david blevins 28 july, 2014 ontologies in medical care data integration and reuse challenges...

David Blevins28 July, 2014

Ontologies in Medical CareData Integration and Reuse Challenges

Ontologies in Medical Care: Data Integration and Reuse Challenges

2Ontologies in Medical Care: Data Integration and Reuse Challenges

Quick Introductions

Ontologies in medicine

Practical uses

Uses in big data


Ontologies in Medical Care

Background– Standards

Implementation– Standards Compliance– Regulatory Compliance– Feasibility– Case studies

Remarks

4

Messaging Standards

HL7– HL7 v2.3 and v2.5 required under Meaningful Use (started in 1989)– HL7 v3 (started 1995, uses ISO Reference Information model)

Purpose: electronically transmit medical requests and information between distributed systems


5

HL7 Samples Lab result

Procedure result (note)

Lab Result Corrections


© Copyright 2008 by Health Level Seven

6

Continuity of Care Documents

Two standards: – Continuity of Care Record (CCR)– Clinical Document Architecture (CDA)

Purpose: Provide a vendor-neutral copy of a structured and well formatted patient health record that can be electronically transmitted and understood by medical record systems


7

Sample CDA excerpt


8

Sample CCR Spec


Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States

9

Other Standards

SNOMED

LOINC

CPT

ICD– ICD-9– ICD-10

Purpose: Provide standard vocabularies for documenting patient procedures, diagnoses, lab results, and various other medical details






Remarks

11

A Quick Note Before We Proceed

Medical data is ideal for big data analysis: high volume, high variety data with high contextual meaning

Massive challenges in spite of mature standards– Data Silos (no cooperation between vendors)– Failure to comply with standards


12

HL7 is a series of tubes, treated like a truck Making the standard perform activities it was never meant to handle

Example: Device interfaces


13

Burn your dictionaries Users can enter custom vocabularies, rendering the LOINC/CPT/ICD dictionaries useless

Labs use different service compendiums



Standards and “Standards”

HL7 variety

Testing Variety

Inconsistent implementation





Remarks

16

Meaningful Use

MU 1– 13 required core objectives– Selection of 5 objectives from a list of 9 optional objectives– Clinical Quality Measures

MU 2– 17 required core objectives– Selection of 3 objectives from a list of 6 optional objectives– Comprehensive CCD

MU 3– Ongoing development. Planned finalization in 2016


17

Meaningful Use certification

Certified third parties– Non-governmental (Industry) groups permitted to certify compliance– The private sector handles certification of functionality

What happens when something breaks?– What about compliance-critical components, like clinical quality measures?






Remarks

19

Feasibility

Acquisitions– Are the new owners maintaining documentation?– Are the new owners concerned about quality, or merely being compliant?

Resources (monetary, human)– Is there enough money to implement changes?– Are there enough competent staff to implement changes?

Outsourcing (Stakeholder engagement, quality, support)– Does the contractor care about quality?– Is the contractor competent?– Does the contractor support their work? If they do, in what ways?






Remarks

21

Immunization Registries

Background– Timeline: 1 year– Impetus: regulatory compliance– Result: “Probably ongoing”– Problem: Vendor support


22

Practice Management Systems Background

– Products: may be vendor supplied, or third party. May or may not be intended to work with a specific system

– Messages: ADTs (Admit Discharge Transfer) and DFTs (Detailed Financial Transactions)


Medscape EHR Report 2014Copyright Medscape 2014

23

Data Migrations

Background– Legislation: right to your data– Vendor approach: have your data (be careful what you wish for)


Medscape EHR Report 2014Copyright Medscape 2014





Remarks