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Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 1
©3M HIS 2005Innovation
Data Transformation Modules:Achieving Semantic Interoperability
Practical Issues in Terminology Implementation and Mapping
Shaun Shakib MPH3M Health Information Systems
Jason Mark3M Health Information Systems
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 2
©3M HIS 2005Innovation
Networking Framework – 7 Layers(Open Systems Interconnection Reference Model)
• Layer 7: Application layer– provides semantic conversion between associated application processes
• Layer 6: Presentation layer– syntax layer; manages syntactical differences in data representation within the end-user systems
• Layer 5: Session layer– manages the dialogue between end-user application processes
• Layer 4: Transport layer– controls the reliability of a given link
• Layer 3: Network layer– controls network routing & flow control
• Layer 2: Data link layer– defines the functional & procedural means to transfer data between network entities
• Layer 1: Physical layer– all electrical & physical specifications for devices
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 3
©3M HIS 2005Innovation
Interoperability
The ability of one computer system to exchange data with another computer system
U.S. National Committee on Vital and Health StatisticsReport on Uniform Data Standards for
Patient Medical Record InformationJuly 6, 2000
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 4
©3M HIS 2005Innovation
Levels of Interoperability(NCVHS Recommendations for Patient Medical Record Information Standards)
• “Basic” Interoperability– messages exchanged between systems, but not interpreted
• “Functional” Interoperability– messages exchanged between systems, context of the data interpreted– a common structural definition for the fields
• “Semantic” Interoperability– messages exchanged between systems, both meaning and context interpreted– content of the data fields within a message populated with standard codes
PaperRecordsPaper
RecordsScannedImages
ScannedImages
TextDatabases
TextDatabases
MessagingStandards
MessagingStandards
Non-StandardizedCoded Data
Non-StandardizedCoded Data
StandardCoded
StructuredData
StandardCoded
StructuredData
Trend inHealth
Records
Trend inHealth
Records
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 5
©3M HIS 2005Innovation
“Functional” InteroperabilityMessaging Standards (HL7 2.x)
OBX|1|CE|1817-72^Ser K|OBX|1|CE|1817-72^Ser K|
OBX|1|CE|2259-73^K|OBX|1|CE|2259-73^K|
OBX|1|CE|2730-72^Potassium|OBX|1|CE|2730-72^Potassium|System A
System B
System C
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 6
©3M HIS 2005Innovation
“Semantic” InteroperabilityData Standardization
Establishing explicit meaning and context and using the same set of codes to encode data throughout a system (a hospital, an organization, a region, a country, a world….)
Clinical Domain: Gender
Unknown3Female2Male1NameCode
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 7
©3M HIS 2005Innovation
Exchanging Standard Codes ExampleLogical Observation Identifier Names and Codes (LOINC®)
OBX|1|CE|2823-3^Potassium:SCNC:PT:SER/PLAS:QN:|OBX|1|CE|2823-3^Potassium:SCNC:PT:SER/PLAS:QN:|
System A System B System C
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 8
©3M HIS 2005Innovation
Exchanging Standard CodesTwo Implementation Strategies
Encode with the identifiers of standard
terminologies
Encode with the identifiers of standard
terminologies
Encode with internal identifiers, “translate”to standard codes for external exchange
Encode with internal identifiers, “translate”to standard codes for external exchange
*CDRPatient:
John DoeLab Result:
2823-32823-3 2823-3
**DTM
Internal code:1234
LOINC®:2823-3
*CDR=Clinical Data Repository **DTM=Data Transformation Module
*CDRPatient:
John DoeLab Result:
1234
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 9
©3M HIS 2005Innovation
Exchanging Standard Codes3M Healthcare Data Dictionary
RegFinancialsMed. Rec.
Transcription
Doc. Imaging
Practice Mgt.
Home Health
LTC
PACS
Order Mgt.
Radiology
Lab
Rx
Scheduling
Single View
ClinicalWorkstation
Clinical Decision Support
Clinical Decision Support
Healthcare Data Dictionary
(HDD)
Healthcare Data Dictionary
(HDD)
mapping
Clinical Data Repository (CDR)
EMPIIn
terf
ace
Engi
ne
Data Analysis andReporting
Data Analysis andReporting
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 10
©3M HIS 2005Innovation
The 3M Healthcare Data DictionaryComponents of the HDD
• Controlled Medical Vocabulary (CMV)– Collection of clinical concepts
• Knowledge Base (KB)– Relationships among concepts
• Medical Information Model (MIM)– Establishes clinical context
Decision Support
Alerts Reports
Knowledge Base(Semantic Network)
Controlled Medical Vocabulary(Medical Concepts)
Medical Information
Model
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 11
©3M HIS 2005Innovation
A collection of medical concepts, organized to support synonyms and other lexical characteristics
concept: a unique, definable idea or object that has a very specific, known meaning
SodiumLab ResultLab Test Chem 4
Potassium
Chloride Glucose
Components of the HDDControlled Medical Vocabulary
Lab Test
Chem 4Sodium
is-a
Lab Result
PotassiumChloride
Glucose
is-component-of
Components of the HDDKnowledge Base/Relationships
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 12
©3M HIS 2005Innovation
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 13
©3M HIS 2005Innovation
Medical Information ModelComponents of the HDD
• Describes the relationships among clinical events and terminologies in a fashion that gives them meaning and context
• Enforces accepted truths but allow for uncertainty and variation inherent in medical information
• Clinically correct, complete, flexible and extensible
• Supported by vocabulary and knowledge base• Obeyed by the data gathering software
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 14
©3M HIS 2005Innovation
Medical Information Model ExampleAllergy Clinical Event
Allergy Type Allergen Severity Reaction Date
Allergy Event
Information Models
Patient AllergyDrug (1550)Aspirin (3000252119)Mild (1554)Rash (82559)20000703
Instance Data
Type Allergen
Severity Reaction
Allergy Event
CDR
HDD
3M Database Architecture
Date20000703
Aspirin
Mild
Drug
Rash
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 15
©3M HIS 2005Innovation
COLD COLD COLDConceptRepresentationConceptRepresentation
ConceptDomainConceptDomain
ConceptDefinitionConceptDefinition
Concept IDConcept ID
a sensory perception
a pulmonary diagnosis
an upper respiratory viral
infection
“I’m feeling cold”
Chronic Obstructive Lung
Disease
“I have a cold”
68215 1005480 1005313
Controlled Medical VocabularyConcept Based Vocabulary
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 16
©3M HIS 2005Innovation
Mapping to the HDD
VZV 243 = Ft Hood Lab Interface Context
Chickenpox Virus
Herpes-zoster Virus
Herpesvirus 3, Human C0042338 = UMLS Concept
Unique Identifier
concept mapping: the process of creating one-way links between concepts and terms in different vocabularies, both standard and legacy
Mapping is accomplished through a variety of techniques such as representation synonymy, term association, relationship, attribute, granularity, composition/decomposition, etc.
