HIMA 4160 Concepts in Health Information Technologies

1. HIMA 4160Concepts in Health Information Technologies Data and Data Standards Fall 2009

2. Data • Data, Information and Knowledge • Source of health care data • Properties of health data • Healthcare Standards • Concepts • Important Health care standards • The desiderata of controlled terminology Outlines

3. http://www.youtube.com/watch?v=YKF3Eo5m1P4

4. Clinical Data

5. The patient in question • The parameter being observed or measured • The value of the parameter in question • The time of observation Elements of Data

6. Narrative • Abbreviation • Phrases • Numeric • Continuous signal • Multimedia • ... Type of Data

7. Clinicians • physicians • nurses • pharmacists • allied health • Office and administration staff. • Medical devices Who collects the data?

8. Create the basis for the historical record • Support communication among providers • Anticipate future health problems • Record standard preventive measures • Identify deviations from expected trends • Provide a legal record • Support clinical research Use of Medical Data

9. Conventional clinical data are semi-structured. • Medicine vs. Computer • Computer needs more structured data. • Coding, terminology, vocabulary systems Structure of Medical Data

10. Data Information Knowledge Data, Information and Knowledge

11. What is standard? • Why do we need standard in health care? • What are some of the major types of standard in health care? • What are some of the standards and standard development organizations? Data Standards

12. To facilitate communication. • To benchmark product or processes. • To increase efficiency. • To increase accessibility – ATM • To decrease cost Why do we need standard?

13. Languages • Transportation • Internet protocols • Operating systems What are some examples of the Standards?

14. Government mandates – HIPAA • Market oriented • De facto – Microsoft Windows, VCR, Blue-Ray? • De Jure • Ad hoc -- DICOM • Consensus – Many SDOs Categories of standard based on the development process

16. SDOs are organizations that develop and maintain the models, data dictionaries, structure, syntax, and implementation materials for electronic transaction standards between and within providers. All designated SDOs maintain policies that meet the requirements of the American National Standards Institute (ANSI), which accredits standards committees and provides an open forum for participants to identify, plan and agree on standards and assurance of due process. Standard Development Organizations

17. Consensus on a proposed standard • Broad based public review and comment on draft standards • Consideration of and response to comments submitted by voting members of the relevant consensus body and by public review commenter. • Incorporation of approved changes into a draft standard • Right to appeal by any participant that believe that due process principles were not sufficiently respected during the standards development in accordance with the ANSI-accredited procedures of the standards developer ANSI SDO Process

18. ISO ANSI ASTM HL7 ASC … … ISO, ANSI, and SDOs … …

19. Facilitate Information Sharing • Improve Efficiency • Avoid Waste and Redundancy • Improve Quality Why Do We Need Standards in Health Care

21. Classifications, Nomenclature, Vocabulary and Terminology • Data Interchange • Health Record Content and Structure Health Care Standards

22. Classifications, Nomenclature, Vocabulary and Terminology – Words and Semantics • Data Interchange – Conversation • Health Record Content and Structure – Composition Analogy -- Language

23. Classification: A clinical vocabulary, terminology, or nomenclature that lists words or phrases with tier meanings, provides for the proper use of clinical words as names or symbols, and facilitate mapping standardized terms to broader classifications for administrative, regulatory, oversight, and fiscal requirements. Classification -- Definition

24. A recognized system of terms used in a science or art that follows pre-established naming conventions; a disease nomenclature is a listing of the proper name for each disease entity with its specific code number. Nomenclature

25. A set of terms representing the system of concepts of a particular subject field; a clinical terminology provides the proper use of the clinical words as names or symbols Terminology -- Definition

26. list or collection of clinical words or phrases and their meanings. Vocabulary – Definition

27. ICD • ICF • CPT • DRG Classification Systems

28. SNOMED • LOINC • RxNorm Terminology

29. SNOMED-CT • Clinical terminology/nomenclature • College of American Pathologies + National Health Service (NHS). Systematic Nomenclature of Medicine – Clinical Term

