Semantic Interoperability in Health Information Exchange

February 26, 2014

Tomasz Adamusiak MD PhD

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Disclosure

Tomasz Adamusiak

Has no real or apparent conflicts of interest to report.

© 2014 HIMSS

Learning Objectives

1. Define vocabulary standards for MU 2

2. Define common MU Data Set

3. Identify challenges

4. Propose solutions

HISTORY OF PRESENT INQUIRY:

Mr. Smith is a 34-year old gentleman who presents at our branch to obtain a car loan secondary to growing maintenance costs of his current vehicle. He otherwise reports doing well. His past financial history is insignificant.

What is Interoperability?

• Semantic

Structural

Foundational

Increased availability for research and BI

http://www.himss.org/ValueSuite

Common MU

Data Set

Common MU

Data Set

Interoperability in care coordination 2014 Edition EHR Certification Criteria 45 CFR §170.314 (e)

C-CDA

Data portability

Create / transmit

transition of care / referral summaries

Clinical information

reconciliation e-Prescribing

Receive / transmit lab

result

Common MU

Data Set

Common MU

Data Set

Interoperability in patient engagement 2014 Edition EHR Criteria 45 CFR §170.314 (e)

Human readable /

C-CDA

View / download / transmit to 3rd party

Clinical summary

New topics in Meaningful Use Stage 3 recommendations

Patient-generated health data

Order tracking

Case reports Drug

adherence

Amendments Summaries for

consults & reports

HIT Policy: Meaningful Use Workgroup

http://www.healthit.gov/FACAS/sites/faca/files/MUWG_Stage3_14_Jan_28.docx

Consolidated CDA provides templates for care summaries

Medication Information

ManufacturedProduct

Medication Activity

SubstanceAdministration

Medication Supply Order

ManufacturedProduct

Immunization

SubstanceAdministration

By إبن البيطارown work - [Public domain], via Wikimedia Commons

Only structured information allowed in MU Transition of Care

<manufacturedProduct classCode="MANU">

<templateId root="2.16.840.1.113883.10.20.22.4.23"/>

<manufacturedMaterial>

<code code="310965"

codeSystem="2.16.840.1.113883.6.88"

codeSystemName="RxNorm"

displayName="Ibuprofen 200 MG Oral Tablet">

</code>

</manufacturedMaterial>

</manufacturedProduct>

Only structured information allowed in MU Transition of Care

<manufacturedProduct classCode="MANU">

<templateId root="2.16.840.1.113883.10.20.22.4.23"/>

<manufacturedMaterial>

<code code="310965"

codeSystem="2.16.840.1.113883.6.88"

codeSystemName="RxNorm"

displayName="Ibuprofen 200 MG Oral Tablet">

</code>

</manufacturedMaterial>

</manufacturedProduct>

Medication

Information

Template

RXCUI

Normalized

Drug Name

Common MU Data Set defines data requirements for ALL care summaries criteria

• Individual criteria might include data requirements that are specific or unique to that criterion

• Many different terminology standards

Common MU Data Set (1-5)

• 1. Patient name

– N/a

• 2. Sex

– N/a

• 3. Date of birth

– N/a

• 4. Race and 5. Ethnicity

– The Office of Management and Budget (OMB) Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, as revised, October 30, 1997

Combined format

(select one or more):

• American Indian or Alaska Native

• Asian

• Black or African American

• Hispanic or Latino

• Native Hawaiian or Other Pacific Islander

• White

Common MU Data Set (6-7)

6. Preferred language

– As specified by the Library of Congress, ISO 639-2 alpha-3 codes limited to those that also have a corresponding alpha-2 code in ISO 639-1

7. Smoking status

– Any of the following SNOMED CT codes:

– (1) Current every day smoker. 449868002

– (2) Current some day smoker. 428041000124106

– (3) Former smoker. 8517006

– (4) Never smoker. 266919005

– (5) Smoker, current status unknown. 77176002

– (6) Unknown if ever smoked. 266927001

– (7) Heavy tobacco smoker. 428071000124103

– (8) Light tobacco smoker. 428061000124105

Common MU Data Set (8-12)

