Getting Health Information Right

The National Institutefor Health Innovation

Getting Clinical Information

Right

Emerging Medication Standards

Koray Atalag, MD, PhD, FACHIk.atalag@auckland.ac.nz

HISO MemberHL7 New Zealand Vice-ChairopenEHR Programme Lead

Agenda

• The problem

• What’s out there?

• Medication Example

• Methods & Standards

• Recommendations & Discussion

What’s the problem?

• Healthcare is hard!– Breadth, depth, complexity, variability etc.

• So is dealing with health information...– What is a Heart Attack?– Is there such a disease as hypertension?– Is Diabetes a single disease?

• Burning issue: getting a core dataset ASAP– Who will be responsible to govern definitions?– How to coordinate and support dataset teams?– How to get clinicians/experts on the same page?

• An obvious gap in current approach• Start with Medication (+ Allergies & ADR)

So what’s actually out there?

• PMS: each vendor has own data model• GP2GP: great start for structure• NZePS: started with a propriety XML payload, now

waiting for standard CDA – PMS vendors implementing Toolkit based Adapter

• Shared Care / Maternity / St John?• Hospitals?• Labs & Pharmacies?• Others?

Can you really trust incoming data?(without human control)

Unified Medication Definition

• Essential to get it right – first in patient safety!– Needs to be clinically valid, computable and support multiple use

• Reused in many places, including:– ePrescribing, eReferrals– My List of Medicines– Shared Care systems– Patient and clinician portals– Health (status & event) summary– Public Health / Research

• New HISO Connected Care suite of standards– HISO 10043 CDA Common Templates – 10041.1 CDA Templates for Medications, Allergies and Adverse

Reactions just passed public consultation – coming soon

• NZMT / NZULM & Formulary > great start!

Why bother?(with a standard structured Medication model)

“If you think about the seemingly simple concept of communicating the timing of a medication, it readily becomes apparent that it is more complex than most expect…”

“Most systems can cater for recording ‘1 tablet 3 times a day after meals’, but not many of the rest of the following examples, ...yet these represent the way clinicians need to prescribe for patients...”

Dr. Sam Heard

Example: Medication timing

Acknowledgement: Sam Heard

Medication timing – and more!!

Acknowledgement: Sam Heard

Medication timing cont.

Acknowledgement: Sam Heard

Medication timing – cont.

Acknowledgement: Sam Heard

Medication timing – even more!

Acknowledgement: Sam Heard

HISO 10040 Interoperability Reference Architecture

10040.1R-CDRs

XDS

10040.2 CCR

SNOMED CT

openEHR

10040.3CDA

Acknowledge Alastair Kenworthy

The Principles

1. Align to national strategy: as per national and regional plans

2. Invest in information: use a technology agnostic common content model, and use standard terminologies

3. Use single content model: information for exchange will be defined and represented in a single consistent way

4. Align to business needs: prioritise the Reference Architecture in line with regional and national programmes

5. Work with sector: respect the needs of all stakeholders

6. Use proven standards: adopt suitable and consistent national and international standards wherever they exist (in preference to inventing new specifications)

7. Use a services approach: move the sector from a messaging style of interaction to one based on web services

It’s REFERENCE LIBRARY (of reusable clinical information models)

Data & meta-data definitions (data dictionary)Relationships & clinical terminology

Usage of the Content Model

Health Information Exchange & More

Single Content Model

CDA

FHIR

HL7 v2/3

EHR Extract

UML

XSD/XMI

PDF

Mindmap

PAYLOAD

System A

Data Source A

MapTo

Content Model

System B

Data Source B

Native CDR / Datamart

Secondary Use

MapTo

Content Model

Automated Transforms

No Mapping

Creating CDA Payload

Draft HISO Medication Standard

Peer review of models

Resulting Models (using CKM Tool)

Who else is doing it?

Other upcoming HISO standards

• 10041.4 CDA Templates for Referral Requests• 10040.4 Clinical Document Metadata Standard• 10050.1 Maternity Data Set Standard• 10050.2 CDA Templates for Maternity Care

Summary• 10052 Ambulance Data Set StandardThey all share common clinical concepts; certainly the

Medication Definition– Who’s responsible for making sure they are aligned?– What mechanism exist to assist dataset developers / clinical

domain experts?– How do you keep them aligned over time / governance?

Options / Recommendations

Who can be responsible for making sure datasets are aligned and interoperable?MoH, NHITB, HISO, HIGEAG, NICLG, other?

What mechanisms to assist dataset developers / clinical domain experts?Policy, principles, guides, examplesHISO 10040.2 Exchange Content ModelTools? CKM but also Word, Excel, mindmaps, UML

How do you keep them aligned over time / support governance?CKM – Not Data dictionary, meta-data registry, Excel

Bottom line

• Content is ‘clinician’s stuff’ – not techy; – yet most standards are meaningless for clinicians

• We need to invest in information– Whatever technology will be

• Method defined in HISO standard– Worked well for Medications

• Let’s build rest of it as we go!– NIHI is keen to facilitate clinical

content development and governance + tooling support

– This will also fulfil MoH “Data Dictionary” need

The National Institutefor Health Innovation

Thank you

Questions?

k.atalag@auckland.ac.nz