NCVHS Subcommittee on Standards and Security Hearings on Message Format standards, 3/29/99

1. NCVHS Subcommittee on Standards and SecurityHearings on Message Format standards, 3/29/99 Mark Shafarman Clinical Information Architect Oacis Healthcare Systems, San Rafael, CA

2. Paradigm for "comparability" discussion • Messaging/object method interfaces must have • a common information model and • a common vocabulary model • with the standard vocabulary applied to the standard information model (e.g. HL7 templates). • The model supports the addition of new specializations of clinical data objects as needed • adds new master file instances of a given specialization rather than new attributes (data driven)

3. PMRI (patient medical record information) • Any information needed by a clinician to care for a patient under his/her professional responsibility. • Also includes financial/insurance/related to what services, medications, procedures, treatments a clinician needs to order to care for a patient. • Excludes financial/admin information not contributing to patient care (e.g. payroll information details about staff). • Includes permissions based on credentials/license (and other factors relating directly and indirectly to the care of the patient: social/family/work/environmental).

4. PMRI (patient medical record information) • Comparability based on information and vocabulary models • Interoperability depends on: • Comparability at this level is the basis for clinical decision support, research, and clinical data sharing. • Model-based paradigms are extensible via specialization • without invalidating existing parts of the model • They are never “done” since knowledge is not static

5. Syntaxes • Not all syntaxes are message based • object • RPC • A syntax does not, de facto, support information standards • requirement is to support the granularity levels specified in the models and vocabularies • Use HL7 approach of “technology neutral/implementation neutral” information standards • Let market decide “for now”, not “for ever”

6. Technologies • Since technology is evolving so rapidly (capacity doubles every 18 months; new media included), concentrate on information modeling and structure and vocabulary standards rather than technology standards. • As above, it's important not to mistake ”technology" level standards with information modeling standards. • Use HL7 approach of “technology neutral/implementation neutral” information standards • For binary (image etc.) ensure that specifications are not bound to a particular technology. • E.g. JPEG

7. Federal Government’s role • Encourage development of models and vocabulary standards: • Extension/evolution of HL7 RIM. • Vocabulary“base level” vocabularies for problems, signs/symptoms, drugs, labs, procedures at the “clinical granularity” level. • HL7 Clinical Templates: standard vocabulary constraints applied to information model-derived structures. • For each of the above, extend by clinical domain (not all at once).

8. Federal Government’s role • Encourage standards for rules and data warehousing also • see relevant HL7 TC’s • Current examples of governmental participation: • CDC’s ELR project • HL7 Claims attachment SIG (with x12N) • HL7 Government SIG

9. Federal Government’s role • Suggestion: for each new project • Interface specification done as “technology neutral” model+vocabulary standard section, plus specific ITS • Use current available standards (see previous current examples) • Builds infrastructure for interoperability • Creates “level playing field” for clinical knowledge-based applications • Motto: • Don’t let the perfect interfere with the good

10. Questions??? Contact: Mark Shafarman 415-482-4570 mshafarm@oacis.com