Health Informatics in Low- and Middle-Income Countries Short
Health Informatics in Low- and Middle-Income Countries Short Course for Health Information System Professionals Data and Interoperability: Standards to Promote Health Information Exchange Standards to Promote Health Information Exchange Learning Objectives Define terms related to standardized terminologies Identify and define terminologies and vocabularies that represent nursing care
Define and give examples of data interchange standards 2 The Problem Understanding what the data say Understanding what the data mean Understanding where the data are Understanding the context in which the data are collected Failure to understand may result in a medical error and maybe even death 3
Data Collection In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison if wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have any means of obtaining at present. Florence Nightingale
4 Information Standards Data set o List of the data elements with uniform definitions Standardized terminologies o Allow merging data for population health studies o Allow use of decision support o Allow mapping between terminologies for patientspecific information (Giannangelo, 2010) 5
Important Terms Data dictionary o Dictionary of the metadata for a particular data set o Definitions, principles, and guidelines for each data element o Specifies values for each element Metadata o Data about the data o Characteristics of each data element (Giannangelo, 2010; Amatayakul, 2009) 6 Interoperability
The ability of different information technology systems to communicate, to exchange data accurately, effectively and consistently and to use the information that has been exchanged. Date of birth formats o 3/22/56 o March 22, 1956 o 22 March 1956 (National Alliance for Health Information Technology, 2008) 7 Interoperability
Standardized terminologies and ontologies o Patient diagnoses, interventions, outcomes Semantic interoperability o Data mean same thing to different users 8 Semantic Interoperability The ability to share data whose meaning is unambiguously clear and precise, their context understood, so they can be used for any purpose. With true semantic interoperability, the receiver is independent from the sender. 9
Problems Preventing Semantic Interoperability There are many problems that prevent us from achieving semantic interoperability. Same words that have different meanings Different words that have the same meaning Words that are too general to convey a specific meaning Localisms that lose meaning beyond that region Failure to pay attention to factors other than name, such as units or how measured Inconsistencies in the level at which things are described 10
Semantic Interoperability: Issues Legacy of existing data More than 400 terminologies in use today, plus local vocabularies Lack of a solution = no semantic interoperability Photo courtesy of Dr. Betsy Humphreys of the National Library of Medicine 11
More Problems There are too many choices for too many purposes. Certain words are required for specific uses, but these choices do not satisfy multiple uses. Most institutions use local vocabularies and map to the broader set of controlled vocabularies they are required to use. 12 Confusion Comes Quickly Vocabulary Terminology
Nomenclature Classification Taxonomy Ontology Groupers 13 Basic Features of Terminology Basic features of terminology include: Unique identifiercode
o Numeric and without meaning o May include check digit o Moving toward use of International Organization for Standardization-based object identifier (paths in a tree structure) o Assigning authority is assigned to organizations who in turn assign the identifiers (Health Level 7 is an assigning authority) Official name
o Female Synonyms o Woman, girl 14 General Categories of Terms Demographics Signs and symptoms Anatomy Physical findings Diagnostic procedures Organisms
Coding the DataGender Data elementgender Class: demographic Controlled terminology (value set) o Male o Female o Unknown (dont know, havent asked) o Unknown (cant tell) (by dress; anatomically) Representation o M,F,U or 0,1,2 or other Administrative or clinical 16
Electronic Health Record Messaging Standards Also called o Data exchange standards o Interoperability standards Support sharing of data o Safe o Accurate Protocols o Data definitions (Amatayakul, 2009) 17
Electronic Health Record Messaging Standards Numerous standards, including o American National Standards Institute (ANSI), Accredited Standards Committee X12-Insurance Subcommittee o Digital Imaging and Communications in Medicine (Amatayakul, 2009) 18 Digital Imaging Communications
in Medicine Facilitates the exchange of images and diagnostic information from manufacturers to vendors to providers Application is in any area using diagnostic images such as radiology, pathology, dentistry Standards address o Data structure o Data dictionary o Message exchange o Media storage o Mapping (Giannangelo, 2010)
19 Health Level 7 ANSI accredited SDO Used for healthcare information exchange around the world Standards for o Clinical data exchange o Vocabulary o Document architecture (Health Level Seven International) 20
