Standards Driven Healthcare Information Integration Infrastructure

June 2016 Page: 1 of 59Hi3 Solutions ~ Your healthcare standards conformance Partner
Standards Driven Healthcare
Information Integration
Infrastructure
AbdulMalik Shakir
President and Chief Informatics Scientist
Hi3 Solutions | your healthcare standards conformance partner

About Me • My information technology experience
spans more than four decades,
including 35+ years in healthcare.
• I have contributed to the advancement
of healthcare related standards since
1991 through volunteer participation in:
 Health Level Seven (HL7),
 X12N Healthcare Task Group,
 OMG Healthcare Domain Task
Force,
 the Workgroup for Electronic Data
Interchange (WEDI), and
 the IEEE Joint Workgroup for a
Common Data Model.
• I served on the HL7 Board of Directors
for three terms (a total of six years) and
as co-chair of the HL7 Modeling and
Methodology workgroup since 1994.
• I received the HL7 Fellowship award in
2012
AbdulMalik Shakir
Hi3 Solutions | your healthcare standards conformance partner
3500 West Olive Ave, Suite # 300, Burbank, CA 91505.

SESSION ABSTRACT
 Healthcare information exchange, integration, and analytic
capabilities are critical to safe, cost effective, high quality
healthcare.
 The technical infrastructure that serves as an enablers for
these capabilities is a complex array of data exchange
standards, clinical terminologies, and infrastructure
technologies.
 This presentation provides an overview of this technical
infrastructure and relevant current and emerging technologies:
 Data Exchange Standards:
 HL7, X12, IEEE, ASTM, NCPDP, and DICOM;
 Clinical Terminologies:
 ICD, SNOMED, LOINC, RxNORM, and CPT;
 Infrastructure Technologies:
 integration engines, terminology servers, standards conformance
validators, integrated data repositories, and business intelligence tools.

Healthcare
Information Integration Infrastructure
Health Information Integration
Health Information Transformation
Health Information Standards Compliance
Inbound
Information
Processing
Standard Compliance and
Conformance Validation
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services
Analysis,
Visualization,
and Reporting
Integrated Data
Repository
Business Intelligence
& Decision
Support Services
Health Information
Exchange Standards
Controlled Clinical
Terminology Services
Healthcare Quality and Performance Monitoring
Reference Model
Developer
Reference
Information Model
Standards Development
Organization
Terminology
Author

Electronic Healthcare
Information Exchange Standards

Effective, meaningful health information exchange
requires that all parties involved in information
exchange adhere to predetermined transaction
formats, usage constraints, and exchange
protocols.
Health Information Exchange
Inbound
Information
Processing
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services

Electronic Health Information Exchange
Pharmacies
Claims/Prescriptions
Testing Organizations
Lab/Images Government
Medicare/Medicaid
Orders
Results
Images
Hospitals
Encounter Data
Patient Data
Medical Records
County/Community
Entities
Mental Health
Family Planning
Medical Society
Public Health
Patients/Consumers
Employers
Health Information
Insurance Updates
Enrollment
Payors
Eligibility
Referral Process
Claim Status
Physicians
Referral Process
Care Plans
Consults

Healthcare
Information
System
HL7
HL7
HL7, X12N
HL7, X12N
HL7
HL7
DICOM
IEEE MIB,
ASTM
X12N / HL7 (Non-US only)
X12N
NCPDP
Healthcare Data Interchange Standards

Leading U.S. Healthcare Data Interchange SDOs
IEEE
Institute of Electrical and Electronic
Engineers
NCPDP
National Council for Prescription
Drug Programs
X12N
Insurance Subcommittee of X12
ASTM
American Society for Testing and
Materials
DICOM
Digital Imaging and
Communications in Medicine
HL7
Health Level Seven

IEEE
Instrumentation communication
standards and generalized information
interchange standards
NCPDP
Standards for communication of
prescription, billing, and other pharmacy
material
X12N
Standards for exchange of healthcare
insurance and billing information
ASTM
Lab reporting standards and standard
guide for content and structure of
computer-based patient records
DICOM
Standards for exchanging digital
radiology images
HL7
Inter-application interoperability
standards for healthcare
Leading U.S. Healthcare Data Interchange SDOs

