Semantic Interoperability in Health Information Exchange

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Presented at HIMSS14 Annual Conference & Exhibition, February 26, 2014, Orlando, FL.
http://www.himssconference.org/Education/EventDetail.aspx?ItemNumber=25331

Meaningful Use certification requires several large vocabulary standards for representing clinical facts in health information exchange. This presents unique challenges for semantic interoperability such as information loss in translating from and to internal data dictionaries, semantic drift, dealing with legacy content (e.g., ICD-9) and clinical information reconciliation.

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Semantic Interoperability in Health Information Exchange

  1. 1. Semantic Interoperability in Health Information Exchange February 26, 2014 Tomasz Adamusiak MD PhD DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
  2. 2. Conflict of Interest Disclosure Tomasz Adamusiak Has no real or apparent conflicts of interest to report. © 2014 HIMSS
  3. 3. Learning Objectives 1. Define vocabulary standards for MU 2 2. Define common MU Data Set 3. Identify challenges 4. Propose solutions
  4. 4. HISTORY OF PRESENT INQUIRY: Mr. Smith is a 34-year old gentleman who presents at our branch to obtain a car loan secondary to growing maintenance costs of his current vehicle. He otherwise reports doing well. His past financial history is insignificant.
  5. 5. What is Interoperability? • Semantic Structural Foundational
  6. 6. Increased availability for research and BI http://www.himss.org/ValueSuite
  7. 7. Interoperability in care coordination 2014 Edition EHR Certification Criteria 45 CFR §170.314 (e) Data portability Common MU Data Set Create / transmit transition of care / referral summaries Receive / transmit lab result C-CDA e-Prescribing Clinical information reconciliation Common MU Data Set
  8. 8. Interoperability in patient engagement 2014 Edition EHR Criteria 45 CFR §170.314 (e) View / download / transmit to 3rd party Common MU Data Set Human readable / C-CDA Clinical summary Common MU Data Set
  9. 9. New topics in Meaningful Use Stage 3 recommendations Patientgenerated health data Amendments Drug adherence Order tracking Summaries for consults & reports Case reports HIT Policy: Meaningful Use Workgroup http://www.healthit.gov/FACAS/sites/faca/files/MUWG_Stage3_14_Jan_28.docx
  10. 10. Consolidated CDA provides templates for care summaries Medication Information ManufacturedProduct Medication Activity SubstanceAdministration Medication Supply Order ManufacturedProduct Immunization SubstanceAdministration By ‫إبن البيطار‬own work - [Public domain], via Wikimedia Commons
  11. 11. Only structured information allowed in MU Transition of Care <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="310965" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 200 MG Oral Tablet"> </code> </manufacturedMaterial> </manufacturedProduct>
  12. 12. Only structured information allowed in MU Transition of Care <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> Medication RXCUI <code code="310965" Information Template codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Ibuprofen 200 MG Oral Tablet"> </code> </manufacturedMaterial> Normalized Drug Name </manufacturedProduct>
  13. 13. Common MU Data Set defines data requirements for ALL care summaries criteria • Individual criteria might include data requirements that are specific or unique to that criterion • Many different terminology standards
  14. 14. Common MU Data Set (1-5) • 1. Patient name – N/a • 2. Sex – N/a • 3. Date of birth – N/a • • • • • • Combined format (select one or more): American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White • 4. Race and 5. Ethnicity – The Office of Management and Budget (OMB) Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, as revised, October 30, 1997
  15. 15. Common MU Data Set (6-7) 6. Preferred language – As specified by the Library of Congress, ISO 639-2 alpha-3 codes limited to those that also have a corresponding alpha-2 code in ISO 639-1 7. Smoking status – Any of the following SNOMED CT codes: – (1) Current every day smoker. 449868002 – (2) Current some day smoker. 428041000124106 – (3) Former smoker. 8517006 – (4) Never smoker. 266919005 – (5) Smoker, current status unknown. 77176002 – (6) Unknown if ever smoked. 266927001 – (7) Heavy tobacco smoker. 428071000124103 – (8) Light tobacco smoker. 428061000124105
