The document discusses clinical data standards and data portability in healthcare. It notes that healthcare needs to better utilize information technologies to improve quality of care, reduce costs, and empower patients. Establishing interoperability between different healthcare systems requires agreed upon data standards to ensure consistent and uniform sharing of information. Examples of data standards that help fulfill interoperability include HL7 for data exchange and SNOMED CT for clinical terminology. Adopting common data standards is key to enabling reliable movement of health information between systems and organizations.

1. Nrip Nihalani
Plus91 Technologies Pvt. Ltd.
Adding Value to Healthcare
Clinical Data Standards and Data Portability

2. Health 2.0 ?
• Healthcare is being pushed
into the Information Age –
the need for this was all-to-
well known due to:
– Breaking up of economic
divides
– Rising Consumerism
– Increasing Costs
– Safety Concerns
• Health care still is not taking
full advantage of the
information &
communications
technologies that have
revolutionized other
industries

3. The Patient Empowerment Movement
• Empowering patients to maintain and improve
their health
• Enabling clinicians and health-care
organizations to provide safer and more
evidence-based care
• THIS REQUIRES “creating a dynamic,
networked information infrastructure” 
must reliably ensure the private and secure
movement of vital health information at the
time that it is needed to the place where it is
needed

4. Examples of Healthcare Info Systems
• Information systems are making important contributions
towards the creation of a safer healthcare industry

5. Benefits of eHealth / Health IT
• Deliver care to people located in remote places ;
who do not have access to a hospital, through a
tele-consultation.
• Help improve the quality of life of patients by, for
e.g., monitoring the condition of the patient at
distance at home, rather than in a hospital 
particularly relevant for elderly, chronically ill
persons and people living in remote regions
• Improve the quality of care by providing easier,
safer and faster access to patient data, thereby
allowing healthcare professionals to “Access the
Right Data at the Right Time” and “Make an
informed-based diagnosis”

6. Benefits of eHealth / Health IT
• The availability of information on the patient –
such as his medical history, past diseases and
interventions, allergies, reaction to
medications in an EHR allows healthcare
professionals to deliver a treatment tailored to
the needs of the patient and thereby reduce
risks of complications, adverse reactions etc.
• Clinical Decision Support Systems help in
reducing reliance on memory, increasing
vigilance, and contributing to standardization
of processes

7. Benefits of eHealth / Health IT
• eHealth tools can help Physicians work more
efficiently, by storing patient information in a
single location, allowing access to information
on the patient faster, taking medical decisions
better and faster
• By allowing healthcare professionals to save
time, eHealth tools also address the issue of
shortage of healthcare professionals in many
areas.

8. New Useful Health IT Solutions - Weekly

9. Data Sharing – Systems and Entities
• Useful New Health IT Solutions, Softwares,
Devices launch every week.
• Also, Various healthcare entities use and
modify a patient’s data, structured as well as
residual, at different times - physicians,
hospitals, laboratories, insurers, researchers
and even the patients themselves
• The need for information sharing between
different systems is thus critical – Else Data
sharing will be a bottleneck and create poor,
ineffective processes

10. Interoperability
• Interoperability means the ability of two or
more systems to use and exchange data and
human understandable information
• With interoperable systems, data can be
exchanged and stored automatically rather
than re-typed into the system each time.
• 3 levels of Interoperability
1. ORGANISATIONAL INTEROPERABILITY
• is the will and ability to work together and exchange
information. It is brought about by an environment
composed of laws, policies, and cooperation
agreements

11. Interoperability
2. SEMANTIC INTEROPERABILITY
• ensures that the precise meaning of exchanged
information is interpretable by any system or
application not initially developed for the same
purpose as the system initiating the exchange
3. TECHNICAL INTEROPERABILITY
• enables the exchange of information from a technical
standpoint and guarantees:
– data security and privacy
– data integrity
– access to relevant data associated with an identified patient

12. Interoperability  Data Standards
• Interoperability requires the creation,
acceptance, and implementation of clinical
data standards to ensure that data in one part
of the system is available and usable across a
variety of clinical settings
• Using standards for data sharing is the first
step of interoperability.
• Standards allow a common definition of data
and data exchange formats which is essential
to enable interoperability both at the
technical and semantic level.

