Health Information Standards - Kevin O'Carroll


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  • Not just a regulator for when things go wrong but promote health and social services excellence by delivering a structured programme aimed at identifying and sharing good practice, building capacity and capability
  • Paper and Electronic formats In paper – common language exists, information usually transferred as letters/prescriptions, structure may be defined and agreed – UK In electronic world – different languages within organisations and across care settings. GP practices there are 4 different practice management systems and in hospitals greater number considering laboratories, Radiology departments, out patients, wards want to communicate Need to define the structure before messaging starts
  • The GPMS standard specifies the structure and content of electronic messages transmitted to and from GP practices . defines a set of building blocks for messages; know as message segments, which may be reused when constructing messages. A total of 20 segments are detailed and are listed below. The patient identification segment , which is used to carry patient demographic and identification information, consists of 38 fields . The fields have been taken directly from the HL7 v2.4 standard. Each individual field in a building block must adhere to certain rules as defined in the GPMS.
  • Segments are used to construct messages specific to clinical scenarios e.g. Emergency Department attendance, Laboratory results. Clinical scenarios use different combinations of the building blocks to create the required message. The Authority’s GPMS details the messages required for 13 clinical scenarios, also known as message flows. For each of these scenarios it identifies the actors , triggers and the structure and content of the message used to transmit relevant clinical information using a use case, messaging interaction diagram, minimum abstract message definitions and constraints
  • Draft dataset developed after consultation Public consultation process 86 responses Qualitiative Quantative – 330+ alterations Process Study in Denmark has shown that electronic GP referrals can lead to a) a faster referral process b) reduction in the loss of referrals c) can be more cost effective for both GPs and hospitals
  • Requirements to develop a national code set for tests currently being ordered by GPs using Healthlink online Assessed suitability of LOINC & SNOMED
  • Requirements to develop a national code set for tests currently being ordered by GPs using Healthlink online Assessed suitability of LOINC & SNOMED
  • A formal, distinct, and unique 6-part name is given to each term for test or observation identity.1 The database currently has over 58,000 observation terms that can be accessed and understood universally. Each database record includes six fields for the unique specification of each identified single test, observation, or measurement: Component- what is measured Glucose post 100g oral bolus dose Kind of property- characteristics of what is measured , such as length , mass , volume, time stamp and so on Time aspect- interval of time over which the observation or measurement was made System- context or specimen type within which the observation was made (example: blood, urine,...) Type of scale- the scale of measure. The scale may be quantitative, ordinal, nominal or narrative Type of method- procedure used to make the measurement or observation
  • A central directory, which becomes a single up to date authoratitive source of information regarding healthcare professionals and healthcare organisatation offering services in the health and social care sector. The sources are professional regulatory authorities and other ICT systems which maintain data on professionals and organisations. The consumers of the central directory include those who require an element of the UHI for Healthcare Practitioners or Organisations data for identification, publication, research or other such purposes. These include National Health Information sources, ICT projects, Service planners ISO 27527 International standard, progress from a draft to a full standard over the lifetime of this project, have fed back our requirements into the development project. At its simpiest it is a document which details the pieces of information which should be collected regarding practitioners and organistion to safely and uniquely identify them We took this standard and thru a survey and working with our advisory group members assessed the impact of adopting the standard. In the report we are recommending adopting the standard with three national adaptations. in the case of healthcare practitioners the field of practice section as mentioned above, the regulatory bodies do not collect this information. The Authority suggests adapting the standard and instead track the data that is currently collected which is the date on which the healthcare practitioner registers with their professional regulatory authority not the date on which they began to practice in a certain field. individual biometric identifiers are ‘required’ for the ISO/TS 27527. Biometric identification is only in its infancy in Ireland, the standard will be adapted to by changing the biometric identification data field as optional. looking at healthcare organisations, the Irish adaptation will include an additional directory record, which will include the services and functions that healthcare organisation provide.
