Medicines reconciliation is a key process to improve health, welfare and patient security. It is also recognized that semantically interoperable systems based on the use of health standards is an adequate strategy to achieve a reliable medicines conciliation process. This paper describes a solution developed for medicines reconciliation at the Hospital de Fuenlabrada in Madrid. It is based on the use of a CEN/ISO 13606 based patient summary that is shared between primary care and the hospital center. The 13606 norm and archetypes were used to achieve the semantic interoperability of the clinical information together with SNOMED CT and the Spanish National Medication Database. This approach has showed that it is feasible to achieve a patient security improvement in an innovative and collaborative way. Publication: David Moner, Marta Terrón, Carlos Angulo, Luis Lechuga, Pablo Serrano, José Alberto Maldonado, Francisco J. Farfán, Montserrat Robles. "Implementation of a CEN/ISO 13606 platform for medicines reconciliation". XXIII International Conference of the European Federation for Medical Informatics (MIE 2011), Oslo

1. Implementation of a CEN/ISO 13606
Platform for Medicines Reconciliation
David Moner1, Marta Terrón2, Carlos Angulo1, Luis Lechuga2,
Pablo Serrano2, José A. Maldonado1, Francisco J. Farfán2, and
Montserrat Robles1
1 ITACA Institute, Universitat Politècnica de València, Spain
2 Hospital de Fuenlabrada, Madrid, Spain
Contact: David Moner (damoca@upv.es)
MIE
2011

2. Project description
• Semantic interoperability must exist between all data sources.
– The CEN/ISO 13606 norm and archetypes were used together
with SNOMED CT and the Spanish National Medication
Database.
– The infrastructure is based on the use of the LinkEHR
Normalization Platform.
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Objective: To define and use a methodology and tools to guarantee
medicines reconciliation between the Hospital de Fuenlabrada in
Madrid and the primary care centres of its health area.

3. Medicines reconciliation
• Medicines reconciliation is the process of evaluating the
complete list of past and current medications of a patient to
avoid medication errors.
• It should be done at every transition of care in which new
medications are ordered or existing orders are rewritten.
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• Up to 67% of patients' prescriptions histories have
one or more errors.
• Up to 46% of medication errors take place when new
orders are written at transition points.

4. The CEN/ISO 13606 norm
• The CEN/ISO 13606 norm for the Communication of
the Electronic Health Record is the basis for health
information systems semantic interoperability.
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• It distinguishes two different models:
- The Reference Model contains basic and generic entities to represent
any kind of health information, together with context information.
- Archetypes are formal definitions of domain concepts whose purpose is
to provide a powerful, reusable and interoperable mechanism for the
creation, description, validation and query of EHR information.

5. LinkEHR® Normalization Platform
• The LinkEHR Normalization Platform facilitates the
creation of normalized and federated views of clinical
information which is distributed among heterogeneous
health information systems.
• LinkEHR is the only existing tool capable of handling
archetypes as a data normalization mechanism.
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www.linkehr.com

6. Architecture of the solution
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LinkEHR Platform
DATA NORMALIZATION
DATA INTEGRATION
NOMENCLATOR
DIGITALIS
LOGS
ARCHETYPES
INDEPENDENT
WEB VIEWER
HOSPITAL EHR
(SELENE)
Web Service
The integrated and normalized
view is offered through a web
service interface to be used
directly or to be integrated into
other systems
Primary care
OMI-AP
Hospital de Fuenlabrada
FARMATOOLS SELENE
Three basic steps:
1. Data integration
2. Archetype definition
3. Data normalization
1
2
3

7. Data integration
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OMI-AP
The primary care
information system
The hospital
electronic health
record system
The hospital
pharmacy information
system
Spanish National
Medication Database
SELENE
FARMATOOLS
Nomenclator
The LinkEHR Integration Engine builds a
virtual integrated XML view of all data of a
patient existing in heterogeneous and
distributed systems.

8. Archetype definition
Knowledge sources
Patient Summary
specifications
CKM archetypes
Medication
specifications
Existing systems and
clinical knowledge
Defined archetypes
Several CEN/ISO 13606 archetypes were
defined using the LinkEHR Editor
Medications Problems

9. Normalization
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The tool generates an XQuery
script that is able to transform
the legacy data into CEN/ISO
13606 EHR extracts
The LinkEHR Editor allows
the specification of mappings
and transformation rules
between archetypes and data
sources.
MAP

10. Deployment
• The LinkEHR Extract Server retrieves the integrated data, applies
the normalization XQuery to it and offers the normalized XML
documents through a web service interface.
• This service was integrated into the hospital EHR system (Siemens
Selene), providing access to the patient summary, including the
medication list from both the hospital and the primary care centres.
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11. Conclusions
• We have demonstrated that CEN/ISO 13606 and the
archetype methodology can be used in real environments.
– Medicines reconciliation is a clear example that semantic
interoperability technologies can highly improve the quality of
care and patient security.
• This project served as an introduction for several clinicians of
a new way of using standards and semantic technologies.
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This project has been financed in part by the Spanish Ministry Science and Innovation
under Grant TIN2010-21388-C02-01, and by the Health Institute Carlos III through the
RETICS Combiomed, RD07/0067/2001.

12. More info
• You can see this technology working at
MIE 2011 Workshop 14:
“CEN/ISO 13606 Implementation and
Communication of Health Information”
• Tuesday, 30th August, 13:45
• Room N4 Christiania