Intro to Health Informatics 第五周笔记

Lesson 5A: Data Standards

Lesson 5A
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Why do we need data standards

Data standards can be different from each other syntactically or semantically.

  • Syntax : Structure difference, need translation.
  • Semantic : Meaning difference, E.g. A doesn't have the capacity to represent all the information in C.
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quiz 1

Clinical data are often represented with different data standards (as shown above). It's often very complicated to aggregate data from different sources.

Standards Evolution

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Standards evolution can be divided into three domains
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Structure of data standards: Classification is list of diseases; Ontology can also represent relationships
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Purposes of standards:
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Purposes of standards: Document Standards
  • Physicians use ICD for diagnostic notes
  • Labs and pharmacies have their own unique classifications. To coordinate care with each other, healthcare facilities need messaging standards between each other.
  • When data exchange is needed (e.g. from physician to hospitals or vise versa), document standards play important role ( however, Document standards are hard to implement).
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Technology of standards: Transport standards
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Technology of standards: EDI/X12, created in early days, cryptic and compact.
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Technology of standards: XML, more descriptive and verbose

The above EDI/X12 and XML examples are showing the same test result. As we can see, that former is more compact, cryptic and hard to understand without training; while the letter is more human readable, descriptive and verbose.

Key Data Standards

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5 Key Data Standards
  • CPT (Current Procedure Terminology) and NDC (National Drug code) are U.S. Specific classifications
  • ICD (The International Classification of Diseases) and CPT are most widely used because they are mostly required for medical billing.
  • ICD, LOINC (Logical Observation Identifiers Names and Codes) and SNOMED (The Systematized Nomenclature of Medicine) are international ontologies.
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Quiz 2
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Quiz 3

ICD

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ICD
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ICD-9 v.s. ICD-10
  • the U.S. is still using ICD-9 while the world is using ICD-10.
  • The U.S. is set to adopt ICD-10 in 2015 when ICD-11 is about out. Some are proposing the idea of skipping ICD-10.
  • ICD-10 provides more codes for more information (e.g. laterality of breast cancer)
  • ICD is classification prior ICD-10. ICD-10 and the following versions are moving to ontology.
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ICD-10 Example

CPT (Current Procedure Terminology)

  • CPT is updated annually by the American Medical Association. It classifies all the medical procedures and is required for all medical billings.
  • There are three code category for widely performed procedures, quality and performance metrics and new or experimental procedures.
  • For each code, there are Full, Medium and Short descriptions (see below).
  • CPT code can be very detailed and specific (e.g. Psychiatry visits by length or size of removal tissue for a procedure)
  • Billing personal must be trained to be able to select the correct codes.
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CPT categories
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CPT descriptions
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CPT code example: Psychiatry vistits by length
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CPT code example: Skin revoval by Area
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Quiz 4: CPT code
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Quiz 5: CPT code

Logical Observation Identifiers Names and Codes (LOINC)

  • it was created and is maintained by the Regenstrief Institute
  • LOINC provides codes for lab results and clinical observations
  • LOINC provides detailed information about an observation with it's names which can be divided into 7 subparts (See slide below).
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LOINC name example
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Quiz 6: LOINC name

National Drug Code

  • maintained by FDA.
  • 10-digit,3-segment structure indicates the vendor, the drug and the packaging.
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NDC example

SNOMED-CT

  • Created by NIH for pathology, CT is specifically for clinical medicine. It is now distributed by the International Health Terminology Standards Development Organisation (IHTSDO)
  • It's always an ontology
  • It's complex
  • 9-digital ID and human readable concept names.
  • It has hierarchy (shown below)
  • Relationship links expressed by "|is a|".
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SNOMED-CT Hierachy
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SNOMED-CT example
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SNOMED-CT Concept example

Activity

  • Click on the link below to get a copy of the sample CCD: Sample HealthVault Continuity of Care Document (CCD). Review the sample CCD carefully and answer the three questions below.
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Activity instruction
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Activity question 1:
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Activity question 2
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Activity question 3
2015-09-21 初稿 至ICD slides
2015-09-22 补充完全

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