topic 05 standards in biomedical informatics part 2 · standards in biomedical informatics –part...

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

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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

https://www.merriam-webster.com/dictionary/nomenclature

Coded Terminologies & Nomenclatures –Motivation for Controlled Terms

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Benefits

Simplify systems development

Facilitate exchange and communication of coded medical information

Limitation

Not good enough for all users

No wide acceptance


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ISO Standard 1087 on Terminology

Figure source: Shortliffe et al, ‘Biomedical Informatics’, 3rd Edition, Figure 7.3, p279

https://www.iso.org/standard/20057.html


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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


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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

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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

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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


DRGs Examples “Simple Pneumonia”code is used insteadof several ICD-9 codes

Coded Terminologies & Nomenclatures –Specific Terminologies: ICPC

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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

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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

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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

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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)


Coded Terminologies & Nomenclatures –Specific Terminologies: LOINC

LOINC example acronyms:

Example

Coded Terminologies & Nomenclatures –Specific Terminologies: Drug Codes

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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

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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


Medical SubjectHeadingsExample

‘Pneumonia’ means‘lung inflammation’

‘Pneumonia’ means‘lung infection’

Coded Terminologies & Nomenclatures –Specific Terminologies: UMLS

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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


UMLSExample

Other terminologiesconcepts

Preferred name

Semantic Network

Synonyms

Topic 5 Outline

24




Interoperability



Interoperability

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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

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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


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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

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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

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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

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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

33

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

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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

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Sender

Hub (Mailbox)

Subscriber1 Subscriber2 Subscriber3


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“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

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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!


39

Application(E.g eChart)

API Specification

Application(Diagnostic

Services)

Internet / Intranet

API Specification

Data-Interchange Standards – Specific Standards: DICOM


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


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


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


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

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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

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

http://www.ncpdp.org/Standards/Standards-Info

Topic 5 Outline

47






Standards Final Comments

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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?

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