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HIMA 4160 Concepts in Health Information Technologies Data and Data Standards Fall 2009 1.

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Presentation on theme: "HIMA 4160 Concepts in Health Information Technologies Data and Data Standards Fall 2009 1."— Presentation transcript:

1 HIMA 4160 Concepts in Health Information Technologies Data and Data Standards Fall 2009 1

2 Outlines Data Data, Information and Knowledge Source of health care data Properties of health data Healthcare Standards Concepts Important Health care standards The desiderata of controlled terminology 2


4 Clinical Data 4

5 Elements of Data The patient in question The parameter being observed or measured The value of the parameter in question The time of observation 5

6 Type of Data Narrative Abbreviation Phrases Numeric Continuous signal Multimedia... 6

7 Who collects the data? Clinicians physicians nurses pharmacists allied health Office and administration staff. Medical devices 7

8 Use of Medical Data Create the basis for the historical record Support communication among providers Anticipate future health problems Record standard preventive measures Identify deviations from expected trends Provide a legal record Support clinical research 8

9 Structure of Medical Data Conventional clinical data are semi- structured. Medicine vs. Computer Computer needs more structured data. Coding, terminology, vocabulary systems 9

10 Data, Information and Knowledge 10 DataInformationKnowledge

11 Data Standards What is standard? Why do we need standard in health care? What are some of the major types of standard in health care? What are some of the standards and standard development organizations? 11

12 Why do we need standard? To facilitate communication. To benchmark product or processes. To increase efficiency. To increase accessibility – ATM To decrease cost 12

13 What are some examples of the Standards? Languages Transportation Internet protocols Operating systems 13

14 Categories of standard based on the development process Government mandates – HIPAA Market oriented De facto – Microsoft Windows, VCR, Blue-Ray? De Jure Ad hoc -- DICOM Consensus – Many SDOs 14

15 15

16 Standard Development Organizations SDOs are organizations that develop and maintain the models, data dictionaries, structure, syntax, and implementation materials for electronic transaction standards between and within providers. All designated SDOs maintain policies that meet the requirements of the American National Standards Institute (ANSI), which accredits standards committees and provides an open forum for participants to identify, plan and agree on standards and assurance of due process. 16

17 ANSI SDO Process Consensus on a proposed standard Broad based public review and comment on draft standards Consideration of and response to comments submitted by voting members of the relevant consensus body and by public review commenter. Incorporation of approved changes into a draft standard Right to appeal by any participant that believe that due process principles were not sufficiently respected during the standards development in accordance with the ANSI-accredited procedures of the standards developer 17


19 Why Do We Need Standards in Health Care Facilitate Information Sharing Improve Efficiency Avoid Waste and Redundancy Improve Quality


21 Health Care Standards Classifications, Nomenclature, Vocabulary and Terminology Data Interchange Health Record Content and Structure 21

22 Analogy -- Language Classifications, Nomenclature, Vocabulary and Terminology – Words and Semantics Data Interchange – Conversation Health Record Content and Structure – Composition 22

23 Classification -- Definition Classification: A clinical vocabulary, terminology, or nomenclature that lists words or phrases with tier meanings, provides for the proper use of clinical words as names or symbols, and facilitate mapping standardized terms to broader classifications for administrative, regulatory, oversight, and fiscal requirements. 23

24 Nomenclature A recognized system of terms used in a science or art that follows pre- established naming conventions; a disease nomenclature is a listing of the proper name for each disease entity with its specific code number. 24

25 Terminology -- Definition A set of terms representing the system of concepts of a particular subject field; a clinical terminology provides the proper use of the clinical words as names or symbols 25

26 Vocabulary – Definition list or collection of clinical words or phrases and their meanings. 26

27 Classification Systems ICD ICF CPT DRG 27

28 Terminology SNOMED LOINC RxNorm 28

29 Systematic Nomenclature of Medicine – Clinical Term SNOMED-CT Clinical terminology/nomenclature College of American Pathologies + National Health Service (NHS). 29

