Post on 07-May-2015
Standards Influenced Research Information Systems
Interoperability
Session Two: Interoperability Specifications
AbdulMalik Shakir, Information Management StrategistCity of Hope, Duarte, CA
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About Me
Abdul-Malik Shakir
• Information Management Strategist with City of Hope• Principal Consultant with Shakir Consulting• HL7 Member since 1991
– Co-Chair of the HL7 Education Workgroup– Member of the HL7:
• Architectural Review Board• Public Health and Emergency Response Workgroup• Regulated Clinical Research Information Management Workgroup• Modeling and Methodology Workgroup
• Member of the BRIDG Board of Directors since January 2010• Modeling Facilitator for CTR&R, SAP, STDM, and caEHR
May 2010
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Research Informatics Systems Engineering
Research Informatics Systems Engineering
Systems Analysis and
Quality Assurance
Solutions Architecture and
Standards
Database Administration and
Inter-system Interface
Solutions Engineering and
Support
Research Informatics Cores
· Biomedical Research Informatics
· Translational Research Informatics
· Clinical Research Informatics
Research Admin/Operations
· Clinical Research Information Mgt
· Clinical Trial Operations
· Cancer Registry
External Research Entities
City of Hope Research
Community
External Research
Community
· National Comprehensive Cancer Network
· National Center for Research Resources
· American Society of Clinical Oncology
Information Technology
Services
Standards Development Organizations
May 2010
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Session Overview• Health Information Exchange Standards
• Informatics Standards Coordination
• HITSP Interoperability Specifications
• Leading Standards Developing Organizations
• X12N and Health Level Seven
• HL7 v3 Reference Information Model
• Controlled Clinical Terminologies
• Health Information Integration Infrastructure
• COH Research Information Factory
May 2010
Health Information Exchange (HIE)
Pharmacies
Physicians
Testing OrganizationsLab/Images
Hospitals
Payors
Employers
County/Community Entities
Patients/ConsumersGovernmentMedicare/Medicaid
Lab results
Patient Data
Orders
ResultsImages
Eligibility
Referral ProcessClaim Status
Claims/Prescriptions
Referral Process
Claim/Status
Health InformationInsurance Updates
Eligibility
Medical Records
Enrollment
Mental Health
Family Planning
Medical Society
Public Health
Leading Health Information Exchange Standards
Healthcare Information System
Clinical System
Images, pictures
Bedside Instruments
Billing, claimsreimbursement
Adverse Events Reporting
Immunization Database
MaterialsManagement
Agency Reporting
ProviderRepository
HL7
HL7
HL7, X12N
HL7, X12N
HL7
HL7
DICOM
IEEE MIB,ASTM
X12N / HL7 (Non-US only)
X12N
Waveforms
Retail Pharmacy Orders & Reimbursement
NCPDP
Informatics Standards Coordination Bodies
American National Standards Institute
ANSI
Standard Developing Organizations
SDO
Standard Developing Organizations
SDO
Standard Developing Organizations
SDO
Standard Developing Organizations
SDOs
Accred
its
Healthcare InteroperabilityStandards
Pro
duce
International Standards Organization
ISO / IEC
Liaison
International Healthcare Interoperability
Standards
Acc
redi
ts
Healthcare Information Technology Standards Panel
HITSP
Office of the National Coordinator for Health
Information Technology
ONC
Fo
rmed
Interoperability Specifications
Pro
duce
Adm
inisters
• IS 01 Electronic Health Record Laboratory Results Reporting
• IS 02 HITSP Biosurveillance Interoperability Specification
• IS 03 HITSP Consumer Empowerment and Access to Clinical Information via Networks Interoperability Specification
• IS 04 HITSP Emergency Responder Electronic Health Record Interoperability Specification
• IS 05 HITSP Consumer Empowerment and Access to Clinical Information via Media Interoperability Specification
• IS 06 HITSP Quality Interoperability Specification
• IS 07 HITSP Medication Management Interoperability Specification
• IS 08 Personalized Healthcare Interoperability Specification
• IS 09 Consultations and Transfers of Care Interoperability Specification
• IS 10 Immunizations and Response Management Interoperability Specification
• IS 11 Public Health Case Reporting Interoperability Specification
• IS 12 Patient-Provider Secure Messaging Interoperability Specification
• IS 77 Remote Monitoring (RMON) Interoperability Specification
• IS 91 Maternal and Child Health Interoperability Specification
• IS 92 Newborn Screening Interoperability Specification
• IS 98 Medical Home Interoperability Specification
• IS 107 EHR Centric Interoperability Specification
• IS 158 Clinical Research Interoperability Specification
HITSP Interoperability Specifications
IEEEInstitute 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
Leading HIE Standards Developing Organizations (SDO)
Leading Healthcare Data Interchange SDOs
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 and other waveform data
HL7Inter-application interoperability
standards for healthcare
• X12N and HL7 are standards development organizations accredited by the American National Standards Institute (ANSI).
