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Survey of Medical Informatics

Survey of Medical Informatics. CS 493 – Fall 2004 September 20, 2004. Health Care Data Standards. Chapter 4: Patient Safety - Achieving a New Standard of Care. IOM Report. Overview of healthcare data standards. Table 4-1 Data standards Interchange Terminologies Knowledge Representation.

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Survey of Medical Informatics

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  1. Survey of Medical Informatics CS 493 – Fall 2004 September 20, 2004

  2. Health Care Data Standards Chapter 4: Patient Safety - Achieving a New Standard of Care. IOM Report

  3. Overview of healthcare data standards • Table 4-1 • Data standards • Interchange • Terminologies • Knowledge Representation

  4. Data Interchange Standards Message Format Standards

  5. Message Format Standards • CHI mandates: • HL7 Version 2.x • DICOM • NCPDP • IEEE standards for medical devices • LOINC

  6. Healthcare Standards HL7 Standard

  7. HL7 Messaging • Established Standards Body (1987) • ANSI accredited (1994) • Over 1700 members • Key efforts • HL7 CDA (XML documents) Effort • HL7 CCOW • HL7 EHR Effort Healthcare Standards: HL7

  8. HL7 Philosophy • Designed as a protocol for exchange of healthcare and related information • Based on an event-based transactional model that mirrors real-life use-case scenarios Healthcare Standards: HL7

  9. HL7 Version Evolution • Produced Version 1.0 late in 1987 • Produced Version 2.0 late in 1988 • Version 3.0 effort underway for a while • Clinical Document Architecture (CDA) effort – release 1 Nov 2000 & CDA release 2 passed in committee ballot – Sept 2003 • Clinical Context Effort (CCOW) • Electronic Health Record (EHR) Functional Model (NHII initiative) Healthcare Standards: HL7

  10. Healthcare Standards HL7 Message Structure • Messages in HL7 are defined by: • A message ID (a 3 letter code - e.g., ADT for Admit, Discharge, Transfer-related messages) • One or more segments (logical grouping - e.g., PID segment to represent patient identifying information) • Nesting and repetition of segments as appropriate • “Z” segments for custom use

  11. Healthcare Standards HL7 Clinical Context Object Working Group (CCOW)

  12. CCOW: Focus is the on the visual integration of diverse applications in the user’s desktop Healthcare Standards: HL7

  13. CCOW: • Technology-neutral specifications that will allow healthcare applications to switch contexts seamlessly—oriented toward making multiple Graphical User Interface (GUI) clients work together • Already have interoperable specifications and implementations • Currently working on an interoperable single-sign-on specification

  14. Server “Data” Integration VisualIntegration Server Server The Clinical Applications The Provider's Workstation The Provider * Acknowledgement: Slide provided by Wes Rishel, Gartner Group CCOW – Visual Integration

  15. University Physicians O’Donnell 2234444 Furlow 6731123 O'Donnell 2234444 ContextManager Patient ID Mapper O'Donnell 3222111 General Hospital Master Patient Index O’Donnell 3222111 Crane 58233 Technology solutions Healthcare Standards * Acknowledgement: Slide provided by Wes Rishel

  16. User P App A CM App B 1 Register with CM 2 Register with CM 3 Log on 4 Context – User P 5 Context – User P 6 Select Patient X 7 Context – Patient X 8 Context – Patient X 9 View Patient X Notes 10 View Patient X Labs 11 Log off 12 Context - Reset 13 Context - Reset CCOW Process View

  17. CCOW current work: • Single sign-on: • users do not have to memorize many user names and passwords • authentication via password, badge swipe, biometrics • Web-based applications * Acknowledgement: Slide provided by Wes Rishel

  18. Healthcare Standards HL7 Version 3.0 Acknowledgement: This set of slides are adapted from: Andrew Hinchley’s “Understanding Version 3 – A primer on the HL7 Version 3 Communication Standard

  19. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM HL7 Reference Information Model (RIM) – basis for all HL7 messages RIM defines about 70 basic classes Storyboard Interaction R-MIM HMD Storyboard Message

  20. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM From RIM we can instantiate a Domain Message Information Model Storyboard Interaction R-MIM HMD Storyboard Message

  21. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM Reference Message Information Model are developed for a restricted group of models HMD Storyboard Message

  22. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM R-MIM’s are used to develop message model definitions – called Hierarchical Message Definitions HMD Storyboard Message

