Transcript HIMA 5060 Health Informatics Health Informatics

HIMA 4160
Concepts in Health
Information Technologies
Data and Data Standards
Fall 2009
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Outlines
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Data
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Data, Information and Knowledge
Source of health care data
Properties of health data
Healthcare Standards
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Concepts
Important Health care standards
The desiderata of controlled terminology
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http://www.youtube.com/watch?v=YKF3Eo5m1P4
Clinical Data
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Elements of Data
• The patient in question
• The parameter being observed or
measured
• The value of the parameter in question
• The time of observation
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Type of Data
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Narrative
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Abbreviation
Phrases
Numeric
Continuous signal
Multimedia
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Who collects the data?
• Clinicians
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physicians
nurses
pharmacists
allied health
• Office and administration staff.
• Medical devices
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Use of Medical Data
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Create the basis for the historical record
Support communication among providers
Anticipate future health problems
Record standard preventive measures
Identify deviations from expected trends
Provide a legal record
Support clinical research
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Structure of Medical Data
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Conventional clinical data are semistructured.
Medicine vs. Computer
Computer needs more structured data.
Coding, terminology, vocabulary systems
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Data, Information and
Knowledge
Data
Information
Knowledge
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Data Standards
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What is standard?
Why do we need standard in health care?
What are some of the major types of
standard in health care?
What are some of the standards and
standard development organizations?
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Why do we need standard?
• To facilitate communication.
• To benchmark product or processes.
• To increase efficiency.
• To increase accessibility – ATM
• To decrease cost
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What are some examples of the
Standards?
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Languages
Transportation
Internet protocols
Operating systems
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Categories of standard based on
the development process
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Government mandates – HIPAA
Market oriented
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De facto – Microsoft Windows, VCR, Blue-Ray?
De Jure
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Ad hoc -- DICOM
Consensus – Many SDOs
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Standard Development
Organizations
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SDOs are organizations that develop and maintain the models, data
dictionaries, structure, syntax, and implementation materials for
electronic transaction standards between and within providers. All
designated SDOs maintain policies that meet the requirements of the
American National Standards Institute (ANSI), which accredits
standards committees and provides an open forum for participants
to identify, plan and agree on standards and assurance of due
process.
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ANSI SDO Process
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Consensus on a proposed standard
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Broad based public review and comment on draft standards
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Consideration of and response to comments submitted by voting
members of the relevant consensus body and by public review
commenter.
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Incorporation of approved changes into a draft standard
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Right to appeal by any participant that believe that due process
principles were not sufficiently respected during the standards
development in accordance with the ANSI-accredited procedures of the
standards developer
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ISO, ANSI, and SDOs
ISO
ANSI
ASTM
HL7
ASC
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Why Do We Need Standards in
Health Care
Facilitate Information Sharing
 Improve Efficiency
 Avoid Waste and Redundancy
 Improve Quality
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Health Care Standards
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Classifications, Nomenclature, Vocabulary
and Terminology
Data Interchange
Health Record Content and Structure
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Analogy -- Language
• Classifications, Nomenclature,
Vocabulary and Terminology – Words
and Semantics
• Data Interchange – Conversation
• Health Record Content and Structure –
Composition
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Classification -- Definition
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Classification: A clinical vocabulary, terminology, or
nomenclature that lists words or phrases with tier
meanings, provides for the proper use of clinical
words as names or symbols, and facilitate mapping
standardized terms to broader classifications for
administrative, regulatory, oversight, and fiscal
requirements.
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Nomenclature
• A recognized system of terms used in a
science or art that follows preestablished naming conventions; a
disease nomenclature is a listing of the
proper name for each disease entity
with its specific code number.
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Terminology -- Definition
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A set of terms representing the system of
concepts of a particular subject field; a
clinical terminology provides the proper
use of the clinical words as names or
symbols
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Vocabulary – Definition
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list or collection of clinical words or
phrases and their meanings.
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Classification Systems
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ICD
ICF
CPT
DRG
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Terminology
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SNOMED
LOINC
RxNorm
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Systematic Nomenclature of
Medicine – Clinical Term
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SNOMED-CT
Clinical terminology/nomenclature
College of American Pathologies +
National Health Service (NHS).
