Presentation on theme: "Healthcare Informatics Standards"— Presentation transcript:
1Healthcare Informatics Standards An Electronic Health Record Developer’s PerspectiveThe 4th International HyTime ConferenceMontreal, CanadaAugust 20, 1997Jason P. WilliamsOceania, IncorporatedGood afternoon. It is a pleasure to be here this afternoon. My name is Jason Williams, and I work with a company called Oceania, a company that develops electronic health record software.The title of my talk is Healthcare Informatics Standards: An Electronic Health REcord Developer's Perspective. What I hope to do today is to give an overview of some of the standards in the healthcare informatics community.Additionally, I hope to shed some light on the new work Oceania is doing with SGML and HyTime Architectural Forms.First began work in SGML at the University of Michigan, where I worked on a large digital library project using the TEI. I also became very interested in medical informatics and information retrieval, went to a couple of standards meetings, and have never looked back!
2Today’s Topics changing healthcare informatics models healthcare informatics standardslanguage and vocabularyHealth Level Seven (HL7)SGML and healthcare informaticsOceania and SGMLOceania and HyTime architectural formsThis what I would like to try to cover this afternoon.We will briefly talk about a major shift in the model for the patient medical record.After that we will dive right in to a discussion of some of the major healthcare informatics standards, including language and vocabulary standards and a major healthcare communications standard, HL7.
4Why Standards? The Vendor Perspective better patient careconcentration on core competenciesproduct interoperabilitybenefits to the clientinternal benefits
5Healthcare Informatics Standards vocabulary and languageSNOMED, ICDREAD, MESH, othersNLM UMLS (meta-thesaurus)information / data representationHL7, DICOM,SGML, XML, RDBMS, othersmedical conventions
6SNOMED ICD-9 many other examples to choose from X-ray examination (PROCEDURE) performed on arm (SITE) makes known a fracture (RESULT-FINDING)ICD-9fracture of radius and ulna [arm], upper end, closed =many other examples to choose fromeach optimized for different purposeseach purpose needs to be addressed by vendorscan’t “just pick one!”
7Health Level Seven (HL7) “Clinical, financial, and administrative data among healthcare oriented computer systems”messaging standard; “trigger event”HL7 defines message types and “structure”messages structure: header: segments: fields
8NK1|JONES^BARBARA^K|WIFE||||||NK^NEXT OF KIN<cr> MSH|^~\&|ADT1|MCM|LABADT|MCM| |SECURITY|ADT^A01|MSG00001|P|2.3|<cr>EVN|A01| ||<cr>PID|||PATID1234^5^M11||JONES^WILLIAM^A^III|| |M||C|1200 N ELM STREET^^GREENSBORO^NC^ |GL|(919) |(919) ||S||PATID ^2^M10| |987654^NC|<cr>NK1|JONES^BARBARA^K|WIFE||||||NK^NEXT OF KIN<cr>PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||||ADM|A0|<cr>Patient William A. Jones, III was admitted on July 18, 1988 at 11:23 a.m. by doctor Sidney J. Lebauer (#004777) for surgery (SUR). He has been assigned to room 2012, bed 01 on nursing unit 2000.The message was sent from system ADT1 at the MCM site to system LABADT, also at the MCM site, on the same date as the admission took place, but three minutes after the admit.
9HL7: The Positives Allows interaction with other systems appointments and schedulinglab resultslarge areas of clinical content definedVersion 3, Reference Information Modellarge user base
10HL7: The Negatives mixture of content with representation standards many non-defined areas: Z segmentsvery customized local implementations make extra-institutional exchange difficultdocument model not supported (not good with text)
11The HL7 SGML SIG charter and design principles sample DTDs Kona Architecture Proposalinteroperability between HL7 and SGMLSGML to encode HL7 messages?Use of HL7 to contain and transport SGML documents?“best of both” approach
12SGML Meeting Healthcare Informatics Needs information exchangeinformation retrieval and reportingsystem and platform independencelong-term access and preservation
13Information Exchange mobility of patients; emergency situations changing nature of patient careclaims and claims attachmentsclaims /attachments vs. clinical documentationHIPAA (Health Insurance Portability and Accountability Act) and HCFASGML/XML and the WWWintra-institutional and extra-institutional exchange
14Information Retrieval smarter full-text retrieval based on semanticsenables implementation of document modelpreserving multiple viewsclinician gets documents (context preserved)population view(system / platform independence; longevity)
15Oceania EMR: WAVETMallows creation and access of clinical data in documentsdocuments and relational tables -- health summary viewaccess to complete document contents not standardizedvocabulary: clinical content knowledge base
16Oceania and Structured Data clinicians create structured sentenceseach word encoded based on its role in the sentenceinterface terminology optimized for clinicians (charting language…charting terms, browsing interface, data entry)clinicians should not have to know about structure
21Oceania DTD: Design Questions granularityretrieval purposes vs. document exchangeattributes vs. elementsnegation and clinical documentationspecificity vs. generality
22DTD Development to Date an ongoing, iterative processmany individuals from different functional areasengineering, clinical informatics, product developmentmore than one DTD
23Oceania and Architectural Forms standardizing implementations of SGMLshould not have to standardize the DTDmultiple uses of architectural forms:bridge multiple representations of the Oceania documentsintra-institutional exchangeextra-institutional exchange (Kona)
24Oceania Experience with the Kona Architecture the SOAP format and Oceania documents: the sectionsarchitectural mappings at different levels of granularitythe Kona “code” and “mention”architectural “collisions”: same element; different contextual semantics
25SGML Standards Family and Healthcare Informatics SGML will go forward: positives, momentumHL7 and SGML: future cooperationHyTime and others add to SGML implementation functionalitywhat we need: collaboration with standards organizations, experience
26Selected ReferencesHealth Level Seven Standard.Health Level Seven SGML SIG.Kona Architecture Proposal to the HL7 SGML SIG.
27Selected ReferencesLincoln, Thomas L, Daniel J Essin, Robert Anderson, Willis H Hare (1994). The Introduction of a New Document Processing Paradigm into Health Care Computing: A CAIT Whitepaper. Santa Monica, California: Rand Corporation. [Available at the HL7 SGML SIG website.]Morris, Jonathan A, Rachael Sokolowski, John E Mattison, David Riley (1997). Standard Generalized Markup Language (SGML) in Healthcare. Accepted for panel discussion at the Healthcare Information Management Systems Society (HIMSS) 1998 Conference in Orlando, Florida.