Callum Bir

1. Achieving Interoperability
Role of Standards
Callum Bir
Deloitte Consulting SEA

2. Stakeholders involved in Healthcare IT Standards to Enable EHR
Healthcare Healthcare
Provider Payer
Gov’t & Policy Standard
Makers Developers
Stakeholders
Consumers Vendors
Healthcare IT Standards to Enable EHR and Beyond
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3. ISO TC215 Health Informatics
Promote
Enable
Interoperability
Compatibility
between
for health info
independent
& data
systems
ISO TC215
Health
Informatics
Reduce
Standardize
Duplication of
information for
Effort &
health
Redundancies
Enable
Consistency
for health info
& data
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4. ISO TC215 Health Informatics
Subcommittee / Workgroup Title
Workgroup 1 Data structure
Workgroup 2 Data Interchange
Workgroup 3 Semantic content
Workgroup 4 Security
Workgroup 6 Pharmacy and medicines business
Workgroup 7 Devices
Workgroup 8 Business requirements for Electronic
Health Records
Workgroup 9 SDO Harmonization
Organizations in liaison:
CDISC, COCIR, DICOM, GS1, HON, ICN, IHE, IHTSDO, IMIA, UNECE, WHO
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5. HIE Interoperability Levels
Multiple levels of data exchange
LEVEL DESCRIPTION EXAMPLES
Mail, phone (no information
1 Non-Electric Data
technology)
PC-based and manual fax, e-
2 Machine-Transportable Data
mail, or scanned documents
Machine-Organizable Data:
Format Structured messages with non-
3
standard data (HL-7 messages)
Syntactic
Machine-Interpretable Data: EDI of structured messages
4 Content using controlled terminology
Semantic
Interoperability is defined as the exchange of data so
that data from application A can be used by Application
B. This requires both Level 3 (Format) and Level 4
(Content). This type of interoperability is needed for
patient safety and analytics
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6. Semantic Interoperability
Interoperability is typically achieved at a Level 3 and focuses on the format of data
Application 1 Application 2
Messages may be
structured, e.g. HL7
ver. 2, but all data
must be first
Database mapped point to Database
point
Meds
Mapping Meds
Problems Problems
HL7
Allergies Allergies
Labs Labs
John Jones 1/27/2001 K 3.7
John Jones 1/27/2001 K 3.7 1/27/01/10:35 John William Jones Potassium 3.7
1/27/01/10:35 John William Jones Potassium 3.7
Source: Center For Information Technology Leadership,
Dr. Barry Blumenfeld
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7. Semantic Interoperability
Semantic Interoperability (Level 4) Targets a Common
Approach to the Meaning of Data
Level 3 vs. Level 4 Interoperability:
15 interactions 6 interactions
App App App App
Controlled
App App Medical
App App
Terminology
Services
App App
App App
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8. Semantic Interoperability (US)
ONC is pushing for some standards: ICD-10, SNOMED, LOINC, etc. Conversely it is not creating a
coherent mandatory set of standards allowing interoperability. As a result interoperability is still an elusive
goal in the U.S.
RULES: PROBLEM LIST: RESULTS: ORDERS:
If ( history of ) ( Diabetes Insulin Dependent Free Iron Serum Ferritin
Mellitus ) and ( free Iron ) Diabetes
( greater than X )
then ( order Ferritin )
Controlled Clinical Terminology Services
SNOMED CPT
NO HISTORY
LOINC
ICD-9/ICD-10 OF
RULE IN
DIABETES SERUM FERRITIN
GESTATIONAL DIABETES INSIPIDUS
DIABETES FAMILY HISTORY OF CBC CBC
DIABETES INSULIN-DEPENDENT HISTORY OF SERUM GLUCOSE
DIABETES SEVERE
MELLITUS DIABETES
MELLITUS TYPE 2 RISK OF FREE IRON IRON
RULE OUT
INSULIN RESISTANT K+ TIBC
TYPE 2 DIABETES DIABETIC COMA
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9. Semantic Interoperability standards (US)
There are many widely accepted industry and Federal data standards throughout the health care
continuum. Adoption of each standard may vary from facility to facility, which underscores the
importance of an HIE to adhere to a core set of messaging, transport and integration standards and
protocols. ANSI’s Healthcare
Information
Technology
CCHIT is a private not- Health Level
Seven Standards Panel was
for-profit organization International created by the ONC
that serves as a (HL7) for Health
recognized US Certification Information
Healthcare
certification authority Commission for
Information Technology to
for electronic health Healthcare
Information
Technology promote
records (EHR) and their Technology
Standards Panel interoperability in
networks. (CCHIT) (HITSP) healthcare by
harmonizing health
Interoperability information
Standards technology
standards.
Established by HHS, Health Information Nationwide Health
Security and Information
HISPC addresses the Privacy Network
privacy and security Collaboration Architecture
challenges presented (HISPC) Projects
by electronic health ASC X12 (NHIN)
information exchange (EDI)
through multistate
collaboration. NHIN, a program under ONC is establishing a
mechanism for nationwide health information
exchange. The NHIN is a set of conventions that
The Accredited Standards Committee (ASC) X12, provide the foundation for the secure exchange
develops electronic data interchange (EDI) of health information that supports meaningful
standards and related documents for national use.
and global markets.
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10. 10 ©2011 Deloitte Touche Tohmatsu Limited