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Healthcare Codes and Terminology Standards
BC Homes,
Chief Technologist
Presented in 2012
www.intelliware.com
www.intelliware.com 2© 2014 Intelliware Development Inc.
About Intelliware Development Inc.
Intelliware is a custom softwa...
www.intelliware.com 3© 2014 Intelliware Development Inc.
HL7 v3 Background
www.intelliware.com 4© 2014 Intelliware Development Inc.
Agenda
» Concepts
» Code Data Types
» Concept Domains, Code Syste...
www.intelliware.com 5© 2014 Intelliware Development Inc.
Opening Salvo
» Codes and Terminology are topics that are easy
to...
www.intelliware.com 6© 2014 Intelliware Development Inc.
Simple Examples
» The classic Canadian example
› ‘en’ or ‘fr’
» T...
www.intelliware.com 7© 2014 Intelliware Development Inc.
Ah-ha!
» At one level, we can conclude that there’s really
nothin...
www.intelliware.com 8© 2014 Intelliware Development Inc.
Recall one of the Complaints about
HL7 v2
» Limited rigour in use...
www.intelliware.com 9© 2014 Intelliware Development Inc.
Code Namespaces
» Consider this example:
en
www.intelliware.com 10© 2014 Intelliware Development Inc.
Not necessarily unique
» “en” = English
» “en” = Printer’s measu...
www.intelliware.com 11© 2014 Intelliware Development Inc.
Key Point
» Context is important
» Sometimes context might not b...
www.intelliware.com 12© 2014 Intelliware Development Inc.
OIDs : Like Namespaces for Codes
» Conceptually, you can imagine...
www.intelliware.com 13© 2014 Intelliware Development Inc.
Example
» English
› code = “en”
› codeSystem = “2.16.840.1.11388...
www.intelliware.com 14© 2014 Intelliware Development Inc.
Question
» Who decided that “en” stands for English?
www.intelliware.com 15© 2014 Intelliware Development Inc.
Answer
» ISO : International Organization for
Standardization
» ...
www.intelliware.com 16© 2014 Intelliware Development Inc.
Answer
» We can say, then, that the “meaning” of our OID,
2.16.8...
www.intelliware.com 17© 2014 Intelliware Development Inc.
The Treachery of OIDs
» Finding the right OID is an extremely tr...
www.intelliware.com 18© 2014 Intelliware Development Inc.
Looking Up OIDs
www.intelliware.com 19© 2014 Intelliware Development Inc.
Surprise! Change!
» In the V02R02 standard, the OID for the ISO
...
www.intelliware.com 20© 2014 Intelliware Development Inc.
A Moment to Discuss OIDs
» Hierarchical system
› 0: itu-t
› 1: i...
www.intelliware.com 21© 2014 Intelliware Development Inc.
It gets more complicated
» Surely no one in this room believes t...
www.intelliware.com 22© 2014 Intelliware Development Inc.
How Important is this?
» Truthfully, I’m not sure
» In Canada, i...
www.intelliware.com 23© 2014 Intelliware Development Inc.
What Does this Example Reveal about the Design of HL7v3?
www.intelliware.com 24© 2014 Intelliware Development Inc.
Key Idea
» We can talk about the notion that people have
communi...
www.intelliware.com 25© 2014 Intelliware Development Inc.
How is this used in HL7 Types?
www.intelliware.com 26© 2014 Intelliware Development Inc.
XML Representation
» Here’s a portion of an HL7 message
<person ...
www.intelliware.com 27© 2014 Intelliware Development Inc.
Using Concept Domains in Definitions
A portion of the message de...
www.intelliware.com 28© 2014 Intelliware Development Inc.
Defining an HL7 Environment
» For any code attribute someone mus...
www.intelliware.com 29© 2014 Intelliware Development Inc.
Quick Recap
» HL7 uses codes a lot
» Codes have two parts:
› cod...
www.intelliware.com 30© 2014 Intelliware Development Inc.
Agenda
» Concepts
» Code Data Types
» Concept Domains, Code Syst...
www.intelliware.com 31© 2014 Intelliware Development Inc.
Let’s Look at a Transport Wrapper
www.intelliware.com 32© 2014 Intelliware Development Inc.
