Interoperability in the 21st Century: Cost Effective Solutions and Guidelines for Interoperable Electronic Health Records
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1 Interoperability in the 21st Century: Cost Effective Solutions and Guidelines for Interoperable Electronic Health Records Kenneth Salyards, SAMHSA Ioana Singureanu, Eversolve Kenneth Lord, MDIX 16 th International HL7 Interoperability Conference June 2016, Genoa, Italy
2 Background SAMHSA Behavioral Health Interoperability Project Goal: To accelerate adoption of MU2 exchange formats for behavioral health EHRs using open-source software components Information Exchange Hub (IExHub) Transforms local/ehr data into information exchange-specific messages Information Exchange Workbench (IEx Workbench) Create consistent profiles/templates regardless of underlying format Common constraint model Exchange Map and implementation guide design tools Expert Map generation based on data equivalence Patient Engagement Application Allows flexible access to patient data using a single format Does not depend on tethered portal Retrieves/sends business-centric data using the IExHub Leverages OHT MDHT and MDMI 2
3 Semantic Mapping: Focus on Data General-purpose IExHub to support EHRs exchanging health information (content) Standards-based information exchange formats: CDA R2 (using templates) FHIR (resources/profiles) HL7 Version 2 (use case-specific implementation guides) Support for any transport protocol and envelope format REST SOAP (IHE ITI XD*, NwHIN) FTP Secure S/MIME (Direct) HL7 MLLP 3
4 Semantic Mapping Based on Common Referent Index Semantic Metadata Repository based on ISO maintains Business Element (BE) Data Dictionary In addition to definition: Standard concept from standard terminology SNOMED-CT, LOINC, RxNorm, UCUM, ICD-10, CPT Synonym/source relationship to standard models FHIM CIMI HL7 Domain Analysis Models Referent Index uses BE for exchange Reference Maps From local to Referent Index From Referent Index to standard format Auto-generated maps Predictive reasoning Data Equivalency Standard Profiles, Local Data Sets Business Data Elements Standard Profiles 4
5 Semantic Mapping Based Business Data Elements Meta Data Repository (ISO 11179) Reference Maps To/from a standard format Syntax Semantics Terminology Business Data Elements Standard Profile (source/target) Standard Profile (target/source) 5
6 Model-Driven Semantic Mapping Syntax Model Canonical Data Element Syntax Model Implementation Guide Semantic Model Referent Index Implementation Guide 6
7 Semantic Mapping Local Data to Referent Index EHR (Local) Data Model Element 1 Referent Index Data Element Id = 1 Concept = (A, LOINC) Ref (M1, E3) References a standardized model (eg FHIM, DAM, CIMI) Element 2 Data Element Id Concept = (B, ) Ref (M1, E1) Element 3 Map Data Element Id = 3 Concept = D, SNOMED-CT Value Domain = SNOMED-CT 7
8 Architectural Objectives Support a variety of information exchange formats HL7, NCPDP, X12, DICOM, and HL7 product lines CDA (Clinical Document Architecture) R2 Consolidated CDA Templates R11 HL7 FHIR (HL7 Fast Healthcare Interoperability Resources) HL7 Version 2x Support domain-specific conceptual and logical models Used for mapping purposes as referent index (as defined by OMG MDMI specification) Domain-specific analysis models HL7 V3 DAMs FHA FHIM (Federal Health Information Model) as a source of data requirements 8
9 IExHub Benefits Avoids ambiguous mappings by using business semantics Base standards require constraints to be implementable thus mapping one standard to another is unreliable HL7 Version 27 to HL7 Version 3 Variable/ambiguous semantics 9
10 IExHub Benefits continued Information exchange semantics require further clarification and input from subject matter experts Standards are often too complex and require refinement and constraints for implementation (templates and IGs) Subject matter experts cannot validate a mapping from local to standard Problem date may be the date date of onset or the day it was date recorded in the chart Mapping to Problemdate ProblemObservationdateOfOnsetdateTime has the added benefit of clarifying semantics across systems Mapping to a business-specific domain clarifies those semantics 10
11 IExHub Benefits continued Mapping local semantics to business-friendly standardized data Implementation guide specific Domain Analysis specific Using referent index as a means of mapping semantically equivalent concepts across information exchange formats Semantic mapping resolves the ambiguity in mapping across formats and systems Information exchange structures are related to a common semantic model Referent Index provides a canonical representation Directly based on business concepts 11
12 May 2015 Demo Scenario Roundtrip: Send and receive document Patient/header information Allergies Medications EHR xml RDMS RDMS EHR A EHR B EHR (A, B) implemented using IExHub 12
13 FHIR Connectathon Scenario Local RI IExHub EHR xml RDMS RDMS 13
14 Semantic Mapping Model-driven Mapping Engine (IExHub) FHIR DSTU HL7 V2 LRI Clinical Database HQMF DSTU 2 QRDA DSTU 3 Semantic mapping using MDMI 14
15 Meaningful Use Interoperability FHIR HL7 V2 NCPDP SCRIPT RDMS X12 15
16 Standards-based Interoperability for MU Certification and Billing FHIR IG IG HL7 V2 IG NCPDP SCRIPT IG Meaningful Use Certified Electronic Health Record (EHR ) System X12 IG 16
17 Interoperability HUB: IExHub Semantic mapping using MDMI FHIR IG IG Meaningful Use Certified Electronic Health Record (EHR ) System HL7 V2 IG NCPDP SCRIPT IG X12 IG HL7 FHIR RESTful service 17
18 Follow-up CBCC Workgroup HL7 Gforge IExHub Connectathon Add-on to HIEs or EHR systems Next steps Projects MDHT template + business data element references Publish reference maps for specific IGs US-specific FHIR IGs 18
19 Questions? 19
20 Thanks! 20
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