Transcript Background / Introduction - HyTime Users' Group Home Page
Healthcare Informatics Standards An Electronic Health Record Developer’s Perspective
The 4th International HyTime Conference Montreal, Canada August 20, 1997 Jason P. Williams Oceania, Incorporated [email protected]
Today’s Topics
• changing healthcare informatics models • healthcare informatics standards – language and vocabulary – Health Level Seven (HL7) • SGML and healthcare informatics • Oceania and SGML • Oceania and HyTime architectural forms
Document Model
Intermittent Fevers Report 1/2/94 Knee Pain Report 11/7/96
Vitals Im m unizations
Y early Physical Report 3/2/97
Longitudinal Patie nt Record
Why Standards? The Vendor Perspective
• better patient care • concentration on core competencies • product interoperability • benefits to the client • internal benefits
Healthcare Informatics Standards
• vocabulary and language – SNOMED, ICD – READ, MESH, others – NLM UMLS (meta-thesaurus) • information / data representation – HL7, DICOM, – SGML, XML, RDBMS, others • medical conventions
SNOMED
X-ray examination
(PROCEDURE) performed on
arm
(SITE) makes known a
fracture
(RESULT-FINDING) ICD-9 fracture of radius and ulna [arm], upper end, closed = 813.00
• many other examples to choose from • each optimized for different purposes • each purpose needs to be addressed by vendors • can’t “just pick one!”
Health Level Seven (HL7)
• “Clinical, financial, and administrative data among healthcare oriented computer systems” • messaging standard; “trigger event” • HL7 defines message types and “structure” • messages structure: header: segments: fields
MSH
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ADT1
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MCM
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LABADT
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MCM
|
198808181126
|SECURITY|ADT^A01 |MSG00001|P|2.3|
EVN
|A01|
198808181123
||
PID
|||PATID1234^5^M11||
JONES
^
WILLIAM
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A
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III
||19610615|M||C|
1200 N ELM STREET
^^GREENSBORO^NC^27401-1020|GL|(919)379 1212|(919)271-3434 ||S||PATID12345001^2^M10|123456789|987654^NC|
NK1
|JONES^BARBARA^K|WIFE||||||NK^NEXT OF KIN
PV1
|1|I|
2000^2012^01
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LEBAUER
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SIDNEY
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SUR
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HL7: The Positives
• Allows interaction with other systems – appointments and scheduling – lab results • large areas of clinical content defined • Version 3, Reference Information Model • large user base
HL7: The Negatives
• mixture of content with representation standards • many non-defined areas: Z segments • very customized local implementations make extra-institutional exchange difficult • document model not supported (not good with text)
The HL7 SGML SIG
• charter and design principles • sample DTDs • Kona Architecture Proposal • interoperability between HL7 and SGML – SGML to encode HL7 messages?
– Use of HL7 to contain and transport SGML documents?
• “best of both” approach
SGML Meeting Healthcare Informatics Needs
• information exchange • information retrieval and reporting • system and platform independence • long-term access and preservation
Information Exchange
• mobility of patients; emergency situations • changing nature of patient care • claims and claims attachments – claims /attachments vs. clinical documentation – HIPAA (Health Insurance Portability and Accountability Act) and HCFA • SGML/XML and the WWW • intra-institutional and extra-institutional exchange
Information Retrieval
• smarter full-text retrieval based on semantics • enables implementation of document model • preserving multiple views – clinician gets documents (context preserved) – population view • (system / platform independence; longevity)
Oceania EMR: WAVE
TM • allows creation and access of clinical data in documents • documents and relational tables -- health summary view • access to complete document contents not standardized • vocabulary: clinical content knowledge base
Oceania and Structured Data
• clinicians create structured sentences • each word encoded based on its role in the sentence • interface terminology optimized for clinicians (charting language…charting terms, browsing interface, data entry) • clinicians should not have to know about structure
Oceania and SGML
• representing WAVE documents internally • providing browser interface to vocabulary • ancillary data: drug information, clinical practice guidelines • benefits to Oceania clients
Early DTD Development
• direct mapping from WAVE document structure • based on CCKB user interface for threading • granularity: word, based on sentence role • attributes for codes and vocabulary
Oceania DTD: Design Questions
• granularity • retrieval purposes vs. document exchange • attributes vs. elements • negation and clinical documentation • specificity vs. generality
DTD Development to Date
• an ongoing, iterative process • many individuals from different functional areas – engineering, clinical informatics, product development • more than one DTD
Oceania and Architectural Forms
• standardizing implementations of SGML • should not have to standardize the DTD • multiple uses of architectural forms: – bridge multiple representations of the Oceania documents – intra-institutional exchange – extra-institutional exchange (Kona)
Oceania Experience with the Kona Architecture
• the SOAP format and Oceania documents: the sections • architectural mappings at different levels of granularity • the Kona “code” and “mention” • architectural “collisions”: same element; different contextual semantics
SGML Standards Family and Healthcare Informatics
• SGML will go forward: positives, momentum • HL7 and SGML: future cooperation • HyTime and others add to SGML implementation functionality • what we need: collaboration with standards organizations, experience
Selected References
• Health Level Seven Standard. http://www.mcis.duke.edu/standards/HL7/hl7.htm
• Health Level Seven SGML SIG. http://www.mcis.duke.edu/standards/HL7/committees/sgml /index.html
• Kona Architecture Proposal to the HL7 SGML SIG. http://www.mcis.duke.edu/standards/HL7/committees/sgml /index.html
Selected References
• Lincoln, Thomas L, Daniel J Essin, Robert Anderson, Willis H Hare (1994).
The Introduction of a New Document Processing Paradigm into Health Care Computing: A CAIT Whitepaper
. Santa Monica, California: Rand Corporation. [Available at the HL7 SGML SIG website.] • Morris, Jonathan A, Rachael Sokolowski, John E Mattison, David Riley (1997).
Standard Generalized Markup Language (SGML) in Healthcare.
Accepted for panel discussion at the Healthcare Information Management Systems Society (HIMSS) 1998 Conference in Orlando, Florida.