X12 HIPAA Transactions
 Health Claims or Equivalent Encounter Information Standard Transaction Form: X12-
837 - Health Care Claim
 Claims Payment and Remittance Advice Standard Transaction Form: X12-835 - Health
Care Claim Payment/Advice Standard
 Healthcare Claims Status Standard Transaction Form: X12-276/277 - Health Care Claim
Status Request and Response
 Coordination of Benefits Standard Transaction Form: X12-837 - Health Care Claim
 Referral Certification and Authorization Standard Transaction Form: X12-278 - Health
Care Services Review - Request for Review and Response
 Enrollment and Disenrollment in a Health Plan Standard Transaction Form: X12-834
 Premium Payments Standard Transaction Form: X12-820
 Eligibility for a Health Plan Standard Transaction Form: X12-270/271
 First Report of Injury Standard Transaction Form: X12-148
 Claims Attachments Standard Transaction Form: X12-275

HL7 Standards Referenced in US
Regulations
 Clinical Document Architecture (CDA®)
 Continuity of Care Document (CCD®)
 HL7 EHR-S Implementation Guide: S&I Framework
Laboratory Results Interface (LRI) Functional Requirements,
Release 1
 HL7 Implementation Guide for CDA® Release 2: Additional
CDA R2 Templates - Clinical Documents for Payers – Set 1
, Release 1 (US Realm)
 HL7 Implementation Guide for CDA® Release 2:
Consolidated CDA Templates for Clinical Notes (US Realm)
DSTU Release 2
 HL7 Implementation Guide for CDA® Release 2: Digital
Signatures and Delegation of Rights, Release 1
 HL7 Implementation Guide for CDA® Release 2: Healthcare
Associated Infection (HAI) Reports
 HL7 Implementation Guide for CDA® Release 2: IHE Health
Story Consolidation, Release 1.1 (US Realm)
 HL7 Implementation Guide for CDA® Release 2: National
Health Care Surveys (NHCS), Release 1 (US Realm)
 HL7 Implementation Guide for CDA® Release 2: Quality
Reporting Document Architecture, DSTU Release 2 (QRDA)
 HL7 Implementation Guide for CDA® Release 2: Reporting
to Public Health Cancer Registries from Ambulatory
Healthcare Providers, Release 1 (US Realm)
 HL7 Implementation Guide: Data Segmentation for Privacy
(DS4P), Release 1
 HL7 Implementation Guide: Decision Support Service,
Release 1.1 (US Realm) Draft Standard for Trial Use
 HL7 Version 2.5.1 Implementation Guide: Electronic
Laboratory Reporting to Public Health Release 2, Release
1.1 (US Realm)
 HL7 Version 2.5.1 Implementation Guide: Orders and
Observations; Interoperable Laboratory Result Reporting to
EHR, Release 1 in ZIP format (1.07 MB)
 HL7 Version 2.5.1 Implementation Guide: S&I Framework
Lab Results Interface, Release 1 (US Realm)
Laboratory Orders from EHR, DSTU Release 2 (US Realm)
Laboratory Test Compendium Framework R2, DSTU
Release 2 (US Realm) in PDF (2.38 MB)
 HL7 Version 3 Implementation Guide: Context-Aware
Knowledge Retrieval (Infobutton) Service-Oriented
Architecture Implementation Guide, Release 1
 HL7 Version 3 Implementation Guide: Family
History/Pedigree Interoperability, Release 1
 HL7 Version 3 Standard: Clinical Decision Support
Knowledge Artifact Specification, Release 1.2
 HL7 Version 3 Standard: Clinical Genomics; Pedigree,
Release 1
 HL7 Version 3 Standard: Context Aware Knowledge
Retrieval Application (“Infobutton”), Knowledge Request,
Release 2
 Messaging Standard Version 2.3.1
 Messaging Standard Version 2.5.1
 Vocabulary Specificationshttp://www.hl7.org/implement/standards/hhsifr.cfm?ref=common

Healthcare Interoperability Standards
IEEE
Institute of Electrical and Electronic
Engineers
NCPDP
National Council for Prescription Drug
Programs
X12N
Insurance Subcommittee of X12
ASTM
American Society for Testing and Materials
DICOM
Digital Imaging and Communications in
Medicine
HL7
Health Level Seven
Standards Accrediting
Bodies
Standards Authority
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDOs
Accredits
Healthcare Interoperability
Standards
Produce
Healthcare Industry
Stakeholders
Stakeholders
Approves
Healthcare Industry
Stakeholders
Healthcare Enterprise