30 SNOMED -- CT Concepts (344,000) ‏ Findings (swelling of arm) ‏ Diseases (pneumonia) ‏ Procedures (biopsy) ‏ Observable entities (tumor stage) ‏ Body structure (structure of thyroid) ‏ Organism (DNA virus) ‏ Substance (Gastric acid) ‏ Pharmaceutical/biologic product (tamoxifen) ‏ 30

31 SNOME – CT Concepts (cont.) ‏ Specimen (urine specimen) ‏ Physical object (suture needle) ‏ Physical force (friction) ‏ Events (flash flood) ‏ Environments/geographical location (intensive care unit) ‏ Social context (organ donor) ‏ Context – dependent categories (no nausea) ‏ Staging and Scales (Nottingham ten-point ADL index assessment scale) ‏ Attribute (controlled temperature) ‏ Qualifier value (bilateral) ‏ Duplicate concept (inactive concept) ‏ 31

32 SNOMED -- CT 913,000 Description/Synonym -- to express the clinical concepts ~1.3 million semantic relationship to enable reliability and consistency of data retrieval 32

33 SNOMED -- CT SNOMED CT Concepts are modelled using Hierarchies Each “child” must be a subtype of its “parent” concept may have multiple parents Defining relationships Using attributes, concepts may be linked to each other Only relationships that are necessarily true are included Appendicitis : site = appendix OK All appendicitis has location in the appendix. SLE : manifestation = anemia O no Only some people with SLE have anemia. 33

34 The Principles behind SNOMED CT structure SNOMED is concept based Each concept represents a unit of meaning Each concept has one or more human language terms that can be used to describe the concept Every concept has inter-relationships with other concepts that provide logical computer readable definitions. These include hierarchical relationships and clinical attributes. 34

35 The Principe Behind SNOMED CT 35

36 Relationship allow multiple hierarchy 36

37 Multiple Hierarchy 37

38 Semantic Relationship SNOMED CT contains relationships that link concepts to form logical computer readable definitions. Logical definitions allow data to be recorded in a flexible way, whilst retaining the ability to analyze it in a consistent fashion. 38

39 39 39

40 40 40

41 Use 41 SNOMED CT is one of a suite of designated data standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information. The National Library of Medicine (NLM), on behalf of the U.S. Department of Health and Human Services, entered into an agreement with College of American Pathologists for a perpetual license for the core SNOMED CT (in Spanish and English) and ongoing updates. The contract provides to NLM a perpetual license to distribute SNOMED within the NLM’s Unified Medical Language System UMLS Metathesaurus for no cost use within the U.S. by both U.S. government (federal, state, local, and territorial) and private organizations. The contract also covers updates to SNOMED CT issued by the College of American Pathologists between June 30, 2003 and June 29, 2008.

42 LOINC Logical Observation Identifier Names and Codes Facilitate lab results transmission Developed and maintained by Regenstreif Institute at IU. About 32,000 observation terms 42

43 LOINC codes are created systematically using a six axis model : : : : : 8331-1 Body temperature: TEMP: PT: MOUTH: QN 43

44 Six Primary Axes Component Ejection fraction, heart beats, cardiac output, circumference Kind of property Angle, area, length, mass, pressure, temperature Timing Point in time, study minimum, maximum in 8 hours System Head of fetus, tricuspid valve, ventilator setting Scale Quantitative, ordinal, nominal, narrative Method Stated, measured, estimated 44

45 RxNorm Standardized nomenclature for the clinical drug Maintained by the National Library of Medicine The name of a clinical drug combines its ingredients, strengths, and form 45

46 RxNorm Acetaminophen 500 MG Oral Tablet for a generic drug name Acetaminophen 500 MG Oral Tablet [Tylenol] for a branded drug name 46

