MMI 405 - HIT Integration, Interoperability & Standards

Course Description:

This courses focus was in providing the details of healthcare information technology (HIT) standards and interoperability. The value proposition of standards will be presented. The course will review health information models and look at the IHE Initiative, HL7, DICOM, CCOW, and other standards, and cover the role of non-medical standards in medical informatics (HTTP, XML, etc.). The course will also cover multi-institutional issues and telemedicine, e-commerce, and Health Insurance Portability and Accountability Act (HIPAA) standards compliance.
Professor: Nicholas Bertram, MS, MBA
Term: Summer 2011
Grade: A
Text: 1) Giannangelo, K. (2010). Healthcare Code Sets, Clinical Terminologies, and Classifications - 2nd edition. Chicago, IL: American Health Information Management Association. ISBN: 978-1-58426-225-1 2) Henderson, M. (2007). HL7 Messaging - 2nd edition. Aubrey, TX: OTech Inc. ISBN: 978-0-9787646-4-7

Learning Objectives:

  • Describe the benefits of standards-based HIT interoperability
  • Identify the resources necessary for an HIT integration project
  • Utilize appropriate HIT standards in an integration project
  • Navigate through US national interoperability standards
  • Explain the policy issues in intra- and inter-institutional health data exchange
  • Recognize how important system interoperability is for healthcare
  • Explain how an interface engine works
  • Identify integration issues and the benefits of integration
  • Discuss how integration impacts the master patient index and data warehouse
  • Specify the different levels of interoperability and illustrate their benefits
  • Identify key factors in the health information exchange (HIE) movement
  • Compare and contrast different health information exchange models
  • Identify obstacles to health information exchange development and operations
  • Identify the value that the IHE provides
  • Identify the main usage models that healthcare information networks support
  • Discuss what the greatest opportunities are when applying a service oriented architecture (SOA)
  • Explain the guidelines for implementing a SOA
  • Examine four levels of enterprise business integration
  • Identify and Illustrate data integration technologies
  • Identify the association between data, technical, functional, and semantic integration
  • Define semantic interoperability
  • Identify the goal, vision, and challenges with semantic interoperability
  • Explain the roadmap and recommendation to achieve semantic interoperability
  • Explain how a service oriented architecture can be used to achieve semantic interoperability in healthcare
  • Identify which types of transactions, code sets, and identifiers are covered under the HIPAA legislations
  • Describe the principles used to guide the choices involved in deciding which standards become designated as HIPAA standards
  • Describe the technical details of X12 transactions
  • Identify the concepts, costs, and benefits of associated with implementing HIPAA compliant transactions, code sets, and identifiers
  • Explain the general purpose of healthcare data interchange standards
  • Identify the relationship between data interchange standards and vocabularies, terminologies, and classification systems
  • Recognize the names and purpose of the major healthcare data interchange standards
  • Explain how vocabularies, terminologies, and classification systems work together in an electronic healthcare environment Identify the implementation issues surrounding the use of vocabulary, terminology, and classification systems
  • Explain the terminology connection to semantic interoperability
  • Analyze an interface engine data flow scenario
  • Identify the development and purpose of CPT along with its types
  • Explain the purpose and function of LOINC and its relationship to other terminologies and code sets
  • Explain the general purpose of healthcare data sets
  • Recognize the relationship between healthcare data sets and vocabularies, terminologies, and classification systems
  • Gain familiarity with HITSP
  • Gain and demonstrate knowledge of data warehousing concepts
  • Identify the purpose and function of the International Classification of Diseases
  • Explain what HIPAA 5010 and ICD-10 are, the reasons for them, and the impact they each have
  • Explain the issues that healthcare organizations should consider as they assess their ICD-10 preparedness

What I Learned:

I greatly anticipated taking this class. As an IT professional, I was eager to learn what it meant to be a Healthcare IT (HIT) Professional, and to learn what distinguishes the two from each other. I believe that healthcare IT is often perceived as having a bad stigma, and the common view is that the industry is far behind in terms of technology.Having spent close to a decade working in high-technology companies, this class surprised me, as I quickly learned that while the industry was not exactly on the fringe, many of the solutions I studied throughout the course focused on bridging gaps in interoperability. For example, by focusing on information exchanges founded on standards based transactions. Moreover, interoperability can be classified to include both semantic and syntactic elements.

My eyes were really opened to the opportunities that were before me in terms of really understanding technology standards within HIT. I studied vocabularies, terminologies, and classification systems as they each relate to defining standard coding systems. I was exposed to SNOMED-CT, Current Procedural Terminology (CPT), Logical Observation Identifiers Names and Codes (LOINC), International Classification of Diseases (ICD) including ICD-9-CM, ICD-10-CM, ICD-10-PCS, Healthcare Common Procedure Coding System (HCPCS), National Drug Codes (NDCs), Current Dental Terminology (CDT) and RxNorm. Previous course experience on ontologies and nomenclatures really helped reinforce the mapping the hierarchy to classification systems like the ones mentioned above.

We also studied data exchanges and standards that exist to transmit standard transactions. Data standards that I gained exposure to included Health Level 7 (HL7), Continuity of Care Document (CCD), Clinical Document Architecture (CDA), Digital Imaging and Communications in Medicine (DICOM), American National Standards Institute (ANSI), Accredited Standards Committee (ASC) with X12N, and Electronic Data Interchange (EDI). EDI, for instance, is widely used within healthcare for exchanging information between (and within) organizations. I gained a better exposure to the standards bodies and organizations that exist that establish and maintain these standards. One of the most useful committees that I was exposed to was Health Information Technology Standards (HITSP) committee. HITSP holds a wealth of information and functions as a panel of joint interest groups for the purpose of "harmonizing and integrating standards that will meet clinical and business needs for sharing information among organizations and systems".

Of particular interest to me during the course is when I learned about service oriented architecture (SOA) and interface engines. This came at an opportune time for me that coincided with an implementation for me at work where I am working on implementing an enterprise service bus (ESB). An ESB is a common means of leveraging an interface engine which is responsible for doing extracts, transformations and loads (ETLs) between integrated systems in an organization. Gaining further background around this helped solidify the reasoning in our approach at my workplace.

The course mostly centered on researching weekly questions by finding answers o questions that were assigned from two textbooks. These questions were repeated on the proctored final exam to test recall and understanding. Unfortunately, there was only a single lecture throughout the entire term, and so successful demonstration of mastery of course material relied on rote memorization and recall on the exam in a multiple choice format with nearly 100 questions in the test bank. While I performed well, I was not impressed with the approach for a graduate level course. Nonetheless, I did enjoy the group work and learned the most in this setting as other students explained how all of the concepts outlined in the course material applied in the real world. I was extremely fortunate to pair up with John Goss and Mike Sleep who had implemented data exchanges in their work experience. I leveraged their expert knowledge and gained a practical perspective for finding application for standards within my own work.

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