topic 05 standards in biomedical informatics part 2 · standards in biomedical informatics –part...
TRANSCRIPT
Kevin Robertson, MBA
Topic 05Standards in Biomedical Informatics – Part 2
ACS-2816 Health Information Systems
Winter 2020
Topic 5 Outline
2
Why do we need standards in health informatics?
What is Interoperability?
What are the relevant standards and how they apply within the field?
Topic 5 Outline
3
Standards Introduction
Undertakings and Organizations
Code Terminologies and Nomenclatures
Interoperability
Data-Interchange Standards
Final Thoughts on Standards
Reading: Biomedical Informatics, 4th Ed, Ch 7, 211-252
Nomenclatures
4
Definition 1 : name, designation … the changing nomenclature of
her streets is even more baffling …— Cornelia O. Skinner 2 : the act or process or an instance of naming
nomenclature … is at its simplest the task of assigning a name to each distinct species— R. I. Smith
3a : a system or set of terms or symbols especially in a particular science, discipline, or art the nomenclature of inorganic chemistry
b : an international system of standardized New Latin names used in biology for kinds and groups of kinds of animals and plants
Reference: https://www.merriam-webster.com/dictionary/nomenclature
Coded Terminologies & Nomenclatures –Motivation for Controlled Terms
5
Benefits
Simplify systems development
Facilitate exchange and communication of coded medical information
Limitation
Not good enough for all users
No wide acceptance
Coded Terminologies & Nomenclatures –Motivation for Controlled Terms
6
ISO Standard 1087 on Terminology
Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.3, p279
Coded Terminologies & Nomenclatures –Motivation for Controlled Terms
7
Medical data encoding levels
Abstraction – examine recorded data and then select a terminology item to label it
Representation – process to code as much detail as possible
Domain of discourse
Need a good match for coding
Coded Terminologies & Nomenclatures –Motivation for Controlled Terms
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Content of the standardDegree of coverageDegree of assembly of terms for codingOverall structure of the terminology (e.g.
lists, hierarchy, semantic networks, etc.)Availability of synonyms Possibility of redundant terms
Terminology maintenance
Coded Terminologies & Nomenclatures –Specific Terminologies: ICD-CM
9
International Classification of Diseases and its Clinical Modifications (ICD – CM)
ICD-9 World Health Organization 1977
ICD-10 World Health Organization 1992
Include terms for: diseases, medical-specialty diagnoses, health status, disablements, procedures and reasons for contact with providers
Coded Terminologies & Nomenclatures –Specific Terminologies: ICD-CM
10Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.4, p281
ICD-9-CM Examples
CM
CM
Coded Terminologies & Nomenclatures –Specific Terminologies: DRGs
11
Diagnosis-Related Groups (DRGs)
Developed in the US (Yale University)
DRGs coding system is an abstraction of an abstraction Groups ICD-CM codes to simplify reimbursements
Provides separation of cases based on severity that affect cost and length of stay
Coded Terminologies & Nomenclatures –Specific Terminologies: DRGs
12Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.6, p284
DRGs Examples “Simple Pneumonia”code is used insteadof several ICD-9 codes
Coded Terminologies & Nomenclatures –Specific Terminologies: ICPC
13
International Classification of Primary Care (ICPC)
Developed by WONCA 1987
Coding system for primary care encounters
Classify diagnostic concepts that are partially mapped to ICD-9
It uses post-coordination of atomic terms by using multiple codes to describe the data
WONCA - World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians
Coded Terminologies & Nomenclatures –Specific Terminologies: CPT
14
Current Procedural Terminology (CPT)
Developed by AMA 1966
Coding system for diagnostic and therapeutic procedures for billing and reimbursement
Differentiate codes based on cost
It is most accepted nomenclature in the US for reporting procedures and services for federal / insurance reimbursements
AMA – American Medical Association
Coded Terminologies & Nomenclatures –Specific Terminologies: SNOMED-CT
15
Systemized Nomenclature of Medicine –Clinical Terms (SNOMED-CT)
It supports multi-axial coding patient information by post-coordination of terms
It supports a logic-based structure called Reference Terminology
It is considered to be the most comprehensive clinical healthcare terminology
Coded Terminologies & Nomenclatures –Specific Terminologies: SNOMED-CT
16 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.7, p286
SNOMED-CTReferenceTerminologyExample
MultipleHierarchy
Definition info
Ways to postcoordinate
Names
Backwardcompatibility
Coded Terminologies & Nomenclatures –Specific Terminologies: LOINC
17
Laboratory Observations, Identifiers, Names and Codes (LOINC)
Identifies medical laboratory observations and others observations like vital signs, ECG, etc.
