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Standards & Coding Systems in Biomedical and Health Informatics
1. Standards & Coding Systems
in Biomedical and Health Informatics
นพ.นวนรรน ธีระอัมพรพันธุ์
บรรยาย ณ สถาบันทันตกรรม ในหลักสูตรทันตสารสนเทศศาสตร์
24 กุมภาพันธ์ 2555
2. A Few Words About Me...
2003 M.D. (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Currently
• Medical Systems Analyst, Health Informatics Division, Ramathibodi
Contacts
ranta@mahidol.ac.th
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
6. Why Healthcare Isn’t Like Any Others?
Life-or-Death
Many & varied stakeholders
Strong professional values
Evolving standards of care
Fragmented, poorly-coordinated systems
Large, ever-growing & changing body of
knowledge
High volume, low resources, little time
7. Why Healthcare Isn’t Like Any Others?
Large variations & contextual dependence
Input Process Output
Patient Decision- Biological
Presentation Making Responses
8. But...Are We That Different?
Banking
Input Process Output
Transfer
Location A Location B
Value-Add
- Security
- Convenience
- Customer Service
9. But...Are We That Different?
Manufacturing
Input Process Output
Raw Materials Assembling Finished
Goods
Value-Add
- Innovation
- Design
- QC
10. But...Are We That Different?
Healthcare
Input Process Output
Sick Patient Patient Care Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skills
- Quality of care; process improvement
- Information
12. Types of Healthcare Information
Clinical Information
Demographics, History, Physical Exam
Laboratory tests & Other Investigations (e.g. ECG), Imaging
Diagnoses, Medications, Treatments
Genomics
Information about Healthcare Organizations & Operations
Public Health Information - Epidemiology, Environmental
Research Information - Basic Science, Clinical Research, Public Health
Generic Health Information (e.g. Patient education materials)
Knowledge Bases (e.g. PubMed) & Professional Education Materials
13. Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records Picture Archiving and
(EHRs) Communication System
(PACS)
14. Still Many Other Forms of Health IT
Health Information
Exchange (HIE)
m-Health
Biosurveillance
Personal Health Records
(PHRs)
Telemedicine &
Information Retrieval Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
16. Recap
Healthcare is complex and information-rich
Healthcare information is heterogeneous
Health IT is a tool to add value to care delivery
Health IT comes in many different shapes and
forms, many must integrate with one another
Yet healthcare is highly fragmented...
That’s why we need “STANDARDS”
18. Standards: Why?
The Large N Problem
N = 2, Interface = 1
N = 3, Interface = 3
N = 5, Interface = 10
# Interfaces = N(N-1)/2
N = 100, Interface = 4,950
20. The Goal Is...
Interoperability
Inter-operable systems
21. Types of Standards
De facto (informal/in practice) standards
Dominant custom, convention, product, system
e.g. Microsoft Word, QWERTY keyboard
De jure (formal) standards
Developed by recognized standard developing
organizations
Maybe obligatory/regulatory, or voluntary
22. Standard-Developing Organizations (SDOs)
Develops, coordinates, revises, interprets &
maintains standards that address interests outside its
own organization
Clear scope
Formal standards development process
International, regional, national authorities
Examples: ISO, IEC, ITU, IEEE, IETF, W3C, ANSI, NIST,
HL7, ASTM
23. Sample Standards Development Process
Public
Working Group
Draft Proposal Comment/
Consideration
Balloting
(Additional
Working Group
Test/Trial Use Balloting or
Amendment
Approval)
(Enforcement/ Evaluation/
Deployment
Certification) Maintenance
24. Various Kinds of Standards
Unique Identifiers
Standard Data Sets
Vocabularies & Terminologies
Exchange Standards
Message Exchange
Document Exchange
Functional Standards
Technical Standards: Data Communications, Encryption
27. Unique Identifiers
A unique convention to identify a class of objects
E.g. serial numbers, national citizen ID, HN (MRN), NDC
Unique within scope of intended operations e.g. a hospital, a
company, a city, a country, or globally
May or may not be “smart numbers” (digits with meaning).
Smart numbers are bad practices.
May or may not have “check digits” (digits used to prevent
data entry errors)
In general, not supposed to be confidential (except U.S.
Social Security Numbers, credit card numbers)
28. Standard Data Sets
Sometimes called minimum data sets
Data structure (fields, formats, meanings) for a specific
purpose
E.g. Ministry of Public Health’s 12-file or 18-file reports
29. Vocabularies & Terminologies
Controlled Vocabulary
A set of terms used in a specific area where the use of each term is predefined, and the set
maintained by the responsible party
Taxonomy
A hierarchical system to classify objects in a specific area
Terminology
A system or study of terms used to label concepts and their meanings in a specific area
Ontology
“A formal representation of knowledge as a set of concepts within a domain, and the
relationships between those concepts.” (Wikipedia)
Coding System
A system to identify how to represent an object or concept
30. Examples
ICD-10, ICD-9
Classification System
Coding System
Taxonomy
CPT (Current Procedural Terminology)
Classification System
Coding System
Taxonomy
SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms)
Controlled Vocabulary
Terminology
LOINC (Logical Observation Identifiers Names and Codes)
Coding System
ICNP, ICPC
31. Exchange Standards
Message
Message
Government
Message
Hospital A Hospital B
Clinic C
Lab Message Patient at Home
Message
32. Exchange Standards
Message Exchange
Goal: Specify format for exchange of data
Internal vs. external messages
HL7 v.2, HL7 v.3 Messaging, DICOM, NCPDP
Document Exchange
Goal: Specify format for exchange of “documents”
HL7 v.3 Clinical Document Architecture (CDA), ASTM
Continuity of Care Record (CCR), HL7 Continuity of Care
Document (CCD)
33. Documents vs. Messages
Clinical Documents
Human Readable
(Ideally) Machine Processable
Messages
Human UnReadable
Machine Processable
36. Functional Standards
Aims for functional interoperability
Example Scenario: Two systems are expected to behave in the same
way with the same trigger event (e.g. once received an electronic
message)
Real-world Example: PDF file viewing by two different viewers
Informatics Example: HL7 EHR Functional Specifications
37. How Standards Support Interoperability
Functional Standards (HL7 EHR
Functional Functional Specifications)
Vocabularies, Terminologies, Coding
Systems (ICD-10, ICD-9, CPT,
SNOMED CT, LOINC)
Semantic Information Models (HL7 v.3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Unique ID
Syntactic Exchange Standards (HL7 v.2, HL7
v.3 Messaging, HL7 CDA, DICOM)
Technical Standards
(TCP/IP, encryption)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
38. More Standards for Self-Study
Medications & Pharmaceutical
RxNorm (U.S. National Library of Medicine)
U.S. National Drug Code (U.S. FDA)
Labs (& Others)
LOINC (Regenstrief Institute)
Clinical Terminologies
SNOMED CT
Organizational/Business
ISO 27799 (Information Security Management in Health)
Integration
IHE (Integrating the Healthcare Enterprise)
OpenEHR (a hybrid of standards for health information in EHRs)
And many more!