Survey of Medical Informatics by vz9r6i

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									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
Data Interchange Standards


    Message Format Standards
Message Format Standards

   CHI mandates:
       HL7 Version 2.x
       DICOM
       NCPDP
       IEEE standards for medical devices
       LOINC
Healthcare Standards



        HL7
      Standard
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
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
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
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
Healthcare Standards


  HL7 Clinical Context
  Object Working Group
         (CCOW)
CCOW:
 Focus is the on the visual integration
 of diverse applications in the user’s
 desktop




                    Healthcare Standards: HL7
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
CCOW – Visual Integration
  “Data”                 Server
Integration                                                     Visual
                                          Server
                                                             Integration
 Server

                                                              The Clinical
                                                              Applications
 The
 Provider's
 Workstation
                                              The Provider
    * Acknowledgement: Slide provided by Wes Rishel, Gartner Group
Technology solutions


  Healthcare Standards                                              University
                                                                    Physicians

                                                               O’Donnell 2234444
                                               O'Donnell       Furlow    6731123
                                                2234444

                              Context
                              Manager
                Patient ID                     O'Donnell
                 Mapper                        3222111



            Master Patient Index                           General Hospital
                       General    University
                       Hospital   Physicians               O’Donnell 3222111
      O'Donnell        3222111 2344444                     Crane       58233
      Furlow                 -- 6731123
      Crane             582233        --


                  * Acknowledgement: Slide provided by Wes Rishel
CCOW Process View
  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 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
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
Key Concepts of V3 methodology
             Application         Trigger
                                             RIM
               Role              Event


                       HL7 Reference        D-MIM
                  Information Model (RIM)
                      – basis for all HL7
Storyboard   Interaction messages
                                            R-MIM
                   RIM defines about 70
                      basic classes

Storyboard                                   HMD



                                            Message
Key Concepts of V3 methodology
             Application          Trigger
                                             RIM
               Role               Event


                     From RIM we can        D-MIM
                   instantiate a Domain
                   Message Information
Storyboard   Interaction Model
                                            R-MIM



Storyboard                                   HMD



                                            Message
Key Concepts of V3 methodology
             Application         Trigger
                                            RIM
               Role              Event


                                           D-MIM


Storyboard   Interaction
                   Reference Message       R-MIM
                  Information Model are
                      developed for a
                    restricted group of
Storyboard                models            HMD



                                           Message
Key Concepts of V3 methodology
             Application         Trigger
                                            RIM
               Role              Event


                                           D-MIM


Storyboard   Interaction
                                           R-MIM

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


                                         D-MIM


Storyboard   Interaction
                                         R-MIM


                 HMD’s are used to
Storyboard       define the HL7 V3        HMD
                messages which are
                used to communicate
                  between systems
                                         Message
Key Concepts of V3 methodology
             Application            Trigger
                                                        RIM
               Role                 Event


                                                       D-MIM
                 This defines the roles of sending
Storyboard           and
             Interaction receiving application.
                     For example: Laboratory           R-MIM
                 Observation Event Informer – an
                 application that notifies pertinent
                   information about lab results
Storyboard                                              HMD



                                                       Message
Key Concepts of V3 methodology
               Application           Trigger
                                                       RIM
                 Role                Event


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


                                              D-MIM


Storyboard    Interaction
                                              R-MIM



             A realistic scenario which        HMD
                     requires a
             communication message
                  to be designed
                                              Message
Key Concepts of V3 methodology
             Application           Trigger
                                              RIM
               Role                Event


                                             D-MIM


Storyboard   Interaction
                                             R-MIM



Storyboard    Scope for the message           HMD
               to be designed – the
             interaction that needs to
                   be supported
                                             Message
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
Examples of R-MIM
 Act Example

Prescription
classCode*: <= SPLY            SPLY: act is related to supply
moodCode*: <= ORD              ORD: an instance of order
statusCode: <= ActStatus       <=: code value or a vocabulary term
activityTime:
availabilityTime:

 Entity Example

Person
classCode*: <= PSN             PSN: refers to person
determinerCode*: <= INSTANCE   INSTANCE: can be an instance or
Name*: PN[1..1]                            quantified value
Addr: AD[1..1]
Examples of R-MIM
 Role Example

                              Person
                              classCode*: <= PSN
                              determinerCode*: <= INSTANCE
                              Name*: PN[1..1]
         1..1 patientPerson   Addr: AD[1..1]

Patient
classCode*: <= PAT
Id*: [0..1]                      Person is playing the role of
                                 a patient.
Examples of R-MIM
 Participation Example
                                        1..1 patient
Prescription             patientSubject
classCode*: <= SPLY      typeCode*: <= PATSBJ
moodCode*: <= ORD
statusCode: <= ActStatus
                            1..1 medicalPractitioner
activityTime:
                         author
availabilityTime:
                         typeCode*: <= AUT

                               1..1 pharmacist
                           performer
                           typeCode*: <= PRF
Examples of R-MIM
 Act_Relationship Example
               Prescription
               classCode*: <= SPLY
               moodCode*: <= ORD
               statusCode: <= ActStatus
               activityTime:
               availabilityTime:
                 component
                 typeCode*: <= COMP       1..* prescriptionItem


          PrescriptionItem
          classCode*: <= SPLY
          moodCode*: <= ORD
          code*: CD CWE[1..1] <= DrugCode
          text*: [1..1]
          activityTime:
          availabilityTime:
Key Concepts of V3 methodology
             Application   Trigger
                                      RIM
               Role        Event


                                     D-MIM


Storyboard   Interaction
                                     R-MIM



Storyboard                            HMD



                                     Message
Healthcare Standards



      HL7 CDA
Technology solutions


  Healthcare Standards
 Sample CDA
 Document
Technology solutions


  Healthcare Standards
Healthcare Standards



      HL7 EHR
  HL7 EHR Functional Model*
   Direct

                          Care Management
   Care


                    DC1.0 Care Management
                          Ops Mgt & Comm
                    DC3.0 Ops Mgt & Comm

                    S1.0    Clinical Support
      Supportive




                                                        DC2.0    Clinical Decision
                                                                 Support
                    S2.0    Measurement, Analysis,
                            Research, Reporting

                    S3.0    Admin & Financial

                    II1.0    Care Management
                            Security
                             Ops Mgt & Comm
                    II2.0   Information and Records Management
   Infrastructure
    Information




                    II3.0    Care Management
                            Unique Identity, Registry, and Directory
                             Ops Mgt & Comm
                    II4.0   Support for Health Informatics & Terminology Standards
                    II5.0    Care Management
                            Interoperability
                             Ops Mgt & Comm
                    II6.0   Business Rules - Administrative Functions
                    II7.0    Care Management
                            Workflow



* Slide courtesy of Dr. Don Mon, Vice President of AHIMA
   Building Block for Info Exchange*
             The Longitudinal Record: Distributed Across EHR’s


                                                           Nursing
                                Hospital
                                                            Home
                                 EHR-S
    Physician        Referral                   Referral   EHR-S       Referral   Home
                      Data                       Data                   Data
     Office                                                                       Health
     EHR-S                                                                        EHR-S




                                             Regional           • Data stays where it is
                 PHR                        Health Info           (distributed, federated)
                                            Exchange            • Federated MPI’s


* Slide courtesy of Dr. Don Mon, Vice President of AHIMA
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
Technology solutions


  Healthcare Standards
 HL7 References




                       HL7: Health Level 7:
                        http://www.hl7.org/

								
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