The document discusses HL7 standards and health information exchange in Thailand. It provides background on the speaker and their experience in health informatics. It outlines the needs for better information in healthcare to improve quality and reduce errors. Thailand's eHealth development has been uneven, with siloed systems and a lack of integration and interoperability. Standards are important to enable health information exchange and interoperability between different systems. HL7 standards are a key focus for enabling information exchange in Thailand going forward.
This document provides an introduction and progress report on FHIR (Fast Healthcare Interoperability Resources). Key points:
- FHIR is a new, implementer-friendly standard for healthcare interoperability that has generated significant interest internationally.
- The core infrastructure is in draft form and several clinical domains are actively working on defining FHIR resources.
- FHIR can be used for RESTful exchanges, documents, messages, services, and integrating with XDS standards.
- The goal is to have more resources balloted in 2013 and release a draft standard for trial use in 2014.
HL7 & HL7 CDA: The Implementation of Thailand's Healthcare Messaging Exchange...Nawanan Theera-Ampornpunt
This document discusses the implementation of HL7 and HL7 CDA standards for healthcare messaging exchange in Thailand. It provides background on the speaker, Nawanan Theera-Ampornpunt, and outlines Thailand's vision for eHealth, current status, and the role of standards. It then describes HL7 standards including versions 2 and 3, the Reference Information Model, and Clinical Document Architecture. The document outlines Ramathibodi Hospital's experience implementing HL7 messaging and CDA documents for lab results exchange. Next steps involve encouraging broader CDA adoption.
The document provides an introduction to FHIR (Fast Healthcare Interoperability Resources). It outlines some of the limitations of previous HL7 standards like V3 being too complex and documents (CDA) not being sufficient. It notes the need for a transition path from V2 and something to address new markets. FHIR is presented as a new approach that is focused on implementers and uses resources as the basic building block. Each resource has its own model and unique ID. The goal is to make implementation easier compared to previous standards.
5 Reasons Why Healthcare Data is Unique and Difficult to MeasureHealth Catalyst
Healthcare data is not linear. It is a complex, diverse beast unlike the data of any other industry. There are five ways in particular that make healthcare data unique:
1. Much of the data is in multiple places.
2. The data is structured and unstructured.
3. It has inconsistent and variable definitions; evidence-based practice and new research is coming out every day. 4. The data is complex.
5. Changing regulatory requirements.
The answer for this unpredictability and complexity is the agility of a late-binding Data Warehouse.
This document provides information about HL7 standards and two experts, Dr. Supachai Parchariyanon and Dr. Nawanan Theera-Ampornpunt. It discusses HL7 Version 2 and Version 3 messaging standards. Version 2 is the most commonly used standard, using segments and a pipe-delimited format. Version 3 adds semantic capability using XML messages based on a Reference Information Model. The document compares the two versions and their approaches to addressing interoperability.
The document discusses HL7 and FHIR. It begins by explaining that HL7 is a standards development organization that provides a framework and standards for exchanging health information to support clinical practices and health services management. It then defines what "Level Seven" refers to in relation to the ISO communication model. The document also provides information on various HL7 product families, including FHIR, CDA, EHR functional model, SOA, and context management architecture. It concludes by summarizing HL7 Version 2 and Version 3 messaging standards.
This document provides an introduction and progress report on FHIR (Fast Healthcare Interoperability Resources). Key points:
- FHIR is a new, implementer-friendly standard for healthcare interoperability that has generated significant interest internationally.
- The core infrastructure is in draft form and several clinical domains are actively working on defining FHIR resources.
- FHIR can be used for RESTful exchanges, documents, messages, services, and integrating with XDS standards.
- The goal is to have more resources balloted in 2013 and release a draft standard for trial use in 2014.
HL7 & HL7 CDA: The Implementation of Thailand's Healthcare Messaging Exchange...Nawanan Theera-Ampornpunt
This document discusses the implementation of HL7 and HL7 CDA standards for healthcare messaging exchange in Thailand. It provides background on the speaker, Nawanan Theera-Ampornpunt, and outlines Thailand's vision for eHealth, current status, and the role of standards. It then describes HL7 standards including versions 2 and 3, the Reference Information Model, and Clinical Document Architecture. The document outlines Ramathibodi Hospital's experience implementing HL7 messaging and CDA documents for lab results exchange. Next steps involve encouraging broader CDA adoption.
The document provides an introduction to FHIR (Fast Healthcare Interoperability Resources). It outlines some of the limitations of previous HL7 standards like V3 being too complex and documents (CDA) not being sufficient. It notes the need for a transition path from V2 and something to address new markets. FHIR is presented as a new approach that is focused on implementers and uses resources as the basic building block. Each resource has its own model and unique ID. The goal is to make implementation easier compared to previous standards.
5 Reasons Why Healthcare Data is Unique and Difficult to MeasureHealth Catalyst
Healthcare data is not linear. It is a complex, diverse beast unlike the data of any other industry. There are five ways in particular that make healthcare data unique:
1. Much of the data is in multiple places.
2. The data is structured and unstructured.
3. It has inconsistent and variable definitions; evidence-based practice and new research is coming out every day. 4. The data is complex.
5. Changing regulatory requirements.
The answer for this unpredictability and complexity is the agility of a late-binding Data Warehouse.
This document provides information about HL7 standards and two experts, Dr. Supachai Parchariyanon and Dr. Nawanan Theera-Ampornpunt. It discusses HL7 Version 2 and Version 3 messaging standards. Version 2 is the most commonly used standard, using segments and a pipe-delimited format. Version 3 adds semantic capability using XML messages based on a Reference Information Model. The document compares the two versions and their approaches to addressing interoperability.
The document discusses HL7 and FHIR. It begins by explaining that HL7 is a standards development organization that provides a framework and standards for exchanging health information to support clinical practices and health services management. It then defines what "Level Seven" refers to in relation to the ISO communication model. The document also provides information on various HL7 product families, including FHIR, CDA, EHR functional model, SOA, and context management architecture. It concludes by summarizing HL7 Version 2 and Version 3 messaging standards.
