1) Clinicians need information to provide quality care to patients, but have limited time and resources. Health information technology (IT) and health information exchange (HIE) can help provide clinicians with complete and timely patient information. 2) For HIE to be effective different health systems need to use common standards for exchanging patient data. Standards help ensure data is exchanged and understood across different technical systems and organizations. 3) The ultimate goals of HIE and health IT standards are to improve continuity of care, quality, safety, timeliness, effectiveness, equity, patient-centeredness and efficiency of healthcare.

1. 1
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University
October 8, 2013
Medical Information Exchange
in ASEAN Countries:
How to Achieve It?
www.SlideShare.net/Nawanan

2. 2
Let’s Start with
Something Simple

3. 3
What Clinicians Want?
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)

4. 4
High Quality Care
• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-Centered
Institute of Medicine, Committee on Quality of Health Care in
America. Crossing the quality chasm: a new health system for the
21st century. Washington, DC: National Academy Press; 2001. 337 p.

5. 5
Information is Everywhere in Medicine
Shortliffe EH. Biomedical informatics in the education of
physicians. JAMA. 2010 Sep 15;304(11):1227-8.

6. 6
Achieving Quality Care with Information
• Safe
– Drug allergies
– Medication Reconciliation
• Timely
– Complete information at point of care
• Effective
– Better clinical decision-making
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/

7. 7
Achieving Quality Care with Information
• Efficient
– Faster care
– Time & cost savings
– Reducing unnecessary tests
• Equitable
– Access to providers & knowledge
• Patient-Centered
– Empowerment & better self-care

8. 8
That’s Where Health IT
Plays A Role...

9. 9
The Anatomy of Health IT
Health
Information
Technology
Goal
Value‐Add
Means

10. 10
Various Forms of Health IT
Hospital Information System
(HIS)
Computerized Provider Order Entry
(CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication
System (PACS)

11. 11
Still Many Other Forms of Health IT
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telemedicine &
Telehealth
Personal Health Records
(PHRs)
Image Sources: Apple Inc., Geekzone.co.nz, Google, Microsoft, PubMed.gov, and American Telecare, Inc.

12. 12
A Vision
for Health Care

13. 13
eHealth & Health Information Exchange
Hospital A Hospital B
Clinic C
Government
Lab Patient at
Home

14. 14
Goals of Health Information Exchange
• Deliver patient’s health information
across systems & settings
• To support high-quality health care
delivery by providers
• As well as facilitating other health
care functions (patient’s access,
reimbursements, public health
operations, policy-making, education,
research)

15. 15
Achieving HIE

16. 16
eHealth Components (WHO-ITU Model)

17. 17
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

18. 18
eHealth & Health Information Exchange
Hospital A Hospital B
Clinic C
Government
Lab Patient at
Home

19. 19
Objectives
• Interoperability
• Inter-operable
systems
Ultimate Goals
• Continuity of Care
• Quality
 Safety
 Timeliness
 Effectiveness
 Equity
 Patient-Centeredness
 Efficiency
Why Health Information Standards?

20. 20
Levels of Interoperability
Functional
Semantic
Syntactic

21. 21
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 (12 & 18 Files)
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID (Provider, Facility, Patient)
Functional
Semantic
Syntactic

22. 22
An Example: SNOMED CT
• A coded clinical terminology for use
in Electronic Health Records
• Currently maintained by IHTSDO
• Each concept has a code, a name
(“term”) and relationships with other
concepts

23. 23
Concepts & Relationships in SNOMED CT
Source: http://ihtsdo.org/fileadmin/user_upload/Docs_01/Publications/SNOMED_CT/SnomedCt_Intro_20130418.pdf

24. 24
Classification vs. Terminology
ICD-10
SNOMED
CT

25. 25
In Real Life...
Patient
Care
Quality
of Care
Profession-
alism
ITPolicy
Limited
Time &
Resources

26. 26
Patients Are Counting on Us...
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/

27. 27
Summary
• Better information means quality of care
• Health IT helps clinicians care for patients
• Health Information Exchange (HIE) should be
our shared VISION
• Standards help us achieve HIE, and thus better
care
• There are many types of standards needed to
achieve HIE, including SNOMED CT
• Let’s walk together toward that common goal,
for the benefits of patients and all stakeholders