Controlled Clinical Terminologies

Controlled Clinical Terminologies
 In addition to standards for data interchange, it is
essential to employ a common set of clinical terminology
and ontology systems.
 Clinical problems and diagnoses are usually coded with
International Classification of Diseases Coding Systems
(ICD-9 or ICD-10)
 Medical procedures are commonly designated using
Current Procedural Terminology Codes (CPT).
 Clinical observations procedures and observation result
values are encoded using a variety of standard,
proprietary, and locally defined code. LOINC and
SNOMED are widely utilized clinical coding schemes.
 RxNorm is used for medication identifiers and metadata.

www.regenstrief.org/loinc [GO]
LOINC

SNOMED

RxNorm

Standards-Based
Inbound
Information
Processing
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services
Health Information
Exchange Standards
Controlled Clinical
Organization
Terminology
Author

HIE Standards Conformance
Profiles

Revealing assumptions is an essential component of effective communication.
Yes, I do
play
football.
Do you
play
football?
Conformance Profiles – Why?

Conformance Profiles are an effective means of documenting our assumptions
about message structures
Conformance Profiles – Why?
Do you
use
HL7?
MSH
EVN
PID
[PD1]
[ { NK1 } ]
Yes, I
use
HL7.
MSH
EVN
PID
[ NK1 ]
OBX

Conformance Profiles provide a language that allows us to
unambiguously express our understanding and assumptions about the
information in a message structure used in a particular scenario
Conformance Profiles – What?

Conformance Profiles – What?
 Use Case Model
 Use Cases
 Use Case Actors
 Exchange Scenarios
 Triggering Events
 Receiver Responsibilities
 Content Profiles
 Element Usage and Cardinality
 Coded Element Terminology Bindings
ud Use Case Model
Local Registry User
1.0 Immunization
History Query
2.0 Patient
Demographic
Update
3.0 Vaccine
Record Update Prov ider Organization
SIIS Registry
Administration
4.0 Immunization
Statistical Analysis
Trusted Third PartiesLocal Registry
Administration
SIIS Analysis Report
SIIS Analysis Report
SIIS Analysis Report SIIS Analysis Report
Update Confirmation
Update Confirmation
Query Response
Vaccine Record Update
Patient Information Update
Immunization History Request
sd Interactions
Requesting Registry
System
SIIS SIP Immunization
Information Exchange
System
Responding Registry
System
Vaccination Record Query (VXQ)
[Invalid VXQ Message]: General Acknowledgement (ACK)
[Valid VXR Message]: Vaccination Record Query (VXQ)
[No Matching Record]: Query Acknowledgement (QCK)
[Invalid QCK Message]: General Acknowledgement (ACK)
[Valid QCK Message]: Query Acknowledgement (QCK)
[Multiple Matching Records]: Vaccination Query Response (VXX)
[Invalid VXX Message]: General Acknowledgement (ACK)
[Valid VXX Message]: Vaccination Query Response (VXX)
[Single Matching Record]: Vaccination Query Response (VXR)
[Invalid VXR Message]: General Acknowledgement (ACK)
[Valid VXR Message]: Vaccination Query Response (VXR)

Major Publishers of Health Information
Exchange Standards Conformance Profiles
 Washington Publishing Company (WPC)
 WPC is a provider of services, publications and products to entities that develop or consume Electronic Data
Interchange Standard Transactions.
 WPC is the publisher of implementation guides for HIPAA related transactions and standards.
 WPC has a close affiliation and working relationship with ASC X12 and the Workgroup for Electronic Data
Exchange (WEDI)
 Integrating the Healthcare Enterprise (IHE)
 IHE brings together healthcare information technology stakeholders to implement standards for communicating
patient information efficiently throughout and among healthcare enterprises by developing a framework for
interoperability.
 IHE does not create new standards, but rather drives the adoption of standards to address specific clinical
needs.
 IHE Integration Profiles specify precisely how standards are to be used to address these needs, eliminating
ambiguities, reducing configuration and interfacing costs, and ensuring a higher level of practical
interoperability.
 Public Health Data Standards Consortium (PHDSC)
 The National Center for Health Statistics (NCHS) was instrumental in establishing the Public Health Data
Standards Consortium (Consortium) in 1999.
 The Consortium, which incorporated as a not-for-profit organization in 2003, is a national non-profit member-
based partnership of federal, state and local health agencies; national and local professional associations; and
public and private sector organizations and individuals.
 PHDSC participates as an active member of the standards development organizations, Health Level Seven
(HL7), Accredited Standards Committee (ASC) X12, and the National Uniform Billing Committee (NUBC) to
ensure that the data needs of public health and health services research are incorporated within the standards
development process.

