achieving interoperability - role of standards

Callum Bir

Deloitte Consulting SEA

Achieving Interoperability

Role of Standards

©2011 Deloitte Touche Tohmatsu Limited

Stakeholders involved in Healthcare IT Standards to Enable EHR

Stakeholders

Consumers

Gov’t & Policy

Makers

Healthcare

Provider

Vendors

Standard

Developers

Healthcare

Payer

Healthcare IT Standards to Enable EHR and Beyond

2


ISO TC215 Health Informatics

Enable Consistency

for health info & data

Enable Compatibility for health info

& data

Promote Interoperability

between independent

systems

Reduce Duplication of

Effort & Redundancies

Standardize information for

health

ISO TC215 Health

Informatics

3


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

4


HIE Interoperability Levels

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

Multiple levels of data exchange

LEVEL DESCRIPTION EXAMPLES

1 Non-Electric Data Mail, phone (no information

technology)

2 Machine-Transportable Data PC-based and manual fax, e-

mail, or scanned documents

3

Machine-Organizable Data:

Format

Syntactic

Structured messages with non-

standard data (HL-7 messages)

4

Machine-Interpretable Data:

Content

Semantic

EDI of structured messages

using controlled terminology


Semantic Interoperability

John Jones 1/27/2001 K 3.7John Jones 1/27/2001 K 3.7

Database

Application 2

Database

Application 1

Meds

Problems

Allergies

Labs

Meds

Problems

Allergies

Labs

HL7

Ma

pp

ing

Messages may be

structured, e.g. HL7

ver. 2, but all data

must be first

mapped point to

point

1/27/01/10:35 John William Jones Potassium 3.71/27/01/10:35 John William Jones Potassium 3.7

Source: Center For Information Technology Leadership,

Dr. Barry Blumenfeld

Interoperability is typically achieved at a Level 3 and focuses on the format of data


Level 3 vs. Level 4 Interoperability:

15 interactions

App App

App App

App App

6 interactions

App App

App App

App App

Controlled

Medical

Terminology

Services

Semantic Interoperability (Level 4) Targets a Common

Approach to the Meaning of Data

Semantic Interoperability


RULES:

If ( history of ) ( Diabetes

Mellitus ) and ( free Iron )

( greater than X )

then ( order Ferritin )

PROBLEM LIST:

Insulin Dependent

Diabetes

RESULTS:

Free Iron

ORDERS:

Serum Ferritin

Controlled Clinical Terminology Services

DIABETES

MELLITUS

INSULIN-DEPENDENT

DIABETES

DIABETIC COMA

DIABETES

ICD-9/ICD-10

SNOMED CPT

LOINC

DIABETES

INSIPIDUS

DIABETES

MELLITUS TYPE 2

INSULIN RESISTANT

TYPE 2 DIABETES

GESTATIONAL

DIABETES HISTORY OF FAMILY

HISTORY OF

RULE OUT

NO HISTORY

OF RULE IN

RISK OF

SERUM FERRITIN

TIBC

FREE IRON IRON

SERUM GLUCOSE

CBC CBC

SEVERE

K+

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.

Semantic Interoperability (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.

Semantic Interoperability standards (US)

Certification Commission for

Healthcare Information Technology

(CCHIT)

Healthcare Information Technology

Standards Panel

(HITSP)

Health Information Security and

Privacy Collaboration

(HISPC)

Nationwide Health Information

Network Architecture

Projects

(NHIN)

Interoperability

Standards

ANSI’s Healthcare

Information

Technology

Standards Panel was

created by the ONC

for Health

Information

Technology to

promote

interoperability in

healthcare by

harmonizing health

information

technology

standards.

CCHIT is a private not-

for-profit organization

that serves as a

recognized US

certification authority

for electronic health

records (EHR) and their

networks.

Established by HHS,

HISPC addresses the

privacy and security

challenges presented

by electronic health

information exchange

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

provide the foundation for the secure exchange

of health information that supports meaningful

use.

Health Level Seven

International

(HL7)

ASC X12

(EDI)

The Accredited Standards Committee (ASC) X12,

develops electronic data interchange (EDI)

standards and related documents for national

and global markets.

achieving interoperability - role of standards

Health & Medicine