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SNOMED -- CT
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Concepts (344,000)
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Findings (swelling of arm)
Diseases (pneumonia)
Procedures (biopsy)
Observable entities (tumor stage)
Body structure (structure of thyroid)
Organism (DNA virus)
Substance (Gastric acid)
Pharmaceutical/biologic product (tamoxifen)
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SNOME – CT Concepts (cont.)
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Specimen (urine specimen)
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Physical object (suture needle)
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Physical force (friction)
Events (flash flood)
Environments/geographical location (intensive care unit)
Social context (organ donor)
Context – dependent categories (no nausea)
Staging and Scales (Nottingham ten-point ADL index assessment scale)
Attribute (controlled temperature)
Qualifier value (bilateral)
Duplicate concept (inactive concept)
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SNOMED -- CT
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913,000 Description/Synonym -- to
express the clinical concepts
~1.3 million semantic relationship to
enable reliability and consistency of data
retrieval
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SNOMED -- CT
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SNOMED CT Concepts are modelled using
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Hierarchies
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Each “child” must be a subtype of its “parent”
concept may have multiple parents
• Defining relationships
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Using attributes, concepts may be linked to each other
Only relationships that are necessarily true are included
• Appendicitis : site = appendix OK
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All appendicitis has location in the appendix.
• SLE : manifestation = anemia O no
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Only some people with SLE have anemia.
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The Principles behind SNOMED CT
structure
• SNOMED is concept based
• Each concept represents a unit of meaning
• Each concept has one or more human
language terms that can be used to describe
the concept
• Every concept has inter-relationships with
other concepts that provide logical computer
readable definitions. These include
hierarchical relationships and clinical
attributes.
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The Principe Behind SNOMED CT
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Relationship allow multiple
hierarchy
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Multiple Hierarchy
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Semantic Relationship
• SNOMED CT contains relationships that
link concepts to form logical computer
readable definitions.
• Logical definitions allow data to be
recorded in a flexible way, whilst
retaining the ability to analyze it in a
consistent fashion.
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Use
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SNOMED CT is one of a suite of designated data standards for
use in U.S. Federal Government systems for the electronic
exchange of clinical health information.
The National Library of Medicine (NLM), on behalf of the U.S.
Department of Health and Human Services, entered into an
agreement with College of American Pathologists for a perpetual
license for the core SNOMED CT (in Spanish and English) and
ongoing updates.
The contract provides to NLM a perpetual license to distribute
SNOMED within the NLM’s Unified Medical Language System
UMLS Metathesaurus for no cost use within the U.S. by both U.S.
government (federal, state, local, and territorial) and private
organizations.
The contract also covers updates to SNOMED CT issued by the
College of American Pathologists between June 30, 2003 and
June 29, 2008.
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LOINC
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Logical Observation Identifier Names and
Codes
Facilitate lab results transmission
Developed and maintained by Regenstreif
Institute at IU.
About 32,000 observation terms
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LOINC codes are created
systematically using a six axis model
• <component>:<property>:<timing>:<sy
stem>:<scale>:<method>
• 8331-1 Body temperature: TEMP: PT:
MOUTH: QN
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Six Primary Axes
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Component
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Kind of property
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Head of fetus, tricuspid valve, ventilator setting
Scale
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Point in time, study minimum, maximum in 8 hours
System
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Angle, area, length, mass, pressure, temperature
Timing
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Ejection fraction, heart beats, cardiac output, circumference
Quantitative, ordinal, nominal, narrative
Method
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Stated, measured, estimated
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RxNorm
• Standardized nomenclature for the
clinical drug
• Maintained by the National Library of
Medicine
• The name of a clinical drug combines its
ingredients, strengths, and form
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RxNorm
• Acetaminophen 500 MG Oral Tablet
for a generic drug name
• Acetaminophen 500 MG Oral Tablet
[Tylenol] for a branded drug name
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RxNorm
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UMLS
• A project at NLM to integrate many
nomenclature systems
• Three basic components
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UMLS Metathesaurus
SPECIALIST Lexicon
UMLS Semantic Network
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Data Interchange Standards
System A
System B
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HL7 Messaging Standard
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OSI Model level 7 – application
Define
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The data to be exchanged
The timing of the exchange
The communication of errors between application
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HL7 Message
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DICOM
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Digital Imaging and Communications in
Medicine.
