Enabling Healthcare Terminology Interoperability using HDD … · 2015. 1. 29. · The 3M HDD is a concept-based terminology server that integrates the current version of many standard

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3M Health Information Systems

© 3M 2015. All rights reserved

Enabling Healthcare Terminology Interoperability using HDD Access

http://www.hddaccess.com

Biomedical Informatics Graduate Seminar

University of Utah

January 29, 2015

Senthil K. Nachimuthu, MD, PhD

3M Health Information Systems, Inc., Murray, Utah

[email protected]

http://www.hddaccess.com/

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Conflict of Interest Disclosure

3M Health Information Systems, Inc.

― Medical Informaticist, Clinical Terminology

University of Utah School of Medicine

― Research Associate, Division of Epidemiology

Elected positions and Standards Development

― IHTSDO – US representative to Technical Committee

― Past Chair, AMIA Open Source Working Group

― Co-author, HL7 Common Terminology Services v2 (CTS2)

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Overview

Understanding terminology needs of healthcare organizations

The need for interoperability

Our approach to the interoperability question

Business model – publicly available and open source

HDD Access community

What’s next for HDD Access?

HDD Access demo

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In a typical hospital near you…

5



Their computers often don’t speak the same languageHow do

you do?

Nimeni on

Linus.

நான் ஹெல்சிங்கியில்இருந்து

வருகிறேன்.

Είμαι 30

ετών.

Уровень глюкозы в

крови 90 мг / дл.

Radiografia del

torace non mostra

risultati anomali.

즉 2백달러될것입니다. 감사합니다!

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If they could all speak the same language…

How do you do?

Nimeni on Linus.நான் ஹெல்சிங்கியில் இருந்து

வருகிறேன்.

Είμαι 30 ετών.

Уровень глюкозы в крови

90 мг / дл.

Radiografia del torace non

mostra risultati anomali.

즉 2백달러될것입니다.

감사합니다!

How do you do?

My name is Linus..

I am from Helsinki.

I’m 30 years old.

My blood glucose is 90

mg/dL.

Chest X-ray shows no

abnormal findings.

That will be $200. Thank you.

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How Many Terminologies Does an Organization Need?

Standard terminologies

― Clinical: SNOMED CT

― Lab: LOINC

― Pharmacy: RxNorm, other

proprietary pharmacy

terminologies

― Billing/reporting: ICD-9-CM,

ICD-10-CM, ICD-10-PCS,

CPT, HCPCS, DRG, and

many others

Local terminologies

― Those created by vendors of

EMRs, pharmacy and lab

systems

― Those created by hospitals

themselves

― Often “uncontrolled” without

consistent governance

processes

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Our Answer to the Terminology Management Question

The 3M Healthcare Data Dictionary (3M HDD) was created in

the early 90s through an SBIR grant

Two of the early users were the DoD EHR and Intermountain

Healthcare

The 3M HDD is a concept-based terminology server that

integrates the current version of many standard and local

terminologies used by hospitals and other healthcare

organizations

Partitioning capabilities are included to support terminology

content from different organizations

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DoD, VA and HDD Access

DoD AHLTA EHR uses the HDD as its data dictionary

VA VistA EHR system uses its own terminology

In 2009, the DoD and the VA announced the joint iEHR

(Integrated Electronic Health Record) project

The DoD and VA gave 3M a contract in 2012 to make the 3M

HDD publicly available as HDD Access, and they will use

HDD Access for interoperability between their EHR systems

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What is HDD Access?

An open source terminology engine to enable

Implementation of various standard terminologies

Interoperability between multiple local and standard terminologies

Contains various standard terminologies and a subset of the 3M

HDD to enable interoperability between them

HDD Access supports standard terminologies by bridging the

gap between SDOs and users – it doesn’t compete with

standard terminologies, but it helps their implementation

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HDD Access Components

Includes terminologies

that we have permission

to release publicly

User can create local

extensions without

modifying the core

content

Database (Oracle, SQL

Server, MySQL, PostgreSQL)

Terminology browser,

authoring tool and search

engine

API (HL7 CTS, 3M)

Runs on Windows and Linux

Import/export tools

1500+ users

Discussion forum, blog, FAQ

Open Exchange – users can

share their contributions

Container

CommunityContent

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Components of the HDD

Controlled Medical Vocabulary

― Collection of clinical concepts

Knowledge Base

― Relationships among concepts

Medical Information Model

― Establishes clinical context

Decision Support

Alerts Reports

Knowledge Base

(Semantic Network)

Controlled Medical Vocabulary

(Medical Concepts)

Medical

Information

Model

*Slides 11-15 from Shaun Shakib, PhD

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A collection of medical concepts, organized to

support synonyms and other lexical

characteristics

• concept: a unique, definable idea or object that has a very

specific, known meaning

Sodium

Lab ResultLab Test Chem 4

Potassium

ChlorideGlucose

Concept Based Vocabulary

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COLD COLD COLDConcept

Representation

Concept

Domain

Concept

Definition

Concept ID

a sensory

perception

a pulmonary

diagnosis

an upper

respiratory

viral infection

“I’m feeling

cold”

Chronic

Obstructive

Lung Disease

“I have a

cold”

68215 1005480 1005313

Concept Based Vocabulary

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Knowledge Base/Relationships

Lab Test

Chem 4

Sodium

is-a

Lab Result

Potassium

Chloride

Glucose

is-component-of

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Medical Information Model

Allergy Type

Allergen

Severity

Reaction

Date

Allergy Event

Information Model

Patient Allergy

Drug (1550)

Aspirin (3000252119)

Mild (1554)

Rash (82559)

20000703

Instance Data

Type Allergen

Severity Reaction

Allergy Event

HDD

Date

20000703

Aspirin

Mild

Drug

Rash

Information Model - instantiated

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Point-to-Point vs Centralized Mapping

Epic

Siemens

HIE

CrimsonEDW

2

)1( nnmaps

LOINC

SNOMED

CT

RxNorm

Cerner

Epic

Cerner

RxNorm

Crimson

HIE

LOINC

SNOMED

CT

HDD

EDW

Siemens

(n-1) maps

HDD reduces mapping and maintenance efforts by using centralized mapping.

