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Data Quality and Standards Majed M. Al Ameel

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Objectives To define data and to appreciate the difference between data and information. To understand the importance central role of standards in the complex worlds of business, IT and health care. To appreciate the benefits in applying standards in HIS. To be familiar with the main standards for coding medical information. To be familiar with the main standard for passing medical information between systems HL7. To be familiar with the main standard for passing medical images between systems DICOM. Main Reference Guide to Health Informatics, Coiera (2003) Chapters 16, 17 and 18.

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Data In the 1960s computers were used for Data Processing Mundane, repetitive processes on large volumes of data Typical data processes: Classification. Rearranging/Sorting. Aggregating. Performing Calculations. Selection. Information Data forms Example Most large information systems are based on databases structured storage of large volumes of data Data inputs transformed to more meaningful data outputs (information)

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Forms of Data Typical forms include Data typeIn a computer In the Real World Alphanumeric dataNumbers, letters and other charactersWhat we read Image datagraphic images and picturesWhat we see Audio dataSound, noise or tones What we hear Video dataMoving images or picturesWhat we see and hear An Information System Information Cognitive Process Meaningful Value

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Monitor data Ventilator data Gas analyser data Infusion pump data

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Data, Information and Knowledge Information Data forms Knowledge informs Wisdom insight Explicit Managed by Systems Tacit Managed by People

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What do we mean by a Standard? Types of Standards: Approved standards: A standard approved by a recognised government or industry-funded body. It will be tightly defined and may be mandated by law. De-facto standards: Standards which have emerged to become recognised as an industry- wide standard without regulation. Betamax vs. VHS See http://en.wikipedia.org/wiki/dvd for details of the Betamax vs. VHS war of the 1990s and how IBM helped to avoid a repeat with the DVD standard.http://en.wikipedia.org/wiki/dvd Images from http://en.wikipedia.org DVD A standard - a definition or format established by consensus and approved by a recognized body

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Pharmacy Standards A Pharmacy without any standards might look like ?!!! 8

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Challenge How many standards relate to a packet of..

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Who sets standards?

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Standards Bodies International Standards Organisation (ISO) UN/EDIFACT (United Nations Directories for Electronic Data Interchange for Administration, Commerce and Transport) GS1 a merger of US Uniform Code Council and European Article Numbering (EAN) European Committee for Standardisation (CEN) ANSI (American National Standards Institute) GCI (Global Commerce Initiative) ISBN (International Standard Book Number) ISSN (International Standard Serial Number)

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Why use standards Inter-operability Globalisation Quality assurance Cost minimisation Safety Others..?

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Standards Ownership Sometimes standards are controlled by private corporations (the Windows GUI interface is owned by Microsoft). Sometimes standards are controlled by open, public, or non- profit organizations (e.g. the schema for XML is recommended by W3C the World Wide Web Consortium - the main international standards organization for the World Wide Web).

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Some examples of standards ISO 9001 TickIT W3 consortium FDA 510k for medical devices HL7 SNOMED-CT A full system implementation involves a combination of many of these hardware, software, working practice

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Medical Coding Standards Medical coding is the transformation of narrative descriptions of diseases, injuries, and healthcare procedures into numeric or alphanumeric designations. Examples of Medical Coding Standards: Read Codes SNOMED ICD-10 Ref: http://www.ahima.org/coding/http://www.ahima.org/coding/

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Read Codes In the UK, Dr James Read's personal code set developed in the 1980s and used in some early computerisation. Adopted by NHS 1990 Summarization and patient care applications Directed acyclic graph Care-giver level of expression Natural clinical terms Used in many computerised systems

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Read Diagnosis Codes All begin with a specific letter relating to a body system For Example G for circulatory system They then break to into parts of the system For example G3 for IHD Then more specifically into other codes such as G30 MI

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Read Diagnosis Codes AInfectious Diseases B Neoplasms CEndocrine, Nutrition, & Metabolic disease D Blood & blood forming organs EMental & behavioural Disturbances FNervous System & Sense.Organs GCirculatory Disorders HRespiratory System Disorders J Digestive System Disorders KGenitourinary System Disorders LComplications of Pregnancy and Childbirth MSkin & Subcutaneous Tissue disorders NMusculoskeletal and Corrective tissue disorders PCongenital anomalies QPeri-natal conditions RSymptoms, signs and ill defined conditions SInjury or poisoning TCauses of injury or poisoning U(x) External causes of morbidity & mortality

