International Patient Summary Terminology — Why, what and how
The International Patient Summary (IPS) is a minimal and non-exhaustive set of basic clinical data of a patient, specialty-agnostic, condition-independent, but readily usable by all clinicians for the unscheduled (cross-border) patient care. The IPS Terminology covers the set of codes from SNOMED CT that can be used in the IPS.
It is free to use even in non member countries — so you do not need a SNOMED CT license to use it!!
What is a Patient Summary?
A patient summary is a standardised set of patient-related clinical data that consists of the most important health and care related data necessary to ensure safe and secure healthcare. This summarized version of the patient’s clinical data gives health professionals the essential information they need to provide care in the case of an unexpected or unscheduled medical situation (e. g. emergency or accident).
The International Patient Summary (IPS) is useful in situations where a citizen may travel from their home country and require unexpected health care from a locality that falls under a different jurisdiction. Readily usable by clinicians, the primary use case for the IPS is to support cross-border and unscheduled patient care. However, it also has the potential to be used in many other scenarios where a patient crosses health information systems, such as travel between provinces/states, cities or organizations that use a different Health Information System and require a summary for immediate care. Here is an overview of the sort of information that the IPS contains:
Why it matters
First, the `free` nature of the IPS means that we now have a mechanism to record and share the summary of a patient internationally across borders in an electronic format. A similar precursor in this space is the epSOS project that was initially created for cross-border patient care in the European Union, but then was extended in scope. epSOS, meaning “Smart Open Services for European Patients”, was a large-scale pilot testing across Europe for the cross-border sharing of a patient’s essential health data in case of unplanned care (the patient summary) and the electronic prescription (ePrescription). It spanned across 25 Countries and about 50 beneficiaries. epSOS resulted in the development of a solid basis for the ePrescription and patient summary services, considering: governance, use cases, data content, semantics, specifications, architecture, testing mechanisms, etc. The epSOS based its interoperability on ICD for diagnosis, however SNOMED CT is a much more comprehensive representation of medical conditions.
So the availability of the IPS now ensures that similar initiatives can rely on SNOMED CT for sharing.
IPS Terminology — A new dedicated terminology
The IPS Terminology is the next evolution of the HL7 IPS free set, providing advanced terminology features for non-Affiliates to use in their IPS implementations. It is a minimal, non-exhaustive set of data elements defined by ISO/EN 17269 and delivered by HL7 in both CDA and FHIR using a curated set of SNOMED CT terms.
Those of you following this space might wonder how the IPS Terminology relates to the Global Patient Set that is also released by SNOMED International. So here is a quick summary of their features and differences.
If you read the guidance by SNOMED International, you will note that they recommend against using the IPS in a country that already has a license for SNOMED CT. This is important because, the IPS is a subset and only when you want to exchange information with a non member country, you need to create a restricted subset of the patient record. So how then do you share information with a country that does not have a SNOMED CT license? Here is SNOMED International’s recommendation:
To share IPS data with non-Affiliates, licensed users may choose to refer to the IPS Reference Set. This reference set identifies the subset of key concepts from the IPS Terminology and is available as a supplementary package from SNOMED International’s MLDS service.
The IPS Terminology is a promising starting point for a shareable patient record that is based on more than some terms and codes. Please note that the IPS Terminology is in its beta version for focused stakeholder testing and feedback. Given the `sub-ontology` (read that as all the clever stuff — SNOMED CT relationships) that sits behind the IPS, we could start to reuse information in it in different ways — think AI, machine learning. If you are unsure how SNOMED CT’s relationships (in the subonotlogy) could be useful in practice, please read part-2 of our SNOMED CT Intro Series that covers this. However, this is a starting point and a lot of thinking is being done in the HL7 world around the IPS. We believe that one of the most important challenges in cross-border interoperability is sharing of lab results, which support ~70% of all clinical pathways and decisions. There is an opportunity here to leverage some of the work that is being done by #NHS Digital in the UK to extend the IPS. We have previously discussed how sharing of lab results could be enabled by a SNOMED CT based Community PaLM (Pathology and Lab Medicine) extension. So watch the space!