We add point to point mappings when necessary in a small number of cases.

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HDD Access Content v.29 – Standard Terminologies

ICD-9-CM Diagnoses

ICD-9-CM Procedures

ICD-10-CM

ICD-10-PCS (codes but not

attributes/hierarchies)

HCPCS Level II

HCPCS Modifiers

Terminologies that we have permission to include in HDD Access are supported and

duly acknowledged

MS-DRG

TRICARE/CHAMPUS MS-

DRG

APC

MS-DRG MDC

TRICARE/CHAMPUS MS-

DRG MDC

RxNorm

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HDD Access Terminology Design

Concept-based terminology, with concept permanence and

graceful evolution

Multi-hierarchical terminology

Supports semantic relationships

Supports and integrates terminology models and content of

multiple standard and local terminologies

Supports mappings between equivalent and non-equivalent

concepts

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HDD Access software is open source under the Apache

License v2 – source code is published in addition to the

binary installers

HDD Access content is “publicly available” under the HDD

Access Content License

― You cannot modify or re-release the core HDD Access content

― But you can extend it and release your extensions as you please

― This is done to protect the integrity of the terminology content, and

in turn, patient safety

HDD Access Licenses

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HDD Access Community

0

500

1000

1500

2000

Au…

Se…

Oc…

No…

De… Ja

…F

e…M

a…A

p…M

a… Ju…

Jul…

Au…

Se…

Oc…

No…

De… Ja

…F

e…M

a…A

p…M

a… Ju…

Jul…

Au…

Se…

Oc…

No…

NewUsers

Total Users

•More than 1,500 users, from government, industry (HIS vendors,

consulting), academia, and international users

•Active discussion forums, blog, FAQ

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HDD Access Content – Data Row Counts

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000 Concepts

Relationshships

Representations

RepresentationContexts

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HDD Access Download Counts

0

50

100

150

200

250

Aug

-12

Sep

-12

Oct

-12

Nov

-12

Dec

-12

Jan-

13F

eb-1

3M

ar-1

3A

pr-1

3M

ay-1

3Ju

n-13

Jul-1

3A

ug-1

3S

ep-1

3O

ct-1

3N

ov-1

3D

ec-1

3Ja

n-14

Feb

-14

Mar

-14

Apr

-14

May

-14

Jun-

14Ju

l-14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Total monthlyInstallerBinarySourceDB SourceContentDocumentation

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Enabling Interoperability

Local Extensions

Namespace Dependencies

Demo

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Local Extensions

Local extensions are implemented as “namespaces” where

the user can author their own terminology content without

modifying the core content

We provide a unique range of identifiers for each user’s local

extension to avoid collision with other users’ extensions

HDD Access Content License allows the user to use or share

their local extension with others

HDD Access tools allow export and import of local extensions

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HDD Access core content and local extensions are made of

“namespaces”, which are logical partitions of the content

Namespaces may have dependencies among them, since we

integrate multiple terminologies using a central concept-

based terminology

Example 1: The SNOMED CT concept of “Aspirin

(substance)” and the RxNorm concept of “Aspirin” (ingredient)

are mapped to the HDD concept “Aspirin” – the SNOMED CT

namespace and the RxNorm namespace depend on the core

namespace

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Example 2: If we load the “SNOMED CT to ICD-10-CM

Mappings from NLM” into HDD Access, the map set will be in

a separate namespace which depends on the SNOMED CT

namespace and the ICD-10-CM namespace

Soon, we will have a complex network of namespaces

The dependencies are between specific versions of

namespaces, rather than the namespaces themselves

The “versioned” namespace dependencies form a directed

acyclic graph

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Namespace Dependencies – Our Approach

Users define the namespaces that their namespace depends

on

The “versioned” namespace dependencies are automatically

calculated by the software

Namespace dependencies form a directed acyclic graph

Content can only be moved from the “leaf” towards the “root”

of the dependency tree, not in the other direction (which

would break concept permanence)

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Demo

Creating your own local extension

― Your namespace will be automatically created

Creating your own terminology

― Let’s create an example drug terminology

Creating your own mappings

― Let’s map your drug terminology concepts to RxNorm

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Thank you!

References

HDD Access website: http://www.hddaccess.com

Online browser: http://search.hddaccess.com

FAQ: http://www.hddaccess.com/home/faqs

Discussion forums: http://www.hddaccess.com/forum

Apache License v2: http://www.apache.org/licenses/LICENSE-2.0.html

HDD Access Content License: http://www.hddaccess.com/hdd-content-download-license

Contact us: http://www.hddaccess.com/contact

3M HDD: http://www.3mhis.com/terminology

Please send your questions to

Senthil K. Nachimuthu, MD, PhD

3M Health Information Systems, Inc.

[email protected]

http://www.hddaccess.com/

http://search.hddaccess.com/

http://www.hddaccess.com/home/faqs

http://www.hddaccess.com/forum

http://www.apache.org/licenses/LICENSE-2.0.html

http://www.hddaccess.com/hdd-content-download-license

http://www.hddaccess.com/contact

http://www.3mhis.com/terminology

mailto:[email protected]

Documents

Enabling Healthcare Terminology Interoperability using HDD … · 2015. 1. 29. · The 3M HDD is a concept-based terminology server that integrates the current version of many standard