Objectives To define data and to appreciate the difference
between data and information. To understand the importance central
role of standards in the complex worlds of business, IT and health
care. To appreciate the benefits in applying standards in HIS. To
be familiar with the main standards for coding medical information.
To be familiar with the main standard for passing medical
information between systems HL7. To be familiar with the main
standard for passing medical images between systems DICOM. Main
Reference Guide to Health Informatics, Coiera (2003) Chapters 16,
17 and 18.
Slide 3
Data In the 1960s computers were used for Data Processing
Mundane, repetitive processes on large volumes of data Typical data
processes: Classification. Rearranging/Sorting. Aggregating.
Performing Calculations. Selection. Information Data forms Example
Most large information systems are based on databases structured
storage of large volumes of data Data inputs transformed to more
meaningful data outputs (information)
Slide 4
Forms of Data Typical forms include Data typeIn a computer In
the Real World Alphanumeric dataNumbers, letters and other
charactersWhat we read Image datagraphic images and picturesWhat we
see Audio dataSound, noise or tones What we hear Video dataMoving
images or picturesWhat we see and hear An Information System
Information Cognitive Process Meaningful Value
Slide 5
Monitor data Ventilator data Gas analyser data Infusion pump
data
Slide 6
Data, Information and Knowledge Information Data forms
Knowledge informs Wisdom insight Explicit Managed by Systems Tacit
Managed by People
Slide 7
What do we mean by a Standard? Types of Standards: Approved
standards: A standard approved by a recognised government or
industry-funded body. It will be tightly defined and may be
mandated by law. De-facto standards: Standards which have emerged
to become recognised as an industry- wide standard without
regulation. Betamax vs. VHS See http://en.wikipedia.org/wiki/dvd
for details of the Betamax vs. VHS war of the 1990s and how IBM
helped to avoid a repeat with the DVD
standard.http://en.wikipedia.org/wiki/dvd Images from
http://en.wikipedia.org DVD A standard - a definition or format
established by consensus and approved by a recognized body
Slide 8
Pharmacy Standards A Pharmacy without any standards might look
like ?!!! 8
Slide 9
Challenge How many standards relate to a packet of..
Slide 10
Who sets standards?
Slide 11
Standards Bodies International Standards Organisation (ISO)
UN/EDIFACT (United Nations Directories for Electronic Data
Interchange for Administration, Commerce and Transport) GS1 a
merger of US Uniform Code Council and European Article Numbering
(EAN) European Committee for Standardisation (CEN) ANSI (American
National Standards Institute) GCI (Global Commerce Initiative) ISBN
(International Standard Book Number) ISSN (International Standard
Serial Number)
Standards Ownership Sometimes standards are controlled by
private corporations (the Windows GUI interface is owned by
Microsoft). Sometimes standards are controlled by open, public, or
non- profit organizations (e.g. the schema for XML is recommended
by W3C the World Wide Web Consortium - the main international
standards organization for the World Wide Web).
Slide 14
Some examples of standards ISO 9001 TickIT W3 consortium FDA
510k for medical devices HL7 SNOMED-CT A full system implementation
involves a combination of many of these hardware, software, working
practice
Slide 15
Medical Coding Standards Medical coding is the transformation
of narrative descriptions of diseases, injuries, and healthcare
procedures into numeric or alphanumeric designations. Examples of
Medical Coding Standards: Read Codes SNOMED ICD-10 Ref:
http://www.ahima.org/coding/http://www.ahima.org/coding/
Slide 16
Read Codes In the UK, Dr James Read's personal code set
developed in the 1980s and used in some early computerisation.
