HIM and Health IT

“Health information management and health information technology are disciplines with completely different functions; however, the two disciplines are striving to find common ground with the emergence of increasing volumes of electronic data. HIM and health IT are finding that the scope and responsibilities of individual job functions are increasingly crossing department domains.
This convergence is occurring at different rates in different healthcare facilities, based on a variety of factors such as organizational size, culture, infrastructure, and degree of electronic health record (EHR) adoption. However, there is a universal need for alignment between the two disciplines to ensure that both business processes and technology are in place to advance successfully toward a fully functional EHR. This practice brief outlines how HIM and health IT can find common ground in an electronic healthcare environment.”
Article
AHIMA, Journal of AHIMA 79, no.11 (November–December 2008): 69-74

Electronic Documentation calls for Standardized Nursing Language

“Electronic documentation has called attention to the need for standardization of nursing terminology and ways to capture nursing interventions.
“Nurses’ voice is a weak echo of the medical voice,” says Marilyn E. Parker, Ph.D., RN, FAAN, professor of nursing at the Florida Atlantic University (FAU) Christine E. Lynn College of Nursing in Boca Raton.
When Parker’s community nursing practice began shifting to an electronic record system, she realized there were places for nurses to record data, such as vital signs or medical symptoms, but no place for them to enter interactions and relationships with patients.”
Article
Cougarnurse, UltimateNurse.com, 11 September 2008

Meeting the Requirements of Project HealthDesign: Comparative Analysis with Respect to Existing and Emerging Clinical Data Standards and Commercial PHR Data Repositories

“Funded by the Robert Wood Johnson Foundation (RWJF), in collaboration with the California HealthCare Foundation, Project HealthDesign is a $5 million national program of PHR systems. Administered by a national program office at the University of Wisconsin-Madison, Project HealthDesign’s goal is to design and test a variety of PHR tools and applications that work together to help people achieve their various and specific health goals in an integrated fashion.
The program is supported by the Foundation’s Pioneer Portfolio, which funds innovative projects that can lead to breakthrough improvements in the future of health and health care.”
Report
Sujansky & Associates, LLC, Project HealthDesign, August 2008

International health terminology toolset in development

“The International Health Terminology Standards Development Organisation (IHTSDO) has launched a campaign to build an essential health terminology toolset to improve access to the tools needed to develop, maintain, and use SNOMED CT in health systems around the world.”
Article
e-Health Europe, 18 July 2008

Health Language technology translates medical terminology and administrative billing codes into consumer-friendly terms

“Health Language, Inc. (HLI), the world’s leading supplier of “language engine” technology, today announced a powerful, new content set that allows for translation of medical terminology and billing codes into easily-understood consumer terminology for streamlined communication of patient data to consumers, physicians and health plans.”
Article
HealthTech Wire, 25 June 2008

Health Language Technology Translates Medical Terminology and Administrative Billing Codes into Consumer-Friendly Terms

“Health Language, Inc. (HLI), the world’s leading supplier of “language engine” technology, today announced a powerful, new content set that allows for translation of medical terminology and billing codes into easily-understood consumer terminology for streamlined communication of patient data to consumers, physicians and health plans.”
Article
PR-Inside, 18 June 2008

Electronic Documentation Calls for Standardized Nursing Language

“Electronic documentation has called attention to the need for standardization of nursing terminology and ways to capture nursing interventions.”
Article
Debra Wood, Nurse Zone, 30 May 2008

Terminology

I have been reading Keselman et al. “Consumer Health Concepts that do not Map to the UMLS” [1]. Very nteresting indeed, although in my view it only scratches the surface of terminology and semantics problems coming our way. It is interesting to see from where they start:
The gap between lay and professional health terminologies has been long identified as one of the significant barriers to empowerment of healthcare consumers. Studies suggest that lay people have difficulty understanding medical jargon, and this affects their ability to search health-related websites, comprehend printed materials, and communicate with their physicians.” (page 4) You will find more on that on the Consumer Health Vocabulary Initiative website.

