Presented at HIMSS14 Annual Conference & Exhibition, February 26, 2014, Orlando, FL.
http://www.himssconference.org/Education/EventDetail.aspx?ItemNumber=25331
Meaningful Use certification requires several large vocabulary standards for representing clinical facts in health information exchange. This presents unique challenges for semantic interoperability such as information loss in translating from and to internal data dictionaries, semantic drift, dealing with legacy content (e.g., ICD-9) and clinical information reconciliation.
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Semantic Interoperability in Health Information Exchange
1. Semantic Interoperability
in Health Information Exchange
February 26, 2014
Tomasz Adamusiak MD PhD
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
3. Learning Objectives
1. Define vocabulary standards for MU 2
2. Define common MU Data Set
3. Identify challenges
4. Propose solutions
4. HISTORY OF PRESENT INQUIRY:
Mr. Smith is a 34-year old gentleman who presents at
our branch to obtain a car loan secondary to growing
maintenance costs of his current vehicle. He
otherwise reports doing well. His past financial
history is insignificant.
7. Interoperability in care
coordination
2014 Edition EHR Certification Criteria 45 CFR §170.314 (e)
Data
portability
Common MU
Data Set
Create /
transmit
transition of
care / referral
summaries
Receive /
transmit lab
result
C-CDA
e-Prescribing
Clinical
information
reconciliation
Common MU
Data Set
8. Interoperability in patient
engagement
2014 Edition EHR Criteria 45 CFR §170.314 (e)
View /
download /
transmit to
3rd party
Common MU
Data Set
Human
readable /
C-CDA
Clinical
summary
Common MU
Data Set
9. New topics in Meaningful Use
Stage 3 recommendations
Patientgenerated
health data
Amendments
Drug
adherence
Order
tracking
Summaries for
consults &
reports
Case reports
HIT Policy: Meaningful Use Workgroup
http://www.healthit.gov/FACAS/sites/faca/files/MUWG_Stage3_14_Jan_28.docx
10. Consolidated CDA provides
templates for care summaries
Medication Information
ManufacturedProduct
Medication Activity
SubstanceAdministration
Medication Supply Order
ManufacturedProduct
Immunization
SubstanceAdministration
By إبن البيطارown work - [Public domain], via Wikimedia Commons
11. Only structured information
allowed in MU Transition of Care
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code code="310965"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="Ibuprofen 200 MG Oral Tablet">
</code>
</manufacturedMaterial>
</manufacturedProduct>
12. Only structured information
allowed in MU Transition of Care
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
Medication
RXCUI
<code code="310965"
Information
Template
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="Ibuprofen 200 MG Oral Tablet">
</code>
</manufacturedMaterial>
Normalized
Drug Name
</manufacturedProduct>
13. Common MU Data Set defines
data requirements for ALL care
summaries criteria
• Individual criteria might include data requirements
that are specific or unique to that criterion
• Many different terminology standards
14. Common MU Data Set (1-5)
• 1. Patient name
– N/a
• 2. Sex
– N/a
• 3. Date of birth
– N/a
•
•
•
•
•
•
Combined format
(select one or more):
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
• 4. Race and 5. Ethnicity
– The Office of Management and Budget (OMB) Standards for
Maintaining, Collecting, and Presenting Federal Data on Race
and Ethnicity, Statistical Policy Directive No. 15, as revised,
October 30, 1997
15. Common MU Data Set (6-7)
6. Preferred language
– As specified by the Library of Congress, ISO 639-2 alpha-3
codes limited to those that also have a corresponding alpha-2
code in ISO 639-1
7. Smoking status
– Any of the following SNOMED CT codes:
– (1) Current every day smoker. 449868002
– (2) Current some day smoker. 428041000124106
– (3) Former smoker. 8517006
– (4) Never smoker. 266919005
– (5) Smoker, current status unknown. 77176002
– (6) Unknown if ever smoked. 266927001