Let’s Look at a Transport Wrapper
A portion of a sample Find Can...
www.intelliware.com 33© 2014 Intelliware Development Inc.
It’s Like I Totally Lied
» Where are the Code System OIDs?
www.intelliware.com 34© 2014 Intelliware Development Inc.
Ah, But these are “Simple” Codes
www.intelliware.com 35© 2014 Intelliware Development Inc.
Code Data Types
» CS: Coded Simple Value
» CV: Coded Value
» CE:...
www.intelliware.com 36© 2014 Intelliware Development Inc.
Code Data Types
» HL7 also defines:
› CO: Coded Ordinal
» I have...
www.intelliware.com 37© 2014 Intelliware Development Inc.
Where are the Data Types defined?
» You have to consult two sour...
www.intelliware.com 38© 2014 Intelliware Development Inc.
Example of Customization
» The International Standard for a basi...
www.intelliware.com 39© 2014 Intelliware Development Inc.
Coded Simple Value (CS)
» The Code System is implicit
» This typ...
www.intelliware.com 40© 2014 Intelliware Development Inc.
Coded Simple in Transport Wrapper
A portion of a sample Find Can...
www.intelliware.com 41© 2014 Intelliware Development Inc.
Coded Simple Value
» The Code System is implicit
» This type is ...
www.intelliware.com 42© 2014 Intelliware Development Inc.
XML Representation
» When a CS value is “immutable” (old term:
“...
www.intelliware.com 43© 2014 Intelliware Development Inc.
Coded Value (CV)
» Possibly the most basic Code type
<administra...
www.intelliware.com 44© 2014 Intelliware Development Inc.
Coded with Equivalents (CE)
» Introduces the concept of “equival...
www.intelliware.com 45© 2014 Intelliware Development Inc.
Coded with Equivalents (CE)
» Consider the example of Clinical D...
www.intelliware.com 46© 2014 Intelliware Development Inc.
Concept Descriptor (CD)
» Very similar to CE
» There’s a key dif...
www.intelliware.com 47© 2014 Intelliware Development Inc.
Post-Coordinated Values
» Used to combine codes more expressivel...
www.intelliware.com 48© 2014 Intelliware Development Inc.
Post-Coordinated Values using Qualifiers
www.intelliware.com 49© 2014 Intelliware Development Inc.
Character String with Code (SC)
» Key idea: the string is more s...
www.intelliware.com 50© 2014 Intelliware Development Inc.
Concept Descriptor for Lab (CD.LAB)
» Same as CD, but displayNam...
www.intelliware.com 51© 2014 Intelliware Development Inc.
Object Hierarchy
This is a strange,
backward hierarchy
www.intelliware.com 52© 2014 Intelliware Development Inc.
Additional Considerations
» Original Text
» Coding Strength
› CN...
www.intelliware.com 53© 2014 Intelliware Development Inc.
Recap
» What we’ve learned about Data Types
› CS, CV, CD, CE, SC...
www.intelliware.com 54© 2014 Intelliware Development Inc.
Exercise
» Find Candidates Payload
› Peruse the MIF
› Look for a...
www.intelliware.com 55© 2014 Intelliware Development Inc.
Agenda
» Concepts
» Code Data Types
» Concept Domains, Code Syst...
www.intelliware.com 56© 2014 Intelliware Development Inc.
Code System and Concept Domains
» We’ve touched on Code Systems ...
www.intelliware.com 57© 2014 Intelliware Development Inc.
Sample Concept Domains
www.intelliware.com 58© 2014 Intelliware Development Inc.
Major Concept Domains
» ActCode
» EntityCode
» ObservationValue
www.intelliware.com 59© 2014 Intelliware Development Inc.
Hierarchical Concept Domains
www.intelliware.com 60© 2014 Intelliware Development Inc.
Hierarchical Concept Domains
www.intelliware.com 61© 2014 Intelliware Development Inc.
What is a Value Set?
» You could think of it as a subset of a co...
www.intelliware.com 62© 2014 Intelliware Development Inc.
An Example
» Code System: Confidentiality
» Codes (about 14 in t...
www.intelliware.com 63© 2014 Intelliware Development Inc.
x_VeryBasicConfidentialityKind
» Only 2 codes
› N: Normal
› R: R...
www.intelliware.com 64© 2014 Intelliware Development Inc.
