1. DR.FATIMAH ALI AL-ROWIBAH Standards and Interoperability

2. Why Do We Need Standards? Standards can be found in almost every area of our daily live

5. What Is The Standards?

6. Definitions A standard : In general is a definition or format established by consensus and approved by a recognized body

7. ISO ? (International Standardization Organization) is an independent, non-governmental membership organization and the world's largest developer of voluntary International Standards.

8. ISO defined a standard as: a document that provides requirements, specifications, guidelines or characteristics that can be used consistently to ensure that materials, products, processes and services are fit for their purpose. What are the benefits of ISO International Standards? ISO International Standards ensure that products and services are safe, reliable and of good quality.

9. Why use standards? Inter-operability Globalisation Quality assurance Cost minimization Safety Others:

10. why do we need standards in healthcare information technology?

11. The healthcare delivery system today employs many different information systems from different vendors, both within a single organization and across multiple organizations. For example, a hospital may have a laboratory system from one vendor, a pharmacy system from another vendor, and a patient care documentation system from a third vendor. Physicians affiliated with the hospital also have different systems in their offices, yet need access to data from the hospital on their patients. In healthcare, standards provide a common language and set of expectations that enable interoperability between systems and/or devices. Ideally, data exchange schema and standards should permit data to be shared between clinician, lab, hospital, pharmacy, and patient regardless of application or application vendor in order to improve healthcare delivery.

12. The health informatics standards: Coordinate. Integrate. Consolidation of information. The encoding of clinical knowledge using accepted standard would allow many people and institutions to share the work done by other To solve the multiple interface problem through the development of messaging standards.

13. Standard development process There are four ways in which a standard can be develop: 1- Ad hoc method: A group of interested people and organization ( e.g.,laboratory-system and hospital-system vendors) agree in standard specification e.g. Digital Imaging and Communications in Medicine ( DICOM). 2-De facto method: A single vendor controls large enough portion of the market to make its product the market standard e.g. Microsoft's Windows. 3-Government-mandate method. Governmental agency e.g. the National Institute of Standard and Technology (NIST) 4-Consensus method: A group of volunteers representing interested parties works in an open process to create a standard e.g. Health Level Seven (HL7)standard for clinical data interchange.

14. Process of creating standard Identification stage. conceptualization stage. discussion stage. implementation stage (critical stage). Certification. Producing a standard is an expensive process in terms of both money and time.

15. Who sets standards? Information standard organization: 1. American National Standards Institute (ANSI), it is a private, nonprofit organization. HL7 standard accreted by ANSI. 2. The European Committee for Standardization( CEN TC251( The TC (Technical Committee) 251 is responsible for (Medical Informatics). 3. International Standard Organization Technical Committee215- health informatics (ISO/TC 215 ). 4. American Society for Testing and Materials(ASTM) That develops and publishes voluntary consensus technical standards for a wide range of materials, products, systems, and services. 5. The National Institute of Standards and Technology (NIST).

16. Standards/System requirements  Data Exchange: HL7, DICOM, ASC X12  Terminology: CPT (Current Procedural Terminology) NDC (National Drug Code) in USA ICD-10,LOINC, &SNOMED NIC,NOC (nursing intervention and outcome classification)  Document: CDA (clinical document architecture) CCR (continuity of care record)  Identification: UPIN (Unique Physician Identification Number) NPI (National Provider Identifier) Authentication: ASTM E 1762-95,E 1985-98 & E 2147-01

17. What is Interoperability? Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user

18. In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor. * The HIMSS Board definition of interoperability on April 5, 2013). Interoperability….cont

19. Interoperability……cont Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities

20. Interoperability ….con There are Three levels of health information technology interoperability: 1) Foundational. 2) Structural. 3) Semantic. The HIMSS Board definition of interoperability on April 5, 2013

21. Interoperability ….con 1 - “Foundational” Interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data. The HIMSS Board definition of interoperability on April 5, 2013

22. Interoperability ….con 2 - “Structural” interoperability is an intermediate level that defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and unaltered.

23. Interoperability ….con 3 - “Semantic” interoperability provides interoperability at the highest level, which is the ability of two or more systems or elements to exchange information and to use the information that has been exchanged. Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate electronic health record (EHR) systems and other systems to improve quality, safety, efficiency, and efficacy of healthcare delivery.

24. Interoperability ….con Inter face : the zone between different computers systems across which users want to pass information Interface engine : A software tool that manages connections among many disparate systems some times called middleware.

