Data Quality Datadriven Medicine for Better Care AI
Data Quality 표준이 필요! Data-driven Medicine for Better Care 정밀의료, 빅데이터, AI
What is a standard after all? • ISO definition: “A standard is a document, established by consensus process, and approved by a recognized body, that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context. ” – Key terms: document, consensus, recognized body
Health information standards Transport Message 메시지 HTTP, IHE XDS. b, IHE XDM, … Document 문서 API Service Information Model 정보모델 HL 7 V 3 RIM, EN 13606, FHIR, CIMI, … Terminology 용어 ICD, SNOMED-CT, LOINC, …
Message, Document, and API System or Application Message (HL 7 V 2. X) Document (HL 7 CDA) API (HL 7 FHIR) System or Application Action View Archive
Standards in Action HIS/PHR 3 rd Party App 메시지, 문서 Devices, LIS, RIS 메시지, 서비스 Mobile App API HIE HIS CPOE Integration EMR 메시지, 문서, API Hospital Clinical Decision Support Terminologies Clinical Contents 용어, 서식 Rules, Knowledge… Public Health, Quality Reporting, Research etc. 지식 표현
표준화 해외 사례 • • USA: Meaningful Use USA: Blue Button+ UK: NHS Digital EU: IPS Apple & Google Cloud SMART on FHIR OMOP Common Data Model
Meaningful Use • Stage 1 Data Capture – HL 7 V 2. X message, HL 7 CDA, ASTM CCR – ICD-9, SNOMED-CT, LOINC, Rx. Norm, CPT, … • Stage 2 Decision Support – HL 7 V 2. 5. 1 message, C-CDA, Info. Button – ICD-10, SNOMED-CT, LOINC, Rx. Norm, CPT, … • Stage 3 Value-based Payment – Almost the same as Stage 2
Blue Button+ • Originates from VA’s Blue Button – C-CDA – Push = IHE XDM (Secure Email) – Pull = Resful API (HL 7 FHIR)
NHS Digital • Information Standards Notices (ISN) – 106 documents • Data Set Change Notices (DSCN) – 807 documents • Key standards* – SNOMED-CT & ICD – Dictionary of Medicines and Devices (dm+d) – FHIR-based API *https: //digital. nhs. uk/about-nhs-digital/our-work/nhs-digital-data-and-technology-standards/framework
HL 7 IPS Project • EU-driven HL 7 project to identify the required clinical data, vocabulary and value sets for an international patient summary • CDA & FHIR IGs
Apple on FHIR
Google Cloud Healthcare API
SMART App Gallery 67 Apps As of Nov 30, 2018
OMOP CDM • CDM = distributed sets of SQL tables – No explicit exchange of data necessary • ETL process is a critical bottleneck – (E) Mapping source table columns to targets 정보모델 – (T) Mapping local codes to standard terminologies 용어 • SNOMED-CT, ICD, Rx. Norm, CPT, …
보건의료용어표준 - 문제점 • Reference terminology 및 CHT 요건 미비 – Stability, formal definition, … – UMLS CUI에 매핑된 한글 용어집 의료기관이 UMLS CUI를 사용하는 경우에만 의미 • UMLS에 대한 의존성 – UMLS 자체는 용어체계가 아니라 S/W 개발을 위한 도구 실무 용도가 아님 – UMLS Source vocabulary 저작권 이슈 – 개념 간의 관계를 UMLS에 의존 • 국내 추가 용어는 관계 정보 부재 – UMLS 관리에 대한 control이 전무 – Semantic Network 및 Specialist Lexicon 활용 불가 • 결과적으로 낮은 활용도 <ISO/TS 17117: 2002, Health informatics Controlled health terminology - Structure and high-level indicators> 1. 2. 3. 4. 5. 6. 7. 8. 9. Concept-orientation: nonredundancy, non-ambiguity, nonvagueness, internal consistency Purpose and scope : coverage, comprehensiveness Mapping Systematic definitions Formal definitions Explicitness of relations Reference terminologies Atomic reference terminologies Colloquial terminologies
EMR 인증 (c. ) • 상호운용성 (Interoperability) 요건
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