09 - Networking and Health Information Exchange - Unit 4 - Basic Health Data Standards - Lecture C

Networking and Health Information
Exchange
Basic Health Data Standards
Lecture c
This material Comp9_Unit4c was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Learning Objectives
2
1. Understand why it is necessary to use a common set of
data elements with common names to be able to
exchange and understand data from other places
(Lecture a)
2. Understand what is meant by semantic interoperability
(Lecture a)
3. Understand many of the sets of controlled vocabularies
in use today how they are used and who requires their
use (Lecture a)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Lecture c
Learning Objectives
3
4. Understand the use, purpose and interrelation among
sets of controlled vocabularies in use today (Lectures b
and c)
5. Identify the more common controlled vocabularies in
use today: ICD, CPT, DRG, NDC, RxNorm, and LOINC
(Lecture b)
6. identify the more common controlled vocabularies in
use today: SNOMED, MEDCIN, MedDRA, Nursing
terminologies, MeSH and UMLS (Lecture c)
7. Understand data elements; attributes of data elements
(Lecture d)

Lecture c
Learning Objectives
4
8. Understand contribution of master meta-dictionary of
data elements to semantic interoperability (Lecture d)
9. Explain how data structures can be built from basic
data components (Lecture e)
10. Explain how templates and archetypes facilitate
networking and information interchange (Lecture e)
and
11. Discuss Clinical Data Architecture (CDA), Continuity of
Care Document (CCD), and Continuity of Care Record
(CCR) Standards (Lecture f)

Lecture c
Common Controlled Vocabularies
SNOMED -CT
MEDCIN
MedDRA
Nursing terminologies
MeSH
UMLS
5
Lecture c
Evolution of SNOMED
Systematized Nomenclature of Diseases and
Organisms (SNDO) - 1928 - NY Academy of
Medicine
Systematized Nomenclature of Pathology
(SNOP) - 1965
Systematized Nomenclature of Medicine
(SNOMED) - 1979
SNOMED-RT (Reference Terminology)(1999)
SNOMED-CT (Merger with Read)(2002)
International Healthcare Terminology SDO
(2007)

6
Lecture c
SNOMED-CT
Created by the merger, expansion and
restructuring of SNOMED-RT and Read
Codes
344,000 concepts, 450,000 medical
descriptions, 700,000 concept
interrelations
Cross maps to ICD9-CM, ICD-10, LOINC

7
Lecture c
SNOMED-CT Components
Concepts
Descriptions
Hierarchies
Relationships

8
Lecture c
Example
284196006|Burn of skin|:
246112005|Severity|=24484000|severe
363698007|Finding Site|=
(113185004|Structure of skin between fourth and fifth
toes|:
272741003|Laterality|=7771000|left)

Such expressions are said to be post-coordinated as
contrasted to pre-coordinated terms.

9
Lecture c
Semantic Representation in
SNOMED-CT
10
Lecture c
Source: Dr. James J. Cimino, NIH Clinical Center.
SNOMED Axes
Findings [F]
Procedures [P]
Body structures (anatomy) [T]
Morphology [M]
Organisms [L]
Substances [C]
Physical agents [A]
Occupations
Social context
General
Other

11
Lecture c
Terminology Model
Ruptured ovarian cyst (D7-75111)
Is a disease (D7-00000)
Has morphology rupture (M-14400)
Has morphology cyst (M-33400)
Has topography ovary (T-87000)

12
Lecture c
MEDCIN
13
Lecture c
System of standardized medical
terminology developed by Medicomp
Systems
Includes over 250,000 clinical data
elements encompassing symptoms,
history, physical exam, tests, diagnoses
and therapy

International Classification for Primary
Care (ICPC)
Used by individual family practices and group
practices
Use is to record primary care patient encounter
Includes reason for encounter (chief complaint)
Focuses on patient perspective
Includes fear of disease
Request for preventive services
Request for treatment

14
Lecture c
Medical Dictionary for Regulatory
Activities (MedDRA)
International medical terminology used by regulatory
authorities and regulated biopharmaceutical industry
Terminology for coding all medical data obtained during
all phrases of development and marketing:
Symptoms
Signs
Disease
Diagnoses
Indications
Investigations/Procedures
Medical/Social History

