1. Panel 3: What level of data granularity, common standards, lexicon elements, and definitions need to be developed by the health system community to meet the needs of an advanced clinical information system? Application of Information Technology to the Transformation of Clinical Research and Health Care in the 21 st Century Lansdowne Resort October 30-31, 2002 James J. Cimino Columbia University

2. Question 1: Standards Today - Current Solutions Laboratory - LOINC Pharmacy – RxNorm Messages – HL7

3. Question 1: Standards Today – Barriers Lack of/shortcomings in standards –Diagnoses –Procedures –Findings Investment in use Duplication of effort Evaluation

4. Question 2: Standard Terminologies – Barriers Licensing restrictions Incorporation into commercial systems Don’t support data reuse

5. Attempting Data Reuse Patient has hantavirus infection “Virus, NEC” - Smallpox - Cowpox - Virus, NEC - Smallpox - Cowpox - Hantavirus - Virus, NEC

6. Question 2: Standard Terminologies – Solutions Improving content Improving licensing Evolving to terminology servers

7. Question 3: Granularity – What’s the Problem? General  Specific Research DataClinical Data

8. Research Data More General than Clinical Data “Goodpasture’s Syndrome” Does the patient have lung disease?

9. Question 3: Granularity – What’s the Problem? General  Specific Research DataClinical Data Clinical Data Research Data

10. Clinical Data More General than Research Data “Fourth Heart Sound” Left Fourth Heart Sound or Right Fourth Heart Sound?

11. Question 3: Granularity – What’s the Solution? Support multiple levels of detail Support multiple hierarchies Improve mapping functions

12. Solutions to the Multiple Granularity Problem Goodpasture’s Syndrome Kidney Disease Hemoptysis Hematuria Finding Lung Kidney Organ has-site Lung Disease is-a has-finding

13. Question 3: Granularity – What’s the Solution? Support multiple levels of detail Support multiple hierarchies Improve mapping functions Inform data collection

14. Question 4: Next Steps Evaluation and improvement of standards Initiate feedback cycles Coordination of terminologies Terminology services Vendor adoption Coordination of data collection