Mapping is accomplished through a variety of techniques such as representation synonymy, term association, relationship, attribute, granularity, composition/decomposition, etc.
Varicella-zoster Virus11557 = HDD ID
HDD
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 17
©3M HIS 2005Innovation
Data Transformation Modules (DTMs)• Reference concept
mapping tables derived from HDD
• Facilitate semantic interoperability by transforming inbound legacy terms and codes to mapped:– standard outbound terms and
codes– legacy terms and codes from
other systems
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 18
©3M HIS 2005Innovation
DTM Messaging Architecture
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 19
©3M HIS 2005Innovation
DTM Technical Implementation
• Direct plug-in for leading interface engines
• Web service API for custom implementations
• Cross-platform capable• Cost effective, scalable
database underpinnings
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 20
©3M HIS 2005Innovation
DTM Mapping Table Domains
Height/Weight, blood pressure other vitals signs, and intake/output information from a nursing systemVital Signs, with I/OHeight/Weight, blood pressure and other vitals signs from a nursing systemVital Signs, without I/ODischarge summary, pathology and/or radiology text report titles from a transcription systemText Report TypesScheduling data received from a scheduling systemSchedulingClinical medical information from a pharmacy system, using proprietary/legacy codes to identify drugsPharmacy (not using NDC)Clinical medical information from a pharmacy system, using NDCs to identify drugfPharmacy (using NDC)Orders from a CPOE system, requires mapping of lab and pharmacy systemsOrders InterfaceMicrobiology results from a lab systemMicrobiologyClinical lab results from a lab information systemLabPatient registration and encounter information from an ADT/registration systemRegistration/EncounterEKG report titles and related information from a nursing systemEKGCoded patient assessment information from a nursing systemAssessmentCoded allergy data from an ADT/Registration system or pharmacy systemAllergies
ExplanationDomain
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 21
©3M HIS 2005Innovation
DTM Mapping Tables
Brucella abortus (organism)Brucella abortus24224000BRUCELLA ABORTUSBRAB
Bordetella pertussis (organism)Bordetella pertussis5247005BORDETELLA PERTUSSISBPER
Babesia species (organism)Babesia species372376003BABESIA SPECIESBABS
SNOMED CT® FULLY SPECIFIEDSNOMED CT® PREFERRED TERMSNOMED CT® CONCEPT IDLOCAL RESULT NAMELOCAL RESULT CODE
SUBMIT LOINC®SerumBRUCELLA IgGBRUGBRUCELLA (IGG,IGM) EIABRUCI
6326-3SerumBRUCELLA IgMBRUMBRUCELLA (IGG,IGM) EIABRUCI
24388-1SerumBRUCELLA,IGMBRUCMBRUCELLA,EIABRUCE
24387-3SerumBRUCELLA,IGGBRUCGBRUCELLA,EIABRUCE
LOINC® CODELOCAL SPECIMEN NAMELOCAL RESULT NAMELOCAL RESULT CODELOCAL TEST NAMELOCAL TEST CODE
3M analyzes system data files and produces maps that link standard codes to local terms and codes
• Local codes mapped to SNOMED CT® concepts
When a standard code does not exist 3M submits a new code request to the standards organization on behalf of the client
• Local codes mapped to LOINC® codes
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 22
©3M HIS 2005Innovation
DTM Implementation and Maintenance• 3M Terminology Consulting Services (TCS) builds DTM Mapping
Tables from local content definitions, current standards, special case definitions
• Facility/Site identifies mappings to perform on HL7 message stream• DTM plug-in or custom implementation added to site messaging
system• Engine processing workflows updated to use 3M DTM as messages
are processed• Updates to underlying domain data and additional local content
provided via 3M TCS
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 23
©3M HIS 2005Innovation
Interlingua of Health Information Systems• DTMs provide a cross reference
accounting for all concepts and terms in the Electronic Health Record (EHR)
• DTMs provide a way to manage ongoing updates from standard terminologies as well as local additions and changes from health care facilities
• DTMs make an enterprise’s mapped data interoperable with the rest of the world via standard codes, e.g. LOINC®, SNOMED CT®, ICD, etc.
LOINC® Code5902-2
Camp LeJeune Interface Code
3650-73
Fort Sill Interface Code
467-73
DoD Short NamePT
DoD Long NameProtime
DTM
Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 24
©3M HIS 2005Innovation
Questions?
Shaun Shakib MPH3M Health Information Systems
Jason Mark3M Health Information Systems