Survey of Medical Informatics CS 493 – Fall 2004 September 20, 2004

Health Care Data Standards Chapter 4: Patient Safety - Achieving a New Standard of Care. IOM Report

Overview of healthcare data standards Table 4-1 Data standards Interchange Terminologies Knowledge Representation

Data Interchange Standards Message Format Standards

Message Format Standards CHI mandates: HL7 Version 2.x DICOM NCPDP IEEE standards for medical devices LOINC

Healthcare Standards HL7 Standard

Healthcare Standards: HL7 HL7 Messaging Established Standards Body (1987) ANSI accredited (1994) Over 1700 members Key efforts HL7 CDA (XML documents) Effort HL7 CCOW HL7 EHR Effort Healthcare Standards: HL7

Healthcare Standards: HL7 HL7 Philosophy Designed as a protocol for exchange of healthcare and related information Based on an event-based transactional model that mirrors real-life use-case scenarios Healthcare Standards: HL7

Healthcare Standards: HL7 HL7 Version Evolution Produced Version 1.0 late in 1987 Produced Version 2.0 late in 1988 Version 3.0 effort underway for a while Clinical Document Architecture (CDA) effort – release 1 Nov 2000 & CDA release 2 passed in committee ballot – Sept 2003 Clinical Context Effort (CCOW) Electronic Health Record (EHR) Functional Model (NHII initiative) Healthcare Standards: HL7

Healthcare Standards Messages in HL7 are defined by: HL7 Message Structure Messages in HL7 are defined by: A message ID (a 3 letter code - e.g., ADT for Admit, Discharge, Transfer-related messages) One or more segments (logical grouping - e.g., PID segment to represent patient identifying information) Nesting and repetition of segments as appropriate “Z” segments for custom use

HL7 Clinical Context Object Working Group (CCOW) Healthcare Standards HL7 Clinical Context Object Working Group (CCOW)

Healthcare Standards: HL7 CCOW: Focus is the on the visual integration of diverse applications in the user’s desktop Healthcare Standards: HL7

Already have interoperable specifications and implementations CCOW: Technology-neutral specifications that will allow healthcare applications to switch contexts seamlessly—oriented toward making multiple Graphical User Interface (GUI) clients work together Already have interoperable specifications and implementations Currently working on an interoperable single-sign-on specification

CCOW – Visual Integration The Provider's Workstation “Data” Integration The Clinical Applications Server Visual Integration * Acknowledgement: Slide provided by Wes Rishel, Gartner Group The Provider

University Physicians Technology solutions Healthcare Standards Patient ID Mapper Context Manager Master Patient Index O'Donnell 2234444 University Physicians 3222111 General Hospital O’Donnell 2234444 Furlow 6731123 O’Donnell 3222111 Crane 58233 * Acknowledgement: Slide provided by Wes Rishel

CCOW Process View App A CM App B User P 1 2 3 4 5 6 7 8 9 10 11 12 13 Register with CM Log on Context – User P Select Patient X Context – Patient X View Patient X Notes View Patient X Labs Log off Context - Reset 1 2 3 4 5 6 7 8 9 10 11 12 13

Web-based applications CCOW current work: Single sign-on: users do not have to memorize many user names and passwords authentication via password, badge swipe, biometrics Web-based applications * Acknowledgement: Slide provided by Wes Rishel

HL7 Version 3.0 Healthcare Standards Acknowledgement: This set of slides are adapted from: Andrew Hinchley’s “Understanding Version 3 – A primer on the HL7 Version 3 Communication Standard

