1 Sep 15Fall 05 Standards in Medical Informatics Standards Nomenclature Terminologies Vocabularies

2 Sep 15Fall 05 What is a Standard? A standard comprises a set of rules and definitions that specify how to carry out a process or produce a product –ASCII –EBCDIC In medical informatics there is great emphasis on collection, manipulation, and transmission of information –Standards are greatly needed –Only recently wide availability

3 Sep 15Fall 05 Standardized Identifiers Individuals (patients) –Very controversial –Privacy issues Healthcare providers –The Health Care Financing Administration has defined a National Provider Identifier Health plans Employers

4 Sep 15Fall 05 Standards for Encoding Patient Data Standards for encoding data about the patient that are collected by one system and used by another The encoding of clinical knowledge using an accepted standard would allow many people and institutions to share the work done by others The Arden Syntax is one such standard

5 Sep 15Fall 05 Standards Development Process Ad hoc method –American College of Radiology/National Electrical Manufacturers Association DICOM standard for medical imaging De facto method –Single vendor monopoly (Microsoft Windows Operating System)

6 Sep 15Fall 05 Standards Development Process… Government mandate method –A government agency creates a standard and legislates its use Consensus method –A group of volunteers representing interested parties work in an open process to create a standard –Most healthcare standards follow this method –Health Level Seven (HL7) standard for clinical data exchange

7 Sep 15Fall 05 Stages of Standards Creation Identification stage –A need for a standard is recognized Conceptualization stage –Characteristics of the standard are defined Discussion stage –Content definition –Timeline

8 Sep 15Fall 05 Stages of Standards Creation… Writing the draft standard Implementation Conformance –Compliance with the standard –Specific agreements among users of a standard Certification –A neutral body certifies vendor products

9 Sep 15Fall 05 Information Standards Organizations American National Standards Institute (ANSI) CEN Technical Committee 251 –The European committee for standardization ISO Technical Committee 215 American Society for Testing and Materials (ASTM) –ASTM committee E31 on computerized systems is responsible for the development of medical information standards

10 Sep 15Fall 05 Information Standards Organizations… Healthcare Informatics Standards Board –Healthcare models and Electronic Health Records –Exchange of clinical data, images, sounds etc. –Healthcare codes and terminology –Healthcare protocols and guidelines –Privacy, confidentiality and security Computer Based Patient Record Institute (CPRI)

11 Sep 15Fall 05 Health Insurance Portability and Accountability Act (HIPAA) Signed into law in 1996 Directive to Health and Human Services (HHS) to adopt standards –Health claims –Health plan enrollment –Healthcare payment –Health claim status –Coordination of benefits Unique health ID for individual, employer, provider, health plan Codes for transactions Security standards

12 Sep 15Fall 05 Terminology, Vocabulary and Nomenclature Terminology –Set of terms representing the system of concepts of a particular subject field Nomenclature –System of terms that is elaborated according to pre-established naming rules Vocabulary –Dictionary containing the terminology of a subject field

13 Sep 15Fall 05 Specific Terminologies International Classification of Diseases and its Clinical Manifestations –ICD-9, ICD-9-CM –ICD-10 –484 Pneumonia in infectious disease Pneumonia in Whooping Cough Pneumonia in Tularemia Pneumonia in Anthrax

14 Sep 15Fall 05 Specific Terminologies… Diagnosis Related Groups (DRG) –To provide a small number of codes for classifying patient hospitalizations –To provide some separation of cases based on severity of illness Current Procedural Terminology (CPT) Diagnostic and Statistical Manual of Mental Disorders (DSM)

15 Sep 15Fall 05 Specific Terminologies… Systematized Nomenclature of Medicine (SNOMED) Read Clinical Codes –Developed by James Read in England GALEN National Drug Codes Medical Subject Heading (MeSH) Unified Medical Language System (UMLS)

16 Sep 15Fall 05 Questions? Comments!