• Each organization adheres to a strict and well-defined set of operating procedures that ensures consensus, openness and balance of interest.
• X12N develops specification that enable the electronic interchange of healthcare insurance and claims processing data.
• HL7 develops standards that enable disparate healthcare applications to exchange key sets of clinical and administrative data.
X12N and HL7
HL7Clinical / Administrative
X12NInsurance / Billing
ASC X12 brings together business and industry professionals in a cross-industry forum to develop and support electronic data exchange standards and related documents for the national and international marketplace to enhance business processes, reduce costs and expand organizational reach
ASC X12 Organization
X12 HIPAA Transactions• Health Claims or Equivalent Encounter Information Standard Transaction Form: X12-837 -
Health Care Claim
• Claims Payment and Remittance Advice Standard Transaction Form: X12-835 - Health Care
Claim Payment/Advice Standard
• Healthcare Claims Status Standard Transaction Form: X12-276/277 - Health Care Claim Status
Request and Response
• Coordination of Benefits Standard Transaction Form: X12-837 - Health Care Claim
• Referral Certification and Authorization Standard Transaction Form: X12-278 - Health Care
Services Review - Request for Review and Response
• Enrollment and Disenrollment in a Health Plan Standard Transaction Form: X12-834
• Premium Payments Standard Transaction Form: X12-820
• Eligibility for a Health Plan Standard Transaction Form: X12-270/271
• First Report of Injury Standard Transaction Form: X12-148
• Claims Attachments Standard Transaction Form: X12-275
Health Level Seven
• Health Level Seven (HL7) is an American National Standards Institute (ANSI) Accredited Standards Developer.
• The mission of HL7 is to provide standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among its stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients.
HL7 International Affiliates
1. Affiliates Council 2. Anatomic Pathology 3. Architectural Review Board 4. Arden Syntax 5. Attachments 6. Child Health 7. Clinical Context Object Workgroup 8. Clinical Decision Support 9. Clinical Genomics 10. Clinical Interoperability Council 11. Clinical Statement 12. Common Message Element Types 13. Community Based Collaborative Care14. Domain Experts Steering Division 15. Dynamic Model 16. Education 17. Electronic Health Records 18. Electronic Services 19. Emergency Care20. Financial Management 21. Foundation and Technology Steering Division 22. Generation of Anesthesia Standards23. Governance and Operations Government Projects 24. Health Care Devices 25. Imaging Integration 26. Implementable Technology Specifications27. Implementation / Conformance
28. Infrastructure and Messaging 29. International Mentoring Committee 30. Marketing Modeling and Methodology 31. Orders and Observations 32. Outreach Committee for Clinical Research33. Patient Administration 34. Patient Care 35. Patient Safety 36. Pharmacy 37. Process Improvement 38. Project Services 39. Public Health and Emergency Response 40. Publishing 41. Regulated Clinical Research Information Management 42. RIMBAA 43. Scheduling and Logistics 44. Security 45. Services Oriented Architecture 46. Structure and Semantic Design Steering Division 47. Structured Documents 48. Technical and Support Services Steering Division 49. Technical Steering Committee 50. Templates 51. Terminfo Project 52. Tooling 53. Vocabulary
As of January 2009
HL7 Workgroups
The Family of HL7 Standards
• Standardization of knowledge representation (Arden / GELLO) • Specification of components for context management (CMA)• Standardization of clinical document structures (CDA)• Electronic Health Record System Functional Model (EHR-S)• Application protocol for electronic data exchange in healthcare
environments (messages)• Support for use of healthcare services in a Service Oriented
Architecture (SOA)• Specification of robust vocabulary definitions for use in clinical
messages and documents• Work in the area of security, privacy, confidentiality, and
accountability
Divide and Conquer / Component Reuse
DATA
Next of Kin (NK 1)
Insurance (IN1)
Patient Visit ( PV1) Patient
Demographics ( PID)
Guarantor( GT 1)
NK 1
IN1
PV1
PID
GT 1OBR
OBX
Next of KIN(NK 1)
Patient Visit(PV1)
Patient Demographics
( PID)
Abstract Message Specification
MSH Message HeaderEVNEvent TypePID Patient Identification [PD1] Additional Demographics[ { NK1 } ] Next of Kin /Associated PartiesPV1 Patient Visit[ PV2 ] Patient Visit - Additional Info.