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Read Codes - Examples 182..A Y7CmDC P Chest pain Xa0wWK Y7CmFC P Pleurodynia 182Z.A Y7CmGC P Chest pain NOS Xa0wWK Y7CmIC S Painful breathing -pleurodynia 1826.A Y7CmJC P Parasternal pain 1823.A Y7CmLC P Precordial pain 1821.A Y7CmNC P Chest pain not present X75rWC Y7CmYC P Pain in heart 1829.A Y7CmZC P Retrosternal pain

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SNOMED Systematized Nomenclature of Medicine Owned by College of American Pathologists Organized into axes Synonyms allowed Assemble complex terms from axes SNOMED-RT (Reference Terminology) under development SNOMED-CT (Clinical Terms) under development incorporates UK Read Codes (known as Clinical Terms)

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SNOMED - Axes D - Diseases C - Drugs F - Function L - Living Organisms X - Manufacturers G - Modifiers M - Morphology J - Occupations A - Physical Agents P - Procedures S - Social Context T - Topography

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SNOMED - Examples "D3-15000" "01" "Myocardial infarction, NOS" "(T-32020) (M-54700)" "D3-15000" "02" "Infarction of heart, NOS" "(T-32020) (M-54700)" "D3-15000" "02" "Cardiac infarction, NOS" "(T-32020) (M-54700) "D3-15000" "02" "Heart attack, NOS "(T-32020) (M-54700)" "D3-15010" "01" "Microinfarct of heart "(T-32000) (M- 54701) "C-C137A" "01" "Bufferin Analgesic Tablets" "C-C137B" "01" "Bufferin Analgesic Caplets" "M-54700" "01" "Infarct, NOS" M-54700" "02" "Infarction, NOS" "M-54700" "05" "Infarcted" "M-54701" "01" "Focal infarct" "M-54701" "02" "Microscopic infarct" "S-10120" "01" "Mother, NOS"

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SNOMED Browser The SNOMED Browser is available at www.snomedbrowser.comwww.snomedbrowser.com

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International Classification of Diseases ICD The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. The International Classification of Diseases is published by the World Health Organization (WHO) and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in medicine. The ICD is revised periodically and is currently in its tenth edition ICD-10. Ref.: http://www.who.int/classifications/icd/implementation/en/index.htmlhttp://www.who.int/classifications/icd/implementation/en/index.html

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ICD-10 Online Available online http://apps.who.int/classifications/icd10/browse/2010/enhttp://apps.who.int/classifications/icd10/browse/2010/en

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Which Coding System?

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Messaging Standard

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What is message passing? Traditional Royal Mail

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HIS HL7 What is message passing? Electronic HL7 Gateway or IEs Result Report

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HL7 Health Language 7 HL7 is the international standard for electronic data exchange in healthcare. HL7 defines the format and content of the messages that pass between medical applications. HL7 v2.x defines messages as a string of fields. HL7 v3 defines messages within an XML schema. The 7 in HL7 comes from the 7 layer Open Systems Interconnection (OSI) Reference Model - one of the founding principles for networked computer architectures. http://en.wikipedia.org/wiki/OSI_model

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Imaging Exchange Standards

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Digital Imaging and Communications in Medicine DICOM DICOM is a global Information Technology standard that is used in hospitals worldwide as a standard for handling, storing, printing, and transmitting information in medical imaging. Its current structure was developed in 1993 and there are many revisions every year. It is designed to ensure the interoperability of systems used to: Produce, Store, Display, Process, Send, Retrieve, Query or Print medical images. Ref: http://dicom.nema.org/http://dicom.nema.org/

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DICOM It is used to process all images in healthcare systems. This includes but not limited to: X-Ray, CT, MRI, Angiograph, Ultrasound, Tomography etc.

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LOINC Logical Observation Identifiers Names and Codes (LOINC) Standard for identifying medical laboratory observations Developed and is maintained by theRegenstrief Institute 34

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Why use standards Inter-operability Globalisation Quality assurance Cost minimisation Safety Others..?

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Standards/System equirements Data Exchange: HL7, DICOM, ASC X12 Terminology: CPT (Current Procedural Terminology) NDC (National Drug Code) in USA ICD-9, ICD-10,LOINC, &SNOMED NIC,NOC (nursing intervention and outcome classification) Document: CDA (clinical document architecture) CCR (continuity of care record) Identification: UPIN (Unique Physician Identification Number) NPI (National Provider Identifier) Authentication: ASTM E 1762-95,E 1985-98 & E 2147-01

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Standards in Healthcare HL7 HL7 SNOMED HL7, NIC NOC HL7 SNOMED SNOMED LOINC DICOM HL7 ASC X12 HL7, CPT, ICD NDCDP NDC UPIN/NPI ASTM EPR = EHR

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Thank You