standards in biomedical informatics

HCI 111

By Dr. Khaled Ouanes Ph.D.E-mail: k.ouanes@seu.edu.sa

Twitter: @khaled_ouanes

Standards in Biomedical Informatics

A standard is any norm, convention or requirement.

It is a set of rules and definitions that specify how to carry out a process or produce a product.

STANDARDS

A standard provides a conventional way to solve a given problem. Other people

should be able to use this way without having to start from

scratch.

STANDARDS

Standards, then, permit two or more disassociated people to

work in some cooperative way, on a same project, draft,

solution…

STANDARDS FOR WHAT?

STANDARDS FOR WHAT?

INFORMATION COMES FROM EVERYWHERE !

INFORMATION IS ANALYSED AND STORED EVERYWHERE

Hospital Information System (HIS)Computerized Provider Order Entry Electronic Health Records

Picture Archiving andCommunication System(PACS)

And many more! E.g.:- Mobile health /mHealth- Biosurveillance- Telemedicine- Etc.

STANDARDS ARE IN EVERY FIELD

STANDARDS ARE IN EVERY FIELD

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Why are standards important in biomedical

informatics?The health care environment has traditionally consisted of a set of

loosely connected, organizationally independent units

Why are standards important in biomedical

informatics?

Clinical data need to be moved from one system to another in the same department or even

in different departments.

You thought this was complex?

Hospital 1 Hospital 2

Hospital 3Patient

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Radiology lab

Blood lab

Indep. Physician

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And that was a simple example capturing a small

portion of the real interactions and

information exchange in the healthcare environment!

Why are standards important in biomedical

informatics?

Clinical data is not used only for traditional health care

endeavors but also for quality assessment, strategic

planning, clinical research, public health surveillance…

We needINTEROPERABILITY

To achieve this, we need standards for

data elements, communications, etc.

Healthcare standards aren’t Like Any Others!

• Life-or-Death matter• Many & varied stakeholders• Strong professional values• Many and different fields of knowledge (Specialties…)

• Evolving knowledge, technologies and standards

• Fragmented, poorly-coordinated systems• High volume, low resources, Urgency

Standards Development Process

There are 4 ways in which a standard can be produced:

1. Ad hoc method2. De facto method3. Government-mandate method (De

jure)4. Consensus method

Standards Development Process1. Ad hoc method:

A group of interested people and organizations (e.g., laboratory-system and hospital-system vendors) agree on a standard specification. e.g.:(ACR/NEMA) DICOM standard for medical imaging.

These specifications are informal and are accepted as standards through mutual agreement of the participating groups

Standards Development Process

2. De facto method: A single vendor controls a large enough portion of the market to make its product the market standard. e.g.: Microsoft Windows, Microsoft Office, Mac OS, Adobe Systems…

Standards Development Process

3. Government-mandate method: A government agency or authority creates a standard and legislates its use. E.g. : is CMS’s UB92 insurance-claim form.

Standards Development Process4. Consensus method: A group of volunteers representing interested parties works in an open process to create a standard. For now, Most health care standards are produced by this method. e.g.: The Health Level 7 (HL7) standard for clinical-data interchange

Information Standards Organizations

American National Standards InstituteEuropean Committee for StandardizationTechnical Committee 251Health Care Informatics Standards BoardComputer-Based Patient Record InstituteNational Institute of Standards and Technology

Sample standards Development Process

Coded Terminologies, Terminologies, and Nomenclatures

The capture, storage, and use of clinical data in computer systems is complicated by

lack of agreement on terms and meanings.

Various Kinds of Standards

Unique IdentifiersStandard Data SetsVocabularies & TerminologiesExchange Standards (Message Exchange &

Document Exchange)Functional StandardsTechnical Standards: Data Communications, Encryptions

Motivations for Controlled Terminologies

The encoding of medical information is a basic function of most clinical systems.

Standards for such encoding can serve 2 purposes: 1- They can save system developers from reinventing the wheel (creating something from scratch). 2- using commonly accepted standards can facilitate exchange of data among systems.

Vocabularies & Terminologies

Controlled Vocabulary: A set of terms used in a specific area where the use of each term is predefined, and the set maintained by the responsible party

Taxonomy: A hierarchical system to classify objects in a specific area

Vocabularies & Terminologies

Terminology: A system or study of terms used to label concepts and their meanings in a specific area.

Ontology: A formal representation of knowledge as a set of concepts within a domain, and the relationships between those concepts.

Coding System: A system to identify how to represent an object or concept.

