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Semantic Interoperability - 15 August, 2006

Semantic Interoperability - 15 August, 2006. Mike Cummens, MD. Agenda. AHLTA Goals Terminology Interoperability Future Directions. AHLTA Scope. 9.2 Million beneficiaries 129,000 Staff 411 clinics 104 Military Treatment Facilities 70 hospitals Theater (partial list) Iraq

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Semantic Interoperability - 15 August, 2006

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  1. Semantic Interoperability - 15 August, 2006 Mike Cummens, MD

  2. Agenda • AHLTA Goals • Terminology Interoperability • Future Directions Northrop Grumman Private / Proprietary Level I

  3. AHLTA Scope • 9.2 Million beneficiaries • 129,000 Staff • 411 clinics • 104 Military Treatment Facilities • 70 hospitals • Theater (partial list) • Iraq • Afghanistan Northrop Grumman Private / Proprietary Level I

  4. AHLTA Weekly Volume • 2.1 million prescriptions • 1.8 million outpatient encounters • 2,000 births for Uniformed Services members, retirees and their families Northrop Grumman Private / Proprietary Level I

  5. What Did the MHS Set Out to Do? • Make patient record available at point of care • Complete • Timely • Accurate • Noise free • Legally acceptable • Capture computable data to support business of healthcare • Achieve Gartner level 5 system • Quality • Granular • Structured • Coded Northrop Grumman Private / Proprietary Level I

  6. The CPR in US Industry: Gartner Group (1999) CHCS II development accelerated predicted timeline Full Automated Generation Of Pathways and Workflow; Use by Consumers AHLTA Release 1 Requirements Fifth Generation: The Mentor Commercially Available Fourth Generation: The Partner Clinical Workflow Intervention Screening Decision Support Care Innovation Functionality Third Generation: The Helper Structured Documentation Spanning Episodes of Care Second Generation: The Document Document Care in Free Text First Generation: The Collector Data Acquired Through Feeder Systems Minimal 1993 1998 2003 Now 2008 2012+ • Predicted Marketplace Maturity Northrop Grumman Private / Proprietary Level I

  7. Systems to be integrated • Outpatient encounter documentation • Medicomp MEDCIN • PKC • Inpatient encounter documentation • CliniComp • Others • Clinical decision support • Medicomp MEDCIN • PKC • Local treatment facilities laboratory systems • Local treatment facilities pharmacy systems • Clinical data repository Northrop Grumman Private / Proprietary Level I

  8. MHS Terminologies (partial) • SNOMED CT • Medicomp MEDCIN • PKC • 3M HDD NCID • MTF Laboratory IEN • MTF Allergy AIEN • NDC • CliniComp Northrop Grumman Private / Proprietary Level I

  9. Healthcare Standards • Consolidated Health Informatics • Office of Management and Budget's (OMB) eGov initiative • Departments of Veterans Affairs and Defense are committed to use of CHI standards for data mediation of terminologies with external agencies • Twenty federal agencies/departments are active in CHI governance Northrop Grumman Private / Proprietary Level I

  10. Healthcare Standards • Consolidated Health Informatics Standards(partial) • Diagnosis, Problem List, Non Laboratory Tests, laboratory Result Contents • SNOMED CT • Medications • Semantic Clinical Drug Name of RXNORM • Drug Product • NDC • Laboratory Test Order • LOINC • Messages • HL7 • Text Based Reports • HL7 CDA Release 1.0 Northrop Grumman Private / Proprietary Level I

  11. COTS Application Terminology Challenges • Non Standard • Task oriented • “Ontology lite” at best • Decentralized usage • Context dependent terms • Propositional terms • Proprietary restrictions Northrop Grumman Private / Proprietary Level I

  12. Text(VISTA) IEN(CHCS) Clinical Data Repository/Health Data Repository (CHDR) • Real TimeInteroperability mediation between Departments of Veterans Affairs and Defense • Drug Allergies Northrop Grumman Private / Proprietary Level I

  13. Text(VISTA) UMLS CUI IEN(CHCS) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Drug Allergies Northrop Grumman Private / Proprietary Level I

  14. Text(VISTA) IEN or Text(CHCS) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Allergic Reactions Northrop Grumman Private / Proprietary Level I

  15. Text(VISTA) SNOMED CT Concept ID IEN or Text(CHCS) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Allergic Reactions Northrop Grumman Private / Proprietary Level I

  16. NDRFT (VISTA) 3M NCID(DoD) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Medications Northrop Grumman Private / Proprietary Level I

  17. NDRFT (VISTA) UMLS RXNORM 3M NCID(DoD) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Medications Northrop Grumman Private / Proprietary Level I

  18. NDRFT (VISTA) UMLS RXNORM NDC 3M NCID(DoD) Clinical Data Repository/Health Data Repository (CHDR) • Interoperability mediation between Departments of Veterans Affairs and Defense • Medications Northrop Grumman Private / Proprietary Level I

