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Mike Cummens, MD

17 Mar 06. Northrop Grumman Private / Proprietary Level I. Agenda. AHLTA GoalsTerminology InteroperabilityFuture Directions. 17 Mar 06. Northrop Grumman Private / Proprietary Level I. AHLTA Scope. 9.2 Million beneficiaries129,000 Staff411 clinics104 Military Treatment Facilities70 hospitalsTh

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Mike Cummens, MD

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

    2. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Agenda AHLTA Goals Terminology Interoperability Future Directions

    3. 17 Mar 06 Northrop Grumman Private / Proprietary Level I AHLTA Scope 9.2 Million beneficiaries 129,000 Staff 411 clinics 104 Military Treatment Facilities 70 hospitals Theater (partial list) Iraq Afghanistan

    4. 17 Mar 06 Northrop Grumman Private / Proprietary Level I AHLTA Weekly Volume 2.1 million prescriptions 1.8 million outpatient encounters 2,000 births for Uniformed Services members, retirees and their families

    5. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    6. 17 Mar 06 Northrop Grumman Private / Proprietary Level I

    7. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    8. 17 Mar 06 Northrop Grumman Private / Proprietary Level I MHS Terminologies (partial) SNOMED CT Medicomp MEDCIN PKC 3M HDD NCID MTF Laboratory IEN MTF Allergy AIEN NDC CliniComp CAP FDA COMMERCIALCAP FDA COMMERCIAL

    9. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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 SNOMED CT SIZE 250,000 termsSNOMED CT SIZE 250,000 terms

    10. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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 SNOMED CT SIZE 250,000 termsSNOMED CT SIZE 250,000 terms

    11. 17 Mar 06 Northrop Grumman Private / Proprietary Level I COTS Application Terminology Challenges Non Standard Task oriented “Ontology lite” at best Decentralized usage Context dependent terms Propositional terms Proprietary restrictions DECENTRALIZED CLINICOMP NDC 270 degrees Temp Scale ¾ turn West Angle measurement PROPOSITIONAL terms in CDS LDL Cholesterol over 100 or above normal rangeDECENTRALIZED CLINICOMP NDC 270 degrees Temp Scale ¾ turn West Angle measurement PROPOSITIONAL terms in CDS LDL Cholesterol over 100 or above normal range

    12. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Real Time Interoperability mediation between Departments of Veterans Affairs and Defense Drug Allergies

    13. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Drug Allergies

    14. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Allergic Reactions

    15. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Allergic Reactions

    16. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Medications

    17. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Medications

    18. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Interoperability mediation between Departments of Veterans Affairs and Defense Medications

    19. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Clinical Data Repository/Health Data Repository (CHDR) Translation table of Drug Allergies, Allergic Reactions and Medications in Real Time

    20. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    21. 17 Mar 06 Northrop Grumman Private / Proprietary Level I AHLTA CDR, MEDCIN, and PKC Interoperability

    22. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Terminology Services Bureau Content management environment Semi-automated term mapping using NLP Manual mapping and editing by terminology experts Run Time environment

    23. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    24. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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.

    25. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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 Deep understanding of source terminologies Map modifiers with core terms. Deep understanding of source terminologies Map modifiers with core terms.

    26. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    27. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Use Case: Lab Flow Sheets - What the Provider Sees Image of docs clicking on the diagnosis. In the encounter – problem list. Clicks on the problem and asks for a flow sheet to be displayed for that problem. The system retrieves the flowsheet and displays it.Image of docs clicking on the diagnosis. In the encounter – problem list. Clicks on the problem and asks for a flow sheet to be displayed for that problem. The system retrieves the flowsheet and displays it.

    28. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Use Case: Lab Flow Sheet - How it is technically done

    29. 17 Mar 06 Northrop Grumman Private / Proprietary Level I 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

    30. 17 Mar 06 Northrop Grumman Private / Proprietary Level I Planned and Future Uses of TSB (cont.) Educate customers to the advantages of reuse of mediating terminologies Increase number of mediation terminologies and maps.

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