Standards & Coding Systems

in Biomedical and Health Informatics

นพ.นวนรรน ธีระอัมพรพันธุ์

บรรยาย ณ สถาบันทันตกรรม ในหลักสูตรทันตสารสนเทศศาสตร์

24 กุมภาพันธ์ 2555

A Few Words About Me...

2003 M.D. (1st-Class Honors) Ramathibodi

2009 M.S. (Health Informatics) University of Minnesota

2011 Ph.D. (Health Informatics) University of Minnesota

Currently

• Medical Systems Analyst, Health Informatics Division, Ramathibodi

Contacts

ranta@mahidol.ac.th

SlideShare.net/Nawanan

www.tc.umn.edu/~theer002

groups.google.com/group/ThaiHealthIT

Manufacturing

Image Source: Guardian.co.uk

Banking

Image Source: Cablephet.com

Healthcare

ER - Image Source: nj.com

Why Healthcare Isn’t Like Any Others?

Life-or-Death

Many & varied stakeholders

Strong professional values

Evolving standards of care

Fragmented, poorly-coordinated systems

Large, ever-growing & changing body of

knowledge

High volume, low resources, little time

Why Healthcare Isn’t Like Any Others?

Large variations & contextual dependence

Input Process Output

Patient Presentation

Decision-Making

Biological Responses

But...Are We That Different?

Input Process Output

Transfer

Banking

Value-Add- Security- Convenience- Customer Service

Location A Location B

Input Process Output

Assembling

Manufacturing

Raw Materials Finished Goods

Value-Add- Innovation- Design- QC

But...Are We That Different?

Input Process Output

Patient Care

Healthcare

Sick Patient Well Patient

Value-Add- Technology & medications- Clinical knowledge & skills- Quality of care; process improvement- Information

But...Are We That Different?

Information is Everywhere

Types of Healthcare Information Clinical Information

Demographics, History, Physical Exam

Laboratory tests & Other Investigations (e.g. ECG), Imaging

Diagnoses, Medications, Treatments

Genomics

Information about Healthcare Organizations & Operations

Public Health Information - Epidemiology, Environmental

Research Information - Basic Science, Clinical Research, Public Health

Generic Health Information (e.g. Patient education materials)

Knowledge Bases (e.g. PubMed) & Professional Education Materials

Various Forms of Health IT

Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)

Electronic Health

Records (EHRs)

Picture Archiving and Communication System

(PACS)

Still Many Other Forms of Health IT

m-Health

Health Information Exchange (HIE)

Biosurveillance

Information RetrievalTelemedicine &

Telehealth

Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.

Personal Health Records (PHRs)

Health IT: What’s In A Word?

Goal

Value-Add

Tools

Recap

Healthcare is complex and information-rich

Healthcare information is heterogeneous

Health IT is a tool to add value to care delivery

Health IT comes in many different shapes and

forms, many must integrate with one another

Yet healthcare is highly fragmented...

That’s why we need “STANDARDS”

Standards Are Everywhere

Standards: Why?

The Large N Problem

N = 2, Interface = 1

# Interfaces = N(N-1)/2

N = 3, Interface = 3

N = 5, Interface = 10

N = 100, Interface = 4,950

Health Information Exchange (HIE)

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

The Goal Is...

Interoperability

Inter-operable systems

Types of Standards

De facto (informal/in practice) standards

Dominant custom, convention, product, system

e.g. Microsoft Word, QWERTY keyboard

De jure (formal) standards

Developed by recognized standard developing

organizations

Maybe obligatory/regulatory, or voluntary

Standard-Developing Organizations (SDOs)

Develops, coordinates, revises, interprets &

maintains standards that address interests outside its

own organization

Clear scope

Formal standards development process

International, regional, national authorities

Examples: ISO, IEC, ITU, IEEE, IETF, W3C, ANSI, NIST,

HL7, ASTM

Sample Standards Development Process

Draft Proposal Working Group Consideration

Public Comment/Balloting

Working Group Amendment

(Additional Balloting or Approval)

