Standards Driven Healthcare Information Integration Infrastructure

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Standards Driven Healthcare Information Integration InfrastructureAbdulMalik ShakirPresident and Chief Informatics ScientistHi3 Solutions|your healthcare standards conformance partner

June 2016Page: # of 59Hi3 Solutions ~ Your healthcare standards conformance Partner

About MeMy information technology experience spans more than four decades, including 35+ years in healthcare. I have contributed to the advancement of healthcare related standards since 1991 through volunteer participation in: Health Level Seven (HL7), X12N Healthcare Task Group, OMG Healthcare Domain Task Force, the Workgroup for Electronic Data Interchange (WEDI), and the IEEE Joint Workgroup for a Common Data Model. I served on the HL7 Board of Directors for three terms (a total of six years) and as co-chair of the HL7 Modeling and Methodology workgroup since 1994. I received the HL7 Fellowship award in 2012AbdulMalik ShakirPresident and Chief Informatics ScientistHi3 Solutions|your healthcare standards conformance partner3500 West Olive Ave, Suite # 300, Burbank, CA 91505.


Session AbstractHealthcare information exchange, integration, and analytic capabilities are critical to safe, cost effective, high quality healthcare. The technical infrastructure that serves as an enablers for these capabilities is a complex array of data exchange standards, clinical terminologies, and infrastructure technologies. This presentation provides an overview of this technical infrastructure and relevant current and emerging technologies: Data Exchange Standards: HL7, X12, IEEE, ASTM, NCPDP, and DICOM; Clinical Terminologies:ICD, SNOMED, LOINC, RxNORM, and CPT; Infrastructure Technologies:integration engines, terminology servers, standards conformance validators, integrated data repositories, and business intelligence tools.


Healthcare Information Integration Infrastructure


Electronic Healthcare Information Exchange Standards


Effective, meaningful health information exchange requires that all parties involved in information exchange adhere to predetermined transaction formats, usage constraints, and exchange protocols. Health Information Exchange


Electronic Health Information Exchange

Pharmacies

Claims/Prescriptions

Testing OrganizationsLab/ImagesGovernmentMedicare/MedicaidOrdersResultsImages

Hospitals

Encounter DataPatient Data

Medical Records

County/Community Entities

Mental HealthFamily PlanningMedical SocietyPublic Health

Patients/ConsumersEmployersHealth InformationInsurance UpdatesEnrollment

PayorsEligibilityReferral ProcessClaim Status

PhysiciansReferral ProcessCare Plans

Consults


7The utilization of Ancillary services will become much more useful after the needs of the Physician and Patient are met.

Healthcare Information SystemClinical SystemImages, picturesBedside InstrumentsBilling, claimsreimbursementAdverse Events ReportingImmunization Database

MaterialsManagement

Agency ReportingProviderRepository

HL7HL7HL7, X12NHL7, X12NHL7HL7DICOM

IEEE MIB,ASTMX12N / HL7 (Non-US only)X12NWaveforms

Retail Pharmacy Orders & Reimbursement

NCPDPHealthcare Data Interchange Standards


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Leading U.S. Healthcare Data Interchange SDOsIEEEInstitute of Electrical and Electronic Engineers

NCPDPNational Council for Prescription Drug Programs

X12NInsurance Subcommittee of X12ASTMAmerican Society for Testing and Materials

DICOMDigital Imaging and Communications in Medicine

HL7Health Level Seven


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IEEEInstrumentation communication standards and generalized information interchange standards

NCPDPStandards for communication of prescription, billing, and other pharmacy material

X12NStandards for exchange of healthcare insurance and billing information ASTMLab reporting standards and standard guide for content and structure of computer-based patient records

DICOMStandards for exchanging digital radiology images

HL7Inter-application interoperability standards for healthcareLeading U.S. Healthcare Data Interchange SDOs


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X12 HIPAA TransactionsHealth Claims or Equivalent Encounter Information Standard Transaction Form: X12-837 - Health Care ClaimClaims Payment and Remittance Advice Standard Transaction Form: X12-835 - Health Care Claim Payment/Advice StandardHealthcare Claims Status Standard Transaction Form: X12-276/277 - Health Care Claim Status Request and ResponseCoordination of Benefits Standard Transaction Form: X12-837 - Health Care ClaimReferral Certification and Authorization Standard Transaction Form: X12-278 - Health Care Services Review - Request for Review and ResponseEnrollment and Disenrollment in a Health Plan Standard Transaction Form: X12-834Premium Payments Standard Transaction Form: X12-820 Eligibility for a Health Plan Standard Transaction Form: X12-270/271 First Report of Injury Standard Transaction Form: X12-148Claims Attachments Standard Transaction Form: X12-275