30. Concepts (344,000)‏ • Findings (swelling of arm)‏ • Diseases (pneumonia)‏ • Procedures (biopsy)‏ • Observable entities (tumor stage)‏ • Body structure (structure of thyroid)‏ • Organism (DNA virus)‏ • Substance (Gastric acid)‏ • Pharmaceutical/biologic product (tamoxifen)‏ SNOMED -- CT

31. Specimen (urine specimen)‏ • Physical object (suture needle)‏ • Physical force (friction)‏ • Events (flash flood)‏ • Environments/geographical location (intensive care unit)‏ • Social context (organ donor)‏ • Context – dependent categories (no nausea)‏ • Staging and Scales (Nottingham ten-point ADL index assessment scale)‏ • Attribute (controlled temperature)‏ • Qualifier value (bilateral)‏ • Duplicate concept (inactive concept)‏ SNOME – CT Concepts (cont.)‏

32. 913,000 Description/Synonym -- to express the clinical concepts • ~1.3 million semantic relationship to enable reliability and consistency of data retrieval SNOMED -- CT

33. SNOMED CT Concepts are modelled using • Hierarchies • Each “child” must be a subtype of its “parent” • concept may have multiple parents • Defining relationships • Using attributes, concepts may be linked to each other • Only relationships that are necessarily true are included • Appendicitis : site = appendix OK • All appendicitis has location in the appendix. • SLE : manifestation = anemia O no • Only some people with SLE have anemia. SNOMED -- CT

34. SNOMED is concept based • Each concept represents a unit of meaning • Each concept has one or more human language terms that can be used to describe the concept • Every concept has inter-relationships with other concepts that provide logical computer readable definitions. These include hierarchical relationships and clinical attributes. The Principles behind SNOMED CT structure

35. The Principe Behind SNOMED CT

36. Relationship allow multiple hierarchy

37. Multiple Hierarchy

38. SNOMED CT contains relationships that link concepts to form logical computer readable definitions. • Logical definitions allow data to be recorded in a flexible way, whilst retaining the ability to analyze it in a consistent fashion. Semantic Relationship

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41. SNOMED CT is one of a suite of designated data standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information. • The National Library of Medicine (NLM), on behalf of the U.S. Department of Health and Human Services, entered into an agreement with College of American Pathologists for a perpetual license for the core SNOMED CT (in Spanish and English) and ongoing updates. • The contract provides to NLM a perpetual license to distribute SNOMED within the NLM’s Unified Medical Language System UMLS Metathesaurus for no cost use within the U.S. by both U.S. government (federal, state, local, and territorial) and private organizations. • The contract also covers updates to SNOMED CT issued by the College of American Pathologists between June 30, 2003 and June 29, 2008. Use

42. Logical Observation Identifier Names and Codes • Facilitate lab results transmission • Developed and maintained by Regenstreif Institute at IU. • About 32,000 observation terms LOINC

43. <component>:<property>:<timing>:<system>:<scale>:<method> • 8331-1 Body temperature: TEMP: PT: MOUTH: QN LOINC codes are created systematically using a six axis model

44. Component • Ejection fraction, heart beats, cardiac output, circumference • Kind of property • Angle, area, length, mass, pressure, temperature • Timing • Point in time, study minimum, maximum in 8 hours • System • Head of fetus, tricuspid valve, ventilator setting • Scale • Quantitative, ordinal, nominal, narrative • Method • Stated, measured, estimated Six Primary Axes

45. Standardized nomenclature for the clinical drug • Maintained by the National Library of Medicine • The name of a clinical drug combines its ingredients, strengths, and form RxNorm

46. Acetaminophen 500 MG Oral Tablet for a generic drug name • Acetaminophen 500 MG Oral Tablet [Tylenol] for a branded drug name RxNorm

47. RxNorm

48. A project at NLM to integrate many nomenclature systems • Three basic components • UMLS Metathesaurus • SPECIALIST Lexicon • UMLS Semantic Network UMLS

49. System A System B Data Interchange Standards

50. OSI Model level 7 – application • Define • The data to be exchanged • The timing of the exchange • The communication of errors between application HL7 Messaging Standard