Role of Standards in Addressing Interoperability Issues in

Role of Standards in Addressing Interoperability Issues in the Complex World of Medical Informatics Prof. J. Mukhopadhyay Computer Science and Engineering IIT, Kharagpur

What is Interoperability? “Ability of two or more systems or components to exchange information and to use the information that has been exchanged. ” Source: IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990

Interoperability Ability to work among multiple versatile systems together. • How easy to plug different systems into a single system. • How much flexible to inter communicate between two systems.

Why is it required? • Different systems manages information in different format (native format). • Information exchange among heterogeneous systems is difficult. • No universally accepted format of data presentation.

System perspective • To enhance flexibility of a system. • To integrate multiple systems to build a large system.

Usability perspective §Exploiting the service based system approach. -Dictionary, weather forecast services § Acceptance of same entity from versatile systems. -Online bank account

Interoperability Basic requirements: • Interconnecting systems should be compatible. OR • A common ground where multiple systems can communicate. System Y Common Ground System X

Complexity in Medical World • Vast and dynamic knowledgebase. • Close interaction of different complex systems. Patient Management, Diagnosis and Investigations, Treatment and Procedures, Drug and pharmacology, Disease classification etc. • Process Standardization. • Regional and demographic variations. • Adjustment with real-life constraints. Infrastructure, Human resource, Material resource.

Interoperability in Healthcare Medical data transfer • among Hospital Information Systems (HIS). • among Telemedicine Systems. • among Telemedicine and HIS systems. Benefits -Tele-consultation among practitioners -Medical knowledge sharing

Effort for Standardization in India • Health Unite: Effort of MCIT, AHSL • Built a national framework for “Information Technology Infrastructure for Health” through health information standards. • Areas for Recommendations 1. Data Elements 2. Health Identifiers 3. Clinical Data Representation (Clinical Standards) 4. Minimum Data Sets 5. Healthcare Billing Formats 6. Message Standards 7. Public Informatics Education 8. Privacy and Confidentiality Information

Principal Patient Care Components • Data Elements • Patient Demographics • Hospital Administration • Health Insurance • Health Identifier • Healthcare Professional • Healthcare Provider Organizations • Support Service Provider • Individual • Employee • Payers

Principal Patient Care Components • Minimum Data Sets • Common across all diseases • • Referrals • Demographics Specific to some diseases. • Disease Assessment – Stage, Risk Factors, Complications • Treatment • Outcomes • Data Representation Standards • Clinical data representation standard • Messaging standard

Clinical standardization Identified three critical areas of standardization through coding • Disease Codes Recommendation – ICD-10 • Procedure Codes Recommendation – ICD-10 -PCS • Clinical Observation Codes Recommendation – LOINC

Messaging standardization Two types of messaging standard • Text messaging standard Recommendation – HL 7 - version is not specified. - needed to be customized to Indian requirement. • Imaging standard : DICOM No strict recommendation of imaging standard.

Standards HL 7: Health Level Seven. It is an international healthcare standard for medical data exchange between computer systems in healthcare. http: //www. hl 7. org/ LOINC: Logical Observation Identifiers Names and Codes. These identify the test results or clinical observations uniquely. http: //www. loinc. org/ ICD-10: International Statistical Classification of Diseases and Related Health Problems. ICD provides codes to classify diseases and a wide variety of signs, symptoms etc. Every health condition can be assigned to a unique category and given a code. http: //www. who. int/classifications/icd/en/ ICD-10 -PCS: ICD-10 Procedure Coding System. This is a system of medical classification used for procedural codes which is developed as a replacement of ICD-9 -CM volume 3 (contains inpatient procedures). DICOM: Digital Imaging and Communications in Medicine. This is a standard for handling, storing, printing, and transmitting information on medical imaging. http: //medical. nema. org/

HL 7: Segments of interest for Telemedicine • Segment for Observation • Segment for Multimedia • Segment for Customization

Data Elements in HL 7 following the Telemedicine Standard • Patient Demographics Patient Registration No (CX) PID - 2 Patient Name (XPN) PID - 5 Sex (IS) PID - 8 Race (CE) PID - 10 Doctor Identification No (XCN) PV 1 - 7 • Hospital Administration • Health Insurance Patient Discharge Type (IS) PV 1 - 36 Patient Admission Type (IS) PV 1 - 4 Specialty/Department (PL) PV 1 - 3 Provider Identification No. (CX) IN 1 - 3 Plan Identification No. (CE) IN 1 - 2

Minimum Data Set in HL 7 • Referral Information: PV 1 Referrer’s code (XCN) PV 1 - 7 Referred to (XCN) PV 1 - 7 Assigned Patient Location (PL) PV 1 - 3 Prior Patient Location (PL) PV 1 - 6 • Demographic Information: PD 1 – As described in the last slide • Other disease specific information – Observation/Result – OBX – Diagnosis – DG 1 – Prescription - RXO

Recommendation on Health Identifiers • Philosophy: – Alphanumeric code for identifiers. – Numbers and alphabets looking alike are omitted – 5, 1, 0, S, I, O • Identifier Format: – Healthcare Professional Identifier format: SST. XXXXXX • SS – State Code, T – Role, XXXXXX – Registration Number – Healthcare Organization Identifier format: XXXX • XXXX – Randomly generated alphanumeric number – Support Service Provider format: XXXXX • XXXXX - Randomly generated alphanumeric number – Individual Identifier format: PPPP. XXXXX • PPPP – 4 digit alphanumeric identifier of the issuer • XXXXX – 10 digit serial number – Payers’ Identifier format: XXXX • XXXX - Randomly generated alphanumeric number

Image Transmission: An example of real-life constraints • • Choice of imaging technology. Choice of Data Compression Methods. Choice of Compression Levels. Use of Quantitative Measures for expressing image quality. PSNR, Other quality metrics.

Which one is more compressed? 114 KB (1) 31. 4 KB (2) 2. 25 MB 27. 8 KB (3) (4)

Which one is uncompressed? Uncompressed (2. 25 MB) Maximum Compression (26. 2 KB)

Choice of appropriate compression level ? 900 KB 17 KB 50 KB 14 KB 36 KB 11 KB