EHM-520 Electronic Health Records Week 10 PDF

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 10 Healthcare Data Exchange Standards Dr. Muneef AlMokhlef 9/29/2022 1 Learning Objectives ▪Understand importance of standards in healthcare data ▪Examine data exchange standards from a technical viewpoint ▪Identify the most commonly used and well-known h...

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 10 Healthcare Data Exchange Standards Dr. Muneef AlMokhlef 9/29/2022 1 Learning Objectives ▪Understand importance of standards in healthcare data ▪Examine data exchange standards from a technical viewpoint ▪Identify the most commonly used and well-known healthcare data exchange standards from a variety of categories. ▪Examine healthcare data exchange standards ▪Identify the Key standards for health data exchange 2 Introduction Comprehensive data standards in healthcare bring the industry one step closer to achieving seamless interoperability — from individual medical facilities to the national level. Without these standards, we’d still be in the stone age of data communication. Which would mean operating within disparate data silos, not having easy access to information from EHRs (Electronic Health Records) and spending too much time on manual tasks. 12/8/2023 3 The need for data exchange standards in healthcare Even within a single institution, the IT system can be very complex and have multiple components that need to access clinical data. Here are some of the benefits your health facility can gain by adopting medical data exchange standards: 4 Benefits gain by adopting medical data exchange standards: Here are some of the benefits your health facility can gain by adopting medical data exchange standards ▪Data integration across all systems. ▪Improvements to decision-making ▪Better compatibility and compliance ▪Quicker and more reliable medical billing and claims processing 5 Standards Development Organizations (SDOs) The organization of health informatics standards development internationally is complex, changes frequently, and has created a fog of acronyms. The International Standardization Organization (ISO) was established in 1947 to provide a focal point for all international standards. ISO is a membership organization, with one member in each country. ISO has established a committee for Health Informatics (ISO TC215). The main task of this committee is to ratify existing standards as full international standards. 12/8/2023 6 HL7 International The name Health Level 7 is derived from the 7th level of the ISO’s Open Systems Interconnect (OSI) model: the application layer, which provides a framework for communication between disparate computer systems. The OSI model has seven layers; the top three layers are concerned with applications (interworking); the lower four layers are concerned with the transmission of data (interconnection): 7 HL7 International 8 Key standards for health data exchange • Data exchange standards. These sets of rules define the electronic encoding of messages that transport information between computer systems. • HL7 standards are grouped into reference categories: • • • • • • • • • • • • Section 1: Primary Standards Section 1a: Clinical Document Architecture (CDA®) Section 1b: EHR - Electronic Health Records Section 1c: FHIR® Section 1d: Version 2 (V2) Section 1e: Version 3 (V3) Section 1f: Arden Syntax Section 1g: CCOW Section 1h: Cross-paradigm/Domain Analysis Models Section 2: Clinical and Administrative Domains Section 3: Implementation Guides Section 4: Rules and References 9 Key standards for health data exchange ➢HL7 Health Level Seven (HL7®) originated in 1987 as a group of companies that came together in Palo Alto, California, to collaborate on standardizing healthcare data exchange, specifically between applications within a hospital. HL7 is the most well-known and widely used data exchange standard in healthcare worldwide. It is employed for the transmission of messages to support data exchange within hospitals, between providers and hospitals, and between providers and registries. 10 Key standards for health data exchange ➢CDA & C-CDA Clinical Document Architecture (CDA) and C-CDA (the first “C” stands for “Consolidated”) have both been developed to help healthcare providers exchange medical documents in electronic format. 11 Key standards for health data exchange ➢CDA & C-CDA CDA is a set of standards that describe the structure and semantics of clinical data in XML (Extensible Markup Language) for easy exchange. The standard covers documents like: Consult Notes Diagnostic Imaging Reports Discharge Summaries History and Physical Operative Notes Procedure Notes Continuity of Care Documents (CCDs) and many more. 12 Key standards for health data exchange ➢Fast Healthcare Interoperability Resources FHIR One of the newest activities in HL7 is the development of Fast Healthcare Interoperability Resources (FHIR). FHIR® takes a pragmatic approach that defines simple structures for a service-oriented, REST-based information exchange. FHIR is an internet-based data standard developed and maintained by HL7 that connects different discrete data elements. FHIR, in conjunction with standardized APPLICATION PROGRAMMING INTERFACES (APIS), allows developers to create apps that can plug into EHR systems and deliver information directly into the provider workflow. 13 Key standards for health data exchange ➢Direct Direct is a popular standard for the secure exchange of health data over the internet. Example, Email 14 More HL7 Family Members 15 Health Information Exchange (HIE) Powered by FHIR® Standards Medical Devices Partners Providers Patients Social Health Information Exchange (HIE) supported by FHIR standards, DAF Profiles, Security & REST APIs Labs Employe rs Pharma Payers Govern ment Agencie s Hospitals HL7 Products HL7 produces four types of document: documents can be: Normative Standard: content is balloted by the general membership and is considered a structural component of the HL7 Standard. Negative ballots must be resolved. Draft Standard for Trial Use (DSTU): Content is balloted by the general membership as the draft of a future standard which will, following a pre-specified period of evaluation and comment (usually 2 years), be expeditiously incorporated into normative standard. Because many DSTUs are used for operational purposes, these may be renamed as Working Standards with different levels of maturity. Reference: content is harmonized during HL7 meetings or approved by the HL7 Board. It is not subject to ballot acceptance. Informative: content is balloted by the general membership. However, it is not considered to be a structural part of the Standard but only supporting information. 