APHL/CDC Presentation to Vietnamese Health Officials and Stakeholders

Analysis. Answers. Action.

www.aphl.org

Standards for Data ExchangeMarch 2016

Analysis. Answers. Action. www.aphl.org

Introduction

• Personal background• Professional background• Project examples


What are standards?• The word “standard” as used in information technology

has multiple meanings. • “Standard” refers to a generally accepted specification

created by an organization that includes more than one corporation or company.

• Ideally, a standards development organization or industry consortium uses a consensus-driven process to create the standard. These organizations may be international, regional, or national governmental, quasi-governmental, or non-governmental entities.


Are there different types of standards?Yes! Standards are typically broken down into three categories:

• Formal Standards refer to a specification that has been approved and published by a standards setting organization, such as ISO or HL7.

• De Jure Standards refer to standards mandated by government legislation or regulation, or may refer generally to any formal standard.

• De Facto Standards refer to a specification, protocol or technology that has achieved widespread use and acceptance - often without being approved by any standards organization or by receiving such approval only after it has already achieved widespread use.


Why do we need standards?• Standards can be found in almost every area of our daily

lives, but why do we need them in healthcare information technology?


Why do we need standards?• The healthcare delivery system today employs many

different information systems from different vendors, both within a single organization and across multiple organizations.

• Example: a hospital may have a laboratory system from one vendor, a pharmacy system from another vendor, and a patient care documentation system from a third vendor. Physicians affiliated with the hospital also have different systems in their offices, yet need access to data from the hospital on their patients.


Why do we need standards?• In healthcare, standards provide a common language

and set of expectations that enable interoperability between systems and/or devices.

• Ideally, data exchange schema and standards should permit data to be shared between clinician, lab, hospital, pharmacy, and patient regardless of application or application vendor in order to improve healthcare delivery.


How do standards relate to interoperability?• Standards are created in order to enable interoperability

between two systems.• HIMSS' definition of interoperability incorporates the

definition given by the Institute of Electronics and Electrical Engineers Standards Association (IEEE-SA), which is the most often quoted and/or paraphrased: "The ability of two or more systems or components to exchange information and to use the information that has been exchanged." (source)

http://www.himss.org/library/interoperability-standards/what-is

http://standards.ieee.org/about/index.html


How do standards relate to interoperability?• A more recent IEEE definition states that a standard

is the "ability of a system or a product to work with other systems or products without special effort on the part of the customer. Interoperability is made possible by the implementation of standards."

• Standards provide a common framework for communicating across a variety of use cases, which thus enables system interoperability.


Examples of Standards• Data exchange and system standards (Link)• Pharmacy and terminology standards (Link)• Medical device standards (Link)• Public health reporting standards (Link)

http://www.himss.org/library/interoperability-standards/standard-health-informatics-hit-systems

http://www.himss.org/library/interoperability-standards/pharmacy-health-it-standards

http://www.himss.org/ResourceLibrary/genResourceSteps.aspx?ItemNumber=24080

http://www.himss.org/library/interoperability-standards/adoption-implementaion


Vocabulary and Terminology StandardsDefine the specific set of values that apply to a specific data type

• SNOMED CT (Systemized Nomenclature of Medicine Clinical Terms)

• ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision)– Note: The US currently uses ICD-9, and will be moving to ICD-

10 in 2015.• LOINC (Logical Observation Identifiers Names and Codes)• DICOM (Digital Imaging Communications in Medicine)• RxNorm - Normalized names for clinical drugs

http://www.ihtsdo.org/snomed-ct

http://www.who.int/classifications/icd/en

http://loinc.org/

http://medical.nema.org/

http://www.nlm.nih.gov/research/umls/rxnorm


Transport Messaging StandardsDescribe how messages get transported/exchanged between systems

• SOAP (Service Object Access Protocol)• TCP/IP (Transmission Control Protocol / Internet Protocol)• Secure VPN (Virtual Private Network) over SSL (Secure Socket

Layer)• DIRECT - like email, using SMTP (Simple Message Transport

Protocol) or XDR (External Data Representation) protocols• EDI (Electronic Data Interchange)• IEEE (Institute of Electronics and Electrical Engineers) - used for

medical device data

http://en.wikipedia.org/wiki/SOAP

http://en.wikipedia.org/wiki/Transmission_Control_Protocol

http://ieee.org/


Content StandardsDescribe what data elements are included, where they are included in the message, field length, data type, etc. Common examples of content and document standards include:

• CDA (Clinical Document Architecture)• HL7 (Health Level Seven) V2.3x, V2.5x and V3• ASC X12 (Accredited Standards Committee) - examples include

277/278 eligibility

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7

http://www.hl7.org/index.cfm

http://www.x12.org/


Additional Standards• Reference Standards - have an assigned value by direct

comparison with a reference base or model• Specification Standards - explicit set of requirements for item,

material, component, system or device• Services Standards - assist in the translation, movement or

securing of data• Certificates - certificate services assure that messages are secure• Technical Standards - usually a formal document that established

uniform engineering or technical criteria, methods, processes and practices


Are Implementation Guides standards?• Standards are helpful because they describe

and constrain the "what" of the data movement. Implementation Guides (IG) describe the "how" for a specific use case.– Although an IG is referred to as a standard by HL7,

the common understanding in the healthcare domain is that an IG is a companion to a standard that describes how the standard should be used to satisfy a specific healthcare use case. The IG is often balloted along with the standard.


Standards and LIS Initiative

• Sustainability and effectiveness • Data Quality• Reporting• Data Exchange• Interoperability


SummaryStandards…• “Get you going”.• Reduce or eliminate competing and often unnecessarily duplicative

efforts.• Foster collaboration.• Need to be adjusted for your organization.• Enable faster development and more rapid time to market/interface. • Allows for a more scalable interface – lower cost structures.• Can be complex and require analysis and training.• Can make a significant impact if there are supporting policies.• Can reduce complexity of supporting interfaces.• Are not the end all.


Contact Information

Eduardo Gonzalez Loumiet, MBA, PMP, CPHIMS

[email protected]

mailto:[email protected]

http://www.uberops.com/

http://www.eduardo.tech/

APHL/CDC Presentation to Vietnamese Health Officials and Stakeholders

Health & Medicine

Transcript of APHL/CDC Presentation to Vietnamese Health Officials and Stakeholders