Chapter 3 Health Information Interchange

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Chapter 3Health Information Interchange

• Yung-Fu Chen, Ph.D.
• Department of Health Services Management, China
  Medical University

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Outline

• Health is information intensive it has many
  disparate groups with multiple perspectives and
  subcultures. Each group sees things slightly
  different, but they must all capture,
  communicate, reliably retrieve and re-use
  information between each other and across
  multiple settings. This chapter examines some of
  the methods used to represent data and to enable
  information interchange across the health
  spectrum.

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Standards

• Standards make an enormous contribution to most
  aspects of our lives although very often, that
  contribution is invisible. It is when there is an
  absence of standards that their importance is
  brought home.

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Introduction

• There are two powerful drivers shaping the face
  of health and the manner in which data are
  collected
• Electronic health record
• The need to share data seamlessly across
  geographical settings
• This should enable clinicians to deliver
  efficient, effective and safer care to patients.
  However, one of the critical issues arising from
  this version is the requirement for standards
  across all platforms and technologies

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What are standards

• Standards contribute to making the development,
  manufacturing and supply of products and services
  more efficiently and safer
• The development of standards for HIM and IT that
  are compatible with the international standards
  activity is necessary for all nations
  contemplating the adoption of technology in
  healthcare
• Standards are best applied where there is a
  genuine need and some gains can be realized

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International Standard Developer

• ISO is the major international standards
  development organization
• A network of the national standards institutes of
  148 countries
• Many of its members are part of the governmental
  structure of their countries, or are mandated by
  their government. Others come from the private
  sector from partnerships of industry association

• Digital Imaging and Communications in Medicine
  (DICOM) Standard Committee is another
  international committee
• Its goals are to achieve compatibility and to
  improve workflow efficiency between imaging
  system and other information systems in
  healthcare environments worldwide
• European Committee for Standardarization

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Type of Standards Needed

• Standards are required for interoperability and
  integration
• Multiple standards are necessary and these can be
  categorized into 4 main areas
• Systems
• Vocabulary
• Messaging
• Security

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System Standards

• The need for interaction and common standards
  across systems to
• Inform other systems that information has been
  created, destroyed, or modified
• Receive information about new, deleted, or
  changed information
• Request information from other systems
• Respond to requests for information from other
  systems
• Significant cost savings can be realized across
  settings when systems share the same information
• However, sharing information can be problematic
  as the language of healthcare can be complex,
  unstructured, and diverse and can include
  regional and sub-domain variations. The only way
  to deal with it is by implementing data and
  vocabulary standards.

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Vocabulary Standards

• Adoption of standard terminology and vocabulary
  are essential for the electronic capture,
  exchange or transmission of health data.
• Computers cannot communicate with each other
  using natural language. They require the use of
  controlled terminologies for efficient
  communication
• Terminologies ensure that as data are entered,
  they are stored in such a way as to enable ready
  and reliable retrieval in a particular context,
  such as in care planning documentation and for
  decision-making

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Data Standards

• Data are the building blocks of all data
  collections and these are the representation of
  real world facts, concepts or instructions in a
  formalized manner suitable for communication,
  interpretation or processing by human beings or
  by automatic means
• Coded data are used in areas such as public
  health research, epidemiological studies at the
  population level and also for hospital
  management, funding and clinical purpose, which
  provide a mean whereby the complexities of
  clinical practice can be described in a standard
  fashion leading itself to comparability,
  aggregation and analysis

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Classifications

• A fully developed classification scheme specifies
  categories of knowledge, provides the means to
  relate the categories to each other, and may
  specify in the code number all or the most
  important of the aspects and facts of a subject
• ICD-10 ICD-10-AM
• Classifications enable the standardized
  collection of health information that
• Provides for the measurement of clinical care
  outcomes and supports an evidence-based approach
  to client assessment

• Flows into case management and decision support
  software facilitating coordinated care across
  sectors
• Improves the monitoring of safety and quality in
  healthcare
• Enables statistical analysis and reporting of
  health information for decision-making, policy
  development, service administration, financial
  management and health research

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Table 3.2 Criteria for classification development
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• Table 3.3 Tabular disease list from ICD-10-AM

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Terminologies

• Interface terminology
• Enables the user to enter and retrieve
  information through the computer system
• Formally linked by the computer to the underlying
  concepts in the reference terminology
• Finely grained
• Interface terms and the concepts they identify
  can be related to each other in a reference
  terminology

• Reference terminology
• Designed to uniquely represent concepts,
  relationships, and their semantic and formal
  definitions
• Communicates information well but is not suited
  for counting information units for statistical
  purposes
• Systematized Nomenclature of Medicine (SNOMED)-CT
  is a good example of a reference terminology
• SNOMED-CT aims to ambiguously represent around
  350000concepts that are both pre- and
  post-coordinated.

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Figure 3.1 Examples and links between the
terminology types
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Examples of domain-specific clinical
classifications

• Nursing
• International Classification for Nursing Practice
  (ICNP)
• Allied health

• Community health terminology
• General practice vocabulary
• Minimum data sets
• A list of data elements with uniform definitions
  and categories that contain the least number of
  data elements required in a data set to do a
  particular job
• Table 3.4

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Table 3.4 A simple minimum data set
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Messaging Standards

• Information is held in a variety of data formats
  and information structures using a range of
  computer applications
• The exchange of data is challenging, particularly
  in health because of legacy systems, multiple
  computer formats, and multiple practitioners
• The basic level where messages can be sent
  between computers and there is no need for data
  to be interpreted by the receiver
• The functional level where messages between
  computers are interpreted at the level of data
  fields. Here data passes from a structured field
  in one system to a comparably structure field in
  another

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HL7

• The seventh level of ISO OSI
• The application level is where the clinical
  information in healthcare is handled

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Security standards