Data Transformation Modules: Achieving Semantic ... · Achieving Semantic Interoperability Shaun...

Achieving Semantic InteroperabilityShaun Shakib and Jason MarkSlide 1

©3M HIS 2005Innovation

Data Transformation Modules:Achieving Semantic Interoperability

Practical Issues in Terminology Implementation and Mapping

Shaun Shakib MPH3M Health Information Systems

[email protected]

Jason Mark3M Health Information Systems

[email protected]



Networking Framework – 7 Layers(Open Systems Interconnection Reference Model)

• Layer 7: Application layer– provides semantic conversion between associated application processes

• Layer 6: Presentation layer– syntax layer; manages syntactical differences in data representation within the end-user systems

• Layer 5: Session layer– manages the dialogue between end-user application processes

• Layer 4: Transport layer– controls the reliability of a given link

• Layer 3: Network layer– controls network routing & flow control

• Layer 2: Data link layer– defines the functional & procedural means to transfer data between network entities

• Layer 1: Physical layer– all electrical & physical specifications for devices



Interoperability

The ability of one computer system to exchange data with another computer system

U.S. National Committee on Vital and Health StatisticsReport on Uniform Data Standards for

Patient Medical Record InformationJuly 6, 2000



Levels of Interoperability(NCVHS Recommendations for Patient Medical Record Information Standards)

• “Basic” Interoperability– messages exchanged between systems, but not interpreted

• “Functional” Interoperability– messages exchanged between systems, context of the data interpreted– a common structural definition for the fields

• “Semantic” Interoperability– messages exchanged between systems, both meaning and context interpreted– content of the data fields within a message populated with standard codes

PaperRecordsPaper

RecordsScannedImages

ScannedImages

TextDatabases

TextDatabases

MessagingStandards

MessagingStandards

Non-StandardizedCoded Data

Non-StandardizedCoded Data

StandardCoded

StructuredData

StandardCoded

StructuredData

Trend inHealth

Records

Trend inHealth

Records



“Functional” InteroperabilityMessaging Standards (HL7 2.x)

OBX|1|CE|1817-72^Ser K|OBX|1|CE|1817-72^Ser K|

OBX|1|CE|2259-73^K|OBX|1|CE|2259-73^K|

OBX|1|CE|2730-72^Potassium|OBX|1|CE|2730-72^Potassium|System A

System B

System C



“Semantic” InteroperabilityData Standardization

Establishing explicit meaning and context and using the same set of codes to encode data throughout a system (a hospital, an organization, a region, a country, a world….)

Clinical Domain: Gender

Unknown3Female2Male1NameCode



Exchanging Standard Codes ExampleLogical Observation Identifier Names and Codes (LOINC®)

OBX|1|CE|2823-3^Potassium:SCNC:PT:SER/PLAS:QN:|OBX|1|CE|2823-3^Potassium:SCNC:PT:SER/PLAS:QN:|

System A System B System C



Exchanging Standard CodesTwo Implementation Strategies

Encode with the identifiers of standard

terminologies

Encode with the identifiers of standard

terminologies

Encode with internal identifiers, “translate”to standard codes for external exchange

Encode with internal identifiers, “translate”to standard codes for external exchange

*CDRPatient:

John DoeLab Result:

2823-32823-3 2823-3

**DTM

Internal code:1234

LOINC®:2823-3

*CDR=Clinical Data Repository **DTM=Data Transformation Module

*CDRPatient:

John DoeLab Result:

1234



Exchanging Standard Codes3M Healthcare Data Dictionary

RegFinancialsMed. Rec.

Transcription

Doc. Imaging

Practice Mgt.

Home Health

LTC

PACS

Order Mgt.

Radiology

Lab

Rx

Scheduling

Single View

ClinicalWorkstation

Clinical Decision Support

Clinical Decision Support

Healthcare Data Dictionary

(HDD)

Healthcare Data Dictionary

(HDD)

mapping

Clinical Data Repository (CDR)

EMPIIn

terf

ace

Engi

ne

Data Analysis andReporting

Data Analysis andReporting



The 3M Healthcare Data DictionaryComponents of the HDD

• Controlled Medical Vocabulary (CMV)– Collection of clinical concepts

• Knowledge Base (KB)– Relationships among concepts

• Medical Information Model (MIM)– Establishes clinical context

Decision Support

Alerts Reports

Knowledge Base(Semantic Network)

Controlled Medical Vocabulary(Medical Concepts)

Medical Information

Model



A collection of medical concepts, organized to support synonyms and other lexical characteristics

concept: a unique, definable idea or object that has a very specific, known meaning

SodiumLab ResultLab Test Chem 4

Potassium

Chloride Glucose

Components of the HDDControlled Medical Vocabulary

Lab Test

Chem 4Sodium

is-a

Lab Result

PotassiumChloride

Glucose

is-component-of

Components of the HDDKnowledge Base/Relationships





Medical Information ModelComponents of the HDD

• Describes the relationships among clinical events and terminologies in a fashion that gives them meaning and context

• Enforces accepted truths but allow for uncertainty and variation inherent in medical information

• Clinically correct, complete, flexible and extensible

• Supported by vocabulary and knowledge base• Obeyed by the data gathering software



