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HL7 Lecture for Kent State University
- 1. Presentation ContentsPresentation Contents •Presenter biography •US healthcare at Glance •What is HL7 •What is an SDO •3 SDOs important to Healthcare •How standards are developed •Types of HIT Standards •Impact of Standards on Healthcare •Absence of HIT Standards in healthcare 08/10/15 1
- 2. Presenter: John GachagoPresenter: John Gachago • BSBA, MS, HITPRO-IM, DHA(eHealth) '15 • E/M-health consultant. • HL7 Ambassador Africa, ACHE, mHealth Alliance, IHE Member, OSEHRA • Passion: Leverage my business, clinical and technology experience in the US Healthcare system to transform the delivery of healthcare in Low to Medium Income Countries (LMICs). • Country Experience; US, Kenya, Rwanda, Haiti, Ghana 08/10/15 2
- 3. US Healthcare at a GlanceUS Healthcare at a Glance • Institute of Medicine (IOM) report of 2000 “To Err Is Human” estimated that 44,000-98,000 lives are lost every year due to medical errors in US hospitals . • In 2014 congressional testimony suggests that the IOM may have actually got it wrong because it underestimated the human suffering from preventable medical errors i.e. the 10,000 serious complications from the medical errors daily (Erin McCann, 2014). • US healthcare spending 17% of GDP ($2.5 Trillion) and growing to 19% by 2017. • Deaths from avoidable medical errors are the equivalent of two 747 crashing and therefore every two months, 9-11 is replayed again in the USA. • By 2011 U.S. health care data alone stood at 150 Exabytes. • By 2015, it is expected that the average US healthcare organization (HCO) will produce over 665 terabytes of data which =697,303,040 megabytes (Willis,2014). • Kaiser Permanente, maintains approximately 26.5 petabytes and 44 petabytes of patient data from electronic health record (EHR) data = the same amount of information in 4,400 Libraries of Congress. 08/10/15 3
- 4. What is HL7 ?What is HL7 ?
- 5. Standards DevelopmentStandards Development OrganizationsOrganizations 5 Photo by Andrew Cudzilo 08/10/15
- 6. Three SDOs Important toThree SDOs Important to HealthcareHealthcare SDO Standard Healthcare Application The DICOM Standards Committee DICOM - Digital Imaging and Communications in Medicine Standards for communication of biomedical diagnostic and therapeutic information using digital images IHTSDO : International Health Terminology Standards Development Organization . SNOMED - Systemized Nomenclature of Medicine Clinical Terms (SNOMED-CT) A comprehensive, multi- axial, controlled terminology created for the indexing of the entire medical record. ISO TC 215 : (ISO Technical Committee on Health Informatics) LOINC - Logical Observations Identifiers Names and Codes. Laboratory results and clinical observations, e.g., vital signs, outcomes management, and research. 08/10/15 6
- 7. How Standards areHow Standards are DevelopedDeveloped • Consensus • Industrywide acceptance. • Voluntary involvement by stakeholders. 08/10/15 7
- 8. Primary Types of HITPrimary Types of HIT StandardsStandards • Data Standards • Information Content Standards • Information Exchange Standards • Identifiers Standards • Privacy and Security Standards • Functional Standards • Other Standards 808/10/15
- 9. Impact of Standards onImpact of Standards on HealthcareHealthcare 908/10/15
- 10. In the Absence of HITIn the Absence of HIT StandardsStandards 08/10/15 10
- 11. John Ritter IntroductionJohn Ritter Introduction • HL7 EHR Work Group co-chair; PHR Work Group co- facilitator; EHR System Usability Work Group co- facilitator • HL7 International Mentoring Committee co-chair • ISO TC/215 U.S. Technical Advisory Group member • Western Pennsylvania HIMSS Board of Director member 08/10/15 11
Editor's Notes
