Principles of Health Interoperability HL7 and SNOMED (eBook)

Foreword to the First Edition 7
Foreword to the Second Edition 9
Preface 11
Series Preface 13
About the Author 15
Acknowledgments 17
Contents 19
Part I: Principles of Health Interoperability 27
Chapter 1: The Health Information Revolution 28
Healthcare is Communication 28
Rules for Twenty-First-Century Healthcare 30
Information Handling 31
Use of Information 31
Clinical Decisions 32
Lessons of History 34
El Camino Hospital 34
Problem-Oriented Medical Records 35
Success in GP Surgeries 36
Failure in NHS Hospitals 36
The NHS National Programme 37
Canada 39
Denmark 39
Meaningful Use 39
Meaningful Use Stage 1 40
References 44
Chapter 2: Why Interoperability is Hard 46
Why Standards are Needed 47
Electronic Health Records 49
The Devil is in the Detail 51
Addresses 52
Complexity Creates Errors 54
Change Management 56
References 56
Chapter 3: Models 58
The Importance of Models 58
Models in Interoperability Standards 59
Model-Driven Architecture 60
Life Cycle 61
Scope 61
Storyboards 63
Fred and His Dog 64
Requirements Specification 66
Conceptual Design 67
Technology-Specific Specification 69
An Example: Colorectal Cancer Referral 70
References 74
Chapter 4: UML and XML 75
UML 75
Class Diagrams 77
Modeling Behavior 81
BPMN 85
XML 88
XML Documents 88
XML Elements 89
XML Attributes 90
XML Schema 90
Namespaces 92
Style Sheets 92
XPath 92
Reference 94
Chapter 5: Privacy 95
Data Protection 96
OECD Principles 97
Information Governance 98
Authentication 99
Authorization 99
Consent Management 100
Cryptography 102
Digital Signature 104
Encryption 104
Other Security Services 105
Refere nces 105
Chapter 6: Standards Development Organizations 106
What is a Standard? 106
How Standards Bodies Work 108
Standards Development Organizations (SDOs) 109
HL7 International 110
HL7 Products 112
Ballot Process 112
Membership 113
The Technical Steering Committee 115
IHTSDO 115
IHE 117
Continua Alliance 117
CDISC 118
OpenEHR 119
Open Health Tools 120
References 121
Part II: HL7 and Interchange Formats 122
Chapter 7: HL7 Version 2 123
Message Syntax 124
Delimiters 125
Segment Definition 128
Segments 129
Message Heavder MSH 129
Event Type (EVN) 131
Patient Identification Details (PID) 131
Patient Visit (PV1) 132
Request and Specimen Details (OBR) 132
Result Details (OBX) 132
Z-Segments 133
A Simple Example 134
Data Types 135
Simple Data Types 135
Complex Data Types 137
Names and Addresses 139
Other Complex Data Types 139
HL7 V2 Tables 139
HL7 V2 Documentation 140
Further Reading 141
Chapter 8: The HL7 V3 RIM 142
Origins 142
Overview 143
The RIM Backbone 144
Common Attributes 146
Act 147
Entity 151
Role 154
Association Classes 154
V3 Data Types 156
Basic Data Types 156
Instance Identifier (II) 156
Code Data Types 158
Dates and Times 160
Name and Address 160
Generic Collections 161
Special Fields 161
Use of the RIM 161
References 162
Chapter 9: Constrained Information Models 163
Types of Model 163
Types of Constraint 165
Vocabulary and Value Sets 166
Artifact Names 166
A Simple Example 167
RMIM Notation 169
Tooling 172
Templates 172
Clinical Statement Pattern 172
Relationships between Entries 173
HL7 Development Framework 174
Profiles 176
Implementation Technology Specification (ITS) 176
Documentation 177
Chapter 10: Clinical Document Architecture 179
The Document Paradigm 179
CDA History 181
Header 182
Patient 185
Author 186
Steward 187
Other Participants 187
Relationships 187
Body 189
Section 189
Clinical Statement 191
CDA Templates 191
Continuity of Care Document (CCD) 193
CCD Body 195
greenCDA 196
References 198
Chapter 11: HL7 Dynamic Model 199
Interaction 199
Trigger Event 199
Application Role 201
Message Type 202
Interaction Sequence 202
Message Wrapper 202
Query 204
Acknowledgement 204
Safety 204
Chapter 12: IHE XDS 206
Why XDS? 206
XDS Metadata 207
Document Data 208
Patient Data 209
Author Data 210
Event Data 211
Technical Data 211
Submission Sets and Folders 212
XDS Transactions and Extensions 212
Point-to-Point Transmission 214
Information Retrieval 215
Security Profiles 215
OpenExchange 216
References 217
Part III: SNOMED and Terminology 218
Chapter 13: Clinical Terminology 219
Importance 219
Coding and Classification 221
Terminology Terms 223
User Requirements 224
Cimino’s Desiderata 226
The Chocolate Teapot 227
References 231
Chapter 14: Coding and Classification Schemes 232
International Classification of Diseases 232
Diagnosis-Related Groups 234
The Read Codes 235
Hierarchical Codes 236
Automatic Encoding 237
Diseases 238
Procedures 238
History/Symptoms 239
Occupations 240
Examination/Signs 240
Prevention 241
Administration 242
Drugs 242
Development 242
Why Read Codes Were Successful 243
Problems 244
SNOP and SNOMED 245
LOINC 246
UMLS 248
References 249
Chapter 15: SNOMED CT 250
Introduction 250
Components 252
The sctId 252
Concept 254
Description 255
Relationships 256
Expressions 257
Precoordination 260
Postcoordination 260
Axis Modification 261
Subsumption Testing 262
Other Aspects 262
Subsets 262
Cross Mappings 264
History Files 265
Releases 265
Documentation 267
References 267
Chapter 16: SNOMED CT Concept Model 269
SNOMED Hierarchies 269
Attributes 270
Object Hierarchies 272
Clinical Findings 272
Procedures 274
Situations with Explicit Context 277
Observable Entities 277
Event 278
Staging and Scales 278
Specimen 278
Value Hierarchies 278
Body Structure 278
Organism 279
Substance 279
Pharmaceutical/Biologic Product 279
Physical Object 279
Physical Force 280
Social Context 280
Environments and Geographic Locations 280
Miscellaneous Hierarchies 280
Qualifier Value 280
Special Concept 280
Record Artifact 280
Core Metadata Concept 281
Foundation Metadata Concept 281
Linkage Concept 281
Chapter 17: Using SNOMED and HL7 Together 283
Terminology Binding 283
Model of Use 284
Model of Meaning 288
Structural Models 289
Implementation Issues 291
When to Use HL7 and SNOMED 293
References 295
Glossary 297
Further Reading 316
Papers and Chapters 316
Standards and Reports 318
Books 319
On-line Resources 322
Index 323