Singapore National EHR -- Adaptive Architecture for Transformation and Innova...Peter Tan
This document summarizes the Singapore National Electronic Health Record (NEHR) system and the adaptive enterprise architecture approach used for its transformation and innovation. It provides context on Singapore's population and healthcare system. It then describes the NEHR strategy to achieve integrated, connected, adopted, and optimized healthcare through electronic health information exchange. The adaptive enterprise architecture is operationalized through collaborative governance processes and a repository to support ongoing NEHR refresh, new initiatives, and extending architecture to new business areas as needed.
FHIR for Developers tutorial as given during the HL7 WGM meetings. Good introductory text for developers getting started with FHIR, HL7's new messaging standard for healthcare.
A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
HL7 is an international standards organization that develops standards for exchanging electronic health information. It aims to allow disparate healthcare applications to exchange clinical and administrative data through interoperability standards. HL7's standards include messaging specifications that define how information is packaged and communicated between parties, as well as document and application standards. HL7 develops standards for different workflows and uses various encoding methods like XML.
This document provides an overview of HL7 standards. It begins with introducing Thailand's certified HL7 specialists and then discusses why standards are important for health information exchange. The document explains different levels of interoperability and describes various HL7 standards including HL7 v2, HL7 v3, and CDA. It highlights key differences between HL7 v2 and v3 and provides examples of HL7 message segments.
The document discusses FHIR documents and their structure. It notes that FHIR documents are bundles that contain a Composition resource along with other resources like sections, lists, observations, etc. bound together. Documents can be used when persistence of data across multiple resources is needed or when authentication of the full content is required. The document describes how FHIR documents can be communicated by posting the bundle to various FHIR endpoints like the Mailbox, Document/Bundle, or as a transaction to create/update the individual resources. It also notes documents can be posted as a Binary resource or referenced through a DocumentReference resource.
The document discusses the relationship between DICOM and FHIR standards for medical imaging data. It provides an overview of DICOM, describes how FHIR represents imaging studies, and discusses approaches to mapping between the two standards. Key challenges addressed include differences in mandatory fields and search capabilities between the standards. The presenter demonstrates connecting a DICOM archive to FHIR through QIDO-RS search endpoints.
Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
Thailand has made progress in adopting electronic health records and computerized physician order entry in hospitals. However, its overall eHealth system remains fragmented with siloed applications and a lack of integration and interoperability. National leadership and a strategic plan are still needed to better coordinate eHealth development and ensure standards and policies keep pace with technology. Future trends may include stronger health IT adoption, localized data exchange, and using insurance claims as a driver for further eHealth advancements.
This document provides an agenda and overview for an HL7 FHIR training course. The morning session will include introductions to FHIR, resources, and the RESTful model. Exercises are planned to apply the concepts. The agenda also includes an introduction to the FHIR data model and more exercises before breaking for lunch. The trainer is identified as Ewout Kramer from Furore in Amsterdam, and he has experience with FHIR and healthcare software development.
Presentation given at HL7 Norway on april 1st, 2014. Subjects are: why a new standard? what are the basic building blocks of FHIR? What are profiles? How do we make documents out of resources? Also contains some example architectures.
Personal health records (PHRs) have the potential to improve health outcomes but face challenges regarding interoperability, security, and privacy. PHRs could allow individuals to manage their own healthcare by communicating with providers and accessing health information. However, PHRs currently lack standardization and the ability to exchange information between different systems. Addressing issues such as determining security protocols, exchanging data between health information exchanges, and clarifying legal policies will help realize the full benefits of PHRs. Widespread adoption also requires resolving questions over who pays for and controls PHR data. Further research is needed to understand how to best design PHRs and incentivize their use.
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
The document provides an overview of HL7 Version 3, including its reference information model (RIM) which defines core classes like Entity, Role, Act, and their relationships. It describes the RIM's object-oriented methodology and backbone classes. The training objectives are to define HL7 terms and concepts, describe its modeling methodology, and introduce HL7 Version 3 at NCICB.
Summary: This presentation provides a concise overview of the history, operational framework, and standards of Health Level Seven (HL7). It is intended to be a guide to those seeking to engage in the HL7 standards development effort or to be consumers of HL7 products and services.
Target Audience: The primary intended audience for this presentation are individuals curious about but not yet engaged in HL7 activities or the use of HL7 standards. Those already familiar with or engaged in the use or development of HL7 standards may also find the distillation of the various aspects of HL7 useful to their work.
HL7 is an organization that develops standards to enable interoperability in healthcare. It has progressed through several stages, starting with simple messaging and expanding to include documents, services and an enterprise architecture framework. IHE builds on standards by providing implementation guides to integrate multiple standards in real-world use cases. What's hot includes CDA documents and SAEAF, while standards adoption remains a challenge.
Singapore National EHR -- Adaptive Architecture for Transformation and Innova...Peter Tan
This document summarizes the Singapore National Electronic Health Record (NEHR) system and the adaptive enterprise architecture approach used for its transformation and innovation. It provides context on Singapore's population and healthcare system. It then describes the NEHR strategy to achieve integrated, connected, adopted, and optimized healthcare through electronic health information exchange. The adaptive enterprise architecture is operationalized through collaborative governance processes and a repository to support ongoing NEHR refresh, new initiatives, and extending architecture to new business areas as needed.
FHIR for Developers tutorial as given during the HL7 WGM meetings. Good introductory text for developers getting started with FHIR, HL7's new messaging standard for healthcare.
A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
HL7 is an international standards organization that develops standards for exchanging electronic health information. It aims to allow disparate healthcare applications to exchange clinical and administrative data through interoperability standards. HL7's standards include messaging specifications that define how information is packaged and communicated between parties, as well as document and application standards. HL7 develops standards for different workflows and uses various encoding methods like XML.
