Dr Kevin O’Carroll, Standards & Technology Manager,

Health Information and Quality Authority

Health Information Standards and the

Health Information and Quality Authority

Health Information and Quality Authority (HIQA)

Health Information Directorate Current Projects

Technical Standards Health Identifiers – IHI, HPI, HOI Information Governance Standards Standards for National Health Information Sources

Overview

To drive continuous improvements in the quality

and safety of health and social care in Ireland.

Remit

Health Act 2007, establishment 15 May 2007 independent - reporting to Minister for Health

and Children close relationship with people using the

service, professionals, providers, public, communities, media, stakeholders

person-centred ethos of “working with” not “doing to”

Background

Social Services Inspectorate (SSI) – residences for older people, people with disabilities, children, etc

Health Technology Assessment (HTA) - colorectal cancer, HPV in cervical screening, prion filtration of red cell concentrates

Healthcare Quality and Safety (HQS) – standard setting and monitoring function in acute hospital setting

Health Information (HI) – Technical standards / Information Quality

Functions

Health Information Directorate - Projects

• Technical Standards– General Practice Messaging Specification– National General Practice Referral Dataset– Laboratory Ordering

• Other projects

General Practice Messaging Specification

What is messaging?

1010001100011100110101

GPMS

• General Practice Messaging Specification (GPMS)

• May 2010 (ministerial approval)• Based on HL7 v2.4 with XML encoding

– Segment definitionsmessage header

+ patient information

+ event information

+ order information

+ result information

MessagesSegments

GPMS

• General Practice Messaging Specification (GPMS)

• May 2010 (ministerial approval)• Based on HL7 v2.4 with XML encoding

– Segment definitions

GPMS - Segments

MSH (message header) PDA (patient death and autopsy)PID (patient identification) RGS (resource group)EVN (event AIP (appointment information –

personnel resources)PV1 (event type/ patient visit) SCH (scheduling activity

information )PV2 (event type additional information)

AIL (appointment information – location resource)

PRD (provider data) ORC (common order segment)DG1 (diagnosis) RF1 (referral information)

NTE (notes and comments) SAC (specimen container detail)OBR (observation request) MSA (message acknowledgement)OBX (observation result) ERR (message error)

GPMS – Clinical Scenarios

Use Case: A laboratory receives a specimen and analyses the specimen. When a result is available this is communicated to the healthcare practitioner responsible for ordering the investigation or to the healthcare practitioner to whom a copy has been requested to be sent.

Describes the use case, messaging interaction, minimum abstract message definitions and constraints

GPMS – clinical scenariosDescribes the use case, messaging interaction, minimum abstract message definitions and constraints

GPMS – Message flows

Emergency department attendance

Cooperative discharge summary

Admission notification Outpatient department summaryClinical discharge summary Waiting list notificationAdministrative discharge Referral and responseDeath notification Laboratory orderUnsolicited laboratory result Unsolicited radiology resultCorrected result

National Dataset for General Practice

Referrals

GP Referral dataset

• National GP Referral Dataset in collaboration with ICGP

• International review– Scotland – 95% referrals electronic– Denmark - 100% by end of 2011

• Development – Local/regional/national/international– Draft for consultation December 2010

• National General Practice Referral Dataset• National Generic Electronic GP Referrals project

National Standard

Referral template

Laboratory Ordering

Laboratory Codes

• Laboratory codes LOINC• Scope – identification of laboratory concepts (orders and

results)• Regenstrief institute• Laboratory - 30,000 – haematology/biochemistry, microbiology,

serology & toxicology, drug and cell counts and antibiotic susceptibility

• Clinical –findings and findings noted with undertaking cardiac procedures, ultrasound etc

• Regenstrief LOINC mapping assistant (RELMA®) • RELMA® and web search (www.loinc.org)• Takes submissions twice yearly• In use in 140 countries

LOINC

• Unique code (format: nnnnn-n) is assigned to each entry upon registration

• Fully specified name - – Component, Kind of property, Time aspect, System, Type of scale– Narrative, Type of method

• Other database fields include short name, status and mapping information for database change management, synonyms, related terms, substance information (e.g. molar mass, CAS registry number), choices of answers for nominal scales, translations.

Unique Code Fully specified name Long name1514-9 GLUCOSE^2H POST 100

G GLUCOSE PO:MCNC:PT:SER/PLAS:QN

Glucose [Mass/volume] in Serum or Plasma --2 hours post 100 g glucose PO

Laboratory Orders

The National Laboratory Medicine Catalogue (NLMC): Editorial Principles

Other projects

Other projects

Projects StandardsIndividual Health Identifier ASTM-E1714, ISO 22220Healthcare practitioner and healthcare organisation identifiers

ISO 27527

Workshops SNOMED CT, HL7, IHEInformation Governance Information Governance toolkit

Information Governance GuidanceHealth Information Sources inventory of all health and social

care data sourcessemi structured interviews to identify themes to develop standards Draft standards for consultation (immanent)Final standards for health information source

eHealth Standards Advisory Committee (eSAG)

• the development of standards and associated technical materials to support eHealth will be based on the Authority’s standard procedures and processes for the development of technical standards. These are broadly in line with the World trade Organisation (WTO) Code of Good Practice for the Preparation, Adoption and Applications of Standards (See Appendix 2.).

• open non-proprietary standards will preferred over proprietary ones. • international standards which have been fully implemented and

validated will be preferred. • there should be a minimum of adaptation of the international standards

to meet the requirements of the Irish health sector. • where there is no international standard available and only as a last

resort will the Authority consider developing a new standard for Ireland. • industry developments and health service delivery opportunities will be

taken into account. • the standards proposed will ensure value for money and minimise cost

of compliance.

Contact Details: kocarroll@hiqa.ie

Thank you.

HPI & HOI

SOURCES

ORGANISATIONS

SOURCES

PRACTITIONERSConsumer

Consumer

Consumer

Consumer

CENTRALINDEX

HPI and HOI

ISO 27527

Consumer

Consumer

Consumer

Central Directory A central directory populated with up to date and accurate information relating to healthcare practitioners and organisations. This information may be sourced from existing data sources, that is professional regulatory authorities or existing information and communication technology systems. It should be governed, managed and maintained by an authority.

International Standards Organization Technical Standard 27525

Workshops

Workshop Title Date LocationOverview of Healthcare

Interoperability Standards

16 Nov 2011 Dublin

Health Level Seven (HL7) v2 and v3

9 March 2011 Cork

Health Level Seven (HL7) v2 and v3

17 November 2010 Dublin

An introduction to SNOMED CT

27 January 2010 Cork

An introduction to SNOMED CT

18 November 2009 Dublin

Health Information Standards

30 June 2009 Dublin

IHI

• Based on American Society for Testing and Materials – (ASTM -E1714)• Criteria for selection of a Unique Health Identifier defined and grouped

into fundamental and differentiating. • Criteria agreed with stakeholders:

Accessible Assignable Identifiable MergeableSplittable Verifiable Linkable Content-FreeControllable Healthcare

FocusedPublic Secure

Legislation Deployable Standard/ Based on Industry Standards

Usable

Atomic Governed Centrally

Networked Permanent

Repository Based Retroactive Unambiguous UniqueUniversal Mappable Dis-identifiable Incremental

Longevity Concise Deactivation Cost Effective

Based on ASTM-E1714 (Blue cells show fundamental criteria / Grey cells show differentiating criteria)