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Consumer Health Concepts that do not Map to the UMLS: Where Do They Fit?

Objective This study has two objectives: first, to identify and characterize consumer health terms not found in the Unified Medical Language System (UMLS) Metathesaurus (2007 AB); second, to describe the procedure for creating new concepts in the process of building a consumer health vocabulary. How do the unmapped consumer health concepts relate to the existing UMLS concepts? What is the place of these new concepts in professional medical discourse?
Design The consumer health terms were extracted from two large corpora derived in the process of Open Access Collaboratory Consumer Health Vocabulary (OAC CHV) building. Terms that could not be mapped to existing UMLS concepts via machine and manual methods prompted creation of new concepts, which were then ascribed semantic types, related to existing UMLS concepts, and coded according to specified criteria.
Results This approach identified 64 unmapped concepts, 17 of which were labeled as uniquely “lay” and not feasible for inclusion in professional health terminologies. The remaining terms constituted potential candidates for inclusion in professional vocabularies, or could be constructed by post-coordinating existing UMLS terms. The relationship between new and existing concepts differed depending on the corpora from which they were extracted.
Conclusion Non-mapping concepts constitute a small proportion of consumer health terms, but a proportion that is likely to affect the process of consumer health vocabulary building. We have identified a novel approach for identifying such concepts.
Article
Alla Keselman, Catherine Arnott Smith, Guy Divita, Hyeoneui Kim, Allen C. Browne, Gondy Leroy, and Qing Zeng-Treitler, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2599

Bridging Radiology and Public Health: The Emerging Field of Radiologic Public Health Informatics

“Radiology and public health have an emerging opportunity to collaborate, in which radiology’s vast supply of imaging data can be integrated into public health information systems for epidemiologic assessments and responses to population health problems. Fueling the linkage of radiology and public health include (i) the transition from analog film to digital formats, enabling flexible use of radiologic data; (ii) radiology’s role in imaging across nearly all medical and surgical subspecialties, which establishes a foundation for a consolidated and uniform database of images and reports for public health use; and (iii) the use of radiologic data to characterize disease patterns in a population occupying a geographic area at one time and to characterize disease progression over time via follow-up examinations. The backbone for this integration is through informatics projects such as Systematized Nomenclature of Medicine Clinical Terms and RadLex constructing terminology libraries and ontologies, as well as algorithms integrating data from the electronic health record and Digital Imaging and Communications in Medicine Structured Reporting. Radiology’s role in public health is being tested in disease surveillance systems for outbreak detection and bioterrorism, such as the Electronic Surveillance System for the Early Notification of Community-based Epidemics. Challenges for radiologic public health informatics include refining the systems and user interfaces, adhering to privacy regulations, and strengthening collaborative relations among stakeholders, including radiologists and public health officials. Linking radiology with public health, radiologic public health informatics is a promising avenue through which radiology can contribute to public health decision making and health policy.”
Abstract
Daniel J. Mollura, John A. Carrino, Diane L. Matuszak, Zaruhi R. Mnatsakanyan, John Eng, Protagoras Cutchis, Steven M. Babin, Carol Sniegoski and Joseph S. Lombardo, Journal of the American College of Radiology, Volume 5, Issue 3, March 2008, Pages 174-181, doi:10.1016/j.jacr.2007.08.020

The Healthcare Challenge

Last week the US National Academy of Engineering (NAE) has declared Health informatics as one of the grand engineering challenges of our time.
They list a number of aspects that are part of that challenge, to start with interoperability and medical records. Their next comment is on the availability of information to professionals: “Doctors suffering from information overload need systematic electronic systems for finding information to treat specific patients and decision support systems to offer “just in time, just for me” advice at the point of care“. This sounds very much like the inventories and knowledge centres ICMCC has been focusing on during the almost 4 years of its existence.”
Article
Lodewijk Bos, ICMCC Blog, 20 February 2008

