitali
       Proprietà       Costo forfettario
       Processo        Servizio di teleassistenza
       Operazione      Chiamata e monitoraggio paziente
       Prodotto        Verbale di incidente
       Paziente        Sottoscrittore servizio di Teleassistenza
       Agente          Centrale operativa Teleassistenza
       Spazio          Trento
       Tempo           > 80 anni



Sunday, May 16, 2010
IAs at work
 45

        L’evento-messaggio

                       Dublin core + dati anagrafici      Metadati descrittivi




                   Metadato Dublin Core “Subject” +       Metadati semantici
                            metadati CRG




                Es: condizione socio-sanitaria, verbale   Dati specifici
                    di incidente Telesoccorso (PDF)       (in funzione della tipologia di
                                                          evento)




Sunday, May 16, 2010
IAs at work
 46




                       UI design
Sunday, May 16, 2010
Tratto da: Mauro Moruzzi, eHealth e Fascicolo
                             Sanitario Elettronico, Milano, 2009


Sunday, May 16, 2010
Tratto da: Mauro Moruzzi, eHealth e Fascicolo
                             Sanitario Elettronico, Milano, 2009


Sunday, May 16, 2010
Tratto da: Mauro Moruzzi, eHealth e Fascicolo
                             Sanitario Elettronico, Milano, 2009


Sunday, May 16, 2010
Three lessons learned
 50




Sunday, May 16, 2010
Lesson learned
 51




                       does FSSE extend the life?
Sunday, May 16, 2010
Lesson learned
 52




                       we aren’t on a mission from God
Sunday, May 16, 2010
Thanks to
53



     Photos from Flickr licensed under a Creative Commons License:

        http://www.flickr.com/photos/extranoise/151980044
        http://www.flickr.com/photos/12392252@N03/2177175124
        http://www.flickr.com/photos/brykmantra/76765412/
        http://www.flickr.com/photos/unknowndomain/12518473
        http://www.flickr.com/photos/twose/887903401
        http://www.flickr.com/photos/repolona/3509726702
        http://www.flickr.com/photos/stiefkind/4280498481
        http://www.flickr.com/photos/gerlos/3119891607/
        http://www.flickr.com/photos/selma90/3675162262
        http://www.flickr.com/photos/dunechaser/142079357/
        http://www.flickr.com/photos/degeuzen/2980637951/
        http://www.flickr.com/photos/pong/288491653
        http://www.flickr.com/photos/andre5/4408196113
        http://www.flickr.com/photos/gavinbell/35089898
        http://www.flickr.com/photos/ilumb/5834003
        http://www.flickr.com/photos/29487767@N02/2973569421
Sunday, http://www.flickr.com/photos/purecaffeine/4325067780
        May 16, 2010
End of game
 54




                                Grazie dell’attenzione!

                                       Domande?

                       Dario Betti              Annamaria Chiasera
                       dbetti@gpi.it              achiasera@gpi.it




Sunday, May 16, 2010

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Il referto (ri)trovato. Appunti per l'architettura dell'informazione di un Fascicolo Socio-sanitario Elettronico