Medical Information Model ExampleAllergy Clinical Event

Allergy Type Allergen Severity Reaction Date

Allergy Event

Information Models

Patient AllergyDrug (1550)Aspirin (3000252119)Mild (1554)Rash (82559)20000703

Instance Data

Type Allergen

Severity Reaction

Allergy Event

CDR

HDD

3M Database Architecture

Date20000703

Aspirin

Mild

Drug

Rash



COLD COLD COLDConceptRepresentationConceptRepresentation

ConceptDomainConceptDomain

ConceptDefinitionConceptDefinition

Concept IDConcept ID

a sensory perception

a pulmonary diagnosis

an upper respiratory viral

infection

“I’m feeling cold”

Chronic Obstructive Lung

Disease

“I have a cold”

68215 1005480 1005313

Controlled Medical VocabularyConcept Based Vocabulary



Mapping to the HDD

VZV 243 = Ft Hood Lab Interface Context

Chickenpox Virus

Herpes-zoster Virus

Herpesvirus 3, Human C0042338 = UMLS Concept

Unique Identifier

concept mapping: the process of creating one-way links between concepts and terms in different vocabularies, both standard and legacy

Mapping is accomplished through a variety of techniques such as representation synonymy, term association, relationship, attribute, granularity, composition/decomposition, etc.

Mapping is accomplished through a variety of techniques such as representation synonymy, term association, relationship, attribute, granularity, composition/decomposition, etc.

Varicella-zoster Virus11557 = HDD ID

HDD



Data Transformation Modules (DTMs)• Reference concept

mapping tables derived from HDD

• Facilitate semantic interoperability by transforming inbound legacy terms and codes to mapped:– standard outbound terms and

codes– legacy terms and codes from

other systems



DTM Messaging Architecture



DTM Technical Implementation

• Direct plug-in for leading interface engines

• Web service API for custom implementations

• Cross-platform capable• Cost effective, scalable

database underpinnings



DTM Mapping Table Domains

Height/Weight, blood pressure other vitals signs, and intake/output information from a nursing systemVital Signs, with I/OHeight/Weight, blood pressure and other vitals signs from a nursing systemVital Signs, without I/ODischarge summary, pathology and/or radiology text report titles from a transcription systemText Report TypesScheduling data received from a scheduling systemSchedulingClinical medical information from a pharmacy system, using proprietary/legacy codes to identify drugsPharmacy (not using NDC)Clinical medical information from a pharmacy system, using NDCs to identify drugfPharmacy (using NDC)Orders from a CPOE system, requires mapping of lab and pharmacy systemsOrders InterfaceMicrobiology results from a lab systemMicrobiologyClinical lab results from a lab information systemLabPatient registration and encounter information from an ADT/registration systemRegistration/EncounterEKG report titles and related information from a nursing systemEKGCoded patient assessment information from a nursing systemAssessmentCoded allergy data from an ADT/Registration system or pharmacy systemAllergies

ExplanationDomain



DTM Mapping Tables

Brucella abortus (organism)Brucella abortus24224000BRUCELLA ABORTUSBRAB

Bordetella pertussis (organism)Bordetella pertussis5247005BORDETELLA PERTUSSISBPER

Babesia species (organism)Babesia species372376003BABESIA SPECIESBABS

SNOMED CT® FULLY SPECIFIEDSNOMED CT® PREFERRED TERMSNOMED CT® CONCEPT IDLOCAL RESULT NAMELOCAL RESULT CODE

SUBMIT LOINC®SerumBRUCELLA IgGBRUGBRUCELLA (IGG,IGM) EIABRUCI

6326-3SerumBRUCELLA IgMBRUMBRUCELLA (IGG,IGM) EIABRUCI

24388-1SerumBRUCELLA,IGMBRUCMBRUCELLA,EIABRUCE

24387-3SerumBRUCELLA,IGGBRUCGBRUCELLA,EIABRUCE

LOINC® CODELOCAL SPECIMEN NAMELOCAL RESULT NAMELOCAL RESULT CODELOCAL TEST NAMELOCAL TEST CODE

3M analyzes system data files and produces maps that link standard codes to local terms and codes

• Local codes mapped to SNOMED CT® concepts

When a standard code does not exist 3M submits a new code request to the standards organization on behalf of the client

• Local codes mapped to LOINC® codes



DTM Implementation and Maintenance• 3M Terminology Consulting Services (TCS) builds DTM Mapping

Tables from local content definitions, current standards, special case definitions

• Facility/Site identifies mappings to perform on HL7 message stream• DTM plug-in or custom implementation added to site messaging

system• Engine processing workflows updated to use 3M DTM as messages

are processed• Updates to underlying domain data and additional local content

provided via 3M TCS



Interlingua of Health Information Systems• DTMs provide a cross reference

accounting for all concepts and terms in the Electronic Health Record (EHR)

• DTMs provide a way to manage ongoing updates from standard terminologies as well as local additions and changes from health care facilities

• DTMs make an enterprise’s mapped data interoperable with the rest of the world via standard codes, e.g. LOINC®, SNOMED CT®, ICD, etc.

LOINC® Code5902-2

Camp LeJeune Interface Code

3650-73

Fort Sill Interface Code

467-73

DoD Short NamePT

DoD Long NameProtime

DTM



Questions?

Shaun Shakib MPH3M Health Information Systems

[email protected]

Jason Mark3M Health Information Systems

[email protected]

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