Data Quality and Standards
Majed M. Al Ameel
Objectives
• To define data and to appreciate the difference between data and
information.
• To understand the importance central role of standards in the complex
worlds of business, IT and health care.
• To appreciate the benefits in applying standards in HIS.
• To be familiar with the main standards for coding medical information.
• To be familiar with the main standard for passing medical information
between systems – HL7.
• To be familiar with the main standard for passing medical images
between systems – DICOM.
Main Reference
Guide to Health Informatics, Coiera (2003) Chapters 16, 17 and 18.
Data
In the 1960s computers were used for
“Data Processing”
Mundane, repetitive processes on
large volumes of data
Typical data processes:
Classification.
Rearranging/Sorting.
Aggregating.
Performing Calculations.
Selection.
Information
Data
forms
Example
Most large information systems are based on “databases”
structured storage of large volumes of data
Data inputs transformed to more meaningful data outputs (information)
Forms of Data
Typical forms include
Data type
In a computer
In the Real World
Alphanumeric data
Image data
Audio data
Video data
Numbers, letters and other characters
graphic images and pictures
Sound, noise or tones
Moving images or pictures
What we read
What we see
What we hear
What we see and hear
Cognitive
Process
An
Information
System
Meaningful
Value
Information
Meaningful
Value
Monitor data
Infusion pump
data
Ventilator data
Gas analyser data
Data, Information and Knowledge
Tacit
Explicit
Managed by People
Managed by Systems
Knowledge
Information
Data
forms
informs
Wisdom
insight
What do we mean by a Standard?
A standard - a definition or format established by consensus and approved by a
recognized body
Types of Standards:
Approved standards:
A standard approved by a recognised government or industry-funded
body. It will be tightly defined and may be mandated by law.
De-facto standards:
Standards which have emerged to become recognised as an industrywide standard without regulation.
DVD
Betamax
vs. VHS
See http://en.wikipedia.org/wiki/dvd for
details of the Betamax vs. VHS war of the
1990s and how IBM helped to avoid a repeat
with the DVD standard.
Images from http://en.wikipedia.org
Pharmacy Standards
• A Pharmacy without any standards might look like ?!!!
8
Challenge
• How many standards relate to a packet of……………………..
Who sets standards?
Standards Bodies
International Standards Organisation (ISO)
UN/EDIFACT (United Nations Directories for Electronic Data Interchange for Administration,
Commerce and Transport)
GS1 – a merger of US Uniform Code Council and European Article Numbering (EAN)
European Committee for Standardisation (CEN)
ANSI (American National Standards Institute)
GCI (Global Commerce Initiative)
ISBN (International Standard Book Number)
ISSN (International Standard Serial Number)
Why use standards
•
•
•
•
•
•
Inter-operability
Globalisation
Quality assurance
Cost minimisation
Safety
Others…………..?
Standards Ownership
• Sometimes standards are controlled by private corporations
(the Windows GUI interface is owned by Microsoft).
• Sometimes standards are controlled by open, public, or nonprofit organizations (e.g. the schema for XML is
“recommended” by W3C – the World Wide Web Consortium the main international standards organization for the World
Wide Web).
Some examples of standards
•
•
•
•
•
•
ISO 9001
TickIT
W3 consortium
FDA – 510k for medical devices
HL7
SNOMED-CT
A full system implementation involves a combination of many of
these – hardware, software, working practice
Medical Coding Standards
• Medical coding is the transformation of narrative descriptions
of diseases, injuries, and healthcare procedures into numeric
or alphanumeric designations.
• Examples of Medical Coding Standards:
Read Codes
SNOMED
ICD-10
Ref: http://www.ahima.org/coding/
Read Codes
• In the UK, Dr James Read's personal code set developed in the
1980’s and used in some early computerisation.