This document provides an overview of HL7 standards. It begins with introducing Thailand's certified HL7 specialists and then discusses why standards are important for health information exchange. The document explains different levels of interoperability and describes various HL7 standards including HL7 v2, HL7 v3, and CDA. It highlights key differences between HL7 v2 and v3 and provides examples of HL7 message segments.
The document discusses FHIR documents and their structure. It notes that FHIR documents are bundles that contain a Composition resource along with other resources like sections, lists, observations, etc. bound together. Documents can be used when persistence of data across multiple resources is needed or when authentication of the full content is required. The document describes how FHIR documents can be communicated by posting the bundle to various FHIR endpoints like the Mailbox, Document/Bundle, or as a transaction to create/update the individual resources. It also notes documents can be posted as a Binary resource or referenced through a DocumentReference resource.
The document discusses the relationship between DICOM and FHIR standards for medical imaging data. It provides an overview of DICOM, describes how FHIR represents imaging studies, and discusses approaches to mapping between the two standards. Key challenges addressed include differences in mandatory fields and search capabilities between the standards. The presenter demonstrates connecting a DICOM archive to FHIR through QIDO-RS search endpoints.
Theera-Ampornpunt N. HL7 Clinical Document Architecture: overview and applications. Presented at: HL7 CDA Workshop at the Faculty of Medicine Ramathibodi Hospital; 2013 Jun 20-21; Bangkok, Thailand. Invited speaker, in Thai.
Thailand has made progress in adopting electronic health records and computerized physician order entry in hospitals. However, its overall eHealth system remains fragmented with siloed applications and a lack of integration and interoperability. National leadership and a strategic plan are still needed to better coordinate eHealth development and ensure standards and policies keep pace with technology. Future trends may include stronger health IT adoption, localized data exchange, and using insurance claims as a driver for further eHealth advancements.
This document provides an agenda and overview for an HL7 FHIR training course. The morning session will include introductions to FHIR, resources, and the RESTful model. Exercises are planned to apply the concepts. The agenda also includes an introduction to the FHIR data model and more exercises before breaking for lunch. The trainer is identified as Ewout Kramer from Furore in Amsterdam, and he has experience with FHIR and healthcare software development.
Presentation given at HL7 Norway on april 1st, 2014. Subjects are: why a new standard? what are the basic building blocks of FHIR? What are profiles? How do we make documents out of resources? Also contains some example architectures.
Personal health records (PHRs) have the potential to improve health outcomes but face challenges regarding interoperability, security, and privacy. PHRs could allow individuals to manage their own healthcare by communicating with providers and accessing health information. However, PHRs currently lack standardization and the ability to exchange information between different systems. Addressing issues such as determining security protocols, exchanging data between health information exchanges, and clarifying legal policies will help realize the full benefits of PHRs. Widespread adoption also requires resolving questions over who pays for and controls PHR data. Further research is needed to understand how to best design PHRs and incentivize their use.
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
The document provides an overview of HL7 Version 3, including its reference information model (RIM) which defines core classes like Entity, Role, Act, and their relationships. It describes the RIM's object-oriented methodology and backbone classes. The training objectives are to define HL7 terms and concepts, describe its modeling methodology, and introduce HL7 Version 3 at NCICB.
Summary: This presentation provides a concise overview of the history, operational framework, and standards of Health Level Seven (HL7). It is intended to be a guide to those seeking to engage in the HL7 standards development effort or to be consumers of HL7 products and services.
Target Audience: The primary intended audience for this presentation are individuals curious about but not yet engaged in HL7 activities or the use of HL7 standards. Those already familiar with or engaged in the use or development of HL7 standards may also find the distillation of the various aspects of HL7 useful to their work.
HL7 is an organization that develops standards to enable interoperability in healthcare. It has progressed through several stages, starting with simple messaging and expanding to include documents, services and an enterprise architecture framework. IHE builds on standards by providing implementation guides to integrate multiple standards in real-world use cases. What's hot includes CDA documents and SAEAF, while standards adoption remains a challenge.
This document discusses health information exchange standards compliance testing via integration testing. It introduces New Zealand's approach of using an Integration Test Platform (ITP) and certification process to test standards compliance for clinical document architecture (CDA) documents. The ITP provides validation, sample instances, and test results for applications. Initial focus is on interoperability standards and providing a plug-and-play environment. Feedback on the integration as a service approach and ITP has been positive from stakeholders. The overall goals are to progress standards adoption and enable objective criteria for purchasing decisions.
Cda generation and integration for health information exchange based on cloud...ieeepondy
Cda generation and integration for health information exchange based on cloud computing system
+91-9994232214,7806844441, ieeeprojectchennai@gmail.com,
www.projectsieee.com, www.ieee-projects-chennai.com
IEEE PROJECTS 2016-2017
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Delivered by Craig Brammer at CITIH 2011. Focus on discussion of regional and national initiatives and opportunities for regional partners to leverage them for driving healthcare improvements, public health and research.
This session will provide a broad perspective on the many initiatives related to HIT. Experts from the regional and national level will discuss data models, privacy concerns and adoption strategies from their different perspectives. Also addressed will be planning for NHIN direct adoption as a complimentary strategic to full HIEs.
The document discusses public policy initiatives related to health information exchange in Georgia. It outlines federal programs like the HITECH Act that provide funding for health IT and meaningful use. It then describes several Georgia-specific projects and organizations working on health information exchange, including the Georgia Cancer Coalition, Central Georgia Health Exchange, Georgia Association for Primary Health Care, and Georgia Partnership for TeleHealth. It positions Atlanta and Georgia as leaders in the national health IT field.
