Intro to Health Informatics 第五周笔记

Lesson 5A: Data Standards

Lesson 5A

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.

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

Standards evolution can be divided into three domains

Structure of data standards: Classification is list of diseases; Ontology can also represent relationships

Purposes of standards:

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).

Technology of standards: Transport standards

Technology of standards: EDI/X12, created in early days, cryptic and compact.

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

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.

Quiz 2

Quiz 3

ICD

ICD

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.

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.

CPT categories

CPT descriptions

CPT code example: Psychiatry vistits by length

CPT code example: Skin revoval by Area

Quiz 4: CPT code

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).

LOINC name example

Quiz 6: LOINC name

National Drug Code

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

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|".

SNOMED-CT Hierachy

SNOMED-CT example

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.

Activity instruction

Activity question 1:

Activity question 2

Activity question 3

2015-09-21 初稿 至ICD slides
2015-09-22 补充完全