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HL7 Standards Referenced in US RegulationsClinical Document Architecture (CDA)Continuity of Care Document (CCD)HL7 EHR-S Implementation Guide: S&I Framework Laboratory Results Interface (LRI) Functional Requirements, Release 1HL7 Implementation Guide for CDA Release 2: Additional CDA R2 Templates - Clinical Documents for Payers Set 1 , Release 1 (US Realm)HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for Clinical Notes (US Realm) DSTU Release 2HL7 Implementation Guide for CDA Release 2: Digital Signatures and Delegation of Rights, Release 1HL7 Implementation Guide for CDA Release 2: Healthcare Associated Infection (HAI) ReportsHL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, Release 1.1 (US Realm)HL7 Implementation Guide for CDA Release 2: National Health Care Surveys (NHCS), Release 1 (US Realm)HL7 Implementation Guide for CDA Release 2: Quality Reporting Document Architecture, DSTU Release 2 (QRDA)HL7 Implementation Guide for CDA Release 2: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1 (US Realm)HL7 Implementation Guide: Data Segmentation for Privacy (DS4P), Release 1HL7 Implementation Guide: Decision Support Service, Release 1.1 (US Realm) Draft Standard for Trial UseHL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health Release 2, Release 1.1 (US Realm)HL7 Version 2.5.1 Implementation Guide: Orders and Observations; Interoperable Laboratory Result Reporting to EHR, Release 1 in ZIP format (1.07 MB)HL7 Version 2.5.1 Implementation Guide: S&I Framework Lab Results Interface, Release 1 (US Realm)HL7 Version 2.5.1 Implementation Guide: S&I Framework Laboratory Orders from EHR, DSTU Release 2 (US Realm)HL7 Version 2.5.1 Implementation Guide: S&I Framework Laboratory Test Compendium Framework R2, DSTU Release 2 (US Realm) in PDF (2.38 MB)HL7 Version 3 Implementation Guide: Context-Aware Knowledge Retrieval (Infobutton) Service-Oriented Architecture Implementation Guide, Release 1HL7 Version 3 Implementation Guide: Family History/Pedigree Interoperability, Release 1HL7 Version 3 Standard: Clinical Decision Support Knowledge Artifact Specification, Release 1.2HL7 Version 3 Standard: Clinical Genomics; Pedigree, Release 1HL7 Version 3 Standard: Context Aware Knowledge Retrieval Application (Infobutton), Knowledge Request, Release 2Messaging Standard Version 2.3.1Messaging Standard Version 2.5.1Vocabulary Specificationshttp://www.hl7.org/implement/standards/hhsifr.cfm?ref=common


Healthcare Interoperability StandardsIEEEInstitute of Electrical and Electronic Engineers

NCPDPNational Council for Prescription Drug Programs

X12NInsurance Subcommittee of X12

ASTMAmerican Society for Testing and Materials

DICOMDigital Imaging and Communications in Medicine

HL7Health Level Seven


Controlled Clinical Terminologies


Controlled Clinical TerminologiesIn addition to standards for data interchange, it is essential to employ a common set of clinical terminology and ontology systems.Clinical problems and diagnoses are usually coded with International Classification of Diseases Coding Systems (ICD-9 or ICD-10)Medical procedures are commonly designated using Current Procedural Terminology Codes (CPT).Clinical observations procedures and observation result values are encoded using a variety of standard, proprietary, and locally defined code. LOINC and SNOMED are widely utilized clinical coding schemes. RxNorm is used for medication identifiers and metadata.


15

www.regenstrief.org/loinc [GO]LOINC


16KMHere is an example of the web site.To download the specification, you can go to the LOINC web site hosted by Regenstrief OR www.loinc.org.

How to get to the web site is on your 3X5 card, you will not need to write this down.

SNOMED


17VS

RxNorm


Standards-Based Health Information Exchange


HIE Standards Conformance Profiles


Revealing assumptions is an essential component of effective communication.Yes, I doplayfootball.Do youplayfootball?

Conformance Profiles Why?


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Conformance Profiles are an effective means of documenting our assumptionsabout message structuresConformance Profiles Why?Do you use HL7?

MSHEVNPID [PD1][ { NK1 } ]Yes, Iuse HL7.

MSHEVNPID[ NK1 ]OBX


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Conformance Profiles provide a language that allows us to unambiguously express our understanding and assumptions about the information in a message structure used in a particular scenario

Conformance Profiles What?