Test/Trial Use

Deployment (Enforcement/Certification)

Evaluation/Maintenance

Various Kinds of Standards

Unique Identifiers

Standard Data Sets

Vocabularies & Terminologies

Exchange Standards

Message Exchange

Document Exchange

Functional Standards

Technical Standards: Data Communications, Encryption

Wisdom

Knowledge

Information

Data

DIKW Pyramid

Levels of Interoperability

Functional

Semantic

Syntactic

Unique Identifiers A unique convention to identify a class of objects E.g. serial numbers, national citizen ID, HN (MRN), NDC Unique within scope of intended operations e.g. a hospital, a

company, a city, a country, or globally May or may not be “smart numbers” (digits with meaning).

Smart numbers are bad practices. May or may not have “check digits” (digits used to prevent

data entry errors) In general, not supposed to be confidential (except U.S.

Social Security Numbers, credit card numbers)

Standard Data Sets

Sometimes called minimum data sets

Data structure (fields, formats, meanings) for a specific

purpose

E.g. Ministry of Public Health’s 12-file or 18-file reports

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

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.” (Wikipedia)

Coding System

A system to identify how to represent an object or concept

Examples ICD-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

Exchange Standards

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Message

Message

Message

MessageMessage

Exchange Standards Message Exchange Goal: Specify format for exchange of data

Internal vs. external messages

HL7 v.2, HL7 v.3 Messaging, DICOM, NCPDP

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)

Documents vs. Messages

Clinical Documents

Human Readable

(Ideally) Machine Processable

Messages

Human UnReadable

Machine Processable

Sample HL7 v.2 Message (Lab Result)

OBX|1|NM|10839-9^TROPONIN-I^LN||5|ng/ml|0-1.3|H||H|F|19980309…

Sample HL7 v.3 Message (Pt. Regist.)<?xml version="1.0" encoding="UTF-8"?>

<PRPA_IN101311UV02 xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"

ITSVersion="XML_1.0" xsi:schemaLocation="urn:hl7-org:v3 ../schemas/PRPA_IN101311UV02.xsd">

...

<name use="SYL" >

<given>นวนรรน</given>

<family>ธีระอัมพรพันธุ์</family>

</name>

<name use="ABC">

<given>Nawanan</given>

<family>Theera-Ampornpunt</family>

</name>

<administrativeGenderCode code="M"/>

...

</PRPA_IN101311UV02>Message source adapted from Ramathibodi HL7 Project by Supachai Parchariyanon, Kavin Asavanant, Sireerat Srisiriratanakul

& Chaiwiwat Tongtaweechaikit

Functional Standards Aims for functional interoperability

Example Scenario: Two systems are expected to behave in the same

way with the same trigger event (e.g. once received an electronic

message)

Real-world Example: PDF file viewing by two different viewers

Informatics Example: HL7 EHR Functional Specifications

How Standards Support Interoperability

Functional

Semantic

SyntacticTechnical Standards (TCP/IP, encryption)

Exchange Standards (HL7 v.2, HL7v.3 Messaging, HL7 CDA, DICOM)

Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9, CPT,

SNOMED CT, LOINC)

Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD)

Standard Data Sets

Functional Standards (HL7 EHRFunctional Specifications)

Some may be hybrid: e.g. HL7 v.3, HL7 CCD

Unique ID

More Standards for Self-Study Medications & Pharmaceutical RxNorm (U.S. National Library of Medicine)

U.S. National Drug Code (U.S. FDA)

Labs (& Others) LOINC (Regenstrief Institute)

Clinical Terminologies SNOMED CT

Organizational/Business ISO 27799 (Information Security Management in Health)

Integration IHE (Integrating the Healthcare Enterprise)

OpenEHR (a hybrid of standards for health information in EHRs)

And many more!