15
Lecture c
MedDRA codes
Unique 8 digit number, starting with
10000001
As terms added, codes assigned
sequentially
Example
Gastric hemorrhage (LLT) = 10017789
Gastric haemorrhage (LLT) = 100177188
Gastrointestinal disorders (SOC) = 10017947

16
Lecture c
Nursing Terminologies
NANDA Taxonomy
Clinical Care Classification
Patient Care Data Set
Omaha System
AORN Perioperative Data Set
International Classification of Nursing Practice
Nursing Interventions Classification
Nursing Outcomes Classification

17
Lecture c
Coding Nursing Concepts
Diagnoses/Judgements
Interventions
Outcomes
Goals

18
Lecture c
Nursing Terminologies
Terminologies Diagnoses Interventions Outcomes Goals
NANDA X
NIC X
NOC X
CCC X X X
PCDS X X X
Omaha X X X
AORN X X X
ICNP X X X X
Table 4.2: Nursing Terminologies.


19
Lecture c
Medical Subject Headings (MeSH)
Used to tag medical abstracts with
concept-based information
Created to improve information retrieval
Introduces the notion of context for the
same concept
Free for use in the US and in most
countries

20
Lecture c
MeSH Example
D011014: Pneumonia
D018410: Pneumonia, Bacterial
D007877: Legionnaires' Disease
D011018: Pneumonia, Pneumococcal
D011019: Pneumonia, Mycoplasma
D009175: Mycoplasma Infections
D011002: Pleuropneumonia, Contagious
D011022: Pneumonia, Rickettsial
D011023: Pneumonia, Staphylococcal
D001996: Bronchopneumonia
D009956: Ornithosis
D011001: Pleuropneumonia
D011015: Pneumonia, Aspiration
D011017: Pneumonia, Lipid
D011020: Pneumonia, Pneumocystis carinii
D011024: Pneumonia, Viral
21
Lecture c
Unified Medical Language System
"The purpose of the [Unified Medical Language
System] is to improve the ability of computer
programs to 'understand' the biomedical meaning
in user inquiries and to use this understanding to
retrieve and integrate relevant machine-readable
information for users."
-Donald A.B. Lindberg, 1993

D. A. B. Lindberg, B. L. Humphreys, and A. T. McCray, (1993).
22
Lecture c
UMLS Structure
Three main components:
Metathesaurus
Semantic Network
Specialist Lexicon and tools

23
Lecture c
Choice of Terminologies
Terminologies
HPI PMH Exam Labs Diag Dx Rx Tx
ICD + ++ ++
CPT + + +
DRG +
NDC +++
RxNorm +++
LOINC +++ +
Nursing ++
SNOWMED +++ +++ +++ ++ ++ +++ ++ ++
MeSH + + + + ++ ++ ++ ++
UMLS ++ ++ ++ ++ ++ ++ ++ ++
Table 4.3 Choice of terminologies


24
Lecture c
Current Situation
SNOMED-CT is gaining momentum as the
terminology of choice
LOINC is used in the US for laboratory test
names
RxNorm is likely to be drug code of choice
in US
ICD x is required for reimbursement
Adverse events maybe MedDRA

25
Lecture c
Summary Lecture c
26
The complex problems caused by use of
local terminologies and too many
controlled terminologies continues to be
an obstacle to interoperability. Until this
problem is solved, the sharing and
aggregation of data among disparate sites
will result in a loss of information and
prone to error.
Lecture c
Summary Lecture c
This Lecture has discussed a set of
controlled terminologies that are used in
healthcare and healthcare processes and
has included characteristics and examples
of each terminology set.
Comparison among the terminologies was
also highlighted.
27
Lecture c
References Lecture c
28
Lecture c
References
Lindberg, D. A. B., Humphreys, B. L., & McCray, A. T. (1993). The Unified Medical Language System. Methods Inform.
Medicine, 32, 281.
Charts, Tables, Figures
4.2 Table. Courtesy of Dr. James J. Cimino, NIH Clinical Center.
4.3 Table. Courtesy of Dr. James J. Cimino, NIH Clinical Center.

Images
Slide 10: : Source: Courtesy of Dr. James J. Cimino, NIH Clinical Center.

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