Other Thoughts
» SNOMED CT
› one code system that tries to descr...
www.intelliware.com 65© 2014 Intelliware Development Inc.
Binding
www.intelliware.com 66© 2014 Intelliware Development Inc.
Agenda
» Concepts
» Code Data Types
» Concept Domains, Code Syst...
www.intelliware.com 67© 2014 Intelliware Development Inc.
Common Healthcare Standards
» DIN
› A Drug Identification Number...
www.intelliware.com 68© 2014 Intelliware Development Inc.
Common Healthcare Standards
» SNOMED CT
› SNOMED CT (Systematize...
www.intelliware.com 69© 2014 Intelliware Development Inc.
Common Healthcare Standards
» LOINC
› Logical Observation Identi...
www.intelliware.com 70© 2014 Intelliware Development Inc.
Common Healthcare Standards
» ICD-10
› The International Statist...
www.intelliware.com 71© 2014 Intelliware Development Inc.
Implementation Considerations
» Change and Lifecycles
» Just bec...
www.intelliware.com 72© 2014 Intelliware Development Inc.
More on Lifecycle
» Some code values are bound to different pan-...
www.intelliware.com 73© 2014 Intelliware Development Inc.
Mapping
» At Partnership, it’s not uncommon to hear
jurisdiction...
www.intelliware.com 74© 2014 Intelliware Development Inc.
Final Recap
» Concepts
» Code Data Types
» Concept Domains, Code...
www.intelliware.com
Intelliware Development
200 Adelaide Street West, Suite 100
Toronto, Canada
www.intelliware.com
© 2014...
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Canadian Healthcare Codes and Terminology Standards

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Codes and Terminology are topics that are easy to introduce, but tricky to understand in full complexity . IT Professionals encounter “codes” all the time . e-Health’s notion is really no different.

This presentation focused on following aspects of HL7v3:

» Concepts
» Code Data Types
» Concept Domains, Code Systems and Value Sets
» Implementation Concerns


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Transcript of "Canadian Healthcare Codes and Terminology Standards "

  1. 1. Healthcare Codes and Terminology Standards BC Homes, Chief Technologist Presented in 2012 www.intelliware.com
  2. 2. www.intelliware.com 2© 2014 Intelliware Development Inc. About Intelliware Development Inc. Intelliware is a custom software, mobile solutions and product development company headquartered in Toronto, Canada. Intelliware is a leader in Agile software development practices which ensure the delivery of timely high quality solutions for clients. Intelliware is engaged as a technical partner by a wide range of national and global organizations in sectors that span Financial Services, Healthcare, ICT, Retail, Manufacturing and Government. /company/intelliware-development-inc- /intelliware.inc /intelliware_inc /GooglePlusIntelliware
  3. 3. www.intelliware.com 3© 2014 Intelliware Development Inc. HL7 v3 Background
  4. 4. www.intelliware.com 4© 2014 Intelliware Development Inc. Agenda » Concepts » Code Data Types » Concept Domains, Code Systems and Value Sets » Implementation Concerns
  5. 5. www.intelliware.com 5© 2014 Intelliware Development Inc. Opening Salvo » Codes and Terminology are topics that are easy to introduce, but tricky to understand in full complexity » IT Professionals encounter “codes” all the time › e-Health’s notion is really no different
  6. 6. www.intelliware.com 6© 2014 Intelliware Development Inc. Simple Examples » The classic Canadian example › ‘en’ or ‘fr’ » The most common example › ‘M’ or ‘F’
  7. 7. www.intelliware.com 7© 2014 Intelliware Development Inc. Ah-ha! » At one level, we can conclude that there’s really nothing to this. › We’ve all seen codes before › What’s the big deal?