  16. 16. Common MU Data Set (8-12) 8. Problems – At a minimum, SNOMED CT International Release July 2012 and US Extension to SNOMED CT March 2012 Release 9. Medications – RxNorm, August 6, 2012 Release 10. Medication allergies – RxNorm, August 6, 2012 Release 11. Laboratory tests – LOINC version 2.40 12. Laboratory values/results – N/a Immunizations HL7 Standard Code Set CVX Vaccines Administered
  17. 17. Common MU Data Set (13-16) 13. Vital signs (height, weight, BP, BMI) – N/a 14. Care plan fields including goals and instructions – N/a 15. Procedures – At a minimum, SNOMED CT International Release, July 2012 with US Extension to SNOMED CT March 2012 or the combination of HCPCS and CPT-4 – Optional: CDT – Optional: ICD-10-PCS 16. Care team members – N/a Not ICD-10-CM
  18. 18. Be aware of these terminology challenges
  19. 19. Codes run out of room (ICD-9) • 985 Toxic effect of other metals – 985.0 Toxic effect of mercury and its compounds – 985.1 Toxic effect of arsenic and its compounds – 985.2 Toxic effect of manganese and its compounds – 985.3 Toxic effect of beryllium and its compounds – 985.4 Toxic effect of antimony and its compounds – 985.5 Toxic effect of cadmium and its compounds – 985.6 Toxic effect of chromium Brass fumes, – 985.8 Toxic effect of other specified metals copper salts, and iron and – 985.9 Toxic effect of unspecified metal nickel compounds High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
  20. 20. Limited hierarchy (ICD-9) • 010-018.99 TUBERCULOSIS – … – … • 137 Late effects of tuberculosis – … • 647.3 Tuberculosis complicating pregnancy childbirth or the puerperium – … High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
  21. 21. Semantic drift (evolution of usage) in multi-year data (ICD-9) – 664.14 Other immediate postpartum hemorrhage, postpartum condition or complication  666.14 New name • 1995 – 664.14 Second-degree perineal laceration, postpartum condition or complication – 785.59 Other shock without mention of trauma • 2003 New term – 785.51 Cardiogenic shock High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
  22. 22. In pursuit of a single language Pieter Brueghel the Elder (1526/1530–1569) [Public domain], via Wikimedia Commons
  23. 23. Integrating terminologies with Unified Medical Language System Clinical Terminologies Donald A.B. Lindberg, M.D UMLS
  24. 24. UMLS Eruption SCT:1806006 rash NOS ICD-10:R21 Cutaneous eruption SCT:112625008 Exanthema C0015230
  25. 25. UMLS Eruption rash NOS Cutaneous eruption SCT:1806006 ICD-10:R21 SCT:112625008 Exanthema C0015230
  26. 26. Practical exploration of UMLS annotated data https://clinminer.hmgc.mcw.edu user: himssdemo password: himssdemo This image by Tomasz Adamusiak is licensed under a CC BY 3.0 US license ClinMiner is a non-commercial, prototype solution For more information see: EHR-based phenome wide association study in pancreatic cancer. Adamusiak T, Shimoyama M, AMIA Summits Transl Sci Proc. 2014 (in press)
  27. 27. SNOMED CT as likely alternative interface terminology • Active collaboration between IHTSDO and Regenstrief (LOINC) http://www.ihtsdo.org/about-ihtsdo/governance-andadvisory/harmonization/loinc • Integration with ICD-11 http://www.ncbi.nlm.nih.gov/pubmed/23920573
  28. 28. Semantic interoperability  knowing more about your patient population http://www.himss.org/ValueSuite
  29. 29. Thank You! Tomasz Adamusiak MD PhD Human and Molecular Genetics Center Medical College of Wisconsin tomasz@mcw.edu @7omasz
  30. 30. Sources HIMSS Definition of Interoperability http://www.himss.org/library/interoperability-standards/whatis?navItemNumber=17333 Implementing Consolidated-Clinical Document Architecture (C-CDA) for Meaningful Use Stage 2 http://www.healthit.gov/sites/default/files/ccda_and_meaningfulusecertification.pdf Consolidated CDA, HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258 Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2, 42 CFR Parts 412, 413, and 495, Federal Register/ Vol. 77, No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology, 45 CFR Part 170, Federal Register/ Vol. 77, No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-0904/pdf/2012-20982.pdf
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