ExamplesICD-10, ICD-9 - Classification System, Coding

System, Taxonomy-

CPT (Current Procedural Terminology) - Classification System, Coding System, Taxonomy-

SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) -Controlled Vocabulary, Terminology-

LOINC (Logical Observation Identifiers Names and Codes)- Coding System-

ICNP, ICPC

International Classification of Diseases and Its Clinical Modifications (ICD)

Revised at roughly 10-year intervals 1st by the Statistical International Institute and later by the World Health Organization (WHO)

The available controlled terminologies

International Classification of Diseases and Its Clinical Modifications (ICD)

The coding system consists of a core classification of 3-digit codes that are the minimum required for reporting mortality statistics to WHO. A 4th digit (in the first

decimal place) provides an additional level of detail; usually .

The available controlled terminologies

International Classification of Diseases and Its Clinical Modifications (ICD)

Also contains several “families” of terms for medical-specialty diagnoses, health status, disablements, procedures, and reasons for

contact with health care providers.

The available controlled terminologies

ICD-9 Example

The available controlled terminologies

The Medical Subject Headings (MeSH), maintained by the NLM (National Library of

Medicine, updated annually):

It is the terminology by which the world medical literature is indexed.

MeSH arranges terms in a structure that breaks from the strict hierarchy used by most other coding schemes

Unified Medical Language System (UMLS):

A resource that would bring together and disseminate controlled medical terminologies.

Contains over 1 million terms collected from over 100 different sources .

Attempts to relate synonymous and similar terms from across the different sources

The available controlled terminologies

Data-Interchange Standards

The need to interconnect health care applications led to the

development of data-interchange standards.

The purpose of a data-interchange standard is to permit one system to transmit to another system, all the data required to accomplish a

specific communication, or transaction set , in a precise, unambiguous fashion.

Data-Interchange Standards

Both systems (Sender and Receiver) must know what format

and content is being sent and must understand the words or

terminology, as well as the delivery mode.

Data-Interchange Standards

Message Exchange:• Goal: Specify format for exchange of data• Internal vs. external messages• HL7 v.2, HL7 v.3 Messaging, DICOM, NCPDP

Data-Interchange Standards

Document Exchange:Goal: Specify format for exchange of “documents”

HL7 v.3 Clinical Document Architecture (CDA), ASTM Continuity of Care Record (CCR), HL7 Continuity of Care Document (CCD)

Data-Interchange StandardsDocuments vs. Messages

Clinical Documents• Human Readable• Machine Processable (Ideally)Messages• Human UnReadable• Machine Processable

A communications model, called the Open Systems Interconnection (OSI) reference

model (ISO 7498-1), has been defined by the ISO. It describes seven levels of requirements

or specifications for a communications exchange: physical, data link, network, transport,

session, presentation, and application

Data-Interchange Standards

Health Level 7, the application level, deals primarily with the semantics or data-

content specification of the transaction set or message.

For the data-interchange standard, HL7 requires the definition of all the data elements to be sent in response to a specific task, such as the admission

of a patient to a hospital.

Data-Interchange Standards

In many cases, the data content requires a specific terminology that can be understood

by both sender and receiver. This terminology understanding is best ensured

through use of a terminology table that contains both the test name and a unique

code. Unfortunately, several code sets exist for each data group, and none are complete.

Data-Interchange Standards

Example: if a physician orders a laboratory test that is to be processed by a commercial laboratory, the ordering system must ensure that the name of the test on the order is the same as the name that the laboratory uses.

When a panel of tests is ordered, both systems must share a common

understanding of the panel composition.

Data-Interchange Standards

The 6th level, presentation, deals with what the syntax of the message is, or how the data are formatted.

There The remaining OSI levels—session, transport, network, data link, and physical—govern the communications and networking protocols and the physical connections made to the system.

some understanding at these lower levels is necessary before a linkage between two systems can be successful

Data-Interchange Standards

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= Message

Specific Data-Interchange Standards Examples

Digital Imaging and Communications in Medicine (DICOM)3

ASTM is the largest nongovernment source of standards in the United States.

IEEE, many of the world’s standards in telecommunications, electronics, electrical applications, and computers have been developed through IEEE.

HL7 is the most widely

implemented health care data-

messaging standard

Specific Data-Interchange Standards Examples

Data

Information

KNOWLEDGE

The Data-to-Knowledge Spectrum (data, information, knowledge)

CONSTANTLY EVOLVING CYCLE : KNOWLEDGE CHANGES

REMEMBER THIS?

Thanks to the standards….

Wisdom

Data

Information

KNOWLEDGEDIKW Pyramid. Standards will allow this!

HCI 111

By Dr. Khaled Ouanes Ph.D.E-mail: k.ouanes@seu.edu.sa

Twitter: @khaled_ouanes