[Informatics] Unit 5 & 6. Key Players in HIT / Data Standards & Medical Coding

Technology Vendors

• Applying new technology innovations in the field of medicine: hardware, software, genomics, etc.

• Data mining

• Interoperability

• Certification

Manpower Needed

1. Chief Medical Informatics Officer

2. Nurse Informaticist

3. Clinical Informaticist

4. Health Information Technician

5. Medical Coder

6. Health Services Administrator

7. IT Analyst

8. Program Analyst

9. Analytics Consultant

10. Chief Technology Officer

Syntax

structure of the communication

Semantics

denotes meaning of the communication

Transport standards

focus on communication between multiple systems

Content standards

rules that dictate format of information as it is packaged for transport

Vocabulary

terms used within a certain domain.

Vocabulary

governs individual segments within a content package

Language

system of communication

Terminology

terms used for a specific purpose

Nomenclature

defined system of naming 

ex. Systematized Nomenclature of Medicine (SNOMED)

Classification

grouping of terms with similar meanings

ex : International Classification of Diseases (ICD)

Taxonomy

science of classification 

-most often used to show a “parent-child” relationship 

ex. Taxonomy of Medication Errors.

Codes

representation of words that permit processing by a computer

-usually applied to vocabularies and classifications

ex. diabetes are associated with codes such as ICD-9 250. 

• EHRs have encoding software that assists with coding

Ontologies

knowledge models about a domain

-include the concepts, attributes and relationships that exist  

ex. healthcare domain (artificial intelligence in medicine or AIM)

XML : Extensible Markup Language

-data packaging standard

-served as a structural component for domain specific languages for health information exchange

XML : Extensible Markup Language

• a common data packaging standard is necessary in order for different health entities to share messages and retrieve results

• set of predefined rules to structure data so it can be universally interpreted and understood

tags

XML messages have headings and message bodies packaging information by wrapping it in layers of “tags.” 

Health Level Seven (HL7)

• not for profit standards development organization (SDO) with chapters in 55 countries

• many HL7 standards were considered open source; available for free download

• domain: clinical & administrative data transmission

Level 7

refers to the seventh level of the International Organization for Standardization (ISO) model for Open System Interconnection. 

HL7

provides a set or family of standards for interactions between healthcare data services.

HL7 version 2.x

separates messages into processable chunks or segments which contain fields (contain components)

• sewn together into messages of a given type 

HL7 version 3.0

•includes The Reference Information Model (RIM)

•is a content standard that makes documents human readable (using a web browser) and machine processable (using XML.7)

Clinical Context Object Workgroup (CCOW) 

-a standard that allows clinical applications to share information at the point of care

•This means interoperability among disparate IT vendors and single sign on capability.

The Consolidated Clinical Document Architecture  (Consolidated CDA or C-CDA)

•CCD has the advantage over CCR of being able to accept free text and being capable of vocabulary specific semantic interoperability. 

•contains the most common information about patients in a summary XML format that can be shared by most computer applications and web browsers

•can be printed (pdf) or shared as html. 

•generally used as a patient summary 

Continuity of Care Document (CCD) standard. 

= its use was recommended by HL7 (in 2007)

= Continuity of Care Record or CCR (developed by ASTM International) + the clinical document  architecture or CDA (developed by the HL7 organization)

Digital Imaging and Communication in Medicine (DICOM)

• was formed by the National  Electrical Manufacturers Association (NEMA) and the American College of Radiology (ACR)

• recognized as potential storage, sharing &transmission of digital images

Logical Observations: Identifiers, Names and Codes (LOINC)

• standard for electronic exchange of lab results transmitted to hospitals, clinics and payers

• necessary as multiple labs have multiple unique codes that would otherwise not be interoperable

• HL7 is a content standard, whereas LOINC is avocabulary terminology standards

RxNorm(US)

• recommended standard for medication vocabulary for clinical drugs & drug delivery devices developed by the National Library of Medicine (NLM).

• Each commercial drug vocabulary company provides medication concept identifiers to the NLM which are then mapped to the concepts in the RxNormvocabulary.

• Rxnorm supports interoperability among organizations that deal with clinical drugs.

RxNorm

• standard for e-prescribing &supports Meaningful Use.

• integrates other drug coding systems, such as National Drug Code (NDC)

• includes three drug elements:

1. active ingredient

2. strength 

3. dose

Systematized Nomenclature of Medicine: Clinical Terminology (SNOMED-CT)

•also known as the International Health Terminology (IHT)

•developed by the American College of Pathologists; ownership was transferred to the IHT Standards Development Organization (www.ihtsdo.org) in 2007

•clinical terminology or medical vocabulary commonly used in software applications, including EHRs

•covers diseases, findings, procedures, drugs, etc.; a more convenient  

SNOMED-CT

• The vocabulary provides more clinical detail than ICD-9 and felt to be more appropriate for EHRs.

• used by the FDA and DOH & Human Services 

EHR-Lab Interoperability and Connectivity Standards (ELINCS)

created in 2005 as lab interface for ambulatory EHRs and a further “constraint” or refinement of HL7 standards

IEEE 11073

Data standards are needed for information to be sent from a medical device to an HER or hospital information system.

• fundamental standard for medical device connectivity and data exchange but is not widely used.

National Council for Prescription Drug Programs (NCPDP)

• a pharmacy related SDO for exchange of prescription related information

• Script (v10.10) is for communication between physician and pharmacist.

National Council for Prescription Drug (ASC) X12

• A standard for electronic data interchange (EDI) or the computer-computer exchange of business data

• used in healthcare, transportation, insurance and finance industries