Standards
DefinesHealthcare Industry
Stakeholders
Stakeholders
Use Case
Community of Users and
Partners
Consortiums
Implementation
Profile
Analyze
Use
Produces
Controlled
Terminologies
Use
Clinical Terminologist and
Medical Specialties
Terminology Authors
Produces
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDOs
Produces
Conformance Profile Authoring

Conformance Profile Authoring
Partners
Consortiums
Participates
in
Profiles and
Implementation Guides
Standards
Produce
Healthcare Industry
Stakeholders
Stakeholders
Approves
Is Refined By
Software Development and
Vendor Organizations
Implementers
Standards Implementation
Produce

Health Information Standards
Compliance

Inbound
Information
Processing
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services
Health Information
Exchange Standards
Controlled Clinical
Organization
Terminology
Author

Conformance Profile Authoring Tools
 Message Workbench (MWB)
 Model Driven Health Tools (MDHT)
 ART-DECOR
 Trifolia Workbench
 MS Word

Instance Validation Technologies
 HL7 v2 Schema Specification
 MWB Profile Validation
 CDA Schema Specification
 MDHT Generated Java Objects
 Trifolia Generated Schematron Logic

Instance Validation Services
 NIST HL7 v2 and v3 CDA Validation
 SMART C-CDA Collaborative
 CDC PHIN Message Quality Framework
 Lantana Consulting Group CDA Validator
 IHE Gazelle HL7 Validator

Instance Validation Commercial Products
 Interface Engine Products
 Interface Engine Product Adapters
 Terminology Management Technologies
 Hi3 Solutions Product Suite

Partners
Consortiums
Profiles and
Produce
Implementers
Produce
Affiliates, Specialties,
Organizations
Conformance Realm
Regulators, Service
Providers, Middleware
Vendors
Conformance Certifiers
Is Used By
Supports
Establishes

Standards Driven Health Information
Exchange
Inbound
Information
Processing
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services
Health Information
Exchange Standards
Controlled Clinical
Organization
Terminology
Author

Healthcare Interoperability Standards
Bodies
Standards Authority
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDOs
Accredits
Standards
Produce
Healthcare Industry
Stakeholders
Stakeholders
Approves
Healthcare Industry
Stakeholders

HIE Conformance Profiles
Partners
Consortiums
Participates
in
Profiles and
Standards
Produce
Healthcare Industry
Stakeholders
Stakeholders
Approves
Is Refined By
Implementers
Produce

Partners
Consortiums
Profiles and
Produce
Implementers
Produce
Organizations
Conformance Realm
Regulators, Service
Vendors
Is Used By
Supports
Establishes

Standards and Profiles
Bodies
Standards Authority
Partners
Consortiums
Participates
in
Profiles and
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDO
Standard Developing
Organizations
SDOs
Accredits
Standards
Produce
Produce
Healthcare Industry
Stakeholders
Stakeholders
Approves
Is Refined By
Implementers
ProduceHealthcare Industry
Stakeholders
Employ
Organizations
Conformance Realm
Regulators, Service
Vendors
Is Used By
Supports
Establishes

Health Information
Integration

Reference Information Model Derived
Integrated Data Repository
Integrated Data
Repository
Reference Model
Developer
Reference
Information Model

Healthcare
Reference Information Models
 CDISC: Operational Data Model (ODM)
 HL7/CDISC: Biomedical Research
Integrated Domain Group (BRIDG) Model
 CDC: Public health conceptual data model
 FDA: Janus Clinical Trials Repository
(CTR)
 HL7: Reference Information Model

HL7 Version 3.0
Reference Information
Model
The HL7 Reference Information Model is the information
model from which all other information models and message
specifications are derived.

HL7 RIM Model Development Process
B
X F
E
C A D
G
1
0..*
0..* 1 0..* 1
0..* 0..1 0..*1
Model I Model II Model III
A
C
B
0..*
0..*
0..* 1 X
C
B
0..*
0..*
0..* 1
D
A B0..* 0..*
0..*
1

HL7 Reference Information Model
 The HL7 Reference Information Model (RIM) is the
combined consensus view of information from the
perspective of the HL7 working group and the HL7
international affiliates
 The RIM is the ultimate source from which the information-
related content of all HL7 version 3.0 protocol specification
standards is drawn.
 Development of the RIM began in April 1996 and was first
deployed for use during the January 1997 HL7 working
group meeting.
 The HL7 RIM was published as an ANSI standard in July
2003 and as an ISO standard in August 2006 .