The document summarizes a public art project called "City of Lives" that took place in Cape Town, South Africa. 100 graphic design students created temporary art installations along a walking route called the City Walk over two weeks. The goal was to surface stories of urban residents and create connections between community members through lighter, quicker, cheaper art interventions. The project culminated with each student designing their own personal artwork to showcase the variety and innovation of their designs. Overall, the project aimed to recognize city streets as places filled with interesting people and stories.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Joseph H. Schneider, MD, MBA, FAAP, Vice President and Chief Medical Information Officer and Medical Director, Clinical Informatics, North Texas, Baylor Scott and White Health at the marcus evans National Healthcare CMO/CMIO Summit 2015 at the Ritz-Carlton Buckhead Atlanta.
The document discusses key factors for successful health information exchange (HIE), including stakeholder engagement, appropriate governance models, clearly defined purpose and vision translated into a mission statement, starting small by exchanging a limited scope of information, and adopting interoperability standards. It also emphasizes the importance of audit and security, privacy protections like opt-out consent models, and leveraging existing infrastructure.
The document discusses creating a roadmap for eHealth in Thailand. It begins with an introduction to health and health information, as well as health IT and eHealth. It then covers health informatics as a discipline and Thailand's current eHealth situation. Thailand's eHealth is currently fragmented with siloed systems and little integration. There is also a lack of national leadership and governance. The document aims to help shape Thailand's eHealth future.
This presentation provides a brief description of the history behind the formation of the Indiana Health Information Exchange as well as a quick summary of the services offered. This presentation is given frequently to groups interested in learning more about IHIE and is updated often.
Meaningful Use Stage 2 and Health Information Exchange (HIE)MassEHealth
Transformational intent of Meaningful Use (MU) and the increased trend toward interoperability in MU Stage 2 (MU2); MU2 objectives with an HIE component and their MU2 measures; Approaches to achieving the transitions of care; Available public health registries and their current status and submission pathway; How to find a trading partner and best practices to engaging
A profit maximization scheme with guaranteednexgentech15
Nexgen Technology Address:
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Email Id: praveen@nexgenproject.com.
www.nexgenproject.com
Mobile: 9751442511,9791938249
Telephone: 0413-2211159.
NEXGEN TECHNOLOGY as an efficient Software Training Center located at Pondicherry with IT Training on IEEE Projects in Android,IEEE IT B.Tech Student Projects, Android Projects Training with Placements Pondicherry, IEEE projects in pondicherry, final IEEE Projects in Pondicherry , MCA, BTech, BCA Projects in Pondicherry, Bulk IEEE PROJECTS IN Pondicherry.So far we have reached almost all engineering colleges located in Pondicherry and around 90km
This ppt is prepared for zeroth level presentation for the B - TECH project on the topic "Design and Implementation of Improved Authentication System for Android Smartphone Users". we also add the application of the upgraded locking system in lost phone detection procedure
Generation of cda xml schema from dicom images using hl7 standard 2IAEME Publication
This document discusses generating CDA/XML schemas from DICOM images using the HL7 standard. It describes how HL7 CDA can be used to interface DICOM and HL7 formats. The process involves extracting data from DICOM images stored in a PACS archive, generating CDA-XML documents from the extracted data, and transmitting patient information summaries using HL7 messages. The research aims to improve interoperability between medical software applications and enable sharing of patient data.
This document proposes standards and solutions for healthcare data exchange and interoperability. It discusses the goals of electronically exchanging health information while maintaining meaning. Standards discussed include HL7, RBAC, ABAC, PBAC, and XACML for access control policies. Implementing attribute-based access control is proposed to allow flexible, multi-factor access decisions. Integrating the Healthcare Enterprise (IHE) and Oracle Entitlement Server are presented as initiatives supporting interoperability and fine-grained authorization.
Conditional identity based broadcast proxy re-encryption and its application ...ieeepondy
This paper proposes a new cryptographic primitive called conditional identity-based broadcast proxy re-encryption (CIBPRE) that allows a sender to encrypt a message for multiple receivers using their identities. The sender can then delegate a re-encryption key to a proxy to convert the ciphertext into a new one for a different set of receivers, conditioned on a certain attribute. An efficient CIBPRE scheme is presented with constant-sized ciphertexts and keys. Finally, the paper discusses how CIBPRE can be applied to build a secure cloud email system.
The document discusses techniques for detecting duplicate web pages. It introduces the problem of finding similar pages, or near duplicates, among the billions of pages on the web. It describes algorithms like minhashing and shingling that represent documents as sketches to efficiently estimate similarity and find near duplicate pairs without comparing all possible pairs. The techniques were evaluated on a dataset of 1.6 billion web pages, and precision results are reported, with minhashing showing potential to effectively detect duplicate and near duplicate web content at scale.
This document summarizes Thailand's journey toward national electronic health (eHealth) and discusses the current state and future directions. Currently, Thailand lacks national eHealth leadership and governance. While hospital adoption of basic EHR is high, systems are siloed with little integration. Standards development is emerging but incomplete. Opportunities now exist to address these gaps through new supportive government leadership, workforce development, and recognition of the need for data integration and standards to reduce burden on clinicians. Overall progress has been made but continued work is needed to advance Thailand's eHealth system and realize the benefits of health information exchange.
This document discusses eHealth in Thailand and the road ahead. It summarizes that eHealth adoption in Thailand is high but siloed, with a lack of integration and interoperability. Standards development is underway but incomplete. The road ahead involves addressing gaps in national leadership, workforce shortages, accelerating standards development, integrating applications, and growing local informatics research. Overall eHealth can be a key component of Thailand's healthcare system if these challenges are addressed.
The document provides an overview of the application of information and communication technologies (ICT) in clinical health settings. It discusses how health information is integral to healthcare and how ICT can help address issues like medical errors by improving access to patient data and care coordination. The speaker has experience implementing health IT systems and is a lecturer on health informatics. They will cover topics like the role of ICT in healthcare delivery and management, health informatics as a field of study, Thailand's national eHealth initiatives, and current trends shaping the use of technology in medicine.