Adopted by NHS 1990 Summarization and patient care applications
Directed acyclic graph Care-giver level of expression Natural
clinical terms Used in many computerised systems
Slide 17
Read Diagnosis Codes All begin with a specific letter relating
to a body system For Example G for circulatory system They then
break to into parts of the system For example G3 for IHD Then more
specifically into other codes such as G30 MI
Slide 18
Read Diagnosis Codes AInfectious Diseases B Neoplasms
CEndocrine, Nutrition, & Metabolic disease D Blood & blood
forming organs EMental & behavioural Disturbances FNervous
System & Sense.Organs GCirculatory Disorders HRespiratory
System Disorders J Digestive System Disorders KGenitourinary System
Disorders LComplications of Pregnancy and Childbirth MSkin &
Subcutaneous Tissue disorders NMusculoskeletal and Corrective
tissue disorders PCongenital anomalies QPeri-natal conditions
RSymptoms, signs and ill defined conditions SInjury or poisoning
TCauses of injury or poisoning U(x) External causes of morbidity
& mortality
Slide 19
Read Codes - Examples 182..A Y7CmDC P Chest pain Xa0wWK Y7CmFC
P Pleurodynia 182Z.A Y7CmGC P Chest pain NOS Xa0wWK Y7CmIC S
Painful breathing -pleurodynia 1826.A Y7CmJC P Parasternal pain
1823.A Y7CmLC P Precordial pain 1821.A Y7CmNC P Chest pain not
present X75rWC Y7CmYC P Pain in heart 1829.A Y7CmZC P Retrosternal
pain
Slide 20
SNOMED Systematized Nomenclature of Medicine Owned by College
of American Pathologists Organized into axes Synonyms allowed
Assemble complex terms from axes SNOMED-RT (Reference Terminology)
under development SNOMED-CT (Clinical Terms) under development
incorporates UK Read Codes (known as Clinical Terms)
Slide 21
SNOMED - Axes D - Diseases C - Drugs F - Function L - Living
Organisms X - Manufacturers G - Modifiers M - Morphology J -
Occupations A - Physical Agents P - Procedures S - Social Context T
- Topography
SNOMED Browser The SNOMED Browser is available at
www.snomedbrowser.comwww.snomedbrowser.com
Slide 24
International Classification of Diseases ICD The ICD is the
international standard diagnostic classification for all general
epidemiological, many health management purposes and clinical use
It is used to classify diseases and other health problems recorded
on many types of health and vital records including death
certificates and health records. The International Classification
of Diseases is published by the World Health Organization (WHO) and
used worldwide for morbidity and mortality statistics,
reimbursement systems, and automated decision support in medicine.
The ICD is revised periodically and is currently in its tenth
edition ICD-10. Ref.:
http://www.who.int/classifications/icd/implementation/en/index.htmlhttp://www.who.int/classifications/icd/implementation/en/index.html
Slide 25
ICD-10 Online Available online
http://apps.who.int/classifications/icd10/browse/2010/enhttp://apps.who.int/classifications/icd10/browse/2010/en
Slide 26
Which Coding System?
Slide 27
Messaging Standard
Slide 28
What is message passing? Traditional Royal Mail
Slide 29
HIS HL7 What is message passing? Electronic HL7 Gateway or IEs
Result Report
Slide 30
HL7 Health Language 7 HL7 is the international standard for
electronic data exchange in healthcare. HL7 defines the format and
content of the messages that pass between medical applications. HL7
v2.x defines messages as a string of fields. HL7 v3 defines
messages within an XML schema. The 7 in HL7 comes from the 7 layer
Open Systems Interconnection (OSI) Reference Model - one of the
founding principles for networked computer architectures.
http://en.wikipedia.org/wiki/OSI_model
Slide 31
Imaging Exchange Standards
Slide 32
Digital Imaging and Communications in Medicine DICOM DICOM is a
global Information Technology standard that is used in hospitals
worldwide as a standard for handling, storing, printing, and
transmitting information in medical imaging. Its current structure
was developed in 1993 and there are many revisions every year. It
is designed to ensure the interoperability of systems used to:
Produce, Store, Display, Process, Send, Retrieve, Query or Print
medical images. Ref:
http://dicom.nema.org/http://dicom.nema.org/
Slide 33
DICOM It is used to process all images in healthcare systems.
This includes but not limited to: X-Ray, CT, MRI, Angiograph,
Ultrasound, Tomography etc.
Slide 34
LOINC Logical Observation Identifiers Names and Codes (LOINC)
Standard for identifying medical laboratory observations Developed
and is maintained by theRegenstrief Institute 34