Normative R6 RIM Class Diagram
Version 2.44 11/22/2013

RIM Derived
Integrated Data Repository
Integrated Data
Repository
Reference Model
Developer
Reference
Information Model

Inbound
Information
Processing
Source
Information System
Information
Transformation
Services
Integrated Data
Repository
Reference Model
Developer
Reference
Information Model
 Clinical Data Repository
 Enterprise Data Warehouse
 Disease Registries
 Encounter Data
 Clinical Outcomes
 Resource Utilization
 Patient Experience

Healthcare Quality and
Performance Monitoring

Healthcare Quality and Performance
Monitoring
Inbound
Information
Processing
Source
Information System
Information
Transformation
Services
Analysis,
Visualization,
and Reporting
Integrated Data
Repository
& Decision
Support Services
 Clinical Data Repository
 Enterprise Data Warehouse
 Disease Registries

Quality Measurement in Healthcare
 Quality measurement in health care is the process of
using data to evaluate the performance of health
plans and health care providers against recognized
quality standards.
 Quality measures assess care across the full
continuum of health care delivery, from the level of
individual physicians all the way up to the level of
health insurance plans.
 Hundreds of different quality measures are used in
health care.
 These measures generally fall into four broad
categories: 1) structure, 2) process, 3) outcome, and 4)
patient experience.

Measurement Development Process
 Convening a committee whose members have expertise on the particular
issue to be measured
 Evaluating the evidence base, including primary research and clinical
practice guidelines
 Reaching consensus on the best measurement approach by considering
numerous criteria, including what the proposed measure would evaluate, the
scientific soundness of the evidence base, the feasibility of data collection
and measurement
 Developing detailed specifications about what will be measured and how
 Vetting the specifications with key interest groups, such as professional
societies or consumer groups
 Conducting rigorous testing to ensure that the measure works as it was
designed
 Obtaining final approval by the entity charged with developing the
measure

Quality Measures Developers
 Government agencies, such as
 the Centers for Medicare and Medicaid Services (CMS)
 the Agency for Health Care Research and Quality (AHRQ)
 Private nonprofits, such as
 the Joint Commission on Accreditation of Health Care
Organizations (JCAHO)
 the National Committee for Quality Assurance (NCQA)
 For-profit companies, such as
 Healthgrades and
 U.S. News and World Report

Standards Driven Healthcare Quality and
Performance Measurement
Inbound
Information
Processing
Source
Information System
Information
Transformation
Services
Analysis,
Visualization,
and Reporting
Integrated Data
Repository
& Decision
Support Services
Health Information
Exchange Standards
Controlled Clinical
Organization
Terminology
Author

Healthcare
Solutions
Inbound
Information
Processing
Outbound
Information
Processing
Source
Information System
Receiving
Information System
Information
Transformation
Services
Analysis,
Visualization,
and Reporting
Integrated Data
Repository
& Decision
Support Services
Health Information
Exchange Standards
Controlled Clinical
Reference Model
Developer
Reference
Information Model
Organization
Terminology
Author

Hi3 Solutions
3500 W. Olive Ave, Suite
300
Burbank, CA 91505
ww.hi3solutions.com +1 800 918-
6520
Healthcare Information Integration Infrastructure Solutions (Hi3 Solutions), is a
privately owned, Health Information Technology vendor, headquartered in Burbank,
California.
Hi3 Solutions, along with its affiliates, provides assistance to public health, healthcare,
and health research organizations attempting to utilize informatics standards to
overcome barriers to interoperability.
The mission of Hi3 Solutions is to assist healthcare organizations with leveraging their
information assets to discover and prosper from evidence-based best practices in
healthcare through proven information management methods, standards, and
techniques.

Hi3 Solutions Product Suite
Standards
Conformance
Validator
Healthcare
Information
Integrator
Healthcare
Quality
Monitor

Thank You!
Peace...AMS
Abdul-Malik Shakir
Hi3 Solutions
3500 West Olive Ave, Suite # 300, Burbank, CA 91505
Skype: +1 9098334661  Mobile: (626) 644-4491
Email: abdulmalik.shakir@hi3Solutions.com

Standards Driven Healthcare Information Integration Infrastructure

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