  8. 8. www.intelliware.com 8© 2014 Intelliware Development Inc. Recall one of the Complaints about HL7 v2 » Limited rigour in use of controlled vocabularies › Links between standard vocabularies and message structures are ad-hoc and implementation specific » As a consequence, HL7v3 spells out a number of very specific things relating to codes › Much more rigour › Often very exacting › Still leaves room for Jurisdictions to make different choices
  9. 9. www.intelliware.com 9© 2014 Intelliware Development Inc. Code Namespaces » Consider this example: en
  10. 10. www.intelliware.com 10© 2014 Intelliware Development Inc. Not necessarily unique » “en” = English » “en” = Printer’s measure » “en” = ethylenediamine
  11. 11. www.intelliware.com 11© 2014 Intelliware Development Inc. Key Point » Context is important » Sometimes context might not be enough › When we’re dealing with (for example) numeric codes, you can have overlaps • I don’t know of a clear case where this has happened, but better safe than sorry
  12. 12. www.intelliware.com 12© 2014 Intelliware Development Inc. OIDs : Like Namespaces for Codes » Conceptually, you can imagine an implementation of codes in which all values exist in one table › A code is only unique when it is accompanies with an OID › All codes using the same OID are considered to be part of a code system
  13. 13. www.intelliware.com 13© 2014 Intelliware Development Inc. Example » English › code = “en” › codeSystem = “2.16.840.1.113883.6.84” » XML: <languageCode code="en" codeSystem="2.16.840.1.113883.6.84"/> » Why does an e-Health system need a language code? › e.g.: no guarantee that a patient speaks any particular language
  14. 14. www.intelliware.com 14© 2014 Intelliware Development Inc. Question » Who decided that “en” stands for English?
  15. 15. www.intelliware.com 15© 2014 Intelliware Development Inc. Answer » ISO : International Organization for Standardization » Specifically, the two-letter code for identifying languages is part of ISO standard 639-1 › First created in 1967 › Contains 184 codes (languages)
  16. 16. www.intelliware.com 16© 2014 Intelliware Development Inc. Answer » We can say, then, that the “meaning” of our OID, 2.16.840.1.113883.6.84, is the ISO 639-1 standard › The “code system” is essentially means a “published standard” (with a defined context) › e.g: ISO 639-1 is a “published standard” to describe “languages” (context of “language”) » In HL7 terms, the notion of the context is called a “Concept Domain” › We’ll say more about this in a bit
  17. 17. www.intelliware.com 17© 2014 Intelliware Development Inc. The Treachery of OIDs » Finding the right OID is an extremely tricky exercise › There are multiple places you can try to look them up. No one source has the complete list › And sometimes they change when you’re not paying attention • These are “living standards”
  18. 18. www.intelliware.com 18© 2014 Intelliware Development Inc. Looking Up OIDs
  19. 19. www.intelliware.com 19© 2014 Intelliware Development Inc. Surprise! Change! » In the V02R02 standard, the OID for the ISO 639-1 was 2.16.840.1.113883.6.84 » In the most recently-published standard, R02.04.02, the OID for ISO 639-1 is 1.0.639.2 › What’s more, Canada no longer uses the 2- character language code. • Rather than “en”, we should use “eng” » Our important take-away: forget I ever told you about 2.16.840.1.113883.6.84
  20. 20. www.intelliware.com 20© 2014 Intelliware Development Inc. A Moment to Discuss OIDs » Hierarchical system › 0: itu-t › 1: iso • 2: member body › 2: joint-iso-itu-t • 16: country o ISO 3166 country code (e.g. Canada = 124) 2.16.124.113635
  21. 21. www.intelliware.com 21© 2014 Intelliware Development Inc. It gets more complicated » Surely no one in this room believes that there are only 184 languages in the world » ISO 639-2 uses a 3-character language code and has more than 450 entries » ISO 639-3 also uses a 3-character language code and has about 7700 entries » Example: › Arabic • Chadian Arabic • Libyan Arabic (and others)
  22. 22. www.intelliware.com 22© 2014 Intelliware Development Inc. How Important is this? » Truthfully, I’m not sure » In Canada, it might be “good enough” to record “Arabic”, rather than “Libyan Arabic” › But if I were implementing an e-Health system in the middle-east, I might have a different opinion » The important part is that the HL7 standard recognizes that some implementations need to make different choices
  23. 23. www.intelliware.com 23© 2014 Intelliware Development Inc. What Does this Example Reveal about the Design of HL7v3?