Health Information Technology & Nursing InformaticsJil Wright
This document discusses health information technology and nursing informatics. It begins with an introduction by Jil Wright who identifies herself as a nursing informatics "geek". The document then provides resources for more information on health IT and nursing informatics. It discusses how nursing informatics integrates nursing science, computer science, and information science to support patients, nurses, and healthcare providers. Examples of clinical information systems and technologies that can help transform nursing practice are also provided, such as electronic medical records, wireless systems, and RFID technologies. Meaningful use requirements and examples of how health IT can improve documentation and the nursing process are summarized as well.
The document discusses the application of information and communications technology (ICT) for clinical care improvement. It outlines how healthcare is error-prone due to human fallibility, and how health information technology (IT) such as computerized provider order entry (CPOE) and clinical decision support systems can help reduce errors. The document also explains why access to complete and accurate patient information through electronic health records improves care delivery and coordination across different healthcare providers and settings.
The document provides an overview of health information technology (IT) and its application for clinical care improvement in Thailand. It discusses why healthcare is complex and error-prone, and how health IT such as electronic health records, computerized provider order entry, and clinical decision support systems can help address issues like medical errors, fragmented care, and inefficient processes. The document then summarizes Thailand's current eHealth situation, noting siloed systems, little integration and interoperability, and a lack of national leadership in eHealth. Survey results show adoption of basic electronic health records in around 50% of hospitals, but more limited adoption of comprehensive EHR systems.
What you need to know about Meaningful Use 2 & interoperabilityCompliancy Group
Does this describe you?
·You are constantly challenged to stay abreast of the latest information on EHR integration and HIE interoperability, Meaningful Use stages, the Direct Project, clinician and patient portals, just to name a few.
·You walk a fine line between adopting health information technology for the good it can bring patient outcomes…….and for the good incentive dollars it can mean to your organization.
·You play a key role in ensuring your organization can attest for meaningful use.
Join Andy Nieto, Health IT Strategist at DataMotion where he’ll explain the key role that interoperability plays in Meaningful Use Stage 2 attestation including:
- What does interoperability really mean
- Why you can’t ignore interoperability
- How to achieve interoperability and make it meaningful
- What you need in order to attest
The document provides an overview of health information technology (IT) and its application for clinical care improvement in Thailand. It discusses how healthcare is error-prone and fragmented, and how health IT can help by improving access to patient information, guidelines, and coordination across settings. The document then summarizes Thailand's current eHealth situation, noting siloed systems, little integration and interoperability, and a lack of national leadership. Surveys found basic electronic health records adopted in around half of Thai hospitals, with higher adoption of computerized medication ordering.
The document discusses the role and direction of mobile health (mHealth) in disease prevention and treatment. It provides an overview of mHealth concepts and adoption, and outlines a research agenda for mHealth and eHealth in areas such as leadership and governance, infrastructure, standards and interoperability, workforce development, and applications. Key issues discussed include the need for evaluation of mHealth implementations and national strategies to guide further development and implementation of eHealth initiatives in Thailand.
This document discusses the application of information and communications technology (ICT) for health in clinical settings. It begins with an outline that covers health and health information, health IT and eHealth, health informatics as a discipline, Thailand's eHealth situation, and current forces impacting eHealth. The document then goes into more detail on each of these topics, providing background information on concepts like electronic health records, telemedicine, mobile health, and health information exchange. It also summarizes Thailand's progress toward eHealth to date and some of the challenges it still faces in areas like interoperability and national leadership.
This document discusses a presentation about ICT applications for healthcare given by Dr. Nawanan Theera-Ampornpunt. It provides background on her education and experience in health informatics. The presentation covers why healthcare needs ICT due to issues like errors, fragmentation, and large amounts of information. It defines key terms like health IT, eHealth, and examples of ICT applications like EHRs, telemedicine, and clinical decision support systems. It discusses the need for standards, interoperability, and a vision for connected healthcare information exchange.
The document discusses using future technology with executives in the era of Industry 4.0. It describes a lecture on medical governance certification for senior executives. The speaker has a PhD in health informatics and is an assistant dean and community medicine professor. He discusses why healthcare is not yet "smart" like manufacturing due to its complex and varied nature. Health IT can help improve quality by supporting clinical decisions, documenting care, and reducing errors through alerts. However, technology also poses risks like alert fatigue if not implemented carefully with a focus on users and processes.
eHealth Practice in Europe: where do we stand?chronaki
eHealth as the use of Information and communication technologies in the practice of health care comprises Electronic health records, Healthcare information exchange cross-jurisdictions, Personal health records, Telehealth, telemedicine and remote monitoring.
There are several efforts to reflect and measure the practice of eHealth including efforts by the OECD and WHO, but in general there is little reported sharing of health data particularly with patients. Specific barriers frequently mentioned are supporting policies and coherent widely implemented standards.
The presentation discusses relevant efforts and programs supported by the European Commission such as the eHealth DSI, eStandards, ASSESS CT, and openMedicine aiming at large scale eHealth adoption It calls for engagement of European Society, its national societies, and its members.
This document provides an overview of hospital IT management from Nawanan Theera-Ampornpunt. It begins with an introduction of the author's background and credentials. The presentation outline is then shown, covering why health IT is needed in hospitals, what forms it takes, and how it should be managed. Key points include the importance of information in healthcare, the risks of medical errors, the value of clinical decision support, and the need to balance technology, people and processes. The presentation emphasizes linking IT to quality improvement rather than seeing it as an end in itself, and ensuring IT aligns with and enhances the overall organizational context.
