Implementation and management of a biomedical observation dictionary in a large healthcare information system.

OBJECTIVE: This study shows the evolution of a biomedical observation dictionary within the Assistance Publique Hôpitaux Paris (AP-HP), the largest European university hospital group. The different steps are detailed as follows: the dictionary creation, the mapping to logical observation identifier names and codes (LOINC), the integration into a multiterminological management platform and, finally, the implementation in the health information system. METHODS: AP-HP decided to create a biomedical observation dictionary named AnaBio, to map it to LOINC and to maintain the mapping. A management platform based on methods used for knowledge engineering has been put in place. It aims at integrating AnaBio within the health information system and improving both the quality and stability of the dictionary. RESULTS: This new management platform is now active in AP-HP. The AnaBio dictionary is shared by 120 laboratories and currently includes 50 000 codes. The mapping implementation to LOINC reaches 40% of the AnaBio entries and uses 26% of LOINC records. The results of our work validate the choice made to develop a local dictionary aligned with LOINC. DISCUSSION AND CONCLUSIONS: This work constitutes a first step towards a wider use of the platform. The next step will support the entire biomedical production chain, from the clinician prescription, through laboratory tests tracking in the laboratory information system to the communication of results and the use for decision support and biomedical research. In addition, the increase in the mapping implementation to LOINC ensures the interoperability allowing communication with other international health institutions.

Implementation of a platform dedicated to the biomedical analysis terminologies management.

BACKGROUND AND OBJECTIVES: Assistance Publique - Hôpitaux de Paris (AP-HP) is implementing a new laboratory management system (LMS) common to the 12 hospital groups. First step to this process was to acquire a biological analysis dictionary. This dictionary is interfaced with the international nomenclature LOINC, and has been developed in collaboration with experts from all biological disciplines. In this paper we describe in three steps (modeling, data migration and integration/verification) the implementation of a platform for publishing and maintaining the AP-HP laboratory data dictionary (AnaBio). MATERIAL AND METHODS: Due to data complexity and volume, setting up a platform dedicated to the terminology management was a key requirement. This is an enhancement tackling identified weaknesses of previous spreadsheet tool. Our core model allows interoperability regarding data exchange standards and dictionary evolution. RESULTS: We completed our goals within one year. In addition, structuring data representation has lead to a significant data quality improvement (impacting more than 10% of data). The platform is active in the 21 hospitals of the institution spread into 165 laboratories.