For Medical Imaging Data Storage and
Transmission
Developed by American College of Radiology
and National Electrical Manufacturer Association
Foundations for PACS (Pictures Archiving and
Communication System)
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NCPDP standards
• National Council on Prescription Drug
Programs
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To create and promote data interchange
standards for the pharmacy services sector
of the health care industry
To provide information and resources that
educate the industry and support the
diverse needs of the members.
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NCPDP standards
• Batch transaction  Manufacturer Rebates,
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standard.
Billing unit
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Compound
transaction
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Data dictionary
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Diskette standard
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External code list
Formulary and
benefit standard
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utilization, plan,
formulary, market basket
and reconciliation flat file
standard.
Member enrolment
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Pharmacy ID card
Prior authorization
Professional pharmacy
Script standard
Telecommunication
standard
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ASC X12N Standards
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Electronic exchange of business
information
X12N deals with insurance industry.
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Health Record Content Standards
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HL7 EHR Functional Model
ASTM Continuity of Care Record Standard
OpenEHR
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HL7 EHR
FUNCTIONAL MODEL
• Need identified for a standardized
functional specification for electronic
health record systems
• Public-private partnership approached
HL7 to develop consensus standard
• Department of Health & Human Services
• Veterans Health Administration
• Health Information Management Systems Society
• Robert Wood Johnson Foundation
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HL7 EHR-S
FUNCTIONAL MODEL
• What is it?
• A reference list of functions that may be
present in an EHR System
• Described from user perspective
• Enables consistent expression of system functionality
• Focuses on systems that operate on the EHR vs. the
EHR as a singular entity
• Presents a superset of functions from which a user
specific subset can be generated
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HL7 EHR
FUNCTIONAL MODEL
• Consists of:
• Functional Outline divided into functions for:
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Direct Care
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Supportive
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Information Infrastructure
• Functional Profiles overlaying the Functional Outline
• Assigned priorities for the functions in the profiles
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HL7 EHR-S
FUNCTIONAL MODEL
• The EHR Functional model does not:
• Address or endorse technology used
• Include data content of the EHR
• Address or endorse the EHR-S as a single
system vs. system-of-systems
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HL7 EHR
FUNCTIONAL MODEL
• Uses of the HL7 EHR Functional Model?
• Facilitate describing end-user benefits in
terms of standard EHR-S functions
• Promote common understanding of EHR
functions
• Provide framework to drive requirements and
applications of next level standards (i.e. EHR
content, coding, information models)
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HL7 EHR FUNCTIONAL MODEL
• Overview
• Three sections in EHR-S Functional
Model
• Direct Care
• Supportive
• Information Infrastructure
• Over 130 functions
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CCR
• ASTM
• Prepared by the provider at the end of a
health care encounter in order to
provide a summary of the patient’s
health status
• Figure 1. Conceptual model.
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OpenEHR
UK + Australia
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promote and publish the formal specification of requirements for
representing and communicating electronic health record information,
based on implementation experience, and evolving over time as health
care and medical knowledge develop;
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promote and publish EHR information architectures, models and data
dictionaries, tested in implementations, which meet these requirements;
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manage the sequential validation of the EHR architectures through
comprehensive implementation and clinical evaluation;
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maintain open source "reference" implementations, available under
license, to enhance the pool of available tools to support clinical
systems; and
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collaborate with other groups working towards high quality,
requirements-based and interoperable health information systems, in
related fields of health informatics.
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Why is making standards in health
care so difficult?
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Resources
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http://www.snomed.org/
http://www.regenstrief.org/loinc/
http://umlsks.nlm.nih.gov/
http://www.hl7.org
http://www.astm.org/cgibin/SoftCart.exe/COMMIT/COMMITT
EE/E31.htm?L+mystore+cnfn0409
http://www.nahit.org.
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Summary
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Three types of standards
The importance of standards
The challenge of standardization in health
care
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