47 RxNorm 47

48 UMLS A project at NLM to integrate many nomenclature systems Three basic components UMLS Metathesaurus SPECIALIST Lexicon UMLS Semantic Network 48

49 Data Interchange Standards 49 System ASystem B

50 HL7 Messaging Standard OSI Model level 7 – application Define The data to be exchanged The timing of the exchange The communication of errors between application 50

51 51

52 HL7 Message 52

53 DICOM Digital Imaging and Communications in Medicine. For Medical Imaging Data Storage and Transmission Developed by American College of Radiology and National Electrical Manufacturer Association Foundations for PACS (Pictures Archiving and Communication System) ‏ 53

54 NCPDP standards National Council on Prescription Drug Programs To create and promote data interchange standards for the pharmacy services sector of the health care industry To provide information and resources that educate the industry and support the diverse needs of the members. 54

55 NCPDP standards Batch transaction standard. Billing unit standard Compound transaction standard Data dictionary Diskette standard External code list Formulary and benefit standard Manufacturer Rebates, utilization, plan, formulary, market basket and reconciliation flat file standard. Member enrolment standard Pharmacy ID card Prior authorization Professional pharmacy Script standard Telecommunication standard 55

56 ASC X12N Standards Electronic exchange of business information X12N deals with insurance industry. 56

57 Health Record Content Standards HL7 EHR Functional Model ASTM Continuity of Care Record Standard OpenEHR 57

58 HL7 EHR FUNCTIONAL MODEL Need identified for a standardized functional specification for electronic health record systems Public-private partnership approached HL7 to develop consensus standard Department of Health & Human Services Veterans Health Administration Health Information Management Systems Society Robert Wood Johnson Foundation 58

59 HL7 EHR-S FUNCTIONAL MODEL What is it? A reference list of functions that may be present in an EHR System Described from user perspective Enables consistent expression of system functionality Focuses on systems that operate on the EHR vs. the EHR as a singular entity Presents a superset of functions from which a user specific subset can be generated 59

60 HL7 EHR FUNCTIONAL MODEL Consists of: Functional Outline divided into functions for: Direct Care Supportive Information Infrastructure Functional Profiles overlaying the Functional Outline Assigned priorities for the functions in the profiles 60

61 HL7 EHR-S FUNCTIONAL MODEL The EHR Functional model does not: Address or endorse technology used Include data content of the EHR Address or endorse the EHR-S as a single system vs. system-of-systems 61

62 HL7 EHR FUNCTIONAL MODEL Uses of the HL7 EHR Functional Model? Facilitate describing end-user benefits in terms of standard EHR-S functions Promote common understanding of EHR functions Provide framework to drive requirements and applications of next level standards (i.e. EHR content, coding, information models) ‏ 62

63 HL7 EHR FUNCTIONAL MODEL Overview Three sections in EHR-S Functional Model Direct Care Supportive Information Infrastructure Over 130 functions 63

64 CCR ASTM Prepared by the provider at the end of a health care encounter in order to provide a summary of the patient’s health status Figure 1. Conceptual model. 64

65 OpenEHR UK + Australia promote and publish the formal specification of requirements for representing and communicating electronic health record information, based on implementation experience, and evolving over time as health care and medical knowledge develop; promote and publish EHR information architectures, models and data dictionaries, tested in implementations, which meet these requirements; manage the sequential validation of the EHR architectures through comprehensive implementation and clinical evaluation; maintain open source "reference" implementations, available under license, to enhance the pool of available tools to support clinical systems; and collaborate with other groups working towards high quality, requirements-based and interoperable health information systems, in related fields of health informatics. 65

66 Why is making standards in health care so difficult? 66

67 Resources bin/SoftCart.exe/COMMIT/COMMITT EE/E31.htm?L+mystore+cnfn0409 bin/SoftCart.exe/COMMIT/COMMITT EE/E31.htm?L+mystore+cnfn0409 67 67

68 Summary Three types of standards The importance of standards The challenge of standardization in health care 68

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