Key Concepts of V3 methodology Application Role Trigger Event RIM HL7 Reference Information Model (RIM) – basis for all HL7 messages RIM defines about 70 basic classes D-MIM Storyboard Interaction R-MIM HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM From RIM we can instantiate a Domain Message Information Model D-MIM Storyboard Interaction R-MIM HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM Reference Message Information Model are developed for a restricted group of models HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM R-MIM’s are used to develop message model definitions – called Hierarchical Message Definitions HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD’s are used to define the HL7 V3 messages which are used to communicate between systems HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM This defines the roles of sending and receiving application. For example: Laboratory Observation Event Informer – an application that notifies pertinent information about lab results Storyboard Interaction R-MIM HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM This defines what causes a message to be sent. Specifies the set of conditions that initiate a message transfer. Trigger events are specified by: a name, identifier, description, structured name and a type. Different types of trigger events: interaction based, state-transition based, user based, unspecified. Storyboard Interaction R-MIM HMD Storyboard Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD A realistic scenario which requires a communication message to be designed Message

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD Storyboard Scope for the message to be designed – the interaction that needs to be supported Message

The Reference Information Model Act – something happened or may happen. Any action of interest. Entity – a person, animal or organization or thing Role – a part played by an entity Participation – the involvement of a role in a act Act_Relationship – a relationship between two acts Role_Link – a relationship between two Roles

Examples of R-MIM Act Example Prescription classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: SPLY: act is related to supply ORD: an instance of order <=: code value or a vocabulary term Entity Example Person classCode*: <= PSN determinerCode*: <= INSTANCE Name*: PN[1..1] Addr: AD[1..1] PSN: refers to person INSTANCE: can be an instance or quantified value

Examples of R-MIM Role Example Person classCode*: <= PSN determinerCode*: <= INSTANCE Name*: PN[1..1] Addr: AD[1..1] 1..1 patientPerson Patient classCode*: <= PAT Id*: [0..1] Person is playing the role of a patient.

Examples of R-MIM Participation Example Prescription patientSubject classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: patientSubject typeCode*: <= PATSBJ 1..1 medicalPractitioner author typeCode*: <= AUT 1..1 pharmacist performer typeCode*: <= PRF

Examples of R-MIM Act_Relationship Example Prescription classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: component typeCode*: <= COMP 1..* prescriptionItem PrescriptionItem classCode*: <= SPLY moodCode*: <= ORD code*: CD CWE[1..1] <= DrugCode text*: [1..1] activityTime: availabilityTime:

Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD Storyboard Message

Healthcare Standards HL7 CDA

Technology solutions Healthcare Standards Sample CDA Document

Technology solutions Healthcare Standards

Healthcare Standards HL7 EHR

HL7 EHR Functional Model* Care Management II7.0 Workflow Ops Mgt & Comm II6.0 Business Rules - Administrative Functions II5.0 Interoperability II4.0 Support for Health Informatics & Terminology Standards II3.0 Unique Identity, Registry, and Directory DC3.0 Ops Mgt & Comm DC1.0 Care Management S3.0 Admin & Financial S2.0 Measurement, Analysis, Research, Reporting S1.0 Clinical Support Direct Care Supportive Infrastructure Information DC2.0 Clinical Decision Support II2.0 Information and Records Management II1.0 Security * Slide courtesy of Dr. Don Mon, Vice President of AHIMA

Building Block for Info Exchange* Physician Office EHR-S Nursing Home Health Regional Health Info Exchange Referral Data Hospital The Longitudinal Record: Distributed Across EHR’s PHR Data stays where it is (distributed, federated) Federated MPI’s * Slide courtesy of Dr. Don Mon, Vice President of AHIMA

HL7 Summary Healthcare Standards: HL7 Version 3.0 Reference Information Model Interoperability Demonstrations using XML and HL7 RIM models have happened since HIMSS 99. HL7 CDA effort has taken root HL7 CCOW has made significant inroads. EHR effort is ground-breaking and is lead by the Dept. of Health and Human Services as part of the NHII. Healthcare Standards: HL7

Healthcare Standards HL7: Health Level 7: http://www.hl7.org/ Technology solutions Healthcare Standards HL7 References HL7: Health Level 7: http://www.hl7.org/