17 The major international Healthcare Standard Organizations. There are many standards tried to achieve the semantic interoperability in EHR environment [15]. After studying some of these standards, we found that these standards have some limitations during practical implementation. The following are some examples of these limitations: Many standards are difficult to understand and complex to implement, which increases the development costs Source information needs adaptation to the standard The standard has to expect all future uses. A standard is one for its domain. It cannot be the best for all applications. 18 The major international Healthcare Standard Organizations. There are about 22 different ICT (Information and Communication Technologies) standards in healthcare domain. From those; there are seven main international organizations interested in ehealth standards, as shown in Figure below. 19 The major international Healthcare Standard Organizations. 20 Digital imaging and communications in medicine (DICOM) Digital imaging and communications in medicine (DICOM) is a successful imaging standard that permits an image to be read on any machine. It enables storing, printing, handling, and transmitting the medical information. It includes a protocol for network communications and a file format definition. DICOM enables integrating The medical images from multiple manufacturers’ devices. 21 Institute of electrical and electronics engineers (IEEE) Institute of electrical and electronics engineers (IEEE) was established in 1963 from the converging between AIEE (American Institute of Electrical Engineers) and the IRE (Institute of Radio Engineers). It is interested in many different technologies such as electric power and energy, wire communications, biomedical and healthcare technology, vital searching digital library, and a significant publisher of scientific journals. 22 OpenEHR The openEHR foundation is an international standard based on XML encoded data. It is a notfor-profit organization, which facilitates health records creation and sharing by clinicians and consumers via open-source. Its main aim is to administrate the EHR architectures validation via clinical evaluation and overall implementation 23 SNOMED CT SNOMED CT is a non-profit universal standard that refers to ‘Systematized Nomenclature of Medicine Clinical Terms.’ It is viewed as the most multilingual, exact, and complete clinical wording everywhere throughout the world. It contains more than 370,000 concepts, 990,000 English portrayals and descriptions, and 1.5 million connections [26]. SNOMED CT consists of concepts, terms, and relationships. It is established to support the perfect recording of clinical data, with the overall aim of enhancing the healthcare of patients. 24 Integrating the Healthcare Enterprise (IHE) IHE (Integrating the Healthcare Enterprise) was established in 1999 by the Healthcare Information Systems and Management Society (HIMSS) and the Radiological Society of North America (RSNA) to help improve the way healthcare computer systems share information. The initial focus of IHE was in radiology, where it developed profiles that specify how to use DICOM and HL7 together, but it has moved on to cardiology, clinical laboratories and other specialties. 25 Others, IHTSDO The International Health Terminology Standards Development Organization (IHTSDO, pronounced ‘itzidoo’) is the custodian for SNOMED CT. IHTSDO is an international not-for-profit organisation, based in London (from 1 January 2016). It was established in 2007, when it acquired the IP of SNOMED CT from the College of American Pathologists (CAP). 26 CDISC The Clinical Data Interchange Standards Consortium (CDISC) has been founded by the pharmaceutical industry to develop worldwide industry standards to support electronic acquisition, exchange, submission and archiving of clinical trials data and metadata for medical and biopharmaceutical product development. 27 Problems With Standards Adoption And Implementation There are 10 to 50 properties for each FHIR resource, such as patient demographic information or medication orders. However, EHR vendors select only some of those resource properties instead of making all of them required, which ultimately hinders data-sharing efforts. 28 Summary • Data healthcare standards are the principal informatics component necessary for information flow through the national health information infrastructure. • FHIR has very quickly become one of the most popular standards for enabling structural – and in some cases semantic – interoperability. Most major EHR vendors have invested in the standard, which has helped publicize the approach and cement FHIR as a leading method for data exchange. • Common data standards also support effective assimilation of new knowledge into decision support tools, such as an alert of a new drug contraindication, and refinements to the care process. 29 Discussion & Video https://www.youtube.com/watch?v= KSEUh-wj7Y0 30 Resources American Medical Informatics Association (AMIA): www.amia.org. Stead, W. W. 2005. “Challenges in Informatics.” In Building a Better Delivery System: A New Engineering/Health Care Partnership, edited by P. P. Reid, W. D. Compton, J. H. Grossman, and G. Fanjiang, 193–94. Washington, DC: National Academy of Engineering and Institute of Medicine. https://ehrintelligence.com/features/how-health-datastandards-support-healthcare-interoperability https://www.hl7.org/implement/standards/ 31 9/29/2022 35