Clinical Data Standards and Data Portability

Nrip NihalaniPlus91 Technologies Pvt. Ltd.Adding Value to Healthcare

Health 2.0 ?• Healthcare is being pushed into

the Information Age – the need for this was all-to-well known due to:– Breaking up of economic divides– Rising Consumerism– Increasing Costs– Safety Concerns

• Health care still is not taking full advantage of the information & communications technologies that have revolutionized other industries

The Patient Empowerment Movement

• Empowering patients to maintain and improve their health

• Enabling clinicians and health-care organizations to provide safer and more evidence-based care

• THIS REQUIRES “creating a dynamic, networked information infrastructure” must reliably ensure the private and secure movement of vital health information at the time that it is needed to the place where it is needed

Examples of Healthcare Info Systems • Information systems are making important contributions

towards the creation of a safer healthcare industry

Benefits of eHealth / Health IT

• Deliver care to people located in remote places ; who do not have access to a hospital, through a tele-consultation.

• Help improve the quality of life of patients by, for e.g., monitoring the condition of the patient at distance at home, rather than in a hospital particularly relevant for elderly, chronically ill persons and people living in remote regions

• Improve the quality of care by providing easier, safer and faster access to patient data, thereby allowing healthcare professionals to “Access the Right Data at the Right Time” and “Make an informed-based diagnosis”

Benefits of eHealth / Health IT

• The availability of information on the patient – such as his medical history, past diseases and interventions, allergies, reaction to medications in an EHR allows healthcare professionals to deliver a treatment tailored to the needs of the patient and thereby reduce risks of complications, adverse reactions etc.

• Clinical Decision Support Systems help in reducing reliance on memory, increasing vigilance, and contributing to standardization of processes

Benefits of eHealth / Health IT

• eHealth tools can help Physicians work more efficiently, by storing patient information in a single location, allowing access to information on the patient faster, taking medical decisions better and faster

• By allowing healthcare professionals to save time, eHealth tools also address the issue of shortage of healthcare professionals in many areas.

New Useful Health IT Solutions - Weekly

Data Sharing – Systems and Entities

• Useful New Health IT Solutions, Softwares, Devices launch every week.

• Also, Various healthcare entities use and modify a patient’s data, structured as well as residual, at different times - physicians, hospitals, laboratories, insurers, researchers and even the patients themselves

• The need for information sharing between different systems is thus critical – Else Data sharing will be a bottleneck and create poor, ineffective processes

Interoperability

• Interoperability means the ability of two or more systems to use and exchange data and human understandable information

• With interoperable systems, data can be exchanged and stored automatically rather than re-typed into the system each time.

• 3 levels of Interoperability1. ORGANISATIONAL INTEROPERABILITY • is the will and ability to work together and exchange

information. It is brought about by an environment composed of laws, policies, and cooperation agreements

Interoperability

2. SEMANTIC INTEROPERABILITY • ensures that the precise meaning of exchanged

information is interpretable by any system or application not initially developed for the same purpose as the system initiating the exchange

3. TECHNICAL INTEROPERABILITY • enables the exchange of information from a technical

standpoint and guarantees:– data security and privacy– data integrity– access to relevant data associated with an identified patient

Interoperability Data Standards

• Interoperability requires the creation, acceptance, and implementation of clinical data standards to ensure that data in one part of the system is available and usable across a variety of clinical settings

• Using standards for data sharing is the first step of interoperability.

• Standards allow a common definition of data and data exchange formats which is essential to enable interoperability both at the technical and semantic level.

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• datastandardsdatastandardsareagreeduponrulesthatallowinformationtobesharedandprocessedinauniformandconsistentmannerforexamplerulesinalanguagesentencesshouldendwithafullstopcommascanbeusedtoseparatepartsofafullsentenceorlistsnamesofindividualsmustbecapitalizedforexamplestandardplugsstandardplugsattachedtodevicesallowthemtobeusedinhomeswheretherearestandardizedsockets

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• Data standards are agreed upon rules – that allow information to be shared and processed in a uniform and consistent manner.

