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.
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.
Preparing for ICD-10: Evaluating Approaches and Potential Pitfalls. (2008, January). Retrieved from http://www.ingenixconsulting.com/content/File/ICD_EvaluationsAndPitfalls_Final.pdf
Brazhnik, O., & Jones, J. F. (2007, June). Anatomy of Data Integration. Jounal of Biomedical Informatics, 40(3), pp. 252-269. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094006/pdf/nihms25350.pdf
Davis, D. (2008, June 10). Why IHE?: The Value Proposition for Implementing IHE Profiles. Retrieved from http://www.ihe.net/north_america/flash/part1/Session_1__Overview_of_the_IHE_Connectathon_Testing_Process_for_New_Participants-20080610_1401.swf
Elia, S. (2008, January 23). Healthcare IT Talk: Healthcare Interfacing Revisited-Community General Hospital. Retrieved from http://www.corepointhealth.com/resource-center/videos-and-podcasts?type=customerinsights&
Ferranti, J. M., Musser, R. C., Kawamoto, K., & Hammond, W. E. (2006). The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis. Journal of American Medical Informatics Association, 13(3), pp. 245-252. doi: 10.1197/jamia.M1963
Hebda, T. L., & Czar, P. (2009). Chapter 11: System Integration and Interoperability. In Handbook of. In Handbook of Informatics for Nurses and Healthcare Professionals (4th ed., pp. 273-291). Upper Saddle River, NJ: Pearson Education, Inc. Retrieved from http://www.amazon.com/Handbook-Informatics-Nurses-Healthcare-Professionals/dp/0135043948
Hebda, T. L., & Czar, P. (2009). Chapter 13: Regional Health Information Organizations (RHIOs). In Handbook of Informatics for Nurses and Healthcare Professionals (4th ed., pp. 316-327). Upper Saddle River, NJ: Pearson Education, Inc. Retrieved from http://www.amazon.com/Handbook-Informatics-Nurses-Healthcare-Professionals/dp/0135043948
Juneja, G., Dournaee, B., Natoli, J., Birkel, S., & Thelin, J. (2007). Chapter 7: SOA in Healthcare. In Service Oriented Architecture Demystified: A. Hillsboro, OR: Intel Press.
Lenz, R., Beyer, M., & Kuhn, K. A. (2005). Semantic Integration in Healthcare Networks. Connecting Medical Informatics and Bio-Informatics: Proceedings of MIE2005 (pp. 385-390). Amsterdam, The Netherlands: The XIXth International Congress of the European. Retrieved from http://www.ijmijournal.com/article/S1386-5056%2806%2900117-1/abstract
Pan, E., Johnston, D., Walker, J., Adler-Milstein, J., Bates, D. W., & Middleton, B. (2004). Executive Summary, Chapter 1: Introduction, Chapter 2: Approach to Analysis, Chapter 12: Conclusions,. In The Value of Healthcare Information Exchange and Interoperability (pp. 1-6,7-11,13-20,133-136,137). Wellesley, MA: Center for Information Technology Leadership.
Rada, R. (2001). Chapter 2: Transactions and Codes. In HIPAA@IT Essentials : Health Information Transactions, Privacy, and Security (p. July). Baltimore, MD: Hypermedia Solutions Limited.
Stockemer, M. (2007, October 2). What Does HL7 Compliance Realy Mean? Retrieved from http://www.corepointhealth.com/resource-center/videos-andpodcasts?
Stroetman, V. N., Kalra, D., Lewalle, P., Rector, A., Rodrigues, J. M., Stroetmann, K. A., . . . Zanstra, P. E. (2009). Semantic Interoperability for Better Health and Safer Healthcare. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fec.europa.eu%2Finformation_society%2Factivities%2Fhealth%2Fdocs%2Fpublications%2F2009%2F2009semantic-health-report.pdf&ei=BzxMT_eIIeWwiQLc35XODw&usg=AFQjCNGkHZOZ
Swann, G. P. (2000, December 11). The Economics of Standardization. Retrieved from http://www.berr.gov.uk/files/file11312.pdf
Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health Care Information Systems: A Practical Approach for Health Care Management. San Francisco, CA: Jossey-Bass-John Wiley & Sons, Inc. Retrieved from http://www.amazon.com/Health-Care-Information-Systems-Management/dp/0470387807