• Adopted by NHS 1990
•
•
•
•
•
Summarization and patient care applications
Directed acyclic graph
Care-giver level of expression
Natural clinical terms
Used in many computerised systems
Read Diagnosis Codes
• All begin with a specific letter
relating to a body system
• For Example G for circulatory
system
• They then break to into parts of the
system
• For example G3 for IHD
• Then more specifically into other
codes such as G30 MI
Read Diagnosis Codes
A Infectious Diseases
B Neoplasms
C Endocrine, Nutrition, & Metabolic disease
D Blood & blood forming organs
E Mental & behavioural Disturbances
F Nervous System & Sense.Organs
G Circulatory Disorders
H Respiratory System Disorders
J Digestive System Disorders
K Genitourinary System Disorders
L Complications of Pregnancy and Childbirth
M Skin & Subcutaneous Tissue disorders
N Musculoskeletal and Corrective tissue disorders
P Congenital anomalies
Q Peri-natal conditions
R Symptoms, signs and ill defined conditions
S Injury or poisoning
T Causes of injury or poisoning
U (x) External causes of morbidity & mortality
Read Codes - Examples
182..A
Xa0wWK
182Z.A
Xa0wWK
1826.A
1823.A
1821.A
X75rWC
1829.A
Y7CmDC
Y7CmFC
Y7CmGC
Y7CmIC
Y7CmJC
Y7CmLC
Y7CmNC
Y7CmYC
Y7CmZC
P Chest pain
P Pleurodynia
P Chest pain NOS
S Painful breathing -pleurodynia
P Parasternal pain
P Precordial pain
P Chest pain not present
P Pain in heart
P Retrosternal pain
SNOMED
• Systematized Nomenclature of Medicine
• Owned by College of American Pathologists
• Organized into axes
• Synonyms allowed
• Assemble complex terms from axes
• SNOMED-RT (Reference Terminology)
• under development
• SNOMED-CT (Clinical Terms) under development
• incorporates UK Read Codes (known as Clinical Terms)
SNOMED - Axes
•
•
•
•
•
•
D - Diseases
C - Drugs
F - Function
L - Living Organisms
X - Manufacturers
G - Modifiers
•
•
•
•
•
•
M - Morphology
J - Occupations
A - Physical Agents
P - Procedures
S - Social Context
T - Topography
SNOMED - Examples
"D3-15000"
"D3-15000"
"D3-15000"
"D3-15000"
"D3-15010"
54701)”
"C-C137A"
"C-C137B"
"M-54700"
“M-54700"
"M-54700"
"M-54701"
"M-54701"
"S-10120"
"01"
"02"
"02"
"02"
"01"
"01"
"01"
"01"
"02"
"05"
"01"
"02"
"01"
"Myocardial infarction, NOS" "(T-32020) (M-54700)"
"Infarction of heart, NOS"
"(T-32020) (M-54700)"
"Cardiac infarction, NOS"
"(T-32020) (M-54700)”
"Heart attack, NOS”
"(T-32020) (M-54700)"
"Microinfarct of heart”
"(T-32000) (M-
"Bufferin Analgesic Tablets"
"Bufferin Analgesic Caplets"
"Infarct, NOS"
"Infarction, NOS"
"Infarcted"
"Focal infarct"
"Microscopic infarct"
"Mother, NOS"
SNOMED Browser
The SNOMED Browser is available at www.snomedbrowser.com
International Classification of Diseases
ICD
• The ICD is the international standard diagnostic classification
for all general epidemiological, many health management
purposes and clinical use
• It is used to classify diseases and other health problems
recorded on many types of health and vital records including
death certificates and health records.
• The International Classification of Diseases is published by
the World Health Organization (WHO) and used worldwide for
morbidity and mortality statistics, reimbursement systems,
and automated decision support in medicine.
• The ICD is revised periodically and is currently in its tenth
edition ICD-10.
Ref.: http://www.who.int/classifications/icd/implementation/en/index.html
ICD-10 Online
Available online http://apps.who.int/classifications/icd10/browse/2010/en
Which Coding System?
Messaging Standard
What is message passing?
Traditional
Royal Mail
What is message passing?
Electronic
HIS
Result
Report
HL7
Gateway or IEs
HL7
HL7
Health Language 7
HL7 is the international standard for
electronic data exchange in
healthcare.
HL7 defines the format and content of
the messages that pass between
medical applications.
HL7 v2.x defines messages as a string of
fields.
HL7 v3 defines messages within an XML
schema.
The 7 in HL7 comes from the 7 layer Open Systems
Interconnection (OSI) Reference Model - one of the founding
principles for networked computer architectures.
http://en.wikipedia.org/wiki/OSI_model
Imaging Exchange Standards
Digital Imaging and Communications in Medicine
DICOM
• DICOM is a global Information Technology standard that is
used in hospitals worldwide as a standard for handling,
storing, printing, and transmitting information in medical
imaging.
• Its current structure was developed in 1993 and there are
many revisions every year.
• It is designed to ensure the interoperability of systems used
to:
Produce, Store, Display, Process, Send, Retrieve, Query or
Print medical images.
Ref: http://dicom.nema.org/
DICOM
• It is used to process all images in healthcare systems. This
includes but not limited to:
X-Ray, CT, MRI, Angiograph, Ultrasound, Tomography …etc.
LOINC
• Logical Observation Identifiers Names and Codes (LOINC)
• Standard for identifying medical laboratory observations
• Developed and is maintained by theRegenstrief Institute
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Why use standards
•
•
•
•
•
•
Inter-operability
Globalisation
Quality assurance
Cost minimisation
Safety
Others…………..?
Standards/System equirements
• Data Exchange: HL7, DICOM, ASC X12
• Terminology:
•
•
•
•
CPT (Current Procedural Terminology)
NDC (National Drug Code) in USA
ICD-9, ICD-10,LOINC, &SNOMED
NIC,NOC (nursing intervention and outcome classification)
• Document:
• CDA (clinical document architecture)
• CCR (continuity of care record)
• Identification:
• UPIN (Unique Physician Identification Number)
• NPI (National Provider Identifier)
• Authentication: ASTM E 1762-95,E 1985-98 & E 2147-01
Standards in Healthcare
HL7
HL7
NDCDP
NDC
HL7
HL7, NIC
NOC
HL7, CPT,
ICD
ASC X12
HL7
HL7
SNOMED
SNOMED
LOINC
DICOM
HL7
ASTM
HL7
SNOMED
UPIN/NPI
EPR = EHR
Thank You