- The Institute of Medicine (IOM) report To Err Is Human estimated that 44,000-98,000 lives are lost every year due to medical errors in hospitals and led to the widespread recognition that health care is not safe enough, initiating a revolution to improve the quality of care (Committee on Quality of Health Care in America, 2000). However 15 years later evidence form recent congressional testimony suggests that the IOM may have actually got it wrong especially because it underestimated the human suffering that occurs as result of preventable medical errors as such as the 10,000 serious complications cases resulting from the medical errors daily (Erin McCann, 2014). When put in perspective the deaths from avoidable medical errors are the equivalent of two 747 crashing and therefore every two months, 9-11 is replayed again in the USA. The question is how we tolerate it in healthcare but not in the twin towers (Erin McCann, 2014). US healthcare spending approximating 17% of GDP ($2.5 Trillion) and growing to an anticipated 19% by 2017 has lead the 21st Century US healthcare system to invest in various sensors, communication technologies and communication technologies . By 2011 U.S. health care data alone stood at 150 exabytes. Five exabytes is equivalent to the amount of data that would contain all the words spoken by all human beings on earth. It is expected that at this rate US healthcare will soon attain the equivalent of a zettabyte (1021 gigabytes) and quite possibly grew to yottabytes (1024 gigabytes) not long after. By 2015, it is expected that the average US healthcare organization (HCO) will produce over 665 terabytes of data which is equal to 697,303,040 megabytes (Willis,2014). Kaiser Permanente, the California-based HCO with approximately 9 million members, maintains approximately 26.5 petabytes and 44 petabytes of patient data under management primarily from electronic health record (EHR) data. This data includes images and annotations and in total is equivalent to the same amount of information in 4,400 Libraries of Congress.
- Health Level Seven International is one of several American National Standards Institute (ANSI) -accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. HL7 Develops and maintains standards for the exchange, management, and integration of data that supports clinical patient care and the management, delivery, and evaluation of health care services. (Essentially a transport standard for health data). That is, messages from one system to another use the HL7 standard so they can be understood by the different systems. The goal of the EHR Work Group is to further the HL7 mission of designing standards to support the exchange of information for clinical decisions and treatments, and help lay the groundwork for nationwide interoperability by providing common language parameters that can be used in developing systems that support electronic records The name HL7 comes from the seven levels of the Open Systems Interconnection (OSI) model. Level Seven is the Application Level.
- What is an SDO ? Standards Development Organizations (SDOs) are entities that develop, coordinate, promulgate, revise, amend, reissue, interpret, or otherwise maintain standards that address the interests of users outside the SDO. In the United States there are several hundred SDOs which are coordinated by the central National Standards Body (NSB) – the American National Standards Institute (ANSI). SDOs accredited by ANSI develop standards using open and transparent processes. Standards development organizations are composed of a group of stakeholders who get together to determine standards in a wide variety of areas. As a simple example, you know that the electric outlets in the US either have two or three slits arranged in a certain way and that plugs on appliances are made so they can fit into them. This is one example of a standard. Who Develops Standards? Health information technology (HIT) standards are developed and maintained by Standards Development Organizations (SDOs), Data Content Committees (DCCs), Standards Setting Organizations (SSOs), and Designated Standard Maintenance Organizations (DSMOs).