  24. 24. www.intelliware.com 24© 2014 Intelliware Development Inc. Key Idea » We can talk about the notion that people have communication preferences in a particular “HumanLanguage” without needing to be specific about what codes are being used › More to the point, HL7 does define many types this way
  25. 25. www.intelliware.com 25© 2014 Intelliware Development Inc. How is this used in HL7 Types?
  26. 26. www.intelliware.com 26© 2014 Intelliware Development Inc. XML Representation » Here’s a portion of an HL7 message <person classCode="PSN" determinerCode="INSTANCE" > ... <administrativeGenderCode code="en" codeSystem="1.0.639.1"/> <languageCommunication> <languageCode code="en" codeSystem="1.0.639.1"/> </languageCommunication> ... </person> » Why is this wrong?
  27. 27. www.intelliware.com 27© 2014 Intelliware Development Inc. Using Concept Domains in Definitions A portion of the message definition for PRPA_MT010001CA
  28. 28. www.intelliware.com 28© 2014 Intelliware Development Inc. Defining an HL7 Environment » For any code attribute someone must define: › What Concept Domain is applicable › What Code System is bound to that Concept Domain » In today’s world, to the best of my knowledge, there is no single source of all those definitions › To the extent that much of it is defined, much of it is defined in word documents or spreadsheets
  29. 29. www.intelliware.com 29© 2014 Intelliware Development Inc. Quick Recap » HL7 uses codes a lot » Codes have two parts: › code › code system (OID) » A “Concept Domain” defines an abstract notion where a code can be used » A “Code System” is a collection of codes defined together and managed by some group › Formal identification via an OID (e.g. 1.0.639.1) › Informal identification via name (e.g. ISO 639-1)
  30. 30. www.intelliware.com 30© 2014 Intelliware Development Inc. Agenda » Concepts » Code Data Types » Concept Domains, Code Systems and Value Sets » Implementation Concerns
  31. 31. www.intelliware.com 31© 2014 Intelliware Development Inc. Let’s Look at a Transport Wrapper
  32. 32. www.intelliware.com 32© 2014 Intelliware Development Inc. Let’s Look at a Transport Wrapper A portion of a sample Find Candidates message
  33. 33. www.intelliware.com 33© 2014 Intelliware Development Inc. It’s Like I Totally Lied » Where are the Code System OIDs?
  34. 34. www.intelliware.com 34© 2014 Intelliware Development Inc. Ah, But these are “Simple” Codes
  35. 35. www.intelliware.com 35© 2014 Intelliware Development Inc. Code Data Types » CS: Coded Simple Value » CV: Coded Value » CE: Coded with Equivalents » CD: Concept Descriptor » also: » SC: Character String with Code » CD.LAB: Concept Descriptor (LAB)
  36. 36. www.intelliware.com 36© 2014 Intelliware Development Inc. Code Data Types » HL7 also defines: › CO: Coded Ordinal » I haven’t seen this example occur in nature
  37. 37. www.intelliware.com 37© 2014 Intelliware Development Inc. Where are the Data Types defined? » You have to consult two sources: › The HL7 site • http://www.hl7.org/v3ballot/html/infrastructure/ datatypes/datatypes.html › The Data Types document of the pan-Canadian standards releases » The HL7 site references the international standard; Canada has customized the standard
  38. 38. www.intelliware.com 38© 2014 Intelliware Development Inc. Example of Customization » The International Standard for a basic Coded Value type allows something that looks like this: <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1" displayName="Female" codeSystemName="HL7v3 AdministrativeGender" /> » The “displayName” and “codeSystemName” properties are Not Permitted according to the Canadian Data Types standard
  39. 39. www.intelliware.com 39© 2014 Intelliware Development Inc. Coded Simple Value (CS) » The Code System is implicit » This type is only used in some very limited circumstances › HL7 defines and manages the list of valid codes › Usually related to • message structure; or • transport wrapper data.
