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Networking and Health

Information Exchange
Basic Health Data Standards
Lecture a
This material Comp9_Unit4a was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

Basic Health Data Standards
Learning Objectives
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1. Understand why it is necessary to use a common set of
data elements with common names to be able to
exchange and understand data from other places
(Lecture a)
2. Understand what is meant by semantic interoperability
(Lecture a)
3. Understand many of the sets of controlled vocabularies
in use today how they are used and who requires their
use (Lecture a)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Basic Health Data Standards
Learning Objectives
3
4. Understand the use, purpose and interrelation among
sets of controlled vocabularies in use today (Lectures b
and c)
5. Identify the more common controlled vocabularies in
use today: ICD, CPT, DRG, NDC, RxNorm, and LOINC,
(Lecture b)
6. identify the more common controlled vocabularies in
use today: SNOMED, MEDCIN, MedDRA, Nursing
terminologies, MeSH and UMLS, (Lecture c)
7. Understand data elements; attributes of data elements
(Lecture d)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Basic Health Data Standards
Learning Objectives
4
8. Understand contribution of master meta-dictionary of
data elements to semantic interoperability (Lecture d)
9. Explain how data structures can be built from basic
data components (Lecture e)
10. Explain how templates and archetypes facilitate
networking and information interchange (Lecture e)
and
11. Discuss Clinical Data Architecture (CDA), Continuity of
Care Document (CCD), and Continuity of Care Record
(CCR) Standards (Lecture f)

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
The Problem
Understanding what the data says
Understanding what the data means
Understanding where the data is
Understanding the context in which the
data is collected
Failure to understand may result in a
medical error and maybe even death

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Semantic Interoperability
The ability to share data whose meaning is
unambiguously clear and precise, its
context understood, and it can be used for
any purpose. With true semantic
interoperability, the receiver is
independent from the sender.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Problems Preventing Semantic
Interoperability
Same words that have different meanings
Different words that have the same meaning
Words that are too general to convey a specific
meaning
Localisms that lose meaning beyond that region
Failure to pay attention to factors other than
name, such as units or how measured
Inconsistencies in the level at which things are
described

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Semantic Interoperability:
Issues
Legacy of existing data
Over 400 terminologies in use today plus local
vocabularies
Lack of a solution = no semantic interoperability

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Photo
courtesy of
Dr. Betsy
Humphreys
of NLM
More Problems
There are too many choices for too many
purposes.
Certain words are required for specific uses,
but these choices do not satisfy multiple uses.
Most institutions use local vocabularies and map
to the broader set of controlled vocabularies
they are required to use
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Confusion Comes Quickly
Vocabulary
Terminology
Nomenclature
Classification
Taxonomy
Ontology
Groupers
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Basic Features of Terminology
Unique Identifier code
Numeric and without meaning
May include check digit
Moving toward use of ISO-based Object Identifier (paths in a tree
structure)
Assigning authority is assigned to organizations who in turn
assign the identifiers
HL7 is an assigning authority at 2.16.840.1.113883 (joint-iso-itu-
t.country.us.organization.HL7)
Official Name
Female
Synonyms
Woman, girl

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
General Categories of Terms
Demographics
Signs and symptoms
Anatomy
Physical Findings
Diagnostic procedures
Organisms
Diagnoses
Medications
Allergies
Therapeutic Procedures
Adverse Events
Genomics

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Coding the Data - Gender
Data element gender
Class: demographic
Controlled terminology (value set)
Male
Female
Unknown (dont know, havent asked)
Unknown (cant tell) (by dress; anatomically)
Representation
M,F,U or 0,1,2 or other
Administrative or clinical

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
What Are The Choices? (1/2)
International Classification of Disease (ICD)
[WHO]
Common Procedural Terminology (CPT)
[American Medical Association]
DSM-IV
Diagnosis-related Group (DRG)
National Drug Codes (FDA)
RxNorm (FDA)
VA National Drug Formulary
Structured Product Labeling
Logical Observation Identifiers, Names and
Codes (LOINC) [Regenstrief]


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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
What Are The Choices (2/2)
MEDCIN
SNOMED CT [IHTSDO}
International Classification of Primary Care
(ICPC) [WONCA]
Medical Dictionary for Regulatory Activities
(MedDRA) [ICH]
Nursing Terminologies
Mesh (NLM)
Gene Ontology
Unified Medical Language System

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Basic Health Data Standards
Summary - Lecture a

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Semantic interoperability unsolved
Too many vocabularies creating ambiguity
in meaning
Limits reuse of data

Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchange
Basic Health Data Standards
Lecture a
Basic Health Data Standards
References Lecture a
Images
Slide 8: Photo courtesy of Dr. Betsy Humphreys of the NLM.
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Networking and Health Information Exchanges
Basic Health Data Standards
Lecture a
References
No references used in this lecture.