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Babithas Notes on unit-4 Health/Nursing Informatics TechnologyBabitha Devu
The document discusses electronic health records (EHR) and shared care in India. It defines EHR and outlines benefits like reducing paperwork, allowing rapid information sharing, and making data accessible to researchers. Challenges of EHR include logistical issues in sharing unsolicited healthcare information, physical storage of data, privacy concerns, and ensuring systems are accessible to patients and clinicians. The document also discusses guidelines for using hardware, networking, connectivity, and mobile health records to properly manage EHRs while respecting data ownership, disclosure, patient privilege, and privacy.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
The document discusses IT and decision support systems in hospital supply chains. It provides an overview of clinical decision making and clinical decision support systems (CDS), including definitions, types of CDS like alerts and reminders, expert systems, and references. It also discusses the roles of information technology in clinical decision making processes and how CDS can help reduce human errors.
Similar to HL7 & Health Information Exchange in Thailand (20)
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Telemedicine provides healthcare at a distance using telecommunications technology. It has grown from focusing on increasing access to now emphasizing convenience and cost reduction. Store-and-forward and home-based telemedicine have evidence for treating chronic diseases, while office/hospital telemedicine is effective for verbal interactions in specialties like neurology and psychiatry. Current trends include expanding telemedicine to more chronic conditions and migrating services from clinical settings to homes and mobile devices. However, reimbursement remains limited and fragmented while quality of remote care compared to in-person visits requires more evidence. Proper guidelines, standards, training and balancing innovation with risk-based regulation can maximize telemedicine's benefits while minimizing harms.
This document discusses digital health transformation and the role of health information technology. It begins by exploring concepts like artificial intelligence, blockchain, cloud computing and big data. It then examines the potential for "smart" machines in healthcare while acknowledging the complexities of digitizing such a system. The document emphasizes that clinical judgment is still necessary given variations in patients. It outlines components of healthcare systems and forms of health IT both within and beyond hospitals. Finally, it discusses using health IT to support clinical decision making and reduce errors.
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
The document discusses the field of health informatics and provides definitions and examples. It defines health informatics as the application of information science to healthcare and biomedical research. It describes the relationships between health informatics and other fields like computer science, engineering, and the medical sciences. The document also discusses different areas of health informatics like clinical informatics, public health informatics, and consumer health informatics. It provides examples of common health information technologies used in healthcare settings like electronic health records, computerized physician order entry, and picture archiving systems.
This document provides an introduction to research ethics and ethics for health informaticians. It begins with definitions of ethics, morals, and norms. It then discusses the role of law, professional codes of conduct, and ethics in establishing standards of acceptable behavior. Key topics in research ethics are introduced through discussions of historic cases like the Nazi human experiments, Beecher's research ethics violations, and the Tuskegee Syphilis Study. The document outlines the Belmont Report's three ethical principles of respect for persons, beneficence, and justice. Ethical issues in health informatics like alerts fatigue from clinical decision support systems and unintended consequences of health IT are also discussed.
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
1. HL7 & Health Information Exchange
in Thailand
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University, Thailand
June 24, 2014
www.SlideShare.net/Nawanan
2. 2
A Bit About Myself...
2003 M.D. (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
2012 Certified HL7 CDA Specialist
• Lecturer, Department of Community Medicine
• Deputy Executive Director for Informatics
(CIO/CMIO), Chakri Naruebodindra Medical Institute
Faculty of Medicine Ramathibodi Hospital
nawanan.the@mahidol.ac.th
http://groups.google.com/group/ThaiHealthIT
Research interests:
• EHRs & health IT applications in clinical settings
• Health IT adoption & eHealth development
• Health informatics education & workforce development
3. 3
Outline
• Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situation
• Standards & interoperability
• HL7 standards
• The road ahead for Thailand's eHealth
6. 6
Needs for Better Information
• Good information needed for quality care
– Past and present history
– Medication list
– Problem list
– Allergies
– Lab & imaging results
• Information gaps prevalent in healthcare
settings (e.g. Stiell A et al. CMAJ. 2003;169:1023-8.)
8. 8
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematically contributes to
medical errors and poor quality
• Recommends reform
• Health IT plays a role in improving patient
safety
IOM Reports Summary
9. 9
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
11. 11
To treat & to
care for their
patients to their
best abilities,
given limited
time &
resources
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
What Clinicians Want?
12. 12
The Question Becomes...
How do we deliver better
information, by supplementing
human clinicians with ICT, so that
they make less errors and
perform better?
13. 13
Outline
Needs for better information in healthcare
• eHealth as a health system's component
• Thailand's eHealth situation
• Standards & interoperability
• HL7 standards
• The road ahead for Thailand's eHealth
17. 17
Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
• Educating the health workforce
• Tracking diseases
• Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)
2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin
eHealth
18. 18
All components are essential
All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth Components: WHO-ITU Model
19. 19
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
20. 20
Outline
Needs for better information in healthcare
eHealth as a health system's component
• Thailand's eHealth situation
• Standards & interoperability
• HL7 standards
• The road ahead for Thailand's eHealth
22. 22
eHealth in Thailand: The current status. Stud Health Technol Inform
2010;160:376–80, Presented at MedInfo2010 South Africa
Thailand’s eHealth: 2010
23. 23
All components are essential
All components should be balanced
Slide adapted from: Dr. Boonchai Kijsanayotin
Recalling eHealth Components
25. 25
Silo-type systems
Little integration and interoperability
Mostly aim for administration and management
40% of work-hours spent on managing reports and
documents
Lack of national leadership and governance body
Inadequate HIS foundations development
Boonchai Kijsanayotin et al. (2010)
Thailand’s eHealth Situation
27. 27
Nationwide survey on hospital IT
adoption conducted in 2011
THAIS: Thai Hospitals’ Adoption
of Information Technology
Survey
Self-administered paper-based
survey mailed to 1,298 hospitals
in Thailand
Thailand’s Hospital IT Adoption
30. 30
Estimate (Partial or Complete
Adoption)
Nationwide
Basic EHR, outpatient 86.6%
Basic EHR, inpatient 50.4%
Basic EHR, both settings 49.8%
Order entry of medications,
outpatient
96.5%
Order entry of medications, inpatient 91.4%
Order entry of medications, both
settings
90.2%
Hospital IT Adoption Estimates
31. 31
• High IT adoption rates
• Drastic changes in adoption landscape
• Adequate infrastructure for information
exchange
• Next question is on interoperability
THAIS: Discussion
33. 33
Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situation
• Standards & interoperability
• HL7 standards
• The road ahead for Thailand's eHealth
35. 35
Standards: Why?