– (7) Heavy tobacco smoker. 428071000124103
– (8) Light tobacco smoker. 428061000124105
16. Common MU Data Set (8-12)
8. Problems
– At a minimum, SNOMED CT International Release July 2012
and US Extension to SNOMED CT March 2012 Release
9. Medications
– RxNorm, August 6, 2012 Release
10. Medication allergies
– RxNorm, August 6, 2012 Release
11. Laboratory tests
– LOINC version 2.40
12. Laboratory values/results
– N/a
Immunizations
HL7 Standard Code Set
CVX Vaccines Administered
17. Common MU Data Set (13-16)
13. Vital signs (height, weight, BP, BMI)
– N/a
14. Care plan fields including goals and instructions
– N/a
15. Procedures
– At a minimum, SNOMED CT International Release, July 2012
with US Extension to SNOMED CT March 2012 or the
combination of HCPCS and CPT-4
– Optional: CDT
– Optional: ICD-10-PCS
16. Care team members
– N/a
Not
ICD-10-CM
19. Codes run out of room (ICD-9)
• 985 Toxic effect of other metals
– 985.0 Toxic effect of mercury and its compounds
– 985.1 Toxic effect of arsenic and its compounds
– 985.2 Toxic effect of manganese and its compounds
– 985.3 Toxic effect of beryllium and its compounds
– 985.4 Toxic effect of antimony and its compounds
– 985.5 Toxic effect of cadmium and its compounds
– 985.6 Toxic effect of chromium
Brass fumes,
– 985.8 Toxic effect of other specified metals
copper salts,
and iron and
– 985.9 Toxic effect of unspecified metal
nickel
compounds
High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
20. Limited hierarchy (ICD-9)
• 010-018.99 TUBERCULOSIS
– …
– …
• 137 Late effects of tuberculosis
– …
• 647.3 Tuberculosis complicating pregnancy childbirth or the
puerperium
– …
High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
21. Semantic drift (evolution of usage)
in multi-year data (ICD-9)
– 664.14 Other immediate postpartum hemorrhage,
postpartum condition or complication 666.14
New name
• 1995
– 664.14 Second-degree perineal laceration, postpartum
condition or complication
– 785.59 Other shock without mention of trauma
• 2003
New term
– 785.51 Cardiogenic shock
High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886
22. In pursuit of a single language
Pieter Brueghel the Elder (1526/1530–1569) [Public domain], via Wikimedia Commons
26. Practical exploration of UMLS
annotated data
https://clinminer.hmgc.mcw.edu user: himssdemo password: himssdemo
This image by Tomasz Adamusiak is licensed under a CC BY 3.0 US license
ClinMiner is a non-commercial, prototype solution
For more information see: EHR-based phenome wide association study in pancreatic cancer.
Adamusiak T, Shimoyama M, AMIA Summits Transl Sci Proc. 2014 (in press)
27. SNOMED CT as likely alternative
interface terminology
• Active collaboration between IHTSDO and
Regenstrief (LOINC)
http://www.ihtsdo.org/about-ihtsdo/governance-andadvisory/harmonization/loinc
• Integration with ICD-11
http://www.ncbi.nlm.nih.gov/pubmed/23920573
29. Thank You!
Tomasz Adamusiak MD PhD
Human and Molecular Genetics Center
Medical College of Wisconsin
tomasz@mcw.edu
@7omasz
30. Sources
HIMSS Definition of Interoperability
http://www.himss.org/library/interoperability-standards/whatis?navItemNumber=17333
Implementing Consolidated-Clinical Document Architecture (C-CDA) for
Meaningful Use Stage 2 http://www.healthit.gov/sites/default/files/ccda_and_meaningfulusecertification.pdf
Consolidated CDA, HL7 Implementation Guide for CDA® Release 2: IHE
Health Story Consolidation,
http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258
Medicare and Medicaid Programs; Electronic Health Record Incentive
Program—Stage 2, 42 CFR Parts 412, 413, and 495, Federal Register/ Vol. 77,
No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf
Health Information Technology: Standards, Implementation
Specifications, and Certification Criteria for Electronic Health Record
Technology, 2014 Edition; Revisions to the Permanent Certification
Program for Health Information Technology, 45 CFR Part 170, Federal
Register/ Vol. 77, No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-0904/pdf/2012-20982.pdf