- While there are several SDOs and multiple standards that have been developed over time 3 SDOs important to healthcare are: DICOM is the international standard for medical images and related information (ISO 12052). It defines the formats for medical images that can be exchanged with the data and quality necessary for clinical use. DICOM is implemented in almost every radiology, cardiology imaging, and radiotherapy device (X-ray, CT, MRI, ultrasound, etc.), and increasingly in devices in other medical domains such as ophthalmology and dentistry. IHTSDO - International Health Terminology Standards Development Organization - SNOMED - Systemized Nomenclature of Medicine. The IHTSDO assumed ownership of SNOMED-CT (Clinical Terms) in 2007; it oversees the strategic direction and scientific maintenance of the Systematized Nomenclature of Medicine, (SNOMED) - a comprehensive, multi-axial, controlled terminology created for the indexing of the entire medical record. The National Library of Medicine, a founding member of the PHDSC, is the U.S. member of the IHTSDO. ISO - International Organization for Standardization ISO is a network of national standards institutes from 140 countries working in partnership with international organizations, governments, industry, business, and consumer representatives. ISO 215 Technical Committee on Health Informatics (ISO/TC 215) works on the standardization of health information and communications technology to allow for compatibility and interoperability between independent systems through several Working Groups: WG 1: Data Structure WG 2: Messaging and Communications WG 3: Health Concept Representation WG 4: Security WG 5: Health Cards WG 6: Pharmacy and Medication WG 7: Devices WG 8: Business Requirements for Electronic Health Records The ISO/TC 215 developed structures and controlled vocabularies for medicinal products (ingredients); pharmaceutical dose forms; units of presentation and routes of administration, measurements, laboratory tests; and common terminology services for the TC 215.
- Standards Development According to the International Standards Organization (ISO), Standards are developed according to the following three principles: Consensus - the interests of all stakeholders are taken into account: manufacturers, users, vendors, consumer groups, testing laboratories, governments, engineering professions and research organizations Industry wide - standards solutions have to satisfy industries and customers worldwide Voluntary - international standardization is market driven and therefore based on voluntary involvement of all stakeholders in the market-place. After standards are developed that is just the beginning of the process. They must then go the process of harmonization, implementation, certification and adoption for their full benefit to be realized. Standards Harmonization is a process to ensure applicability of various standards for a Use Case / Value Case that describes the use of a Software Application. Standards harmonization includes the following steps: Use Case development Use Case’s requirements analysis Identification of candidate standards Resolution of standards gaps, duplications and overlaps through the work with the standards development organizations Standards selection Construction of the Use Case’s Interoperability Specification Interoperability Specification’s inspection test Interoperability Specification release and dissemination Standards implementation is a process of demonstrating the use of standards in an information technology application. To help implement standards, standard development organizations create Implementation Guides - technical documents that describe how to implement standards. Certification of health information technology standards is referred to as a process of ensuring implementation of the standards in a software application. CCHIT is a nonprofit organization with a mission to accelerate the adoption of health information technology by creating an efficient, credible, and sustainable certification program for electronic health records and their networks. ONC established the Permanent Certification Program for Health Information Technology to ensure Electronic Health Record technologies meet the adopted standards, certification criteria, and other technical requirements to achieve Meaningful Use requirements. Adoption of Standards-Based Health IT is the process of implementing, deploying, and utilizing standards-based information technology in real world applications. The Health IT Adoption Stories module is a resource that provides examples of how standards-based HIT products have been adopted in public health. It is also a resource for tools and other materials that assist public health entities to understand and navigate the complexities of health IT standards, facilitate public health adoption of national standards in current and future HIT projects, and align public health applications with those of the broader health care industry.
- Categories of health IT standards: In February 2006, Health Information Technology Standards Panel (HITSP) identified the following health information technology standards categories: Data Standards Information Content Standards Information Exchange Standards Identifiers Standards Privacy and Security Standards Functional Standards Other Standards
- Evidence based medicine (EBM) or evidence based practice (EBP) is a term most physicians become familiar with through their medical training. In broad definition it is the practice of medicine based on clinical guidelines that are developed to aid in the decision making process of healthcare professionals. However while the practice of medicine is based on guidelines, healthcare still remains the last bastion of industry where standardized guidelines particularly in the area of health information technology still have a way to go. There is already an abundance of evidence demonstrating the benefits of Health Information technology. Research shows that the US economy would save $79 billion dollars annually simply by accepting technological standards and guidelines in the practice of medicine.
- In the absence of HL7 data transport standards and other HIT standards we are left with confusion and a higher incidence of data challenges that are not conducive to developing a highly efficient, patient centric, timely , effective and equitable system of care.