Basic Health Data Standards and Information Exchange

Networking and Health Information Exchange Basic Health Data Standards Lecture e This material (Comp 9 Unit 4) was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by Normandale Community College, funded under Award Number 90WT0003. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

Basic Health Data Standards Learning Objectives 1. Understand why it is necessary to use a common set of data elements with common names to be able to exchange and understand data from other places 2. Understand what is meant by semantic interoperability 3. Understand many of the sets of controlled vocabularies in use today how they are used and who requires their use 2

Basic Health Data Standards Learning Objectives (2) 4. Understand the use, purpose and interrelation among sets of controlled vocabularies in use today 5. Identify the more common controlled vocabularies in use today: ICD, CPT, DRG, NDC, RxNorm, and LOINC, 6. identify the more common controlled vocabularies in use today: SNOMED, MEDCIN, MedDRA, Nursing terminologies, MeSH and UMLS, 7. Understand data elements; attributes of data elements 3

Basic Health Data Standards Learning Objectives (3) 8. Understand contribution of master meta-dictionary of data elements to semantic interoperability Explain how data structures can be built from basic data components 10. Explain how templates and archetypes facilitate networking and information interchange and 11. Discuss Clinical Data Architecture (CDA), Continuity of Care Document (CCD), and Continuity of Care Record (CCR) Standards 9. 4

Building Data Structures Starting with well-defined, finely-grained data elements, it is useful to build data structures for consistency in content, collection, and presentation. Structures permit binding related data components into a single structure. This concept is familiar because we see it on paper forms. Examples include person names and addresses as well as many health data components. The scope ranges from simple compound elements to data collection protocols. 5

Compound Data Elements Attributes similar to data elements Examples include blood pressure, heart murmur, titers Expressed as Templates (HL7) Archetypes (openEHR) Common Message Element Type (CMET) Clinical Statement Use XML syntax 6

Complex Data Elements Attributes similar to data elements Examples include drug sensitivity, microbiology results, body mass index, pulmonary functional tests May include description logic and mathematical calculations May invoke an action 7

Common Message Element Type Administrative complex data elements defined by groups within HL7. Examples include person names, addresses, telephone numbers, etc. Support international variations Reusable components Can be reused without redefining the data object 8

What Is An HL7 Template? Formally, an HL7 Template is a registered set of constraints on a balloted HL7 static model. HL7 balloted static models are all derived from the HL7 Reference Information Model. Templates are used in the HL7 standards Clinical Document Architecture. 9

Types of Constraints HL7 Templates constrain both structure and content Structural constraints further restrict model elements such as cardinality, new class clones derived from balloted class clones, their attributes, relationships and HL7 data-types Non-structural constraints include valid value set expressions and conditional constraints affecting more than one model element Object Constraint Language may be used to define constraints on the model 10

Document Templates Applied to the CDA schema to produce a desired level of information structure and content for a particular purpose A particular type of document Various templates structures may be use as document templates 11

Atomic Concept Definition Templates A template applied to part of a static model that specifies the structure and permitted coding to completely define a particular clinical concept Atomic concept definition templates are designed to be reusable in many different contexts The stereotypical example is Blood Pressure, composed of two numerical measures with optional additional information about patient positioning, cuff size, etc. 12

Computed Measures Templates A template applied to an observation that has multiple components. The constraints apply to the content and relationships of the components, but also describe the computational algorithm that derives a computed measure from the component measures 13

How Are Templates Created? Different approaches have been used A static model derived from a balloted static model using the HL7 Design tools Derive and then hand refine a static model schema New tools that start with a balloted static model and add constraints Schematron may be use to validate business rules o Rule-based validation language 14

Archetypes Archetype denotes a model defining some domain concept, expressed using constraints on instance structures of an underlying reference model Uses Archetype Description Language Similar to XML Easily redefined in XML 15

Detailed Clinical Model Combines knowledge, data specification, and terminology Conceptual specification of the semantics of discrete structured clinical information Defines data elements and attributes, including the possible values Provides unambiguous detail that cross clinical; permits consistent use of medical data; is reusable 16

DCM Template Examples Apgar Score Barthel Index Blood Pressure Body Height Body Temperature Body Weight Glasgow Coma Score Pulse Rate Respiration 17

Clinical Information Modeling Initiative (CIMI) Organized in 2011 International with participation from SDOs, vendors, providers, governments, and interested parties Dedicated to providing a common format for detailed specifications for the representation of health information content 18

Basic Health Data Standards Summary Lecture e Introduction to the concept and kinds of data structures Types of data structures including complex and compound structures Groups creating data structures include HL7 (CMETS, templates, clinical statements, CDAs), CEN, ISO, openEHR 19

Basic Health Data Standards References Lecture e References Detailed Clinical Models. (n.d.). Retrieved from HL7 International website: http://wiki.hl7.org/index.php?title=Detailed_Clinical_Models Acknowledgement: Material used in this lecture comes from the following sources Health Level Seven International. (n.d.). Retrieved fromHealth Level Seven International website: www.hl7.org openEHR. (n.d.). Retrieved fromopenEHR website: www.openehr.org International Organization for Standardization. (n.d.). Retrieved fromISO website: www.iso.org/iso/iso_technical_committee?commid=54960 cen - European Committee for Standardization. (n.d.). Retrieved fromCEN website: www.cen.eu/cen/Sectors/TechnicalCommitteesWorkshops/CENTechnicalCommittees/ Pages/default.aspx?param=6232&title=CEN/TC%20251 20

Basic Health Data Standards Lecture e This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by Normandale Community College, funded under Award Number 90WT0003. 21