Transcript standards for interoperability

The Role of Standardization
Ronald Cornet, PhD
Dept. of Medical Informatics
Academic Medical Center – University of Amsterdam
Standards…
“The good thing about standards is
that there are so many to choose from”
Outline
 Examples
(I)
 Standards Development
 Standards Organizations
 Health IT Standards Organizations
 Examples (II)
 Importance of Standards
 Drawbacks of Standards
Standards – Example
≟ 2008
 1386 ‫ ديماه‬15 ≡ 5 January 2008
 1386
 “Early”
standards:
Time (second), Length (meter), Weight (kilogram)
 “New”
standards:
DICOM, HTTP, HL7v3, …
Standards – Example
Standards Development

Ad hoc
 A standard defined on-the-fly for a specific purpose
(e.g., the template of this presentation)

De facto
 Alphabet, English as “lingua franca”, Google

Government Mandate (“De jure”)
 Protecting patient data, privacy

Consensus
 Agreed by a group / committee; e.g., calling codes
(Iran: +98; Netherlands: +31)
Discrepancy
De Jure
De Facto
Standards organizations
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ANSI
CEN
IEEE
ISIRI
ISO
W3C
– American National Standards Institute
– European Committee for Standardization
– Institute of Electrical and Electronics Engineers
– Institute of Standards and Industrial
Research of Iran
– International Standards Organization
– World Wide Web Consortium
(Health) IT Standards organizations

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– Digital Imaging and Communications
in Medicine
HL7
– Health Level 7
IHTSDO – International Health Terminology Standards
Development Organization
ISO TC215 – Health informatics
OASIS
– Organization for the Advancement of
Structured Information Standards
WHO
– World Health Organization
DICOM
ISO TC215 – Health informatics

Working Groups
1.
2.
3.
4.
5.
6.
7.
8.
Data structure
Data interchange
Semantic content
Security
Health Cards
Pharmacy and Medicines business
Devices
Business requirements for Electronic Health Records
(Health IT) Standards Categories (I)
 Data
Exchange/Messaging Standards
 Contain instructions (or specifications) for format, data
elements, and structure in order to allow transactions to
flow consistently between systems/organizations
 E.g., HL7v2.x, HL7v3, DICOM

Terminology Standards
 Provide specific codes for clinical concepts (diseases,
allergies, medications)
 E.g., ICD-9, SNOMED CT
Standards Categories (II)
 Document
Standards
 Indicate which type of information is included
in a document and where it can be found
 E.g., Clinical Document Architecture (CDA)
 Conceptual
Standards
 Allow data to be transported across systems
without losing meaning and context
 E.g., HL7 RIM
Standards Categories (III)
 Application
Standards
 Determine how business rules are implemented
and how software systems interact
 E.g., Clinical Context Management
Specification (CCOW)
 Architecture
Standards
 Define data storage and distribution processes
 E.g., Public Health Information Network
(PHIN)
Standards – Examples
 ISO/OSI
Model
 HL7
 SNOMED
CT
HTTP, FTP
ASCII, MPEG
Sockets, NetBIOS
Transmission Control Protocol (TCP)
User Datagram Protocol (UDP)
Dynamic Host Configuration
Protocol (DHCP)
Internet Protocol (IP)
Ethernet
Point-to-point protocol (PPP)
RS-232, 10baseT, UMTS L1
HL7 – Health Level 7
 ANSI-accredited
Standards Developing
Organization
 Focus on clinical and administrative data
 Provides standards for interoperability
that improve care delivery, optimize
workflow, reduce ambiguity, and enhance
knowledge transfer
HL7 - organization
 Started
as an Ad hoc standards group
 Turned into consensus-based process
 Specification
of data interchange
 Originally focused on message syntax
HL7 standards
 Messaging
Standard
 HL7v2.4, HL7v3
 Reference
Information Model (RIM)
 Clinical Document Architecture (CDA)
 Clinical Context Management Specification
(CCOW)
 Arden Syntax for Medical Logic Systems
HL7 version 3
 Based
on Reference Information Model
(RIM)
 Data exchange
 Representation
 Terminology
 Clinical
Document Architecture (CDA)
More on Wednesday…
SNOMED CT
 Systematized
Nomenclature of Medicine
 Aiming at Semantic Interoperability
 Standardization of meaning
 Description of meaning
 Detailed description, e.g., “first episode of
severe, acute E-coli pneumonia with sudden
onset”
SNOMED CT
 Infective
Pneumonia:
More on Wednesday…
Drawbacks of Standards

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Proper standard may not yet exist
Standards development takes time and money
It is hard to find the most appropriate standard
There may be too many
Standards may change over time
Standards can be hard to comprehend
Standards may be hard to implement
Conformance testing may be hard
Standards may conflict
They may be expensive to use
Estimated effort 
Importance of Standards
No standards
Using standards
time 
Importance of Standards
 Increase
(vendor) acceptance
 Reduce (integration) cost
 Availability of off-the-shelf tools
 Maintenance
Applying standards
 Determine
context
 (future) collaborations, usage

Determine standards in relevant categories
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Architecture
Application
Conceptual
Document
Terminology
Data exchange / Messaging
Final example: Units
2
teams: design & implementation
 Specification: metric units
 Implementation group: English units (i.e.
pounds force instead of Newton)
 Conversion factor: 4.45
 Overlooked…
Mars Climate Orbiter
 Crashed
23-sept-1999
 Costs: US$ 125 million
Conclusion
千里之行，始於足下。
A journey of a thousand miles begins with a
single step
Round-up
 Standards
require short-term investment for
longer-term profit
 Applying standards is standing on the
shoulders of moving giants
 Focus on standardization of “higher layers”
(application, content and semantics)
More information
www.hl7.org
www.ihtsdo.org
www.iso.org
[email protected]