  • Fundamental & differentiating
  • Health Information Standards - Kevin O'Carroll

    1. 1. Dr Kevin O’Carroll, Standards & Technology Manager, Health Information and Quality Authority Health Information Standards and the Health Information and Quality Authority
    2. 2. <ul><li>Health Information and Quality Authority (HIQA) </li></ul><ul><li>Health Information Directorate </li></ul><ul><li>Current Projects </li></ul><ul><ul><li>Technical Standards </li></ul></ul><ul><ul><li>Health Identifiers – IHI, HPI, HOI </li></ul></ul><ul><ul><li>Information Governance Standards </li></ul></ul><ul><ul><li>Standards for National Health Information Sources </li></ul></ul>Overview
    3. 3. <ul><li>To drive continuous improvements in the quality and safety of health and social care in Ireland. </li></ul>Remit
    4. 4. <ul><li>Health Act 2007, establishment 15 May 2007 </li></ul><ul><li>independent - reporting to Minister for Health and Children </li></ul><ul><li>close relationship with people using the service, professionals, providers, public, communities, media, stakeholders </li></ul><ul><li>person-centred ethos of “working with” not “doing to” </li></ul>Background
    5. 5. <ul><li>Social Services Inspectorate (SSI) – residences for older people, people with disabilities, children, etc </li></ul><ul><li>Health Technology Assessment (HTA) - colorectal cancer, HPV in cervical screening, prion filtration of red cell concentrates </li></ul><ul><li>Healthcare Quality and Safety (HQS) – standard setting and monitoring function in acute hospital setting </li></ul><ul><li>Health Information (HI) – Technical standards / Information Quality </li></ul>Functions
    6. 6. Health Information Directorate - Projects <ul><li>Technical Standards </li></ul><ul><ul><li>General Practice Messaging Specification </li></ul></ul><ul><ul><li>National General Practice Referral Dataset </li></ul></ul><ul><ul><li>Laboratory Ordering </li></ul></ul><ul><li>Other projects </li></ul>
    7. 7. <ul><li>General Practice Messaging Specification </li></ul>
    8. 8. What is messaging? 1010001100011100110101
    9. 9. GPMS <ul><li>General Practice Messaging Specification (GPMS) </li></ul><ul><li>May 2010 (ministerial approval) </li></ul><ul><li>Based on HL7 v2.4 with XML encoding </li></ul><ul><ul><li>Segment definitions </li></ul></ul>Segments message header + patient information + event information + order information + result information Messages
    10. 10. GPMS <ul><li>General Practice Messaging Specification (GPMS) </li></ul><ul><li>May 2010 (ministerial approval) </li></ul><ul><li>Based on HL7 v2.4 with XML encoding </li></ul><ul><ul><li>Segment definitions </li></ul></ul>
    11. 11. GPMS - Segments ERR (message error) OBX (observation result) MSA (message acknowledgement) OBR (observation request) SAC (specimen container detail) NTE (notes and comments) RF1 (referral information) DG1 (diagnosis) ORC (common order segment) PRD (provider data) AIL (appointment information – location resource) PV2 (event type additional information) SCH (scheduling activity information ) PV1 (event type/ patient visit) AIP (appointment information – personnel resources) EVN (event RGS (resource group) PID (patient identification) PDA (patient death and autopsy) MSH (message header)
    12. 12. GPMS – Clinical Scenarios Use Case: A laboratory receives a specimen and analyses the specimen. When a result is available this is communicated to the healthcare practitioner responsible for ordering the investigation or to the healthcare practitioner to whom a copy has been requested to be sent. Describes the use case, messaging interaction , minimum abstract message definitions and constraints
    13. 13. GPMS – clinical scenarios Describes the use case, messaging interaction, minimum abstract message definitions and constraints
    14. 14. GPMS – Message flows Corrected result Unsolicited radiology result Unsolicited laboratory result Laboratory order Death notification Referral and response Administrative discharge Waiting list notification Clinical discharge summary Outpatient department summary Admission notification Cooperative discharge summary Emergency department attendance
    15. 15. <ul><li>National Dataset for General Practice Referrals </li></ul>
    16. 16. GP Referral dataset <ul><li>National GP Referral Dataset in collaboration with ICGP </li></ul><ul><li>International review </li></ul><ul><ul><li>Scotland – 95% referrals electronic </li></ul></ul><ul><ul><li>Denmark - 100% by end of 2011 </li></ul></ul><ul><li>Development </li></ul><ul><ul><li>Local/regional/national/international </li></ul></ul><ul><ul><li>Draft for consultation December 2010 </li></ul></ul><ul><li>National General Practice Referral Dataset </li></ul><ul><li>National Generic Electronic GP Referrals project </li></ul>