  • 1. Il referto (ri)trovato Appunti per l'architettura dell'informazione di un Fascicolo Socio-Sanitario Elettronico Giampaolo Armellin, Dario Betti, Annamaria Chiasera IV Italian IA Summit - Pisa, 7 maggio 2010 Sunday, May 16, 2010
  • 2. Index 2 Houston, we have a problem Goals Under the hood: la cooperazione applicativa IAs at work Three lessons learned Sunday, May 16, 2010
  • 3. Houston, we have a problem 3 Sunday, May 16, 2010
  • 4. Houston, we have a problem 4 WORLD POPULATION AGEING: 1950-2050 DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS POPULATION DIVISION, United Nations New York, 2001 Sunday, May 16, 2010
  • 5. Houston, we have a problem 5 Spesa sanitaria totale pro-capite USD Anni 1960-2006 OECD HEALTH DATA 2008 – Indicatori del G7 Sunday, May 16, 2010
  • 6. Houston, we have a problem 6 age Sunday, May 16, 2010
  • 7. Houston, we have a problem 7 health expenditure Sunday, May 16, 2010
  • 8. Houston, we have a problem 8 huge data Sunday, May 16, 2010
  • 9. Houston, we have a problem 9 data confidentiality Sunday, May 16, 2010
  • 10. Houston, we have a problem 10 plurality of consumers Sunday, May 16, 2010
  • 11. Houston, we have a problem 11 citizen as errand boy Sunday, May 16, 2010
  • 12. Houston, we have a problem 12 operator as scriba Sunday, May 16, 2010
  • 13. Goals 13 goals of FSSE Sunday, May 16, 2010
  • 14. Goals 14 quality of assistance Sunday, May 16, 2010
  • 15. Goals 15 Patient empowerment Sunday, May 16, 2010
  • 16. Goals 16 dematerialization Sunday, May 16, 2010
  • 17. Goals 17 privacy Sunday, May 16, 2010
  • 18. Goals 18 information from data Sunday, May 16, 2010
  • 19. Under the hood 19 Sunday, May 16, 2010
  • 20. Under the hood 20 EMR EMR EMR Lab MMG Ospedale EHR FSSE Sunday, May 16, 2010
  • 21. Under the hood Producer 21 Consumer Legacy Legacy app app Connector Connector Evento Evento socio- socio- sanitario sanitario FSSE Service bus Gestore Indice Regionale regole visibilità eventi socio-san BPM engine Sunday, May 16, 2010
  • 22. IAs at work 22 Sunday, May 16, 2010
  • 23. IAs at work “ 23 L’FSE contiene diverse informazioni inerenti allo stato di salute di un individuo relative ad eventi clinici presenti e trascorsi (es.: referti, documentazione relativa a ricoveri, accessi al pronto soccorso), volte a documentarne la storia clinica. I dati personali sono collegati tra loro con modalità informatiche di vario tipo che ne rendono, comunque, possibile un'agevole consultazione unitaria da parte dei diversi professionisti o organismi sanitari che prendono nel tempo in cura l'interessato (fonte: Garante privacy). Sunday, May 16, 2010
  • 24. IAs at work “ 24 L’FSE contiene diverse informazioni inerenti allo stato di salute di un individuo relative ad eventi clinici presenti e trascorsi (es.: referti, documentazione relativa a ricoveri, accessi al pronto soccorso), volte a documentarne la storia clinica. I dati personali sono collegati tra loro con modalità informatiche di vario tipo che ne rendono, un'agevole comunque, possibile consultazione unitaria da parte dei diversi professionisti o organismi sanitari che prendono nel tempo in cura l'interessato (fonte: Garante privacy). Sunday, May 16, 2010
  • 25. IAs at work 25 process analysis Sunday, May 16, 2010
  • 26. IAs at work 26 scenarios Sunday, May 16, 2010
  • 27. IAs at work 27 formalism Sunday, May 16, 2010
  • 31. IAs at work 31 classification Sunday, May 16, 2010
  • 32. IAs at work 32 Classificazione degli eventi: un’analisi/1  contenuti omogenei, appartenenti al dominio socio-sanitario specifico;  numero crescente e potenzialmente elevato di items-eventi; Sunday, May 16, 2010
  • 33. IAs at work 33 Tratto da: Mauro Moruzzi, eHealth e Fascicolo Sanitario Elettronico, Milano, 2009 Sunday, May 16, 2010
  • 34. IAs at work 34 Classificazione degli eventi: un’analisi/2  numerosità delle tipologie di producer, consumer e degli scenari di fruizione;  probabilità di modificare/integrare nel corso del tempo i criteri di classificazione (aggiunta attributi semantici) Sunday, May 16, 2010
  • 35. IAs at work 35 event Sunday, May 16, 2010
  • 36. IAs at work 36 change of state Sunday, May 16, 2010
  • 37. IAs at work 37 message Sunday, May 16, 2010