Used by data interchange standards
Health Level 7 (HL7)
Integrating the Healthcare Enterprise (IHE)
18Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.9, p290
Coded Terminologies & Nomenclatures –Specific Terminologies: LOINC
LOINC example acronyms:
Example
Coded Terminologies & Nomenclatures –Specific Terminologies: Drug Codes
19
Several projects active for drug codes
Some projects
The WHO Drug Dictionary
ATC - Anatomical-Therapeutic-Chemical classification
NDC – National Drug Codes
RxNorm
Coded Terminologies & Nomenclatures –Specific Terminologies:Medical Headings
20
Medical Subject Headings is a terminology by which the world medical literature is indexed
Terms can appear in multiple places in the hierarchy
Plays a central role in UMLS (see page 24)
Coded Terminologies & Nomenclatures –Specific Terminologies:Medical Headings
21 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.10, p291
Medical SubjectHeadingsExample
‘Pneumonia’ means‘lung inflammation’
‘Pneumonia’ means‘lung infection’
Coded Terminologies & Nomenclatures –Specific Terminologies: UMLS
22
UMLS - Unified Medical Language System
Compendium of several vocabularies (e.g. ICD, SNOMED, etc)
Provides a mapping structure for a large number of those vocabularies
Meta-thesaurus is the principal component
Maintained by the US National Library of Medicine
Coded Terminologies & Nomenclatures –Specific Terminologies: UMLS
23 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.13, p295
UMLSExample
Other terminologiesconcepts
Preferred name
Semantic Network
Synonyms
Topic 5 Outline
24
Standards Introduction
Undertakings and Organizations
Code Terminologies and Nomenclatures
Interoperability
Data-Interchange Standards
Final Thoughts on Standards
Interoperability
25
The ability of clinical applications, systems, organisations and clinical teams to seamlessly work together
Originally designed for technical integration but now has moved beyond that to include cross functional collaboration and data reuse
Requires standards integration, interpretation and data presentation
Interoperability - Challenges
26
Goes beyond local data sharing e.g. Pan-Canadian
Expands beyond organisational boundaries E.g. Acute Care & Private Clinics
Workflows extend beyond the boundaries of one organisation and need to integrate
No standard application architectures or technology controls
Data-Interchange Standards
27
Need to interconnect health care applications
Therefore we need Data-interchange standards
Several efforts to define data-interchange standards in separate healthcare domains
General concepts and requirements
Data-Interchange Standards – General Concepts and Requirements
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Sender – transmits data to another system
Receiver – gets data required to carry out task
Transaction set – well defined task steps
Need to agree
Format & content
Terminology
Delivery mode
Health Information Access Layer - HIAL
29
Deals with “what” to transfer and not “how”
The HIAL can be many different technologies and models
Security
Privacy
Message Analysis
Replay
Types of Interfaces
30
Health Information Access Layer - HIAL
Deals with the what to transfer and not how
The HIAL can be many different technologies and models
Security
Privacy
Message Analysis
Replay
Goals of Integration Standards
31
Goal is to allow data to be sent from the sending system to the receiving system
Standards must accommodate all data elements required
Application (on top) free to use the data
Application independence, i.e. data can be used for many purposes
Integration Methods: File Based
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Sender
Receiver
File
Integration Methods
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File Based Output (reports/queries) in a file format Emailed or “dropped off” for processing
LimitationsProne to problems with file formatsVirus, malwareChanges to internal structureNeeds a program to import dataShould be encrypted
Integration Methods: Point-2-Point
34
Sender