The Healthcare Challenge

Last week the US National Academy of Engineering (NAE) has declared Health Informatics as one of the grand engineering challenges of our time.
They list a number of aspects that are part of that challenge, to start with interoperability and medical records. Their next comment is on the availability of information to professionals: “Doctors suffering from information overload need systematic electronic systems for finding information to treat specific patients and decision support systems to offer “just in time, just for me” advice at the point of care“. This sounds very much like the inventories and knowledge centres ICMCC has been focusing on during the almost 4 years of its existence.
Monitoring information is mentioned next as one of the tools to improve healthcare. I should have been presenting at the German KIS meeting today, but due to medical problems I was unable to attend. I was supposed to talk about “Mobile devices from a patient viewpoint” and one of the issues I wanted to raise was the fact that these devices should be unobtrusive, easy to handle and if possible self-explanatory. The NAE even completely focuses on micro technology and interoperability once more is a key element: “Seamlessly integrating the input from such devices into a health informatics system raises the networking challenge to a new level“.
In the next part of their declaration the focus changes to public health emergencies, firstly the environmental monitoring to signal possible chemical and biological attacks, followed by a large chapter on disease surveillance to tackle pandemics, one of the other focussing points in the ICMCC history.

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Finding A Common Language In Health Care Information Technology

“I may say soda and you may say pop, but what if the hospital lab you go to today says BMP and the one you visit next week calls the same test SMA7? Your physician knows that these are the same tests, but the computer systems they use don’t automatically know. How can we develop a national healthcare information network, or even regional healthcare information exchanges, if we don’t have a lingua franca?”
Article
Medical News Today, 27 December 2007

A Model for Evaluating Interface Terminologies

“Objective: Evaluations of individual terminology systems should be driven in part by the intended usages of such systems. Clinical interface terminologies support interactions between healthcare providers and computer-based applications. They aid practitioners in converting clinical “free text” thoughts into the structured, formal data representations used internally by application programs. Interface terminologies also serve the important role of presenting existing stored, encoded data to end users in human-understandable and actionable formats. The authors present a model for evaluating functional utility of interface terminologies based on these intended uses.
Conclusion: A formal evaluation model will permit investigators to evaluate interface terminologies using a consistent and principled approach. Terminology developers and evaluators can apply the proposed model to identify areas for improving interface terminologies.”
Abstract
S. Trent Rosenbloom, Randolph A. Miller, Kevin B. Johnson, Peter L. Elkin, and Steven H. Brown, J Am Med Inform Assoc. 2008;15:65-76. DOI 10.1197/jamia.M2506

Auditing description-logic-based medical terminological systems by detecting equivalent concept definitions

“To specify and evaluate a method for auditing medical terminological systems (TSs) based on detecting concepts with equivalent definitions. This method addresses two important problems: redundancy, where the same concept is represented more than once (described by different terms), and underspecification, where different concepts have the same representation and hence appear indistinguishable from each other.”
Abstract
Ronald Cornet and Ameen Abu-Hanna, International Journal of Medical Informatics, 10 August 2007

Semantic interoperability of EHR systems

Dipak Kalra a & Bernd Blobel b
a CHIME – Centre for Health Informatics and Multiprofessional Education, University College London, United Kingdom
b eHealth Competence Center, University of Regensburg Medical Center, Regensburg, Germany

Abstract.

This paper describes the challenges that are being tackled and those that remain to be addressed if we are to enable electronic health record information to be shared seamlessly and meaningfully. This goal is known as semantic interoperability, and is needed if computational services are to be able to interpret safely clinical data that has been integrated from diverse sources. Based on sustainable architectural approaches, the paper describes the clinical case for consistently expressed clinical meaning within electronic health records, in particular where computers rather than humans need to be able to process EHR data safely. It outlines the main kinds of information and knowledge artefact that are used to represent meaning within EHRs, and considers for each its role and limitations. The problems that arise with trying to use terminology consistently with EHR reference models is explored, together with the implications for designing EHR archetypes. Examples are given of situations where a diversity of options exists for how to represent compound (multi-part) clinical expressions. Recommendations are made for the kinds of change that are needed both in record structures and in terminology systems to minimise this diversity and thereby aid semantic interoperability.