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Conformance Profiles What?Use Case ModelUse CasesUse Case Actors

Exchange ScenariosTriggering EventsReceiver Responsibilities

Content ProfilesElement Usage and CardinalityCoded Element Terminology Bindings


Major Publishers of Health Information Exchange Standards Conformance ProfilesWashington Publishing Company (WPC)WPC is a provider of services, publications and products to entities that develop or consume Electronic Data Interchange Standard Transactions.WPC is the publisher of implementation guides for HIPAA related transactions and standards.WPC has a close affiliation and working relationship with ASC X12 and the Workgroup for Electronic Data Exchange (WEDI)Integrating the Healthcare Enterprise (IHE)IHE brings together healthcare information technology stakeholders to implement standards for communicating patient information efficiently throughout and among healthcare enterprises by developing a framework for interoperability. IHE does not create new standards, but rather drives the adoption of standards to address specific clinical needs. IHE Integration Profiles specify precisely how standards are to be used to address these needs, eliminating ambiguities, reducing configuration and interfacing costs, and ensuring a higher level of practical interoperability.Public Health Data Standards Consortium (PHDSC) The National Center for Health Statistics (NCHS) was instrumental in establishing the Public Health Data Standards Consortium (Consortium) in 1999. The Consortium, which incorporated as a not-for-profit organization in 2003, is a national non-profit member-based partnership of federal, state and local health agencies; national and local professional associations; and public and private sector organizations and individuals. PHDSC participates as an active member of the standards development organizations, Health Level Seven (HL7), Accredited Standards Committee (ASC) X12, and the National Uniform Billing Committee (NUBC) to ensure that the data needs of public health and health services research are incorporated within the standards development process.


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Conformance Profile Authoring


Conformance Profile Authoring


Health Information Standards Compliance


Health Information Standards Compliance


Conformance Profile Authoring ToolsMessage Workbench (MWB)Model Driven Health Tools (MDHT)ART-DECORTrifolia WorkbenchMS Word


Instance Validation TechnologiesHL7 v2 Schema SpecificationMWB Profile ValidationCDA Schema SpecificationMDHT Generated Java ObjectsTrifolia Generated Schematron Logic


Instance Validation ServicesNIST HL7 v2 and v3 CDA ValidationSMART C-CDA CollaborativeCDC PHIN Message Quality FrameworkLantana Consulting Group CDA ValidatorIHE Gazelle HL7 Validator


Instance Validation Commercial ProductsInterface Engine ProductsInterface Engine Product AdaptersTerminology Management Technologies Hi3 Solutions Product Suite


Conformance Validation


Standards Driven Health Information Exchange


Healthcare Interoperability Standards


HIE Conformance Profiles


Conformance Validation


Health Information Exchange Standards and Profiles


Health Information Integration


Reference Information Model Derived Integrated Data Repository


Healthcare Reference Information ModelsCDISC: Operational Data Model (ODM)HL7/CDISC: Biomedical Research Integrated Domain Group (BRIDG) ModelCDC: Public health conceptual data modelFDA: Janus Clinical Trials Repository (CTR)HL7: Reference Information Model


HL7 Version 3.0 Reference Information ModelThe HL7 Reference Information Model is the information model from which all other information models and message specifications are derived.


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HL7 RIM Model Development Process

BX

FECA

DG

10..*

0..*1

0..*1

0..*0..1

0..*1Model IModel IIModel III

ACB

0..*0..*

0..*1

XCB

0..*0..*0..*1

DAB

0..*0..*

0..*1


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HL7 Reference Information ModelThe HL7 Reference Information Model (RIM) is the combined consensus view of information from the perspective of the HL7 working group and the HL7 international affiliates The RIM is the ultimate source from which the information-related content of all HL7 version 3.0 protocol specification standards is drawn. Development of the RIM began in April 1996 and was first deployed for use during the January 1997 HL7 working group meeting.The HL7 RIM was published as an ANSI standard in July 2003 and as an ISO standard in August 2006 .


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Normative R6 RIM Class DiagramVersion 2.44 11/22/2013


RIM Derived Integrated Data Repository


Health Information Integration

Clinical Data RepositoryEnterprise Data WarehouseDisease RegistriesEncounter DataClinical OutcomesResource UtilizationPatient Experience


Healthcare Quality and Performance Monitoring


Healthcare Quality and Performance Monitoring

Clinical Data RepositoryEnterprise Data WarehouseDisease Registries


Quality Measurement in HealthcareQuality measurement in health care is the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards.Quality measures assess care across the full continuum of health care delivery, from the level of individual physicians all the way up to the level of health insurance plans. Hundreds of different quality measures are used in health care. These measures generally fall into four broad categories: 1) structure, 2) process, 3) outcome, and 4) patient experience.


