Achieving Interoperability - role of standards


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Callum Bir

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Achieving Interoperability - role of standards

  1. 1. Achieving Interoperability Role of StandardsCallum BirDeloitte Consulting SEA
  2. 2. Stakeholders involved in Healthcare IT Standards to Enable EHR Healthcare Healthcare Provider Payer Gov’t & Policy Standard Makers Developers Stakeholders Consumers Vendors Healthcare IT Standards to Enable EHR and Beyond2 ©2011 Deloitte Touche Tohmatsu Limited
  3. 3. ISO TC215 Health Informatics Promote Enable Interoperability Compatibility between for health info independent & data systems ISO TC215 Health Informatics Reduce Standardize Duplication of information for Effort & health Redundancies Enable Consistency for health info & data3 ©2011 Deloitte Touche Tohmatsu Limited
  4. 4. ISO TC215 Health InformaticsSubcommittee / Workgroup TitleWorkgroup 1 Data structureWorkgroup 2 Data InterchangeWorkgroup 3 Semantic contentWorkgroup 4 SecurityWorkgroup 6 Pharmacy and medicines businessWorkgroup 7 DevicesWorkgroup 8 Business requirements for Electronic Health RecordsWorkgroup 9 SDO HarmonizationOrganizations in liaison:CDISC, COCIR, DICOM, GS1, HON, ICN, IHE, IHTSDO, IMIA, UNECE, WHO4 ©2011 Deloitte Touche Tohmatsu Limited
  5. 5. HIE Interoperability Levels Multiple levels of data exchange LEVEL DESCRIPTION EXAMPLES Mail, phone (no information 1 Non-Electric Data technology) PC-based and manual fax, e- 2 Machine-Transportable Data mail, or scanned documents Machine-Organizable Data: Format Structured messages with non- 3 standard data (HL-7 messages) Syntactic Machine-Interpretable Data: EDI of structured messages 4 Content using controlled terminology Semantic Interoperability is defined as the exchange of data so that data from application A can be used by Application B. This requires both Level 3 (Format) and Level 4 (Content). This type of interoperability is needed for patient safety and analytics ©2011 Deloitte Touche Tohmatsu Limited
  6. 6. Semantic InteroperabilityInteroperability is typically achieved at a Level 3 and focuses on the format of data Application 1 Application 2 Messages may be structured, e.g. HL7 ver. 2, but all data must be first Database mapped point to Database point Meds Mapping Meds Problems Problems HL7 Allergies Allergies Labs Labs John Jones 1/27/2001 K 3.7 John Jones 1/27/2001 K 3.7 1/27/01/10:35 John William Jones Potassium 3.7 1/27/01/10:35 John William Jones Potassium 3.7 Source: Center For Information Technology Leadership, Dr. Barry Blumenfeld ©2011 Deloitte Touche Tohmatsu Limited
  7. 7. Semantic InteroperabilitySemantic Interoperability (Level 4) Targets a CommonApproach to the Meaning of Data Level 3 vs. Level 4 Interoperability: 15 interactions 6 interactions App App App App Controlled App App Medical App App Terminology Services App App App App ©2011 Deloitte Touche Tohmatsu Limited
  8. 8. Semantic Interoperability (US)ONC is pushing for some standards: ICD-10, SNOMED, LOINC, etc. Conversely it is not creating acoherent mandatory set of standards allowing interoperability. As a result interoperability is still an elusivegoal in the U.S. RULES: PROBLEM LIST: RESULTS: ORDERS: If ( history of ) ( Diabetes Insulin Dependent Free Iron Serum Ferritin Mellitus ) and ( free Iron ) Diabetes ( greater than X ) then ( order Ferritin ) Controlled Clinical Terminology Services SNOMED CPT NO HISTORY LOINC ICD-9/ICD-10 OF RULE IN DIABETES SERUM FERRITIN GESTATIONAL DIABETES INSIPIDUS DIABETES FAMILY HISTORY OF CBC CBC DIABETES INSULIN-DEPENDENT HISTORY OF SERUM GLUCOSE DIABETES SEVERE MELLITUS DIABETESMELLITUS TYPE 2 RISK OF FREE IRON IRON RULE OUT INSULIN RESISTANT K+ TIBC TYPE 2 DIABETES DIABETIC COMA ©2011 Deloitte Touche Tohmatsu Limited
  9. 9. Semantic Interoperability standards (US) There are many widely accepted industry and Federal data standards throughout the health care continuum. Adoption of each standard may vary from facility to facility, which underscores the importance of an HIE to adhere to a core set of messaging, transport and integration standards and protocols. ANSI’s Healthcare Information TechnologyCCHIT is a private not- Health Level Seven Standards Panel wasfor-profit organization International created by the ONCthat serves as a (HL7) for Healthrecognized US Certification Information Healthcarecertification authority Commission for Information Technology tofor electronic health Healthcare Information Technology promoterecords (EHR) and their Technology Standards Panel interoperability innetworks. (CCHIT) (HITSP) healthcare by harmonizing health Interoperability information Standards technology standards. Established by HHS, Health Information Nationwide Health Security and Information HISPC addresses the Privacy Network privacy and security Collaboration Architecture challenges presented (HISPC) Projects by electronic health ASC X12 (NHIN) information exchange (EDI) through multistate collaboration. NHIN, a program under ONC is establishing a mechanism for nationwide health information exchange. The NHIN is a set of conventions that The Accredited Standards Committee (ASC) X12, provide the foundation for the secure exchange develops electronic data interchange (EDI) of health information that supports meaningful standards and related documents for national use. and global markets. ©2011 Deloitte Touche Tohmatsu Limited
  10. 10. 10 ©2011 Deloitte Touche Tohmatsu Limited