Ten Theses on Clinical Ontologies

Stefan Schulz and Holger Stenzhorn
Department of Medical Informatics, Freiburg University Hospital, Germany

Abstract.

We present ten principles for clinical ontologies that describe the authors’ opinion about what should be understood by the notion of clinical ontologies and what not. In contrast to clinical terminology systems, clinical ontologies are considered to be semantic reference systems and for that – first of all – strive to account for the properties of the domain entities themselves and their proper formal definitions – rather than just linking clinical terms together.

A Standard Ontology for the Semantic Integration of Components in Healthcare Organizations

I. Román, L.M. Roa, G. Madinabeitia and L.J. Reina
Group of Telematic Engineering; Biomedical Engineering Group; Dept. of Signal Theory and Communications, University of Seville, Spain

Abtract

In this paper we introduce an ontology that covers all the terminology involved in the ODP standard. This ontology has been extended with concepts taken from the prEN12967 in order to apply it in the healthcare domain. Describing components formally and using this ontology, their semantic integration can be eased together with the benefits derived from the assistance to the automatic discovery, selection, invocation and composition of components facilities.

SNOMED-CT: The Advanced Terminology and Coding System for eHealth

Kevin Donelly
SNOMED® International, College of American Pathologists, Northfield, Illinois, USA

Abstract

A clinical terminology is essential for Electronic Health records. It represents clinical information input into clinical IT systems by clinicians in a machine-readable manner. Use of a Clinical Terminology, implemented within a clinical information system, will enable the delivery of many patient health benefits including electronic clinical decision support, disease screening and enhanced patient safety. For example, it will help reduce medication-prescribing errors, which are currently known to kill or injure many citizens. It will also reduce clinical administration effort and the overall costs of healthcare.

Formal Design of Electronic Public Health Records

Diego M. Lopez and Bernd Blobel
eHealth Competence Center Regensburg, University of Regensburg Medical Center, Germany

Abstract

EHR systems have evolved from management of medical and patient records to the management of comprehensive health records including information about any observed health states e.g., social, economic and environmental conditions; and process such as public health surveillance, health promotion, prevention, education, etc. The paper discusses the analysis and design of Electronic Public Health Records (EPHR) according to the advanced state of knowledge in methodologies, models, techniques and tools for the specification of EPHR systems. A formal component-based architectural approach, based on internationally agreed terminologies, healthcare standards and software engineering de facto standards is presented.

Standardized Semantic Markup for Reference Terminologies, Thesauri and Coding Systems: Benefits for distributed E-Health Applications

Simon Hoelzer MD(1,2), Ralf K. Schweiger PhD(1,2), Raymond Liu(3), Dirk Rudolf(1), Joerg Rieger(1), Joachim Dudeck MD(1,2)
(1)Institute of Medical Informatics, Justus-Liebig-University of Giessen, Germany
(2)HL7 User Group, Germany
(3)University of California, Department of Medicine, San Francisco, USA

Abstract:

With the introduction of the ICD-10 as the standard for diagnosis, the development of an electronic representation of its complete content, inherent semantics and coding rules is necessary. Our concept refers to current efforts of the CEN/TC 251 to establish a European standard for hierarchical classification systems in healthcare. We have developed an electronic representation of the ICD-10 with the extensible Markup Language (XML) that facilitates the integration in current information systems or coding software taking into account different languages and versions. In this context, XML offers a complete framework of related technologies and standard tools for processing that helps to develop interoperable applications.