13. canyouundertstandthis
• datastandardsdatastandardsareagreeduponrul
esthatallowinformationtobesharedandprocess
edinauniformandconsistentmannerforexample
rulesinalanguagesentencesshouldendwithafull
stopcommascanbeusedtoseparatepartsofafull
sentenceorlistsnamesofindividualsmustbecapi
talizedforexamplestandardplugsstandardplugs
attachedtodevicesallowthemtobeusedinhome
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14. Now try this 
• Data standards are agreed upon rules – that allow
information to be shared and processed in a
uniform and consistent manner.
• For example “Rules in a language”
• Sentences should end with a fullstop. Commas
can be used to separate parts of a full sentence or
lists. Names of individuals must be capitalized.
• For Example “Standard Plugs”:
• Standard plugs attached to devices allow them to
be used in homes where there are standardized
sockets.

15. Data Standards
• At a minimum a Data Standard Must Contain:
– Interface Specification
– Nomenclature Standard

16. E.g of fulfilling Interoperability
• HL7 - (A Syntax Standard)
– Successful standard for the intra-hospital communication
of clinical, administrative and financial data. It supports the
active management of key workflows within and across
providers through data exchange, e.g. registration of
patients, placement of orders and reporting of results.
• SNOMED CT: ( A Semantic Standard)
– It is a systematically organised collection of medical
terminology covering most areas of clinical information. It
provides a consistent way to index, store, retrieve and
aggregate clinical data across specialties and sites of care
• Syntax + Semantics can fulfill Interoperability

17. CATEGORIES OF DATA STANDARDS
• DATA EXCHANGE STANDARDS  HL7, DICOM
– Allow transactions to flow between systems/organizations
• TERMINOLOGY SNOMED, ICD-9
– Vocabularies, provide specific codes for clinical concepts
• DOCUMENT  CCR
– Indicate what type of information is included in a
document and where can it be found.
• APPLICATION CCOW
– Determine the way business rules are implemented and
software systems interact

18. STANDARDS  FOLLOWING QUALITIES:
• TRANSPARENT: should be easily available for
all stakeholders
• RELEVANT AND USER-DRIVEN: should be
based on real-world business use cases
• APPROPRIATE: should provide reasoning
behind the choice of implementation
technologies
• EFFECTIVE: should reuse existing work as well
as global and ISO/IEC Base Standards as much
as possible

19. STANDARDS  FOLLOWING QUALITIES:
• THOROUGH: should address eHealth
interoperability in relation to application
functionality, data integrity and availability,
patients’ privacy and safety and performance
aspects
• COLLABORATIVE: setting procedures should
maintain a cooperative spirit
• TESTING AND VALIDATION: should have clear
criteria that can be tested in order to validate
interoperability

20. Standards for Standards
• Standards must be made such that they
– Ensure applications developed for various
platforms catering to different healthcare
processes will work for another
– Enable the movement of a datastore (database or
otherwise) from one eHealth solution to another.
– Enable reversibility, moving data from software
systems to Non- software processes

21. Nomenclature
• Data Portability - is the process by which the
is medical record in whole or in part can be
transferred between two Electronic Systems
• Structured Field - is a data element in a
medical record which is defined and has a
defined structure
• Residual Data is The data in a medical record
that is not defined by structured fields and is
important information for patient care

22. Data Set forming a Medical Record
• A longitudinal
representation of a
patient medical record:
– Practice Management
Data
– Cumulative Patient
Profile
– Extended Patient
Information
• This is an example of a
Patient Data Standard
Set for Data Portability

23. Practice Management Data
• Appointments and Related Information
• Patient Demographics
• Patient Identification

24. Cumulative Patient Profile
• Family History
• Past Health
• Problem List
• Clinical Care Data
• Risk Factor
• Medication
• Immunization
• Allergies and Adverse
Reaction
• Alerts and Special
Needs

25. Extended Patient Information
• Laboratory Results
• Special Notes by the
physician/surgeon
• External Reports
received
– Images
– Scanned or Transcribed
documents
– Emails from the patient
– Text of Telephonic
conversations between
the Patient and Physician

26. Thanks for Viewing this Presentation
If you’d wish for me further help, please contact me
Blog: http://wirelysis.blogspot.com
Twitter: @nrip
Email: n.nihalani@plus91.in
Corporate: http://www.plus91.in

27. References
• Clinical Data Standards in Healthcare - ihealth
Reports
• http://www.scoop.it/t/healthcare-technology
• COCIR eHealth Toolkit 2012
• http://technology4doctors.blogspot.com
• Connecting for Health – Markle Foundation

28. Appendix: Committee-itis