Subscriber1 Subscriber2 Subscriber3
Integration Methods: Point to Point
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Asynchronous
Receiver acknowledge receipt and does its “work”
Synchronous
receiver responds with a response containing information relative to the message received
Integration Methods: Publish-Subscribe
36
Sender
Hub (Mailbox)
Subscriber1 Subscriber2 Subscriber3
Integration Methods: Publish-Subscribe
37
“Fire and forget”, does not care what system uses the message
Does not wait for a response
The subscriber sets rules that define what messages it is interested in
Subscribers have to be validated as to what messages they want to receive
Application Program Interface - API Approach
38
No longer use the terms Sender/Receiver Based on Web Services Applications provide a formal specification for
their application Details the interactions, processes and data
that is exposed through the API The consumer then develops their own API
through which their application can call the other API
Application Independence!
Integration Methods: Publish-Subscribe
39
Application(E.g eChart)
API Specification
Application(Diagnostic
Services)
Internet / Intranet
API Specification
Data-Interchange Standards – Specific Standards: DICOM
40 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.14, p299
DICOM – Digital Imaging and Communications in Medicine
Data-Interchange Standards – Specific Standards: Health Level 7 (HL7)
41
Original goal was to enable data exchange among hospital systems
Most widely implemented data-messaging standard
It is message based and uses an event trigger model with transmit request-response messages
Data-Interchange Standards – Specific Standards: Health Level 7 (HL7)
42
Version 2.3 expanded scope Patient administration (e.g. admission,
discharge, etc) Patient accounting Order entry Clinical-observation data Patient and resource scheduling Patient-referral messages … and several more
Data-Interchange Standards – Specific Standards:HL7 ADT Transaction Message
43 Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.16, p302
Message heading
Event: Patient is transferred from OR to the ICU.There are two independent HIS.
Event trigger
Patientidentification
Patient visit
General order
Results
HL7 v2.xSegments
Data-Interchange Standards – Specific Standards: Health Level 7 (HL7)
44
Version 3.x (aka CDA) Object oriented Based on a Reference Information Model (RIM) It includes terminology, data representation and
data exchange Market is migrating to v3.x, but v2.x heavily
utilized Very difficult to implement! Massive numbers of legacy V2.3.x need
migrating
Data-Interchange Standards – Specific Standards: IEEE Standards
45
IEEE - Institute of Electrical and Electronics Engineers
Several data exchange standards for medical devices
See www link at
http://standards.ieee.org/findstds/standard/healthcare_it.html
Data-Interchange Standards – Specific Standards: NCPDP
46
NCPDP – National Council for Prescription Drug Programs
Data-interchange standards for the pharmacy service sectorhttp://www.ncpdp.org/Standards/Standar
ds-Info
Goal is to improve communication within the pharmacy industry
Topic 5 Outline
47
Standards Introduction
Undertakings and Organizations
Code Terminologies and Nomenclatures
Data-Interchange Standards
Final Thoughts on Standards
Standards Final Comments
48
Systems must use a variety of standards to support health information services
Standards require a lot of negotiations
Most of the standards are not complete
Vendors may interpret data field usage differently
Create operational confusion
Standards Final Comments
49
From a user’s perspective, the problem is how close the vendor’s implementation adheres to the standardCertification may be one approach to
minimize risks
Government and policy leadership to define and enforce most robust standardsSeveral standards will be required overall
Two Questions (Recap)
50
Why do we need standards in health informatics?
What is Interoperability?
What are the relevant standards and how they apply within the field?