Standards & Coding Systems in Biomedical and Health Informatics


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Standards & Coding Systems in Biomedical and Health Informatics

  1. 1. Standards & Coding Systemsin Biomedical and Health Informatics นพ.นวนรรน ธีระอัมพรพันธุ์ บรรยาย ณ สถาบันทันตกรรม ในหลักสูตรทันตสารสนเทศศาสตร์ 24 กุมภาพันธ์ 2555
  2. 2. A Few Words About Me...2003 M.D. (1st-Class Honors) Ramathibodi2009 M.S. (Health Informatics) University of Minnesota2011 Ph.D. (Health Informatics) University of MinnesotaCurrently• Medical Systems Analyst, Health Informatics Division, RamathibodiContacts
  3. 3. Manufacturing Image Source:
  4. 4. Banking Image Source:
  5. 5. Healthcare ER - Image Source:
  6. 6. Why Healthcare Isn’t Like Any Others?  Life-or-Death  Many & varied stakeholders  Strong professional values  Evolving standards of care  Fragmented, poorly-coordinated systems  Large, ever-growing & changing body of knowledge  High volume, low resources, little time
  7. 7. Why Healthcare Isn’t Like Any Others? Large variations & contextual dependence Input Process Output Patient Decision- Biological Presentation Making Responses
  8. 8. But...Are We That Different? Banking Input Process Output Transfer Location A Location B Value-Add - Security - Convenience - Customer Service
  9. 9. But...Are We That Different? Manufacturing Input Process Output Raw Materials Assembling Finished Goods Value-Add - Innovation - Design - QC
  10. 10. But...Are We That Different? Healthcare Input Process Output Sick Patient Patient Care Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information
  11. 11. Information is Everywhere
  12. 12. Types of Healthcare Information Clinical Information  Demographics, History, Physical Exam  Laboratory tests & Other Investigations (e.g. ECG), Imaging  Diagnoses, Medications, Treatments  Genomics Information about Healthcare Organizations & Operations Public Health Information - Epidemiology, Environmental Research Information - Basic Science, Clinical Research, Public Health Generic Health Information (e.g. Patient education materials) Knowledge Bases (e.g. PubMed) & Professional Education Materials
  13. 13. Various Forms of Health ITHospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records Picture Archiving and (EHRs) Communication System (PACS)
  14. 14. Still Many Other Forms of Health IT Health Information Exchange (HIE) m-Health BiosurveillancePersonal Health Records (PHRs) Telemedicine & Information Retrieval Telehealth Images from Apple Inc.,, Google,, and American Telecare, Inc.
  15. 15. Health IT: What’s In A Word? Goal Value-Add Tools
  16. 16. Recap  Healthcare is complex and information-rich  Healthcare information is heterogeneous  Health IT is a tool to add value to care delivery  Health IT comes in many different shapes and forms, many must integrate with one another  Yet healthcare is highly fragmented...  That’s why we need “STANDARDS”
  17. 17. Standards Are Everywhere
  18. 18. Standards: Why? The Large N Problem N = 2, Interface = 1 N = 3, Interface = 3 N = 5, Interface = 10 # Interfaces = N(N-1)/2 N = 100, Interface = 4,950
  19. 19. Health Information Exchange (HIE) Government Hospital A Hospital B Clinic C Lab Patient at Home
  20. 20. The Goal Is...  Interoperability  Inter-operable systems
  21. 21. Types of Standards  De facto (informal/in practice) standards  Dominant custom, convention, product, system  e.g. Microsoft Word, QWERTY keyboard  De jure (formal) standards  Developed by recognized standard developing organizations  Maybe obligatory/regulatory, or voluntary
  22. 22. Standard-Developing Organizations (SDOs)  Develops, coordinates, revises, interprets & maintains standards that address interests outside its own organization  Clear scope  Formal standards development process  International, regional, national authorities  Examples: ISO, IEC, ITU, IEEE, IETF, W3C, ANSI, NIST, HL7, ASTM
  23. 23. Sample Standards Development Process Public Working Group Draft Proposal Comment/ Consideration Balloting (Additional Working Group Test/Trial Use Balloting or Amendment Approval) (Enforcement/ Evaluation/ Deployment Certification) Maintenance
  24. 24. Various Kinds of Standards Unique Identifiers Standard Data Sets Vocabularies & Terminologies Exchange Standards  Message Exchange  Document Exchange Functional Standards Technical Standards: Data Communications, Encryption