• The Large N Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950
36. 36
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Goal: Health Information Exchange
39. 39
Various Kinds of Standards
• Unique Identifiers
• Standard Data Sets
• Vocabularies & Terminologies
• Exchange Standards
– Message Exchange
– Document Exchange
• Functional Standards
• Technical Standards
– Data Communications, Encryption, Security
40. 40
Functional
Semantic
Syntactic
How Standards Support Interoperability
Technical Standards
(TCP/IP, encryption,
security)
Exchange Standards (HL7 v.2,
HL7 v.3 Messaging, HL7 CDA,
DICOM)
Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 v.3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID
41. 41
Message Exchange
• Goal: Specify format
for exchange of data
• Internal vs. external
messages
• Examples
HL7 v.2
HL7 v.3 Messaging
DICOM
NCPDP
Document Exchange
• Goal: Specify format
for exchange of
“documents”
• Examples
HL7 v.3 Clinical Document
Architecture (CDA)
ASTM Continuity of Care
Record (CCR)
HL7 Continuity of Care
Document (CCD)
Exchange Standards
42. 42
Messages
• Human Unreadable
• Machine Processable
Clinical Documents
• Human Readable
• (Ideally) Machine
Processable
Exchange Standards
43. 43
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message Exchange
Message
Message
Message
Message
Message
44. 44
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Clinical Document Exchange
Message containing
Referral Letter
Message containing
Claims Request
Message containing
Lab Report
Message containing
Patient Visit Summary
Message containing
Communicable
Disease Report
45. 45
Standards National
1. Core data set standards 12 & 18 files standards
2. Semantic standards Personal ID,
Provider ID
ICD-10-TM, ICD-9-CM
3. Syntactic standards X
4. Security and privacy standards X
Slide adapted from: Dr. Boonchai Kijsanayotin
Existing Standards in Thailand
46. 46
Standards National
1. Core data set standards Referral, Chronic Diseases
2. Semantic standards
Drug Terminology (TMT),
SNOMED-CT
Lab Code (LOINC)
Providers IDs
3. Syntactic standards HL7 Messaging, CDA
4. Security and privacy
standards
X
Standards Being Explored/Developed
Slide adapted from: Dr. Boonchai Kijsanayotin
47. 47
Thai Health Information Standards
Development Center
www.this.or.th
http://www.facebook.com/thishsri
this@this.or.th
Standards Development Organization
Slide adapted from: Dr. Boonchai Kijsanayotin
49. 49
• HL7 Certified Specialists
Kevin
Asavanant
HL7 V3 RIM (2009)
Supachai
Parchariyanon
HL7 CDA (2010)
Nawanan
Theera-Ampornpunt
HL7 CDA (2012)
49
Sireerat
Srisiriratanakul
HL7 V3 RIM (2013)
Capacity Building on Standards
50. 50
URGES Member States:
(1) to consider, as appropriate, options to collaborate with
relevant stakeholders, including national authorities, relevant
ministries, health care providers, and academic institutions, in
order to draw up a road map for implementation of ehealth and
health data standards at national and subnational levels;
(2) to consider developing, as appropriate, policies and
legislative mechanisms linked to an overall national eHealth
strategy, in order to ensure compliance in the adoption of ehealth
and health data standards by the public and private sectors, as
appropriate, and the donor community, as well as to ensure the
privacy of personal clinical data;
... http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf
World Health Assembly Resolution WHA66.24 (2013) on
eHealth Standardization & Interoperability
51. 51
Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situation
Standards & interoperability
• HL7 standards
• The road ahead for Thailand's eHealth
52. What is HL7?
• HL7 is an ANSI-accredited Standards
Development Organization (SDO)
operating in the healthcare arena.
• It is a non-profit organization made up of
volunteers – providers, customers,
vendors, government, etc.
52
Slide adapted from: Dr. Supachai Parchariyanon
53. What is HL7? (Cont.)
• HL7 is an acronym for Health Level Seven
– Seven represents the highest, or “application”
level of the International Standards
Organization (ISO) communications model for
Open Systems Interconnection (OSI) networks.
53
Slide adapted from: Dr. Supachai Parchariyanon
55. 55
HL7 Standards
• HL7 V2.x
– Defines electronic messages supporting hospital
operations
• HL7 V3
• HL7 Clinical Document Architecture
(CDA) Releases 1 and 2
• HL7 Arden Syntax
– Representation of medical knowledge
• HL7 EHR & PHR Functional Specifications
• Etc.
56. 56
HL7 V3 Standards
• A family of standards based on V3
information models and development
methodology
• Components
– HL7 V3 Reference Information Model (RIM)
– HL7 V3 Messaging
– HL7 Development Framework (HDF)
60. 60
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
61. 61
HL7 V3 Messaging
• V3 provides messaging standards for
– Patient administration
– Medical records
– Orders
– Laboratory
– Claims & Reimbursement
– Care provision
– Clinical genomics
– Public Health
– Etc.
62. 62
What Is HL7 CDA?
• “A document markup standard that
specifies structure & semantics of “clinical
documents” for the purpose of exchange”
[Source: HL7 CDA Release 2]
• Focuses on document exchange, not
message exchange
• A document is packaged in a message
during exchange
• Note: CDA is not designed for document
storage. Only for exchange!!