Classifications, Terminologies and Vocabularies Classification systems designed to group similar or related data o Group similar or related data International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) (Giannangelo, 2010) 21
Classifications, Terminologies and Vocabularies Terminologies o Contain terms that represent a system of concepts (Giannangelo, 2010) 22 Classifications, Terminologies and Vocabularies Vocabularies o List or collection of words and their meanings
(Amatayakul, 2009) 23 Clinical Terminologies Designed for the documentation by providers when delivering clinical care Allow for the information to be codified and used in electronic health records (EHRs) 24 ICD-10-CM
Modification of the World Health Organizations ICD-10 ICD-10-CM implemented in 2015 Numerous purposes o Statistics and research o Reimbursement o Analyzing patterns of care o Strategic planning 25 National Drug Codes Used for reporting retail pharmacy
transactions Owned by the U.S. Food and Drug Administration Medications o Prescription drugs o Over-the-counter drugs o
Drugs used by veterinarians Used for billing and reimbursement Used for tracking drugs for many purposes (U.S. Food and Drug Administration, 2012) 26
National Committee on Vital and Health Statistics Health Level 7 for: o Messaging o Clinical encounters Systematized Nomenclature of Medicine, Clinical Terminology (SNOMED CT) for: o Diagnosis and problem list o Nonlaboratory procedures and interventions o Anatomy and nursing data 27
Systematized Nomenclature of Medicine Clinical Terms Developed by College of American Pathologists Ownership transferred to International Health Terminology Standards Development Organisation Distributed free in the United States by the National Library of Medicine (International Health Terminology Standards Development Organization) 28 SNOMED CT Compilation of many healthcare terminologies
Comprehensive clinical terminology Controlled medical terminology Multilingual Hierarchical Captures clinical information in EHR Source: (Giannangelo, 2010) 29 Logical Observation Identifiers, Names, and Codes Developed by the Regenstrief Institute Provides a standard set of codes and names for the
electronic reporting of laboratory results Expanded to include items related to measurement of clinical observations, such as blood pressure and symptoms (Giannangelo, 2010) 30 Standards to Promote Health Information Exchange Summary Define terms related to standardized terminologies Identify and define terminologies and vocabularies
that represent nursing care Define and give examples of data interchange standards 31 Standards to Promote Health Information Exchange References References Amatayakul, M.K. (2009). Electronic health records: A practical guide for professionals and organizations. Chicago, IL: American Home Information Management Association. American Medical Association. (2011). Current procedural terminology (CPT). 4th edition. Chicago, IL: American Medical Association.
Centers for Medicare and Medicaid Services. Overview of HIPAA. U.S. Department of Health and Human Services. Retrieved from: http://www.cms.gov Giannangelo K. (Ed.). (2010. Healthcare code sets, clinical terminologies, and classifications. 2nd edition. Chicago, IL: American Home Information Management Association. Health Level Seven International. About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav International Health Terminology Standards Development Organization. About SNOMED. Retrieved from http://www.ihtsdo.org/snomed-ct/ International Nursing Knowledge Association. (n.d.). Center for nursing classification. Retrieved from http://www.nanda.org/center-for-nursing-classification.html 32
Standards to Promote Health Information Exchange References References National Alliance for Health Information Technology. (2008). Report to the Office of the National Coordinator for Health Information Technology on defining key health information technology terms (p. 10). Chicago, IL: Healthcare Information and Management Systems Society. Nightingale, F. (1863). Notes on hospitals. London, UK: Longman, Green, Longman, Roberts, and Green; 1863. Retrieved from http://pds.lib.harvard.edu/pds/view/7024419? n=208. Thede, L., & Schwiran, P. (2011). Informatics: the standardized nursing terminologies: a national survey of nurses experiences and attitudes. The Online Journal of Issues in Nursing,16(2).
U.S. Department of Health and Human Services, Office of the National Coordinator. Consolidated health informatics. Retrieved from: http://www.hhs.gov/healthit/chi.html U.S. Food and Drug Administration. (n.d.). National drug code directory. Retrieved from http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm Images Microsoft Clip Art, Used with Permission of Microsoft. 33 This material was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007. This presentation was produced with the support of the United
States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AID-OAA-L14-00004. MEASURE Evaluation is implemented by the Carolina Population Center, University of North Carolina at Chapel Hill in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of USAID or the United States government. www.measureevaluation.org
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