  40. 40. www.intelliware.com 40© 2014 Intelliware Development Inc. Coded Simple in Transport Wrapper A portion of a sample Find Candidates message
  41. 41. www.intelliware.com 41© 2014 Intelliware Development Inc. Coded Simple Value » The Code System is implicit » This type is only used in some very limited circumstances › HL7 defines and manages the list of valid codes › Usually related to • message structure; • transport wrapper data; or • part of another data type. <quantity value="400" unit="ml" />
  42. 42. www.intelliware.com 42© 2014 Intelliware Development Inc. XML Representation » When a CS value is “immutable” (old term: “structural”) then the code value appears as an XML attribute <sender typeCode="SND" > ... » Otherwise a CS value appears as a normal XML element <processingCode code="P" /> » I think it’s largely because of the first case that they don’t show the codeSystem
  43. 43. www.intelliware.com 43© 2014 Intelliware Development Inc. Coded Value (CV) » Possibly the most basic Code type <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1" />
  44. 44. www.intelliware.com 44© 2014 Intelliware Development Inc. Coded with Equivalents (CE) » Introduces the concept of “equivalent” codes » Consider the example of HumanLanguage <code code="eng" codeSystem="1.0.639.2"> <translation code="en" codeSystem="1.0.639.1"/> </code> » This is a bad example, because language code is never defined as a “CE” type. › Language is a pretty simple concept
  45. 45. www.intelliware.com 45© 2014 Intelliware Development Inc. Coded with Equivalents (CE) » Consider the example of Clinical Drug › In Canada, most pharmacists tend to refer to drugs using DIN numbers › Other drug numbers exist. E.g.: Health Canada defines an Active Ingredient Group code › There are times when they’re equivalent ways of referring to the same thing <code code="02147629" codeSystem="2.16.840.1.113883.5.1105"> <translation code="0131282002" codeSystem="2.16.840.1.113883.5.1106"/> </code> » Both indicate 400mg of Acebutol
  46. 46. www.intelliware.com 46© 2014 Intelliware Development Inc. Concept Descriptor (CD) » Very similar to CE » There’s a key difference between HL7 International and HL7 Canada, here › qualifiers » Canada has changed its support for qualifiers › V02R02 (MR 2007) vs. R02.04.02 (MR 2009) » Notion of post-coordinated codes › HL7 International would use a series of qualifiers to provide qualifying codes
  47. 47. www.intelliware.com 47© 2014 Intelliware Development Inc. Post-Coordinated Values » Used to combine codes more expressively <value code="397956004:363704007=24136001:272741003=7771000{363699004=3041200 07,260686004= 257867005}" codeSystem="2.16.840.1.113883.6.96"/> › 397956004 = prosthetic arthroplasty of the hip › 363704007 = Procedure site › 24136001 = Hip joint structure › 272741003 = laterality › 7771000 = left › 363699004 = direct device › 304120007 = Total hip replacement prosthesis
  48. 48. www.intelliware.com 48© 2014 Intelliware Development Inc. Post-Coordinated Values using Qualifiers
  49. 49. www.intelliware.com 49© 2014 Intelliware Development Inc. Character String with Code (SC) » Key idea: the string is more salient than the code is » Only example I know of is address parts:
  50. 50. www.intelliware.com 50© 2014 Intelliware Development Inc. Concept Descriptor for Lab (CD.LAB) » Same as CD, but displayName is permitted
  51. 51. www.intelliware.com 51© 2014 Intelliware Development Inc. Object Hierarchy This is a strange, backward hierarchy
  52. 52. www.intelliware.com 52© 2014 Intelliware Development Inc. Additional Considerations » Original Text » Coding Strength › CNE (coded, non-extensible) › CWE (coded, with extensibility)
  53. 53. www.intelliware.com 53© 2014 Intelliware Development Inc. Recap » What we’ve learned about Data Types › CS, CV, CD, CE, SC » Translations » Qualifiers » Original Text and Coding Strength
  54. 54. www.intelliware.com 54© 2014 Intelliware Development Inc. Exercise » Find Candidates Payload › Peruse the MIF › Look for all the properties (attributes) that are defined as code values • Hint: look at <mif:type name=”??” /> › What kind of codes are they? › Also, look at the XSDs and see how the corresponding properties (XML Elements) are defined there
  55. 55. www.intelliware.com 55© 2014 Intelliware Development Inc. Agenda » Concepts » Code Data Types » Concept Domains, Code Systems and Value Sets » Implementation Concerns
  56. 56. www.intelliware.com 56© 2014 Intelliware Development Inc. Code System and Concept Domains » We’ve touched on Code Systems and Concept Domains before › All codes associated with a particular “standard” are part of the same code system › A Concept Domain is used to describe a particular business concept that can be described using a code.