Measurement Development ProcessConvening a committee whose members have expertise on the particular issue to be measured Evaluating the evidence base, including primary research and clinical practice guidelines Reaching consensus on the best measurement approach by considering numerous criteria, including what the proposed measure would evaluate, the scientific soundness of the evidence base, the feasibility of data collection and measurementDeveloping detailed specifications about what will be measured and how Vetting the specifications with key interest groups, such as professional societies or consumer groups Conducting rigorous testing to ensure that the measure works as it was designed Obtaining final approval by the entity charged with developing the measure


Quality Measures Developers

Government agencies, such as the Centers for Medicare and Medicaid Services (CMS) the Agency for Health Care Research and Quality (AHRQ) Private nonprofits, such as the Joint Commission on Accreditation of Health Care Organizations (JCAHO) the National Committee for Quality Assurance (NCQA) For-profit companies, such as Healthgrades and U.S. News and World Report


Standards Driven Healthcare Quality and Performance Measurement


Healthcare Information Integration InfrastructureSolutions


Healthcare Information Integration InfrastructureSolutions


Hi3 Solutions 3500 W. Olive Ave, Suite 300Burbank, CA 91505ww.hi3solutions.com +1 800 918-6520

Healthcare Information Integration Infrastructure Solutions (Hi3 Solutions), is a privately owned, Health Information Technology vendor, headquartered in Burbank, California. Hi3 Solutions, along with its affiliates, provides assistance to public health, healthcare, and health research organizations attempting to utilize informatics standards to overcome barriers to interoperability. The mission of Hi3 Solutions is to assist healthcare organizations with leveraging their information assets to discover and prosper from evidence-based best practices in healthcare through proven information management methods, standards, and techniques.


Hi3 Solutions Product Suite

StandardsConformanceValidatorHealthcareInformationIntegratorHealthcareQualityMonitor


Thank You!

Peace...AMSAbdul-Malik ShakirPresident and Chief Informatics Scientist

Hi3 Solutions3500 West Olive Ave, Suite # 300, Burbank, CA 91505

Skype: +1 9098334661 Mobile: (626) 644-4491Email: [email protected]


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Staging and scales Attribute

Physical object

Substance Events

Organism Body structure

Procedure Clinical finding

SNOMED CT SNOMED CT Components

1. Clinical finding 2. Procedure / intervention 3. Observable entity 4. Body structure 5. Organism 6. Substance 7. Pharmaceutical/

biologic product 8. Specimen 9. Special concept

10. Physical object 11. Physical force 12. Events 13. Environments /

geographical locations 14. Social context 15. Context-dependent

categories 16. Staging and scales 17. Attribute 18. Qualifier value

Concepts

Concepts are organized into these upper level hierarchies

There are two types of relationships between SNOMED CT concepts:

1. IS-A relationships connect concepts in a single hierarchy.

2. Attribute relationships connect concepts in different hierarchies. A few important SNOMED CT attributes: Finding site Procedure site Associated morphology Method

Relationships

IS-A relationships connect concepts in a hierarchy

Arthritis Arthropathy IS-A

Disease concept Disease concept

Pneumonia IS-A

Inflammation ASSOCIATED-MORPHOLOGY Lung structure FINDING-SITE Bronchial structure FINDING-SITE

1785531017

1764202015 Bronchopneumonia (disorder)

1776258010 Bronchopneumonia

Bronchial pneumonia

Fully specified name 396285007Concept ID

This relationship connects concepts in the Disease hierarchy and the Body structure hierarchy: Appendicitis is in the Disease hierarchy. Inflammation is in the Morphologically abnormal structure

section of the Body structure hierarchy.

Attribute relationships connect concepts in different hierarchies

Appendicitis Inflammation ASSOCIATED-MORPHOLOGY

Morphology concept

Disease concept

Attribute

Attributes IS-A relationships Attribute relationships Descriptions Concepts Concept IDs Hierarchies Relationships

Example of hierarchy of Is-a relationships

Disorder by body site

Disorder of musculoskeletal system

Arthropathy

Arthritis

Arthritis of knee

IS-A

IS-A

IS-A

IS-A

IS-A

IS-A

Disorder of body system

Date post:	10-Feb-2017
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Standards Driven Healthcare Information Integration Infrastructure

Data & Analytics