• For example “Rules in a language” • Sentences should end with a fullstop. Commas

can be used to separate parts of a full sentence or lists. Names of individuals must be capitalized.

• For Example “Standard Plugs”:• Standard plugs attached to devices allow them to

be used in homes where there are standardized sockets.

Data Standards

• At a minimum a Data Standard Must Contain:– Interface Specification – Nomenclature Standard

E.g of fulfilling Interoperability

• HL7 - (A Syntax Standard)– Successful standard for the intra-hospital communication

of clinical, administrative and financial data. It supports the active management of key workflows within and across providers through data exchange, e.g. registration of patients, placement of orders and reporting of results.

• SNOMED CT: ( A Semantic Standard) – It is a systematically organised collection of medical

terminology covering most areas of clinical information. It provides a consistent way to index, store, retrieve and aggregate clinical data across specialties and sites of care

• Syntax + Semantics can fulfill Interoperability

CATEGORIES OF DATA STANDARDS• DATA EXCHANGE STANDARDS HL7, DICOM– Allow transactions to flow between systems/organizations

• TERMINOLOGY SNOMED, ICD-9– Vocabularies, provide specific codes for clinical concepts

• DOCUMENT CCR– Indicate what type of information is included in a

document and where can it be found.• APPLICATION CCOW– Determine the way business rules are implemented and

software systems interact

STANDARDS FOLLOWING QUALITIES:

• TRANSPARENT: should be easily available for all stakeholders

• RELEVANT AND USER-DRIVEN: should be based on real-world business use cases

• APPROPRIATE: should provide reasoning behind the choice of implementation technologies

• EFFECTIVE: should reuse existing work as well as global and ISO/IEC Base Standards as much as possible

STANDARDS FOLLOWING QUALITIES:

• THOROUGH: should address eHealth interoperability in relation to application functionality, data integrity and availability, patients’ privacy and safety and performance aspects

• COLLABORATIVE: setting procedures should maintain a cooperative spirit

• TESTING AND VALIDATION: should have clear criteria that can be tested in order to validate interoperability

Standards for Standards

• Standards must be made such that they– Ensure applications developed for various

platforms catering to different healthcare processes will work for another

– Enable the movement of a datastore (database or otherwise) from one eHealth solution to another.

– Enable reversibility, moving data from software systems to Non- software processes

Nomenclature

• Data Portability - is the process by which the is medical record in whole or in part can be transferred between two Electronic Systems

• Structured Field - is a data element in a medical record which is defined and has a defined structure

• Residual Data is The data in a medical record that is not defined by structured fields and is important information for patient care

Data Set forming a Medical Record• A longitudinal

representation of a patient medical record: – Practice Management

Data– Cumulative Patient

Profile– Extended Patient

Information

• This is an example of a Patient Data Standard Set for Data Portability

Practice Management Data

• Appointments and Related Information• Patient Demographics• Patient Identification

Cumulative Patient Profile• Family History • Past Health • Problem List • Clinical Care Data• Risk Factor • Medication • Immunization • Allergies and Adverse

Reaction • Alerts and Special

Needs

Extended Patient Information• Laboratory Results • Special Notes by the

physician/surgeon• External Reports

received – Images – Scanned or Transcribed

documents – Emails from the patient – Text of Telephonic

conversations between the Patient and Physician

Thanks for Viewing this Presentation

If you’d wish for me further help, please contact me

Blog: http://wirelysis.blogspot.comTwitter: @nripEmail: n.nihalani@plus91.inCorporate: http://www.plus91.in

References

• Clinical Data Standards in Healthcare - ihealth Reports

• http://www.scoop.it/t/healthcare-technology• COCIR eHealth Toolkit 2012• http://technology4doctors.blogspot.com• Connecting for Health – Markle Foundation

Appendix: Committee-itis