All about healthcare: Health Data & Interoperability Standards

SNOMED-CT

Summary:
Classifications vs. Ontologies
Basics of SNOWMED -CT

Classification: a list
Ontology: encompasses relationship among lists
- ICD-10, LOINC & SNOWMED-CT all include relationships

SNOWMED-CT relationships
Example: Heart Attack

311,000 concepts and 1.3 million relationships in this system. Very complex.

OID
Classifications of standard - ensure that operators know which database or system to be used/is using

MESSAGING STANDARDS

Outline:
Rationale for HL7 messages
Basics of HL7 messages
Recognize difference btween EDI/X12 (v2) and XML (v3)

Messaging standards - Hospital Order Entry/Results reporting

Sample message (EDI/X12) lab message from lab back to ward

Sample message (XML) same message
- easier viewing for people
- shown on browser (EDI/X12 before browsers existed)

DOCUMENT STANDARDS

Outline
Understand purpose of document standards
understand basics of HL7 CCDA

Key justifications: transition of care - errors made mostly between transfer from specialist to specialist. 80% of medical errors happened during the hand off between medical providers.

HL7 Consolidated Clinical Document Architecture

Objective data - physician done by inspecting patient.

Sections
- entries

Reference Information Model of Healthcare (RIM)

Proposed stage 3 - providers must send electronic document for over 50% and receive 40%. Must use data in document to reconcile medications etc.

User interface. Can be used as portal for patients to see their own data too.

ADVANCED STANDARDS

Clinical Decision support
- guide decisions for physicians and deliver most efficient care.

Example: ARDEN syntax

Blood thinner

Example: CIMI Clinical Information Modeling Initiative

Context management specification (CMS)
- Allow independent developed applications from many systems to synchronize and coordinate.

FHIR STANDARDS

Outline
Understand rationale for FHIR
Have basic understanding of web services and a simplified data model

To solve the problem of interoperability

Rise and Fall of HL7
- Eliot Muir: Complicated standards can be pushed for a while but ultimately market reject them. Even government will reject them." Cost too high. Too complex.

JASON AHRQ April 2014
- Should move to API based approach

FHIR - Fast Healthcare Interoperability Resources
- API (application programming interface) for exchanging Eletronic Heatlh records.
- Eaiser to implement because uses modern web-based suite of API technology
- represented by JASON or XML
- Can search patient, all of patient's problem
- Implication: can ensure real-time data gathering
- CRUD - create, read, update and delete

Example