  19. Clinical Data Repository/Health Data Repository (CHDR) • Translation table of Drug Allergies, Allergic Reactions and Medications in Real Time Northrop Grumman Private / Proprietary Level I

  20. Terminology Services Bureau • Mediation of MHS terminologies • “Core Domain” ontology based SNOMED CT as modified by Language & Computing • Hosted in Language &Computing LinkFactory • Source terminologies retained intact • Source terminologies mapped to “Core Domain” • Content management environment • Run Time environment Northrop Grumman Private / Proprietary Level I

  21. PKC Codes and Structure 3M Codes and Structure MEDCIN Codes and Structure Provider MHS Clinical Ontology (From TSB) AHLTA CDR, MEDCIN, and PKC Interoperability Separate Clients: AHLTA Client, PKC Client, MEDCIN Client Single Client AHLTA CDR PKC • Systems isolated • Provider must correlate data • Provider must filter data • No knowledge support across all data • Duplicate data entry • Systems integrated • System correlates data • System filters data • Knowledge support across all data • Eliminate duplicate data entry Stovepipe Systems Integrated Systems MEDCIN Northrop Grumman Private / Proprietary Level I

  22. Terminology Services Bureau • Content management environment • Semi-automated term mapping using NLP • Manual mapping and editing by terminology experts • Run Time environment Northrop Grumman Private / Proprietary Level I

  23. Terminology Services Bureau Contents • SNOMED CT • Core Domain for all areas of medical practice • PKC • Wellness, health screening, military readiness • MEDCIN • Granular outpatient encounter documentation • RXNORM • Medications • LOINC • Laboratory results • Document types Northrop Grumman Private / Proprietary Level I

  24. Terminology Services Bureau Advantages • Reusability • LOINC Laboratory Content integrated into TSB for MEDCIN flowsheet implementation • LOINC content is being used for AHLTA Clinical Reminder Notification • LOINC content is being reused for CliniComp Monitoring Device data integration • Ease of maintenance • Central mapping repository versus distributed, redundant hard code and data tables. Northrop Grumman Private / Proprietary Level I

  25. Terminology Services Bureau Challenges • Proprietary content • Source terminology issues • Inconsistent use of terminology • Task specific structure of terminologies. • Context dependency • Rules based mapping • The content of several local fields determine concept to be mapped to core ontology • “Systolic blood pressure in the left arm while seated” • Run time implementation • One to one mapping • Rules assisted information translation Northrop Grumman Private / Proprietary Level I

  26. Use Case: Lab Flow Sheet • Goal: • Given diagnosis from MEDCIN – show all related lab results for the patient. • Issues: • Diagnosis is a MEDCIN ID • Lab data stored in the CDR using 3M NCIDs • CDR does not understand MEDCIN IDs for Lab • MEDCIN contains list of LOINC codes associated with each diagnosis • Solution: • Need to correlate knowledge from MEDCIN and CDR Northrop Grumman Private / Proprietary Level I

  27. Provider Use Case: Lab Flow Sheets - What the Provider Sees 1. Select the patient. 2. Show list of the current problems. 3. Show only lab results which are pertinent to the selected problem. Northrop Grumman Private / Proprietary Level I

  28. MEDCIN/LOINC Mappings MEDCIN/LOINC Mappings Lab Results from CDR MEDCIN/LOINC Mappings NCID/LOINC Mappings NCID LOINC MEDCIN ID LOINC Lab Results via NCID MEDCIN AHLTA CDR Use Case: Lab Flow Sheet - How it is technically done TSB Run-time Environment MHS Clinical Ontology (in TSB) Export Displays Pertinent Lab Results For Diagnosis Web Services Import Data Display Flow Sheet Knowledge Agent Web Services Northrop Grumman Private / Proprietary Level I

  29. Planned and Future Uses of TSB • Encourage use of TSB for all integration tasks • Eliminate custom point-to-point mappings • Map once – use many times • Lab flow sheet project in progress • Allow provider to retrieve pertinent lab results for specific problem • Interoperability MEDCIN and AHLTA CDR • Interoperability between PKC, MEDCIN, and CDR • Pre-populate PKC coupler with data already in CDR • Pre-populate MEDCIN note with data already in CDR • Pre-populate MEDCIN note with data entered into the coupler • Use of PKC knowledge engine against CDR and MEDCIN data • Use of MEDCIN Diagnosis Prompt against CDR and PKC coupler data Northrop Grumman Private / Proprietary Level I

  30. Planned and Future Uses of TSB (cont.) • Educate customers to the advantages of reuse of mediating terminologies • Increase number of mediation terminologies and maps. Northrop Grumman Private / Proprietary Level I

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