63. 63
A Clinical Document (1)
• A documentation of clinical observations
and services, with the following
characteristics:
Persistence - continues to exist in an
unaltered state, for a time period defined by
local and regulatory requirements
Stewardship - maintained by an organization
entrusted with its care
Potential for authentication - an assemblage
of information that is intended to be legally
authenticated Source: HL7 CDA R2
64. 64
A Clinical Document (2)
• A documentation of clinical observations
and services, with the following
characteristics:
Context - establishes the default context for its
contents; can exist in non-messaging contexts
Wholeness - Authentication of a clinical
document applies to the whole and does not
apply to portions of the document without full
context of the document
Human readability - human readable
Source: HL7 CDA R2
65. 65
A Clinical Document (3)
• A CDA document is a defined & complete
information object that can include
Text
Images
Sounds
Other multimedia content
Source: HL7 CDA R2
66. 66
CDA Releases
• CDA Release 1 (ANSI-approved in 2000)
– First specification derived from HL7 RIM
• CDA Release 2 (2005) - Current Release
– Basic model essentially unchanged from R1
• Document has a header & a body
• Body contains nested sections
• Sections can be coded using standard vocabularies and can
contain entries
– Derived from HL7 RIM Version 2.07
Source: HL7 CDA R2
67. 67
Key Aspects of CDA
• CDA documents are encoded in XML
When alternative implementations are feasible,
new conformance requirements will be issued
• CDA documents derive their machine
processable meaning from HL7 RIM and
use HL7 V3 Data Types
• CDA specification is richly expressive &
flexible
Templates can be used to constrain generic
CDA specifications
Source: HL7 CDA R2
68. 68
Scope of CDA
Lab Technician Physician
Lab Report
Create
document
Process &
Store
document
Transmit
document
CDA
69. 69
CDA & HL7 Messages
• Documents complement HL7 messaging
specifications
• Documents are defined and complete information
objects that can exist outside of a messaging
context
• A document can be a MIME-encoded payload
within an HL7 message
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
70. 70
CDA & Message Exchange
• CDA can be payload (or content) in any kind of
message
– HL7 V2.x message
– HL7 V3 message
– EDI ANSI X12 message
– IHE Cross-Enterprise Document Sharing (XDS)
message
• And it can be passed from one kind to
another
Source: “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
71. 71
CDA & Message Exchange
Clinical Document
(Payload)
HL7 V3 Message
(Message)
HL7 V2 Message
(Message)
Source: Adapted from “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
72. 72
CDA As Payload
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
73. 73
CDA Model
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
74. 74
A Closer Look at a CDA Document
<ClinicalDocument> ... CDA Header ...
<structuredBody> <section> <text>... Single
Narrative Block ...</text>
<observation>...</observation>
<substanceAdministration>
<supply>...</supply>
</substanceAdministration> <observation>
<externalObservation>...
</externalObservation> </observation>
</section> <section> <section>...</section>
</section> </structuredBody>
</ClinicalDocument>
Source: HL7 CDA R2
Human Readable Part
Machine Processable Parts
75. 75
Rendering CDA Documents (1)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
76. 76
Rendering CDA Documents (2)
Source: From “What is CDA R2? by Calvin E. Beebe
at HL7 Educational Summit in July 2012
77. 77
Human Readability &
Rendering CDA Documents (3)
Source: HL7 CDA R2
<ClinicalDocument> ... CDA Header ...
<structuredBody> <section> <text>... Single
Narrative Block ...</text>
<observation>...</observation>
<substanceAdministration>
<supply>...</supply>
</substanceAdministration> <observation>
<externalObservation>...
</externalObservation> </observation>
</section> <section> <section>...</section>
</section> </structuredBody>
</ClinicalDocument>
Text to be rendered
78. 78
Some Possible Use Cases of CDA
Intra-institutional
Exchange of parts of medical records (scanned or
structured electronic health records)
Lab/Imaging requests & reports
Prescriptions/order forms
Admission notes
Progress notes
Operative notes
Discharge summaries
Payment receipts
Other forms/documents (clinical or administrative)
79. 79
Some Possible Use Cases of CDA
Inter-institutional
Referral letters
Claims requests or reimbursement documents
External lab/imaging reports
Visit summary documents
Insurance eligibility & coverage documents
Identification documents
Disease reporting
Other administrative reports
80. 80
Achieving Interoperability
CDA is a general-purpose, broad standard
Use in each use case or context requires
implementation guides to constrain CDA
Examples
Operative Note (OP)
Consultation Notes (CON)
Care Record Summary (CRS)
Continuity of Care Document (CCD)
CDA for Public Health Case Reports (PHCRPT)
Quality Reporting Document Architecture (QRDA)
81. 81
Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situation
Standards & interoperability
HL7 standards
• The road ahead for Thailand's eHealth
85. 85
Faculty of Medicine Ramathibodi Hospital, Mahidol University
http://med.mahidol.ac.th/has/85
Healthcare CIO Certificate Program
86. 86Faculty of Tropical Medicine, Mahidol University86
Diploma & Master Graduates in Biomedical &
Health Informatics, First Batch
87. 87
• In January 2013, the Thai Medical
Informatics Association (TMI) approved
establishment of the “Biomedical and
Health Informatics Education Special
Interest Group” within TMI (BHI-ED-SIG)
87
Informatics Education SIG
89. 89
• International Medical Informatics
Association (IMIA)
– MEDINFO & APAMI
• HIMSS AsiaPac
• Asia eHealth Information Network (AeHIN)
• American Medical Informatics Association
(AMIA)
89
Internationalization
91. 91
Outline
Needs for better information in healthcare
eHealth as a health system's component
Thailand's eHealth situation
Standards & interoperability
HL7 standards
• The road ahead for Thailand's eHealth
93. 93
• Addressing
– Lack of national leadership & governance,
strategy & investment, policy & regulation
– Shortage of informatics workforce
– Accelerating standards development
– Harmonizing applications
– Facilitating local research in informatics
93
The Road Ahead