  23. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD’s are used to define the HL7 V3 messages which are used to communicate between systems HMD Storyboard Message

  24. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM This defines the roles of sending and receiving application. For example: Laboratory Observation Event Informer – an application that notifies pertinent information about lab results Storyboard Interaction R-MIM HMD Storyboard Message

  25. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM This defines what causes a message to be sent. Specifies the set of conditions that initiate a message transfer. Trigger events are specified by: a name, identifier, description, structured name and a type. Different types of trigger events: interaction based, state-transition based, user based, unspecified. Storyboard Interaction R-MIM HMD Storyboard Message

  26. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD A realistic scenario which requires a communication message to be designed Message

  27. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD Storyboard Scope for the message to be designed – the interaction that needs to be supported Message

  28. The Reference Information Model Act – something happened or may happen. Any action of interest. Entity – a person, animal or organization or thing Role – a part played by an entity Participation – the involvement of a role in a act Act_Relationship – a relationship between two acts Role_Link – a relationship between two Roles

  29. Examples of R-MIM Act Example Prescription classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: SPLY: act is related to supply ORD: an instance of order <=: code value or a vocabulary term Entity Example Person classCode*: <= PSN determinerCode*: <= INSTANCE Name*: PN[1..1] Addr: AD[1..1] PSN: refers to person INSTANCE: can be an instance or quantified value

  30. Examples of R-MIM Role Example Person classCode*: <= PSN determinerCode*: <= INSTANCE Name*: PN[1..1] Addr: AD[1..1] 1..1 patientPerson Patient classCode*: <= PAT Id*: [0..1] Person is playing the role of a patient.

  31. patientSubject typeCode*: <= PATSBJ author typeCode*: <= AUT performer typeCode*: <= PRF Examples of R-MIM Participation Example 1..1 patient Prescription classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: 1..1 medicalPractitioner 1..1 pharmacist

  32. component typeCode*: <= COMP Examples of R-MIM Act_Relationship Example Prescription classCode*: <= SPLY moodCode*: <= ORD statusCode: <= ActStatus activityTime: availabilityTime: 1..* prescriptionItem PrescriptionItem classCode*: <= SPLY moodCode*: <= ORD code*: CD CWE[1..1] <= DrugCode text*: [1..1] activityTime: availabilityTime:

  33. Key Concepts of V3 methodology Application Role Trigger Event RIM D-MIM Storyboard Interaction R-MIM HMD Storyboard Message

  34. Healthcare Standards HL7 CDA

  35. Technology solutions Healthcare Standards Sample CDA Document

  36. Technology solutions Healthcare Standards

  37. Healthcare Standards HL7 EHR

  38. Direct Care DC1.0 Care Management Care Management DC2.0 Clinical Decision Support Ops Mgt & Comm DC3.0 OpsMgt& Comm S1.0 Clinical Support Supportive S2.0 Measurement, Analysis, Research, Reporting S3.0 Admin & Financial Information Infrastructure II1.0 Security Care Management Ops Mgt & Comm II2.0 Information and Records Management II3.0 Unique Identity, Registry, and Directory Care Management Ops Mgt & Comm II4.0 Support for Health Informatics & Terminology Standards II5.0 Interoperability Care Management Ops Mgt & Comm II6.0 Business Rules - Administrative Functions II7.0 Workflow Care Management HL7 EHR Functional Model* * Slide courtesy of Dr. Don Mon, Vice President of AHIMA

  39. The Longitudinal Record: Distributed Across EHR’s Hospital EHR-S Nursing Home EHR-S Physician Office EHR-S Home Health EHR-S Referral Data Referral Data Referral Data PHR Regional Health Info Exchange • Data stays where it is(distributed, federated) • Federated MPI’s Building Block for Info Exchange* * Slide courtesy of Dr. Don Mon, Vice President of AHIMA

  40. HL7 Summary • Version 3.0 Reference Information Model • Interoperability Demonstrations using XML and HL7 RIM models have happened since HIMSS 99. • HL7 CDA effort has taken root • HL7 CCOW has made significant inroads. • EHR effort is ground-breaking and is lead by the Dept. of Health and Human Services as part of the NHII. Healthcare Standards: HL7

  41. Technology solutions Healthcare Standards HL7 References HL7: Health Level 7: http://www.hl7.org/

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