A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.

1. Abdul-Malik Shakir Information Management Strategist City of Hope National Cancer Center Presented to: The Los Angeles Basin Clinical Translational Science Institute Center for Biomedical Informatics USC Health Sciences Campus March 25, 2009 Informatics Standards & Interoperability A Foundation for Healthcare Information Management

5. Electronic Information Interchange Pharmacies Physicians Testing Organizations Lab/Images Hospitals Payors Employers County/Community Entities Patients/Consumers Government Medicare/Medicaid Lab results Patient Data Orders Results Images Eligibility Referral Process Claim Status Claims/Prescriptions Referral Process Claim/Status Health Information Insurance Updates Eligibility Medical Records Enrollment Mental Health Family Planning Medical Society Public Health

6. Leading Healthcare Data Interchange Standards Healthcare Information System Clinical System Images, pictures Bedside Instruments Billing, claims reimbursement Adverse Events Reporting Immunization Database Materials Management Agency Reporting Provider Repository HL7 HL7 HL7, X12N HL7, X12N HL7 HL7 DICOM IEEE MIB, ASTM X12N / HL7 (Non-US only) X12N Waveforms Retail Pharmacy Orders & Reimbursement NCPDP

12. Informatics Standards Coordination Bodies

15. Clinical Research Value Case

17. Pathway to Interoperability Input

21. An X12N Data Interchange Scenario User Interface Program Module Dataset Outbound Transformation Inbound Transformation User Interface Program Module Dataset Outbound Transformation Inbound Transformation B to A Transformation A to B Transformation Patient Billing Application System Claims Processing Application System Claim Transaction Patient Billing Application System Claims Processing Application System Remittance Transaction

22. An HL7 Data Interchange Scenario User Interface Program Module Dataset Outbound Transformation Inbound Transformation User Interface Program Module Dataset Outbound Transformation Inbound Transformation B to A Transformation A to B Transformation Order Entry Application System Laboratory Application System Lab Order Transaction Order Entry Application System Laboratory Application System Lab Result Transaction

24. ASC X12 Organization

27. HL7 Affiliates Canada New Zealand Finland Germany Netherlands Japan United States United Kingdom India Taiwan China Czech Republic Mexico France Argentina Brazil Australia Denmark Greece Ireland Italy Spain Sweden Switzerland South Korea Turkey Uruguay Singapore Romania Croatia Austria Colombia Chile

34. An HL7 Messaging Scenario: Why User Interface Program Module Dataset User Interface Program Module Dataset Message Creation Message Parsing A to B Transformation Message Parsing Message Creation B to A Transformation Order Entry Application System Laboratory Application System Lab Order Transaction Order Entry Application System Laboratory Application System Lab Result Transaction

35. Reaching the Limits of Application Interfaces Lab Order Entry ADT Pharmacy Radiology Decision Support Electronic Health Record Administrative Systems ? Enterprise Systems ? External Systems ?

37. Health Level Seven: Why Tolerable Painful Intolerable

38. Divide and Conquer / Component Reuse DATA Visit Billing Results Reporting Next of Kin ( NK 1 ) Insurance ( IN 1 ) Patient Visit ( PV 1 ) Patient Demographics ( PID ) Guarantor ( GT 1 ) NK 1 IN 1 PV 1 PID GT 1 OBR OBX Next of KIN ( NK 1 ) Patient Visit ( PV 1 ) Patient Demographics ( PID )

40. HL7 2.x Segment Definition SEQ - position within segment LEN - length of field DT - data type for field OPT - optionality for field RP /# - repeatability TBL # - table number for codes ITEM # - HL7 field number ELEMENT NAME - name

43. Reveal Assumptions Revealing assumptions is an essential component of effective communication. Yes, I do play football. Do you play football?

44. Reveal Assumptions Message Profiles are an effective means of documenting our assumptions about message structures Do you use HL7? MSH EVN PID [PD1] [ { NK1 } ] Yes, I use HL7. MSH EVN PID [ NK1 ] OBX

45. Reduce Ambiguity Message Profiles provide a language that allows us to unambiguously express our understanding and assumptions about the information in a message structure used in a particular scenario MSH EVN PID [PD1] [ { NK1 } ]

46. Highlight Conflicts Sharing message profiles provides an opportunity to identify and reconcile conflicts in our understanding and to validate our assumptions about message structures. MSH EVN PID [PD1] [ { NK1 } ] MSH EVN PID [ NK1 ] OBX

47. Consolidate Viewpoints Message Profile Message Profile Message Profile MSH EVN PID [PD1] [ { NK1 } ] MSH EVN PID [ NK1 ] OBX MSH EVN { PID } [PD1] [ { GT1 } ] MSH EVN { PID } [PD1] [ { NK1 } ] [ { GT1 } ] [ OBX ] Canonical Message Profile

50. Standards Moving in Ever-Increasing Circles Source: Gartner International National Inter-Enterprise Enterprise Institution

52. HL7 v3.0 Foundational Artifacts Reference Information Model Datatype Specification Vocabulary Specification Reference Models The HL7 Reference Information Model is the information model from which all other information models and message specifications are derived. The HL7 Vocabulary Specification defines the set of all concepts that can be taken as valid values in an instance of a coded attribute or data type property. The HL7 Datatype Specification defines the structural format of the data carried in an attribute and influences the set of allowable values an attribute may assume.