25. Interoperability ….con What is a HL7 interface engine? A HL7 interface engine is an interface or integration engine built specifically for the healthcare industry. It connects legacy systems by using a standard messaging protocol. Because hospitals and other healthcare providers usually have different systems for different aspects of services, they are often unable to communicate with each other. HL7 gets around that problem by providing the framework for the exchange, integration, sharing and retrieval of electronic health information.

26. Interoperability ….con How do HL7 interface engines work? HL7 interface engines are software which work as a go-between for different systems. They monitor different types of interfaces and communication points and perform actions according to rules defined by the organization. HL7 works with a number of standards (Conceptual Standards, Document Standards, Application Standards and Messaging Standards). Messaging standards define how information is packaged and communicated from one system to another

27. Motivation to control terminology The encoding of medical information is a basic function of most clinical system. Specific terminology : International Statistical Classification of Diseases and Related Health Problems 10th Revision(ICD-10) Is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups It is used to monitor the incidence and prevalence of diseases and other health problems, proving a picture of the general health.

28. ICD-10 ICD is used by physicians Nurses Researchers Health information managers Coders Health information technology workers Policy-makers Insurers Patient organizations to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records national mortality and morbidity statistics by WHO Member States. World Health Organization (WHO)

30. Motivation to control terminology Specific Data – Interchange Standards. Hl7,SNOMED, ICD-10,DICOM,LOING. Medical Subject Headings (MeSH®) UMLS RxNorm

31. Health Level Seven International (HL7) HL7 - What Does it Mean? Health Level Seven International (HL7) "Level Seven" refers to the seventh level of the International Organization for Standardization (ISO) seven-layer communications model for Open Systems Interconnection (OSI) - the application level. The application level interfaces directly to and performs common application services for the application processes.

32. HL7 …..Cont Founded in 1987, Health Level Seven International (HL7) is a not- for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.

33. HL7 …..Cont HL7 is supported by more than 1,600 members from over 50 countries, including 500+ corporate members from : healthcare providers government stakeholders payers pharmaceutical companies, vendors suppliers consulting firms

38. HL7 …..Cont HL7 defines the format and content of the messages that pass between medical applications. Health Level Seven International – Homepage, http://www.hl7.org

39. Digital Imaging and Communications in Medicine DICOM DICOM is implemented in almost every radiology, cardiology imaging, and radiotherapy device (X-ray, CT, MRI, ultrasound, etc.), and increasingly in devices in other medical domains such as ophthalmology and dentistry. DICOM is one of the most widely deployed healthcare messaging standards in the world

41. Digital Imaging and Communications in Medicine

42. DICOM (PACS)&

43. Picture Archiving and Communications System (PACS) PACS enables x-ray and scan images to be stored electronically and viewed on screens, helping to improve diagnosis methods.

44. SNOMED CT (Systematized Nomenclature of Medicine--Clinical Terms) (Systematized Nomenclature of Medicine--Clinical Terms), is a comprehensive clinical terminology, originally created by the College of America pathologist (CAP).

45. (LOINC) The Logical Observation Identifier Names and Codes (LOINC) is a database provides a universal code system for reporting laboratory and other clinical observations. Its purpose is to identify observations in electronic messages such as Health Level Seven (HL7) observation messages, so that when hospitals, health maintenance organizations, pharmaceutical manufacturers, researchers, and public health departments receive such messages from multiple sources, they can automatically file the results in the right slots of their medical records, research, and/or public health systems. For each observation, the database includes a code.

46. The database comes with a mapping program called Regenstrief LOINC Mapping Assistant (RELMA(TM)) to assist the mapping of local test codes to LOINC codes and to facilitate browsing of the LOINC results

47. Unified Medical Language System (UMLS) What is the UMLS? The UMLS, or Unified Medical Language System, is a set of files and software that brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems. You can use the UMLS to enhance or develop applications, such as electronic health records, classification tools, dictionaries and language translators

48. (MeSH®) Medical Subject Headings Medical Subject Headings (MeSH®): is the National Library of Medicine's controlled vocabulary thesaurus. It consists of sets of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.

49. RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, MediSpan, Gold Standard Drug Database, and Multum. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary

52. Standard In Health Care

53. Biomedical Informatics: Computer Applications in Health Care and biomedicine, Biomedicine,Edward H. Shortliffe, 3 rd edition ‏James J. Cimino - 2006 Electronic health records,apractical guide for professional and organizations, Margeret K. Amatayakul AHiMAH,4 th edition. References