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

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

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

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

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

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

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

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

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

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

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

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

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

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