  57. 57. www.intelliware.com 57© 2014 Intelliware Development Inc. Sample Concept Domains
  58. 58. www.intelliware.com 58© 2014 Intelliware Development Inc. Major Concept Domains » ActCode » EntityCode » ObservationValue
  59. 59. www.intelliware.com 59© 2014 Intelliware Development Inc. Hierarchical Concept Domains
  60. 60. www.intelliware.com 60© 2014 Intelliware Development Inc. Hierarchical Concept Domains
  61. 61. www.intelliware.com 61© 2014 Intelliware Development Inc. What is a Value Set? » You could think of it as a subset of a code system › A value set includes some or all of the codes from a code system › All codes in a value set come from the same code system
  62. 62. www.intelliware.com 62© 2014 Intelliware Development Inc. An Example » Code System: Confidentiality » Codes (about 14 in total) › N: Normal › R: Restricted › HIV: HIV-related › ETH: Substance-abuse related › PSY: Psychiatry-related › C: Celebrity › T: Taboo
  63. 63. www.intelliware.com 63© 2014 Intelliware Development Inc. x_VeryBasicConfidentialityKind » Only 2 codes › N: Normal › R: Restricted » Note that there are relationships between codes › Everything except “N” can been “rolled up” to “R”
  64. 64. www.intelliware.com 64© 2014 Intelliware Development Inc. Other Thoughts » SNOMED CT › one code system that tries to describe medical terminology across many, many concept domains › We generally care about specific subsets (Value Sets), rather than the whole code system • e.g.: ActServiceDeliveryLocationService » Inconveniently, HL7.org often uses the same names to describe a Value Set and a Concept Domain › Adds to confusion
  65. 65. www.intelliware.com 65© 2014 Intelliware Development Inc. Binding
  66. 66. www.intelliware.com 66© 2014 Intelliware Development Inc. Agenda » Concepts » Code Data Types » Concept Domains, Code Systems and Value Sets » Implementation Concerns
  67. 67. www.intelliware.com 67© 2014 Intelliware Development Inc. Common Healthcare Standards » DIN › A Drug Identification Number (DIN) is a computer-generated eight digit number assigned by Health Canada to a drug product prior to being marketed in Canada. It uniquely identifies all drug products sold in a dosage form in Canada and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada.
  68. 68. www.intelliware.com 68© 2014 Intelliware Development Inc. Common Healthcare Standards » SNOMED CT › SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms), is a systematically organised computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, substances, etc.
  69. 69. www.intelliware.com 69© 2014 Intelliware Development Inc. Common Healthcare Standards » LOINC › Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994.
  70. 70. www.intelliware.com 70© 2014 Intelliware Development Inc. Common Healthcare Standards » ICD-10 › The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (known as "ICD-10") is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the World Health Organization (WHO).
  71. 71. www.intelliware.com 71© 2014 Intelliware Development Inc. Implementation Considerations » Change and Lifecycles » Just because a standard exists, doesn’t mean that it never changes › Country codes • Example: Sint Maarten
  72. 72. www.intelliware.com 72© 2014 Intelliware Development Inc. More on Lifecycle » Some code values are bound to different pan- Canadian standards releases. » A jurisdiction that implements a prior release should use the previous codes » On the other hand, some code systems are updated regularly › e.g.: ClinicalDrug • The list of drug products managed by Health Canada is updated every quarter » There’s no formal distinction of these code categories
  73. 73. www.intelliware.com 73© 2014 Intelliware Development Inc. Mapping » At Partnership, it’s not uncommon to hear jurisdictions talk about “implementation” › What they’re often talking about is code mapping » In the target architecture, Accenture plans to use a HLI to provide mapping services › Don’t assume that mapping is a trivial exercise › Some concepts don’t map neatly
  74. 74. www.intelliware.com 74© 2014 Intelliware Development Inc. Final Recap » Concepts » Code Data Types » Concept Domains, Code Systems and Value Sets » Implementation Concerns
  75. 75. www.intelliware.com Intelliware Development 200 Adelaide Street West, Suite 100 Toronto, Canada www.intelliware.com © 2014 Intelliware Development Inc. 75
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