    17. 17. National Standard
    18. 18. Referral template
    19. 19. <ul><li>Laboratory Ordering </li></ul>
    20. 20. Laboratory Codes <ul><li>Laboratory codes LOINC </li></ul><ul><li>Scope – identification of laboratory concepts (orders and results) </li></ul><ul><li>Regenstrief institute </li></ul><ul><li>Laboratory - 30,000 – haematology/biochemistry, microbiology, serology & toxicology, drug and cell counts and antibiotic susceptibility </li></ul><ul><li>Clinical –findings and findings noted with undertaking cardiac procedures, ultrasound etc </li></ul><ul><li>Regenstrief LOINC mapping assistant (RELMA ®) </li></ul><ul><li>RELMA ® and web search ( ) </li></ul><ul><li>Takes submissions twice yearly </li></ul><ul><li>In use in 140 countries </li></ul>
    21. 21. LOINC <ul><li>Unique code (format: nnnnn- n ) is assigned to each entry upon registration </li></ul><ul><li>Fully specified name - </li></ul><ul><ul><li>Component, Kind of property, Time aspect, System, Type of scale </li></ul></ul><ul><ul><li>Narrative, Type of method </li></ul></ul><ul><li>Other database fields include short name , status and mapping information for database change management, synonyms , related terms , substance information (e.g. molar mass , CAS registry number ), choices of answers for nominal scales, translations . </li></ul>Glucose [Mass/volume] in Serum or Plasma --2 hours post 100 g glucose PO GLUCOSE^2H POST 100 G GLUCOSE PO:MCNC:PT:SER/PLAS:QN 1514-9 Long name Fully specified name Unique Code
    22. 22. Laboratory Orders The National Laboratory Medicine Catalogue (NLMC): Editorial Principles
    23. 23. <ul><li>Other projects </li></ul>
    24. 24. Other projects inventory of all health and social care data sources semi structured interviews to identify themes to develop standards Draft standards for consultation (immanent) Final standards for health information source Health Information Sources Information Governance toolkit Information Governance Guidance Information Governance SNOMED CT, HL7, IHE Workshops ISO 27527 Healthcare practitioner and healthcare organisation identifiers ASTM-E1714, ISO 22220 Individual Health Identifier Standards Projects
    25. 25. eHealth Standards Advisory Committee (eSAG) <ul><li>the development of standards and associated technical materials to support eHealth will be based on the Authority’s standard procedures and processes for the development of technical standards. These are broadly in line with the World trade Organisation (WTO) Code of Good Practice for the Preparation, Adoption and Applications of Standards (See Appendix 2.). </li></ul><ul><li>open non-proprietary standards will preferred over proprietary ones. </li></ul><ul><li>international standards which have been fully implemented and validated will be preferred. </li></ul><ul><li>there should be a minimum of adaptation of the international standards to meet the requirements of the Irish health sector. </li></ul><ul><li>where there is no international standard available and only as a last resort will the Authority consider developing a new standard for Ireland. </li></ul><ul><li>industry developments and health service delivery opportunities will be taken into account. </li></ul><ul><li>the standards proposed will ensure value for money and minimise cost of compliance. </li></ul>
    26. 26. Contact Details: Thank you.
    27. 27. HPI & HOI International Standards Organization Technical Standard 27525
    28. 28. Workshops Dublin 30 June 2009 Health Information Standards Dublin 18 November 2009 An introduction to SNOMED CT Cork 27 January 2010 An introduction to SNOMED CT Dublin 17 November 2010 Health Level Seven (HL7) v2 and v3 Cork 9 March 2011 Health Level Seven (HL7) v2 and v3 Dublin 16 Nov 2011 Overview of Healthcare Interoperability Standards Location Date Workshop Title
    29. 29. IHI <ul><li>Based on American Society for Testing and Materials – (ASTM -E1714) </li></ul><ul><li>Criteria for selection of a Unique Health Identifier defined and grouped into fundamental and differentiating. </li></ul><ul><li>Criteria agreed with stakeholders: </li></ul>Based on ASTM-E1714 (Blue cells show fundamental criteria / Grey cells show differentiating criteria) Cost Effective Deactivation Concise Longevity Incremental Dis-identifiable Mappable Universal Unique Unambiguous Retroactive Repository Based Permanent Networked Governed Centrally Atomic Usable Standard/ Based on Industry Standards Deployable Legislation Secure Public Healthcare Focused Controllable Content-Free Linkable Verifiable Splittable Mergeable Identifiable Assignable Accessible