…[ { GT1 } ] Guarantor[ { IN1 Insurance [ IN2 ] Insurance Additional Info. [ IN3 ] Insurance Add'l Info - Cert. } ]
…
[ ] optional
{ } may repeat
Segment ID Segment Name
MSH Segment DefinitionSEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT NAME
1 1 ST R 00001 Field Separator2 4 ST R 00002 Encoding Characters3 180 HD O 00003 Sending Application4 180 HD O 00004 Sending Facility5 180 HD O 00005 Receiving Application6 180 HD O 00006 Receiving Facility7 26 TS O 00007 Date/Time Of Message8 40 ST O 00008 Security9 7 CM R 00009 Message Type10 20 ST R 00010 Message Control ID11 3 PT R 00011 Processing ID12 8 ID R 0104 00012 Version ID13 15 NM O 00013 Sequence Number14 180 ST O 00014 Continuation Pointer15 2 ID O 0155 00015 Accept Acknowledgment Type16 2 ID O 0155 00016 Application Ack. Type17 2 ID O 00017 Country Code18 6 ID O Y/3 0211 00692 Character Set19 60 CE O 00693 Principal Language Of Message
MSH Segment DefinitionSEQ LEN DT OPT RP/# TBL# ITEM # ELEMENT NAME
1 1 ST R 00001 Field Separator2 4 ST R 00002 Encoding Characters3 180 HD O 00003 Sending Application4 180 HD O 00004 Sending Facility5 180 HD O 00005 Receiving Application6 180 HD O 00006 Receiving Facility7 26 TS O 00007 Date/Time Of Message8 40 ST O 00008 Security9 7 CM R 00009 Message Type10 20 ST R 00010 Message Control ID11 3 PT R 00011 Processing ID12 8 ID R 0104 00012 Version ID13 15 NM O 00013 Sequence Number14 180 ST O 00014 Continuation Pointer15 2 ID O 0155 00015 Accept Acknowledgment Type16 2 ID O 0155 00016 Application Ack. Type17 2 ID O 00017 Country Code18 6 ID O Y/3 0211 00692 Character Set19 60 CE O 00693 Principal Language Of Message
SEQ - position within segment
LEN - length of field
DT - data type for field
OPT - optionality for field
RP/# - repeatability
TBL# - table number for codes
ITEM# - HL7 element number
ELEMENT NAME - name
Standards Moving in Ever-Increasing CirclesInternational
National
Inter-Enterprise
Enterprise
InstitutionSource: Gartner
HL7 v3.0 Foundational Artifacts
ReferenceInformationModel
ReferenceInformationModel
DatatypeSpecificationDatatypeSpecification
VocabularySpecificationVocabularySpecification
The HL7 Reference Information Model is the information model from which all other information models and message specifications are derived.
The HL7 Vocabulary Specification defines the set of all concepts that can be taken as valid values in an instance of a coded attribute or data type property.
The HL7 Datatype Specification defines the structural format of the data carried in an attribute and influences the set of allowable values an attribute may assume.
HL7 RIM Class Diagram
• Entitya physical thing or an organization/group of physical things capable of participating in Acts. This includes living subjects, organizations, material, and places.
• Acta discernible action of interest in the healthcare domain. An instance of Act is a record of that action. Acts definitions (master files), orders, plans, and performance records (events) are all represented by an instance of Act.
RIM Entity and Act
Entity Act
RIM Core Classes
Entity
classCode : CSdeterminerCode: CScode: CEstatusCode : CSid : II
Role
classCode : CScode: CEeffectiveTime : IVL<TS>statusCode : CSid : II
Participation
typeCode : CStime : IVL<TS>statusCode : CS
Act
classCode : CSmoodCode: CScode: CDstatusCode : CSeffectiveTime : GTSid : II
0..1
0..*1
0..*
1
0..*
Role Link
typeCode : CSeffectiveTime : IVL<TS>
Act Relationship
typeCode : CS
0..1
0..*
plays
scopes
1 1
0..* 0..*
1 1
0..* 0..*
Definition of RIM Core Classes• Act – a discernible action of interest in the healthcare domain. An instance of Act is a
record of that action. Acts definitions (master files), orders, plans, and performance records (events) are all represented by an instance of Act.
• Act relationship – an association between two Acts. This includes Act to Act associations such as collector/component, predecessor/successor, and cause/outcome. The semantics of the association is captured by the Act Relationship attributes.
• Entity - a physical thing or an organization/group of physical things capable of participating in Acts. This includes living subjects, organizations, material, and places.
• Participation – an association between a Role and an Act representing the function assumed by the Role within the context of the Act. A single Role may participate in multiple Acts and a single Act may have multiple participating Roles. A single Participation is always an association between a particular Role and a particular Act.
• Role – a classification/specialization of an Entity defined by the relationship of the playing Entity to a scoping Entity. An example of Role is “Employee”. An employee is a classification attributed to a person which has an employment relationship with an organization (Employer).
• Role Link – An association between two Roles. It is used to capture relationships that exists between Entities other than the scoping relationships. A single Role may have a Role Link with multiple other Roles. A single Role Link is always between two distinct instances of Role.