8. Problems

– At a minimum, SNOMED CT International Release July 2012

and US Extension to SNOMED CT March 2012 Release

9. Medications

– RxNorm, August 6, 2012 Release

10. Medication allergies

– RxNorm, August 6, 2012 Release

11. Laboratory tests

– LOINC version 2.40

12. Laboratory values/results

– N/a

Immunizations

HL7 Standard Code Set

CVX Vaccines Administered

Common MU Data Set (13-16)

13. Vital signs (height, weight, BP, BMI)

– N/a

14. Care plan fields including goals and instructions

– N/a

15. Procedures

– At a minimum, SNOMED CT International Release, July 2012 with US Extension to SNOMED CT March 2012 or the combination of HCPCS and CPT-4

– Optional: CDT

– Optional: ICD-10-PCS

16. Care team members

– N/a

Not

ICD-10-CM

Be aware of these terminology challenges

Codes run out of room (ICD-9)

• 985 Toxic effect of other metals

– 985.0 Toxic effect of mercury and its compounds

– 985.1 Toxic effect of arsenic and its compounds

– 985.2 Toxic effect of manganese and its compounds

– 985.3 Toxic effect of beryllium and its compounds

– 985.4 Toxic effect of antimony and its compounds

– 985.5 Toxic effect of cadmium and its compounds

– 985.6 Toxic effect of chromium

– 985.8 Toxic effect of other specified metals

– 985.9 Toxic effect of unspecified metal

Brass fumes,

copper salts,

and iron and

nickel

compounds

High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886

Limited hierarchy (ICD-9)

• 010-018.99 TUBERCULOSIS

– …

– …

• 137 Late effects of tuberculosis

– …

• 647.3 Tuberculosis complicating pregnancy childbirth or the puerperium

– …

High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886

Semantic drift (evolution of usage) in multi-year data (ICD-9)

– 664.14 Other immediate postpartum hemorrhage, postpartum condition or complication 666.14

• 1995

– 664.14 Second-degree perineal laceration, postpartum condition or complication

– 785.59 Other shock without mention of trauma

• 2003

– 785.51 Cardiogenic shock

High-quality, Standard, Controlled Healthcare Terminologies Come of Age, J. J. Cimino,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408886

New term

New name

In pursuit of a single language

Pieter Brueghel the Elder (1526/1530–1569) [Public domain], via Wikimedia Commons

Integrating terminologies with Unified Medical Language System

Donald A.B. Lindberg, M.D

Clinical

Terminologies

UMLS

Exanthema C0015230

UMLS

rash NOS

ICD-10:R21

Cutaneous eruption

SCT:112625008

Eruption

SCT:1806006

Exanthema C0015230

Cutaneous eruption

SCT:112625008

UMLS

rash NOS

ICD-10:R21

Eruption

SCT:1806006

Practical exploration of UMLS annotated data https://clinminer.hmgc.mcw.edu user: himssdemo password: himssdemo

This image by Tomasz Adamusiak is licensed under a CC BY 3.0 US license

ClinMiner is a non-commercial, prototype solution

For more information see: EHR-based phenome wide association study in pancreatic cancer.

Adamusiak T, Shimoyama M, AMIA Summits Transl Sci Proc. 2014 (in press)

SNOMED CT as likely alternative interface terminology

• Active collaboration between IHTSDO and Regenstrief (LOINC) http://www.ihtsdo.org/about-ihtsdo/governance-and-advisory/harmonization/loinc

• Integration with ICD-11 http://www.ncbi.nlm.nih.gov/pubmed/23920573

Semantic interoperability

knowing more about your patient population

http://www.himss.org/ValueSuite

Thank You!

Tomasz Adamusiak MD PhD

Human and Molecular Genetics Center

Medical College of Wisconsin

tomasz@mcw.edu

@7omasz

Sources

HIMSS Definition of Interoperability http://www.himss.org/library/interoperability-standards/what-is?navItemNumber=17333

Implementing Consolidated-Clinical Document Architecture (C-CDA) for Meaningful Use Stage 2 http://www.healthit.gov/sites/default/files/c-cda_and_meaningfulusecertification.pdf

Consolidated CDA, HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, http://www.hl7.org/implement/standards/product_brief.cfm?product_id=258

Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2, 42 CFR Parts 412, 413, and 495, Federal Register/ Vol. 77, No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-21050.pdf

Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology, 45 CFR Part 170, Federal Register/ Vol. 77, No. 171 http://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-20982.pdf