  • 38. IAs at work 38 L’evento-messaggio Metadati descrittivi e anagrafici Metadati semantici Dati Sunday, May 16, 2010
  • 39. IAs at work 39 I metadati di un evento  “descrittivi”: ospitano i contenuti propri/ esclusivi di ciascun evento (es: ID, data, abstract,…);  “semantici”: attributi significativi dal punto di vista semantico (classificazione) Sunday, May 16, 2010
  • 40. IAs at work 40 Una proposta: la classificazione multidimensionale  catalogare uno stesso evento sotto più categorie (facets), ciascuna descrittiva di un aspetto particolare dell’evento.  Individuare insieme di attributi/metadati mutuamente esclusivi rappresentanti un aspetto “persistente” dell’evento. Sunday, May 16, 2010
  • 41. IAs at work 41 Per i metadati descrittivi: subset del Dublin Core  Title  Creator  Contributor  Description  Date  Format  Identifier  Language  Relation Sunday, May 16, 2010
  • 42. IAs at work 42 Per i metadati di tipo “semantico”  Subject  Publisher  Type  Source  Coverage ipotizziamo alcune faccette:  appoggiate allo standard CRG  innestate nel metadato Subject del set Dublin Core Sunday, May 16, 2010
  • 43. IAs at work 43 Categoria CRG Faccetta dell’evento socio-sanitario Oggetto evento socio-sanitario (default) Tipo tipologia di evento (domanda, visita specialistica, ricovero, …) Parte operazioni/attività interne all’evento Proprietà costo, quota di compartecipazione, … Processo prestazione a cui l’evento è correlato Operazione azione svolta in occasione dell’evento Prodotto referto, prescrizione, lettera dimissioni, … Paziente destinatario dell’evento (solitamente il paziente) Agente soggetto mediante cui si svolge l’operazione (U.O., ufficio, …) Spazio comune in cui avviene l’evento Tempo fascia d’età del Paziente Sunday, May 16, 2010
  • 44. IAs at work 44 Categoria CRG Faccetta dell’evento socio-sanitario Oggetto Evento socio-sanitario Tipo Chiamata telesoccorso Parte Identificazione utente e telediagnosi parametri vitali Proprietà Costo forfettario Processo Servizio di teleassistenza Operazione Chiamata e monitoraggio paziente Prodotto Verbale di incidente Paziente Sottoscrittore servizio di Teleassistenza Agente Centrale operativa Teleassistenza Spazio Trento Tempo > 80 anni Sunday, May 16, 2010
  • 45. IAs at work 45 L’evento-messaggio Dublin core + dati anagrafici Metadati descrittivi Metadato Dublin Core “Subject” + Metadati semantici metadati CRG Es: condizione socio-sanitaria, verbale Dati specifici di incidente Telesoccorso (PDF) (in funzione della tipologia di evento) Sunday, May 16, 2010
  • 46. IAs at work 46 UI design Sunday, May 16, 2010
  • 47. Tratto da: Mauro Moruzzi, eHealth e Fascicolo Sanitario Elettronico, Milano, 2009 Sunday, May 16, 2010
  • 48. Tratto da: Mauro Moruzzi, eHealth e Fascicolo Sanitario Elettronico, Milano, 2009 Sunday, May 16, 2010
  • 49. Tratto da: Mauro Moruzzi, eHealth e Fascicolo Sanitario Elettronico, Milano, 2009 Sunday, May 16, 2010
  • 50. Three lessons learned 50 Sunday, May 16, 2010
  • 51. Lesson learned 51 does FSSE extend the life? Sunday, May 16, 2010
  • 52. Lesson learned 52 we aren’t on a mission from God Sunday, May 16, 2010
  • 53. Thanks to 53 Photos from Flickr licensed under a Creative Commons License: http://www.flickr.com/photos/extranoise/151980044 http://www.flickr.com/photos/12392252@N03/2177175124 http://www.flickr.com/photos/brykmantra/76765412/ http://www.flickr.com/photos/unknowndomain/12518473 http://www.flickr.com/photos/twose/887903401 http://www.flickr.com/photos/repolona/3509726702 http://www.flickr.com/photos/stiefkind/4280498481 http://www.flickr.com/photos/gerlos/3119891607/ http://www.flickr.com/photos/selma90/3675162262 http://www.flickr.com/photos/dunechaser/142079357/ http://www.flickr.com/photos/degeuzen/2980637951/ http://www.flickr.com/photos/pong/288491653 http://www.flickr.com/photos/andre5/4408196113 http://www.flickr.com/photos/gavinbell/35089898 http://www.flickr.com/photos/ilumb/5834003 http://www.flickr.com/photos/29487767@N02/2973569421 Sunday, http://www.flickr.com/photos/purecaffeine/4325067780 May 16, 2010
  • 54. End of game 54 Grazie dell’attenzione! Domande? Dario Betti Annamaria Chiasera dbetti@gpi.it achiasera@gpi.it Sunday, May 16, 2010