Amy Sheide

Clinical Informaticist

3M Health Information Systems

USA

Achieving Data Standardization in Health Information Exchange and Quality Measurement

AbstractThis presentation reviewsthe benefits and challenges of achieving and maintaining interoperability.

Specifically, it showcases successful implementation of a centralized terminology server in health information exchange, biosurveillance and quality measurement.

Exchange

Interpret

Share

Understand

Background“Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.”http://www.himss.org/library/interoperability-standards/what-is

Benefits of interoperability Delivery of High Quality Cost Effective

CareProcess

ImprovementCoordination Across

Care SettingsMedical Error

Reduction

Providing care within clinical

guidelines

A complete health history

Accurate medication

Lists

Examining variation in physician practice

Allergy and adverse

reaction lists

Vaccine history

“The complexity of patient data in electronic medial records, coupled with expectations that these data facilitate clinical decision making, healthcare cost effectiveness, medical error reduction, and evidence based medicine, makes obvious the role of standardized terminologies as a foundation for comparable and consistent representation of patient information.”

-Pathak and Chute, Division of Biomedical Statistics and Informatics, Mayo Clinic

Pathak, J., & Chute, C. G. (2010). Analyzing categorical information in two publicly available drug terminologies: RxNorm and NDF-RT. Journal of the American Medical Informatics Association, 17(4), 432-439.

EHR

MU is centere

d around CollectingExchanging &Reporting

structured

clinical data and

leveraging

CEHRT to do it

Drivers for interoperability in the US•The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act has the goal of using certified electronic health record technology (CEHRT) to promote patient safety and interoperability between and within health care systems.

•The initiative in HITECH Act are also known as Meaningful Use (MU).

• How do you obtain and implement the standards?• Are the current standards robust to function in current

clinical workflows? • Standard terminology is free but how much does it cost

to implement and understand?• How is your organization going to share data elements

that don’t have a standard code?

Reaching the interoperability target• Governing bodies have defined

structured data requirements with standard terminology

• Limitations and challenges exist in adopting these standards

Current State

Challenges in interoperabilityStandardizati

on

Multiple Standard Terminologies

Variable Versions

Gaps in Standard Terminologies

Integration

Variable Release Formats

Synonymous concepts with

different Identifiers

Unidirectional Data Translation

Organization

Flat Lists of Codes

Variation in Granularity

Significant effort to maintain mappings

Centralized Terminology Server (CTS) solution • Metadata repository which

enables the translation and integration of healthcare data

• Standardized terminology vocabulary compliance

• Knowledge Base to understand how data is represented and structured across the organization

Addresses the simple questions that are hardest to manage,“ What does it mean, where is it from, and how does it relate to

everything else!”

CTS components

• Terminology consulting • Integration of local codes

• Interoperability

• Translation between source and target system

• Browsing and Runtime Services

• Terminology and mapping container

• Search and browse content• Mapping tools

• Delivery of standard terminologies in a consistent consumable format

• Update to the standards content• Local content Content Software

Mapping Services

Web Service

APIs

Health Information Exchange (HIE) use case

Goal: Make patient lab results available to any provider regardless

of performing laboratory

Standardization:Map labs to Standard

Terminology

Integration:Translate Standard

Terminology back to Source

Lab

Organization:Location to Store

the Mappings

HIE without a CTS

HGB

HEME

12HB

HPLAS Plasma

Hemoglobin

Requires mapping from each source system. Each change at one site require a remap across systems.

Updates require a remap across all systems

The amount of variability results in difficulty maintaining translation and consumption to source systems

Facilitating HIE with a CTS

HGB

12HB

HEME

HPLAS

Mapping storage and retrieval via the CTS

Bidirectional Data Exchange

Economies of scale in Centralized Mapping

Plasma Hemoglob

in

Updates applied once and automated across systems

Biosurvalence use case

Goal: Automate the identification and tracking of reportable diseases

Standardization:Identify LOINC, ICD

or SNOMED CT codes for reportable

diseases

Integration:Group standard

terminology codes by disease group

Organization:Store the

requirements from the county, state and federal level

Biosurvalence without a CTS• Intensive data mining effort to find

diagnosis and lab information that meet the reportable criteria (due to the use of multiple code systems required)

• Resources to manage updates from the reporting agencies as well as updates to the code system

• Maintaining the lists at each level of reporting (county, state, federal)

ICD-9-CM Coding:072.9

MumpsSNOMED CT 36989005

ICD-10-CM Coding:B26.9

Campylobacter coliSNOMED CT 40614002

ICD-10-CM Coding:A04.5

Mumps Virus Antibodies, Serum, Semi-Quantitative

LOINC 31503-6Local Code: A

008.43Campylobacter Species Identified, Stool Culture

LOINC 6331-3

$

ICD-9-CM Coding:008.43Campylobacteriosis

SNOMED CT 86500004

Campylobacter SpeciesSNOMED CT 116457002

Campylobacter jejuniSNOMED CT 66543000

Facilitating biosurvalence with a CTS

Local Code: B008.43

Local Code: A008.43

Utah Reportable Conditions

US Nationally Reportable Conditions

Has Associated Disease

County Reportable Conditions

ICD-9-CM Coding:008.43

ProblemsICD-9-CM Coding:

072.9

MumpsSNOMED CT 36989005

ICD-10-CM Coding:B26.9

Has AnalyteNCID 76770

Campylobacter coliSNOMED CT 40614002

Labs

CampylobacteriosisSNOMED CT 86500004

Campylobacter Species Identified, Stool Culture

LOINC 6331-3

Campylobacter jejuniSNOMED CT 66543000

Campylobacter SpeciesSNOMED CT 116457002

ICD-10-CM Coding:A04.5

Mumps Virus Antibodies, Serum, Semi-Quantitative

LOINC 31503-6

• Centralized location to manage code sets• Add groupings across terminologies• Allows instantiation of reports to different agencies• Enterprise wide structured data integration

Clinical Quality Measure (CQM) use case

Goal: Identify groups of patients receiving or eligible for treatment

Standardization:Over 20 different

code systems required to

calculate CQMs

Integration:Manage multiple versions of value

sets and code systems

Organization:Link local codes

to CQM data elements and

measures

Clinical Quality Measure without a CTS•Simple CQMs require multiple data elements•Each CQM data element can have multiple value sets•Value set and code set versioning cause a high level of variability

Facilitating CQM with a CTS•Cost and process benefits in managing the complexity of data value sets and values •Technical benefit in accessing CQM content with APIs and runtime services•Versioning reduces variability of content

Achieving enterprise intelligence with a scalable CTS

Enterprise Intelligence

Accelerates implementation of electronic health records• Longitudinal patient

care record• Personal health

records

Enables structured clinical data capture, queries and analytics

• Data mining• Complex secondary

data use

Semantically interoperable data for exchange, analytics, decision support, alerts and reminders• Lower total cost of

ownership• Maximized

consistency, quality and efficiency of mapping

Questions