Role of Standards in Addressing Interoperability Issues in the Complex World of Medical Informatics Prof. J. Mukhopadhyay Computer Science and Engineering.

Role of Standards in Addressing

Interoperability Issues in the Complex World of

Medical Informatics

Prof. J. MukhopadhyayComputer Science and

EngineeringIIT, Kharagpur

What is Interoperability?

“Ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990

InteroperabilityAbility to work among multiple versatile

systems together.

•How easy to plug different systems into a single system.

•How much flexible to inter communicate between two systems.

Why is it required?

• Different systems manages information in different format (native format).

• Information exchange among heterogeneous systems is difficult.

• No universally accepted format of data presentation.

System perspective

• To enhance flexibility of a system.

• To integrate multiple systems to build a large system.

Usability perspective

Exploiting the service based system approach.

-Dictionary, weather forecast services

Acceptance of same entity from versatile systems.

-Online bank account

InteroperabilityBasic requirements:

• Interconnecting systems should be compatible.

OR

• A common ground where multiple systems can communicate.

System X

System Y

CommonGround

Complexity in Medical World

• Vast and dynamic knowledgebase.• Close interaction of different complex

systems. Patient Management, Diagnosis and Investigations,

Treatment and Procedures, Drug and pharmacology, Disease classification etc.

• Process Standardization.• Regional and demographic variations.• Adjustment with real-life constraints. Infrastructure, Human resource, Material resource.

Interoperability in Healthcare

Medical data transfer

• among Hospital Information Systems (HIS).

• among Telemedicine Systems.

• among Telemedicine and HIS systems.

Benefits

-Tele-consultation among practitioners

-Medical knowledge sharing

Effort for Standardization in India• Health Unite: Effort of MCIT, AHSL

• Built a national framework for “Information Technology Infrastructure for Health” through health information standards.

• Areas for Recommendations1. Data Elements

2. Health Identifiers

3. Clinical Data Representation (Clinical Standards)

4. Minimum Data Sets

5. Healthcare Billing Formats

6. Message Standards

7. Public Informatics Education

8. Privacy and Confidentiality Information

Principal Patient Care Components• Data Elements

• Patient Demographics

• Hospital Administration

• Health Insurance

• Health Identifier

• Healthcare Professional

• Healthcare Provider Organizations

• Support Service Provider

• Individual

• Employee

• Payers

Principal Patient Care Components• Minimum Data Sets

• Common across all diseases

• Referrals

• Demographics

• Specific to some diseases.

• Disease Assessment – Stage, Risk Factors, Complications

• Treatment

• Outcomes

• Data Representation Standards

• Clinical data representation standard

• Messaging standard

Clinical standardizationIdentified three critical areas of standardization through coding

• Disease Codes

Recommendation – ICD-10

• Procedure Codes

Recommendation – ICD-10-PCS

• Clinical Observation Codes

Recommendation – LOINC

Messaging standardizationTwo types of messaging standard

• Text messaging standard

Recommendation – HL7

- version is not specified.

- needed to be customized to Indian requirement.

• Imaging standard : DICOM

No strict recommendation of imaging standard.

StandardsHL7: Health Level Seven. It is an international healthcare standard for medical data exchange between computer systems in healthcare. http://www.hl7.org/

LOINC: Logical Observation Identifiers Names and Codes. These identify the test results or clinical observations uniquely. http://www.loinc.org/

ICD-10: International Statistical Classification of Diseases and Related Health Problems. ICD provides codes to classify diseases and a wide variety of signs, symptoms etc. Every health condition can be assigned to a unique category and given a code. http://www.who.int/classifications/icd/en/

ICD-10-PCS: ICD-10 Procedure Coding System. This is a system of medical classification used for procedural codes which is developed as a replacement of ICD-9-CM volume 3 (contains inpatient procedures).

DICOM: Digital Imaging and Communications in Medicine. This is a standard for handling, storing, printing, and transmitting information on medical imaging. http://medical.nema.org/

HL7: Segments of interest for Telemedicine

Segment for Observation

Segment for Multimedia

Segment for Customization

Data Elements in HL7 following the Telemedicine

Standard • Patient Demographics

• Hospital Administration

• Health Insurance

Patient Registration No (CX)

PID - 2

Patient Name (XPN) PID - 5

Sex (IS) PID - 8

Race (CE) PID - 10Doctor Identification No (XCN)

PV1 - 7

Patient Discharge Type (IS)

PV1 - 36

Patient Admission Type (IS)

PV1 - 4

Specialty/Department (PL) PV1 - 3Provider Identification No. (CX)

IN1 - 3

Plan Identification No. (CE)

IN1 - 2

Minimum Data Set in HL7

• Referral Information: PV1

• Demographic Information: PD1– As described in the last slide

• Other disease specific information– Observation/Result – OBX– Diagnosis – DG1– Prescription - RXO

Referrer’s code (XCN) PV1 - 7

Referred to (XCN) PV1 - 7

Assigned Patient Location (PL)

PV1 - 3

Prior Patient Location (PL)

PV1 - 6

Recommendation on Health Identifiers

• Philosophy:– Alphanumeric code for identifiers.– Numbers and alphabets looking alike are omitted – 5, 1,

0, S, I, O

• Identifier Format:– Healthcare Professional Identifier format: SST.XXXXXX

• SS – State Code, T – Role, XXXXXX – Registration Number– Healthcare Organization Identifier format: XXXX

• XXXX – Randomly generated alphanumeric number– Support Service Provider format: XXXXX

• XXXXX - Randomly generated alphanumeric number– Individual Identifier format: PPPP.XXXXXXXXXX

• PPPP – 4 digit alphanumeric identifier of the issuer• XXXXXXXXXX – 10 digit serial number

– Payers’ Identifier format: XXXX• XXXX - Randomly generated alphanumeric number

Image Transmission: An example of real-life constraints

• Choice of imaging technology.

• Choice of Data Compression Methods.

• Choice of Compression Levels.

• Use of Quantitative Measures for expressing image quality.

PSNR, Other quality metrics.

2.25 MB

114 KB 31.4 KB

27.8 KB

Which one is more compressed?

(4)

(1) (2)

(3)

Uncompressed Maximum Compression(2.25 MB) (26.2 KB)

Which one is uncompressed?

900 KB 50 KB 36 KB

17 KB 14 KB 11 KB

Choice of appropriate compression level ?