53. HL7 RIM Class Diagram

55. RIM Core Classes 0..* 0..* Entity classCode : CS determinerCode: CS code: CE statusCode : CS id : II Act classCode : CS moodCode: CS code: CD statusCode : CS effectiveTime : GTS id : II

56. RIM Core Classes Entity classCode : CS determinerCode: CS code: CE statusCode : CS id : II Role classCode : CS code: CE effectiveTime : IVL<TS> statusCode : CS id : II Participation typeCode : CS time : IVL<TS> statusCode : CS Act classCode : CS moodCode: CS code: CD statusCode : CS effectiveTime : GTS id : II 0..1 0..* Role Link typeCode : CS effectiveTime : IVL<TS> Act Relationship typeCode : CS 0..1 0..* plays scopes 1 0..* 1 0..* 1 1 0..* 0..* 1 1 0..* 0..*

57. HL7 RIM Class Diagram

60. HL7 V3 Message Development Framework Content Use Case Modeling Interaction Modeling Message Design Information Modeling RIM Restrict R-MIM Serialize HMD Restrict Message Type Example Storyboard Storyboard Example D-MIM Derive Application Role Sender Receiver Trigger Event Triggers Interaction References

63. HL7 V3 Vocabulary Specification Metamodel

64. Vocabulary Binding Vocabulary Terms Vocabulary Binding Information Model Class Attribute Vocabulary Domain Value Set Coded Concept Code System 1 0..* 0..* 0..1 0..1 0..* 0..* 0..* 0..* 0..* 0..* 1 0..* 0..1

67. LOINC www.regenstrief.org/loinc [ GO ]

68. SNOMED

71. Semantic Interoperability Infrastructure

76. Semantic Interoperability Infrastructure

78. Semantic Interoperability Infrastructure (SII)

79. Intra-Enterprise Information Sharing Infrastructure Transformation Inbound Message Processing Outbound Message Processing Heterogeneous Applications Application A Application B Application C Application D Application E Syntax Mapping Semantic Mapping

80. Inter-Enterprise Data Exchange Infrastructure Transformation Inbound Message Processing Outbound Message Processing Heterogeneous Applications Application A Application B Application C Application D Application E Syntax Mapping Semantic Mapping EDI EDI EDI

81. Shared Services Layer Transformation Inbound Message Processing Outbound Message Processing Heterogeneous Applications Application A Application B Application C Application D Application E Syntax Mapping Semantic Mapping EDI EDI Reusable Services Service X Service Y Service Z

82. Semantic Interoperability Infrastructure (SII) Transformation Inbound Message Processing Outbound Message Processing Heterogeneous Applications Application A Application B Application C Application D Application E Syntax Mapping Semantic Mapping EDI EDI Metadata Knowledge Management System Reusable Services Service X Service Y Service Z

83. LAC DPH Project Scope

84. Los Angeles County Public Health Department PHIS-PACS Interface

85. Semantic Interoperability Infrastructure (SII) Metadata Knowledge Management System Transformation Syntax Mapping Semantic Mapping Inbound Message Processing Outbound Message Processing EDI EDI

86. Metadata and Knowledge Management Syntax Mapping Semantic Mapping Metadata Management Knowledge Management

87. Service Functional Specifications

88. Operational Data Store (ODS) Operational Data Store Metadata Knowledge Management System Transformation Syntax Mapping Semantic Mapping Inbound Message Processing Outbound Message Processing EDI EDI Integrated Data Repository

89. Integrated Data Repository (IDR) Operational Data Store Metadata Knowledge Management System Transformation Syntax Mapping Semantic Mapping Inbound Message Processing Outbound Message Processing EDI EDI Integrated Data Repository Derive HL7 Reference Information Model Integrated Data Repository

90. LAC PHD PHIS-PACS Interface with IDR

91. SNHD IDR Project Scope

92. SNHD Integrated Data Repository Project

93. Healthcare Information Integration Infrastructure

94. Electronic Data Interchange

95. Syntactic Interoperability

96. Semantic Interoperability

97. Semantic Data Integration

98. Semantically Sound Business Intelligence

99. Acronym Proliferation OMG R-MIM CTS CMA EHR-CR MDA D-MIM RuleML RCRIM HITSP-IS PHDSC RIM OWL-DL OCCR HITSP WPC NCI IHE HIPAA OMB NUBC BRIDG XML DICOM HHS IDR CDISC UML X12N ONC ODS MedDRA ADT HL7 IEC CPT LOINC SOA NCPDP ISO ICD SNOMED EHR-S ASTM ANS HMD NCBO CDA IEEE ANSI