Survey of Medical Informatics

1. Survey of Medical Informatics CS 493 – Fall 2004 September 13, 2004

2. Federal Leadership and Public-Private Partnerships Chapter 3: Patient Safety - Achieving a New Standard of Care. IOM Report

3. Federal Leadership Needed • To streamline standards development process • To promote public-private partnerships

4. Standards in three different areas • Interchange standards • Terminology standards • Knowledge representation standards

5. Data Interchange Standards

6. Data Interchange Standards • Three mechanisms in play • Federal mandates • Consensus balloting in voluntary organizations • De-facto standards • Figure 3.1, pg 98 of the IOM book • Box 3-1, pg 99

7. Consensus Balloting Process • Process used by HL7, IEEE and NCPDP • Draft circulated to Standards Development Organization (SDO) members and other interested parties • Reviewers cannot be all vendors – a 50% balance is maintained between vendors and users • All comments reviewed and negative ballots has to be reconciled • 90% or greater consensus needed to pass the standard for data interchange. Majority in most other cases.

8. ANSI process • ANSI approves the standards proposed by SDOs. Once approved, they become American National Standards. • Standards need to be reviewed at least every 5 years for relevance.

9. Implementing Standards • Conformance assurance for standards compliance • Accreditors check compliance • Can be either be public – National Voluntary Laboratory Accreditation program run by NIST • Or private – American Association for Laboratory Accreditation

10. European Standards and overlapping efforts • Comite’ European de Normalisation (CEN) • ANSI counterpart in Europe • Significant overlap in standards body roles and responsibilities (Table 3-1 – page 102) • Standards in US are formulated by voluntary participation by vendors and providers • Europe, Japanese, Australian and others rely on government funds to establish standards for their country.

11. Terminologies

12. Terminologies • Over 150 terminology systems in use • Very little standardization – not interoperable • International Classification of Diseases [ICD] • Box 3-2 – pg 104

13. Knowledge Representation standards

14. Knowledge representation • 1997 Report by the National Committee on Quality Assurance • National rate for an annual diabetic eye exam is 38.4% • AHRQ  Evidence-based practice centers (EPCs http://www.ahrq.gov/clinic/epc/ ), primary care practice-based research networks (PBRNs - http://www.ahrq.gov/research/pbrnfact.htm ) and Integrated Delivery System Research Network (IDSRN - http://www.ahrq.gov/research/idsrn.htm )

15. Evidence-based guidelines • 13 EPCs  Goal is to develop guidelines based on rigorous analysis of scientific literature • To translate these guidelines into computer readable format is the challenge to the informatics community. • PBRN  for example the role of antibiotics in the care of acute otitis media (ear infection) • IDSRN  44 IDSRN projects funded – quality measurement and improvement, bioterrorism, information technology, organization and financing, disparities in access to care. • Cochrane Collaboration: UK-based effort at developing reliable guidelines for practice http://www.cochrane.org/index0.htm • The Centers for Education and Research on Therapeutics (CERTs) – program of AHRQ in consort with FDA to conduct research and provide education on the optimal use of drugs, medical devices, and biological products. http://www.certs.hhs.gov/ • MedBiquitous : consortium with goals to create educational environment that is tied to the practice of medicine. http://www.medbiq.org/index.html

16. Reporting Standards • CMS & Premier demonstration: • http://www.cms.hhs.gov/researchers/demos/phqidemo.asp • http://www.cms.hhs.gov/quality/hospital/PremierMeasures.pdf • Medicare Equity and Access Act: • http://www.theorator.com/bills108/hr2033.html • DHHS has given a contract to Kevric Corp to integrate patient safety reporting within DHHS. • Appendix C [need to check] • Quality Interagency Coordination Task Force (QuIC) • http://www.quic.gov/index.htm • Diabetes Quality Improvement Project

17. Reporting Standards • National Quality Forum (NQF) • http://www.qualityforum.org/ • National Committee for Quality Assurance (NCQA) • http://www.ncqa.org/ • HEDIS – Health Plan Employer Data and Information Set – to compare commercial, Medicaid and Medicare managed health plans • Consumer Assessment of Health Plans, the Diabetes Quality Improvement Project, and the Health Outcomes Survey. • JCAHO • http://www.jcaho.org/ • Core Measures: http://www.jcaho.org/pms/core+measures/index.htm • FACCT – Foundation for Accountability • http://www.facct.org/facct/site/facct/facct/home • Consumer Information Framework: Basics, staying healthy, getting better, living with illness, and changing needs • IOM Recommendation: QuIC be given the lead role to coordinate reporting standards and work with NQF, NCQA, JCAHO & FACCT.

18. National Committee on Vital and Health Statistics • Has the lead role in identifying and recommending clinical data standards. • HIPAA standards established: • ANSI ASC X12N EDI standard for administrative and financial transactions • NCPDP standard for pharmacy billing transactions. • Adopted: ICD-9 CM, HCPCS, NDCs, Common Dental Terminology – CDT-2 • Identifiers for employers • Privacy rules that safeguards personal health information • Rules for claims attachment are in progress

19. Consolidated Health Informatics Initiative • CHI members include: • DHHS, NCVHS, VHA, DoD, Indian Health Service, Dept of Agriculture, EPA & FDA. • Goal of CHI is to articulate and execute a coherent vision and strategy for the adoption of interoperability standards in healthcare. • DHHS, DoD & VHA have announced that they will adopt: HL7, NCPDP, IEEE 1073, DICOM & LOINC based largely on the recommendations from CHI.

20. Public Health Data Standards Consortium • http://www.phdatastandards.info/ • Organization that promote data standards that serve the interest of public health services • Membership includes: • CDC, AHRQ, CMS, managed care organizations, business coalitions and consumer groups

21. National Alliance for Health Information Technology • http://www.aha.org/nahit/about.html • Over 100 members from: • Providers: Hospitals, health systems, medical groups • Payors: Insurance companies, managed care organizations • Supply chain: pharmaceutical, medical device manufacturers • Other stakeholders: government, standards bodies • Promote adoption of consensus-based standards leading to a national health information infrastructure

22. Integrating the Healthcare Enterprise • HIMSS, RSNA started this collaborative effort in 1998. • Process overview: • Identify integration scenarios/problems • Specify applicable technology standards that can address the integration profile • Recruit vendors to implement and showcase solution to the integration problem • Development and dissemination of integration profile documents

23. IOM recommendations • Figure 3-2, pg 120