HL7 RIM Class Diagram
Controlled Clinical Terminologies
“…Behold, they are one people, and they have all one language; and this is only the beginning of what they will do; and nothing that they propose to do
will now be impossible for them.” ~ Genesis 11:6
Controlled Clinical Terminologies
• In 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.
SNOMED
HL7 Common Terminology Services Project Scope
• Establish a common model for terminology, and how it is related to meta-data (models of data) and data (the information itself)
• Specify both an information and functional model that addresses the relationships and use of terminology in data – how data elements are constrained to ranges of possible codes, how selection lists built and queried, how terminological information is validated.
• Specify the interactions between terminology providers and consumers – how users can submit unambiguous requests for corrections and extensions and how revisions to content are identified, distributed and integrated into running systems.
• Specify how mapping between compatible terminologies and data models is defined, exchanged and revised.
• Specify how logic-based terminologies can be queried about subsumption, classification and inferred relationships.
HL7 CTS II Conceptual Data Model
Standards Influenced Research Information Systems Interoperability
CTS II Simplified View
May 2010 Slied: 36 of 29
ParentConcept
VocabularyDomain
name : Stringdescription : String
CodedConcept
conceptCode : StringconceptDesignation : String
0..*0..*
ValueSet
name : Stringdescription : StringdefiningExpression : String
0..*
0..*
0..*
0..*0..*
0..*0..*
0..*
includes
CodeSystem
identifier : OIDname : Stringdescription : String
0..*0..*
0..*
0..1
0..*
0..1
based on
ValueSetContext
contextExpression : String
Standards Influenced Research Information Systems Interoperability
Vocabulary Binding
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Vocabulary TermsVocabulary BindingInformation Model
Class
Attribute
Vocabulary Domain
Value Set CodedConcept
CodeSystem
1
0..* 0..*
0..1
0..10..*
0..*
0..*
0..* 0..*
0..*
1
0..*
0..1
Healthcare Information Integration Infrastructure
DataCollection
InboundInformationProcessing
Quality AssuranceServices
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Analysis, Visualization,And Reporting
Integrated Data Repository
Business Intelligence
Environment
Healthcare Information Integration Infrastructure
MetadataServices
TerminologyServices
HL7 ReferenceInformation Model
Electronic Data Interchange
DataCollection
InboundInformationProcessing
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Healthcare Information Integration Infrastructure
Syntactic Interoperability
DataCollection
InboundInformationProcessing
Quality AssuranceServices
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Healthcare Information Integration Infrastructure
MetadataServices
Semantic Interoperability
DataCollection
InboundInformationProcessing
Quality AssuranceServices
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Healthcare Information Integration Infrastructure
MetadataServices
TerminologyServices
Semantic Data Integration
DataCollection
InboundInformationProcessing
Quality AssuranceServices
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Integrated Data Repository
Healthcare Information Integration Infrastructure
MetadataServices
TerminologyServices
HL7 ReferenceInformation Model
Semantically Sound Business Intelligence
DataCollection
InboundInformationProcessing
Quality AssuranceServices
OutboundInformationProcessing
Source HealthcareInformation System
Case ManagementInformation System
CaseManagement
Information Transformation
Services
Analysis, Visualization,And Reporting
Integrated Data Repository
Business Intelligence
Environment
Healthcare Information Integration Infrastructure
MetadataServices
TerminologyServices
HL7 ReferenceInformation Model
COH Research Information Factory(Current State)
Information Technology Services Research Information Factory
COH Clinical and Administrative
Systems
Enterprise Data Warehouse
ETL
Interface Engine
Research Information
Systems
Reporting Services
COH Research Information Factory(Future State)
Information Technology Services Research Information Factory
COH Clinical and Administrative
Systems
Enterprise Data Warehouse
ETL
Interface Engine
Research Integrated Data
Repository
Research Information Systems and
Services
Research Business Intelligence
RIF Architectural Redesign
• Research Information Systems and ServicesReduce redundancies and inefficiencies in the existing application portfolio by adopting a multi-tiered service oriented architectural pattern
• Integrated Data RepositoryImplement an operational data store and data access services for shared research related data based upon the HL7 Reference Information Model
• Research Business IntelligenceExpand research analytic capabilities by implementing star schema dimensional datamart databases, data access services, and information delivery applications.
COH Research Information Factory(Future State)
Information Technology Services Research Information Factory
COH Clinical and Administrative
Systems
Enterprise Data Warehouse
ETL
Interface Engine
Research Integrated Data
Repository
Research Information Systems and
Services
Research Business Intelligence
AbdulMalik ShakirInformation Management Strategist
City of Hope1500 E. Duarte Road
Duarte, CA 91010
Office: (626) 256-4673 x63160 Mobile: (626) 644-4491Email: AShakir@COH.org