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The Role of Standardization

The Role of Standardization. Ronald Cornet, PhD Dept. of Medical Informatics Academic Medical Center – University of Amsterdam. Standards…. “The good thing about standards is that there are so many to choose from”. Outline. Examples (I) Standards Development Standards Organizations

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The Role of Standardization

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  1. The Role of Standardization Ronald Cornet, PhD Dept. of Medical Informatics Academic Medical Center – University of Amsterdam

  2. Standards… “The good thing about standards is that there are so many to choose from”

  3. Outline • Examples (I) • Standards Development • Standards Organizations • Health IT Standards Organizations • Examples (II) • Importance of Standards • Drawbacks of Standards

  4. Standards – Example • 1386 ≟ 2008 • 1386 ديماه 15 ≡ 5 January 2008 • “Early” standards: Time (second), Length (meter), Weight (kilogram) • “New” standards: DICOM, HTTP, HL7v3, …

  5. Standards – Example

  6. Standards Development • Ad hoc • A standard defined on-the-fly for a specific purpose (e.g., the template of this presentation) • De facto • Alphabet, English as “lingua franca”, Google • Government Mandate (“De jure”) • Protecting patient data, privacy • Consensus • Agreed by a group / committee; e.g., calling codes (Iran: +98; Netherlands: +31)

  7. De Jure De Facto Discrepancy

  8. Standards organizations • ANSI – American National Standards Institute • CEN – European Committee for Standardization • IEEE – Institute of Electrical and Electronics Engineers • ISIRI – Institute of Standards and Industrial Research of Iran • ISO – International Standards Organization • W3C – World Wide Web Consortium

  9. (Health) IT Standards organizations • DICOM – Digital Imaging and Communications in Medicine • HL7 – Health Level 7 • IHTSDO – International Health Terminology Standards Development Organization • ISO TC215 – Health informatics • OASIS – Organization for the Advancement of Structured Information Standards • WHO – World Health Organization

  10. ISO TC215 – Health informatics • Working Groups • Data structure • Data interchange • Semantic content • Security • Health Cards • Pharmacy and Medicines business • Devices • Business requirements for Electronic Health Records

  11. (Health IT) Standards Categories (I) • Data Exchange/Messaging Standards • Contain instructions (or specifications) for format, data elements, and structure in order to allow transactions to flow consistently between systems/organizations • E.g., HL7v2.x, HL7v3, DICOM • Terminology Standards • Provide specific codes for clinical concepts (diseases, allergies, medications) • E.g., ICD-9, SNOMED CT

  12. Standards Categories (II) • Document Standards • Indicate which type of information is included in a document and where it can be found • E.g., Clinical Document Architecture (CDA) • Conceptual Standards • Allow data to be transported across systems without losing meaning and context • E.g., HL7 RIM

  13. Standards Categories (III) • Application Standards • Determine how business rules are implemented and how software systems interact • E.g., Clinical Context Management Specification (CCOW) • Architecture Standards • Define data storage and distribution processes • E.g., Public Health Information Network (PHIN)

  14. Standards – Examples • ISO/OSI Model • HL7 • SNOMED CT

  15. HTTP, FTP

  16. ASCII, MPEG

  17. Sockets, NetBIOS

  18. Transmission Control Protocol (TCP) User Datagram Protocol (UDP)

  19. Dynamic Host ConfigurationProtocol (DHCP) Internet Protocol (IP)

  20. EthernetPoint-to-point protocol (PPP)

  21. RS-232, 10baseT, UMTS L1

  22. HL7 – Health Level 7 • ANSI-accredited Standards Developing Organization • Focus on clinical and administrative data • Provides standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity, and enhance knowledge transfer

  23. HL7 - organization • Started as an Ad hoc standards group • Turned into consensus-based process • Specification of data interchange • Originally focused on message syntax

  24. HL7 standards • Messaging Standard • HL7v2.4, HL7v3 • Reference Information Model (RIM) • Clinical Document Architecture (CDA) • Clinical Context Management Specification (CCOW) • Arden Syntax for Medical Logic Systems

  25. HL7 version 3 • Based on Reference Information Model (RIM) • Data exchange • Representation • Terminology • Clinical Document Architecture (CDA) More on Wednesday…

  26. SNOMED CT • Systematized Nomenclature of Medicine • Aiming at Semantic Interoperability • Standardization of meaning • Description of meaning • Detailed description, e.g., “first episode of severe, acute E-coli pneumonia with sudden onset”

  27. SNOMED CT • Infective Pneumonia: More on Wednesday…

  28. Drawbacks of Standards • Proper standard may not yet exist • Standards development takes time and money • It is hard to find the most appropriate standard • There may be too many • Standards may change over time • Standards can be hard to comprehend • Standards may be hard to implement • Conformance testing may be hard • Standards may conflict • They may be expensive to use

  29. No standards Importance of Standards Estimated effort  Using standards time 

  30. Importance of Standards • Increase (vendor) acceptance • Reduce (integration) cost • Availability of off-the-shelf tools • Maintenance

  31. Applying standards • Determine context • (future) collaborations, usage • Determine standards in relevant categories • Architecture • Application • Conceptual • Document • Terminology • Data exchange / Messaging

  32. Final example: Units • 2 teams: design & implementation • Specification: metric units • Implementation group: English units (i.e. pounds force instead of Newton) • Conversion factor: 4.45 • Overlooked…

  33. Mars Climate Orbiter • Crashed 23-sept-1999 • Costs: US$ 125 million

  34. Conclusion 千里之行，始於足下。 A journey of a thousand miles begins with a single step

  35. Round-up • Standards require short-term investment for longer-term profit • Applying standards is standing on the shoulders of moving giants • Focus on standardization of “higher layers” (application, content and semantics)

  36. More information www.hl7.org www.ihtsdo.org www.iso.org r.cornet@amc.uva.nl

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