  25. 25. DIKW Pyramid Wisdom Knowledge Information Data
  26. 26. Levels of Interoperability Functional Semantic Syntactic
  27. 27. Unique Identifiers A unique convention to identify a class of objects E.g. serial numbers, national citizen ID, HN (MRN), NDC Unique within scope of intended operations e.g. a hospital, a company, a city, a country, or globally May or may not be “smart numbers” (digits with meaning). Smart numbers are bad practices. May or may not have “check digits” (digits used to prevent data entry errors) In general, not supposed to be confidential (except U.S. Social Security Numbers, credit card numbers)
  28. 28. Standard Data Sets Sometimes called minimum data sets Data structure (fields, formats, meanings) for a specific purpose E.g. Ministry of Public Health’s 12-file or 18-file reports
  29. 29. Vocabularies & Terminologies Controlled Vocabulary  A set of terms used in a specific area where the use of each term is predefined, and the set maintained by the responsible party Taxonomy  A hierarchical system to classify objects in a specific area Terminology  A system or study of terms used to label concepts and their meanings in a specific area Ontology  “A formal representation of knowledge as a set of concepts within a domain, and the relationships between those concepts.” (Wikipedia) Coding System  A system to identify how to represent an object or concept
  30. 30. Examples ICD-10, ICD-9  Classification System  Coding System  Taxonomy CPT (Current Procedural Terminology)  Classification System  Coding System  Taxonomy SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms)  Controlled Vocabulary  Terminology LOINC (Logical Observation Identifiers Names and Codes)  Coding System ICNP, ICPC
  31. 31. Exchange Standards Message Message Government Message Hospital A Hospital B Clinic C Lab Message Patient at Home Message
  32. 32. Exchange Standards Message Exchange  Goal: Specify format for exchange of data  Internal vs. external messages  HL7 v.2, HL7 v.3 Messaging, DICOM, NCPDP Document Exchange  Goal: Specify format for exchange of “documents”  HL7 v.3 Clinical Document Architecture (CDA), ASTM Continuity of Care Record (CCR), HL7 Continuity of Care Document (CCD)
  33. 33. Documents vs. Messages Clinical Documents  Human Readable  (Ideally) Machine Processable Messages  Human UnReadable  Machine Processable
  34. 34. Sample HL7 v.2 Message (Lab Result) OBX|1|NM|10839-9^TROPONIN-I^LN||5|ng/ml| 0-1.3|H||H|F|19980309…
  35. 35. Sample HL7 v.3 Message (Pt. Regist.)<?xml version="1.0" encoding="UTF-8"?><PRPA_IN101311UV02 xmlns="urn:hl7-org:v3" xmlns:xsi="" ITSVersion="XML_1.0" xsi:schemaLocation="urn:hl7-org:v3 ../schemas/PRPA_IN101311UV02.xsd"> ... <name use="SYL" > <given>นวนรรน</given> <family>ธีระอัมพรพันธุ์</family> </name> <name use="ABC"> <given>Nawanan</given> <family>Theera-Ampornpunt</family> </name> <administrativeGenderCode code="M"/>...</PRPA_IN101311UV02> Message source adapted from Ramathibodi HL7 Project by Supachai Parchariyanon, Kavin Asavanant, Sireerat Srisiriratanakul & Chaiwiwat Tongtaweechaikit
  36. 36. Functional Standards Aims for functional interoperability Example Scenario: Two systems are expected to behave in the same way with the same trigger event (e.g. once received an electronic message) Real-world Example: PDF file viewing by two different viewers Informatics Example: HL7 EHR Functional Specifications
  37. 37. How Standards Support Interoperability Functional Standards (HL7 EHR Functional Functional Specifications) Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9, CPT, SNOMED CT, LOINC) Semantic Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD) Standard Data Sets Unique ID Syntactic Exchange Standards (HL7 v.2, HL7 v.3 Messaging, HL7 CDA, DICOM) Technical Standards (TCP/IP, encryption)Some may be hybrid: e.g. HL7 v.3, HL7 CCD
  38. 38. More Standards for Self-Study Medications & Pharmaceutical  RxNorm (U.S. National Library of Medicine)  U.S. National Drug Code (U.S. FDA) Labs (& Others)  LOINC (Regenstrief Institute) Clinical Terminologies  SNOMED CT Organizational/Business  ISO 27799 (Information Security Management in Health) Integration  IHE (Integrating the Healthcare Enterprise) OpenEHR (a hybrid of standards for health information in EHRs) And many more!