HL7 and DICOM Standards in Taiwan

1. HL7 and DICOM Standards in Taiwan 李友專, M.D., Ph.D. 中華民國醫療資訊學會 台北醫學大學醫學資訊研究所

2. Current Status of Healthcare Information in Taiwan

3. Problems with Current Status • 編碼系統缺乏一致性及臨床表達能力 • 缺乏一致的資料交換格式 • 結果 • Bad code portability and reusability • Complicated sub-system integration • Hard to upgrade • We need some standards!!!

4. Medical Information Standards

5. The nice thing about standard is… There are so MANY to choose from!!!

6. Medical Information Standard • Many different purposes • For financial transaction, insurance claims, clinical data, images, …etc. • Many different standard organizations • ANSI, ISO (TC215),CEN (TC251), IEEE, ASTM, HL7, DICOM (ACR-NEMA), various medical associations such as CAP, AMA, ADA…etc.

7. Medical Information Standard(cont.) • Standards for Data Interchange • Allow data to be exchanged among different systems, intra-hospital or inter-hospital • e.g. HL7, DICOM…etc. • Standards for terms, codes and vocabularies • Sets of codes that represents medical terms • e.g. SNOMED, LOINC…etc.

8. Standards for Data Interchange

9. Layers of Standards ISO OSI (Open Systems Interconnection) 7 Layers • Layer 7 – Application protocol • Layer 5, 6 – Session & Presentation protocols • Layer 2,3,4 – Link, Network and Transport protocols – e.g. TCP/IP • Layer 1 – Physical protocol

10. Text/Multimedia Interchange • HL7 (Health Level 7) • a messaging standard for clinical and administrative data in healthcare • DICOM (Digital Imaging and Communications in Medicine) • a communication standard for bio-medical images

11. HL7 Standard

12. HL 7 • Established in 1987 as a messaging standard for clinical and administrative data in healthcare • 20 technical committees, 17 special interest groups → Technical Steering Committee • Currently in V 2.4.1, transition to V 3.0 • 15 Chapters

13. HL 7 (cont.1) • V 3.0 (balloting till the end of 2003) • A leapfrog approach • Message Development Framework (MDF) • Reference Information Model (RIM) • Object-oriented models with 126 class, 861 attributes • Can be exchanged as ASCII or XML form • Use of Object Brokerage (CORBA, DCOM)

17. HL 7 (cont.2) • New development in conjunction with V 3.0 • Arden Syntax Standard (for clinical decision support) • Clinical Document Architecture (CDA) • XML defined EHR, v1.0 transition to v2.0 • Clinical Context Management Specification (CCOW) • ANSI approved, version 1.3 • Vocabulary TC • SNOMED, LOINC (Logical Observation Identifiers Names and Codes)

18. What is the CDA The HL7 Clinical Document Architecture (CDA) is a document markup standard that specifies the structure and semantics of "clinical documents" for the purpose of exchange. A clinical document contains observations and services and has the following characteristics: • Persistence – A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements. • Stewardship – A clinical document is maintained by a person or organization entrusted with its care. • Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated. • Context - Contents of a clinical document share a common context unless all or part of that context is overridden or nullified. • Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without the full context of the document. • Human readability – A clinical document is human readable. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content.

19. More on CDA • CDA vs. HL7 Messages • A CDA document is a defined and complete information object that can exist outside of a messaging context and/or can be a MIME-encoded payload within an HL7 message.

21. HL 7 (cont.3) • HL7 Taiwan is now a member nation of International HL7 Affiliate • HL7 Website: • www.hl7.org.tw (Taiwan) • www.hl7.org (US)

22. DICOM Standard

23. DICOM • Created by ACR(American College of Radiology) and NEMA(National Electrical Manufacturers Association) in 1994 as a communication standard for bio-medical images • Driven by real needs, very fast development • Now with 21 Working Groups, including cardiology, ophthalmology, nuclear medicine, dermatology…etc.

25. DICOM (cont.) • Start from Radiological images, now also • Visible light and sonogram images • 3D images • Radiotherapy objects • Structured reports • Widely available for CT, MRI, CR, DR, Sonogram machines • Quite popular in Taiwan

26. DICOM (cont.) • Basic requirement for medical imaging device • Now 16 Chapters • Website: • http://medical.nema.org/

27. DICOM Part 1: Introduction and Overview • DICOM Part 2: Conformance • DICOM Part 3: Information Object Definitions • DICOM Part 4: Service Class Specifications • DICOM Part 5: Data Structure and Semantics • DICOM Part 6: Data Dictionary • DICOM Part 7: Message Exchange • DICOM Part 8: Network Communication Support for Message Exchange • DICOM Part 10: Media Storage and File Format for Media Interchange • DICOM Part 11: Media Storage Application Profiles • DICOM Part 12: Media Formats and Physical Media for Media Interchange • DICOM Part 14: Grayscale Standard Display Function • DICOM Part 15: Security Profiles • DICOM Part 16: Content Mapping Resource

32. DICOM 3.0 Standard

33. Integrating the Healthcare Enterprise - IHE • IHE was started by RSNA (Radiological Society of North America) and HIMSS (Healthcare Information and Management Systems Society). Now in Year 5 (RSNA 2003 and HIMSS 2004). • Integration framework for DICOM and HL7

34. IHE technical framework • IHE Infrastructure Technical Framework • Radiology Technical Framework

37. Other Standards

38. Vocabulary • UMLS (Unified Medical Language System) • Metathesaurus, from National Library of Medicine (NLM) • SNOMED 3 • from College of American Pathologist (CAP) • LOINC – from HL7 Inc. • ICD9-CM, ICD-10 – from WHO • READ Classification • From NHS of UK

39. Reusable knowledge • Developed in the 1990s as MLM (Medical Logic Modules) • Arden Syntax • PASCAL-like, rule-based • Columbia University • Now part of HL7 and ANSI Standard

40. Why Standards?

41. Why NOT Standards • Lack of recognition • Don’t know, don’t care • Less short-term overhead • Takes a lot of time to understand standards • Easier to implement (at first) • Legacy systems • Need to be retrofitted

42. Why Standards • Interchangeability • Manageability • Subsystems can be upgraded independently • Integration • Pick the best of breeds • Competitiveness • Med info industry

43. How Standards

44. Integrated Effort • Government • Legislation issues • Funding – NHI? • Hospitals/Clinics • Think Big, start small • Industry • Get involved at the early stage • Schools • Localization • Find out what we can/cannot use

45. Integrated Effort (cont.) • HL7 Taiwan has been formed through the help of 中華民國醫療資訊學會 in 2000 • 生物醫學工程學會 has joined the DICOM committee, now DICOM Taiwan in 2003 • More effort needed to sustain its future operation

46. For More Information • http://www.medinfo.org.tw/ • http//www.hl7.org.tw/ • http://www.dicom.org.tw/