Our response to the 2016 ONC Interoperability Standards Advisory

The Office of the National Coordinator (ONC) recently published the draft version of the 2016 Interoperability Standards Advisory (2016 Advisory). The 2016 Advisory is the ONC’s “identification, assessment and determination of the ‘best available’ interoperability standards and implementation specification for health IT.”¹ This article asks and answers, the following questions:

• What are the most important clinical interoperability needs?
• What are the best available vocabulary, structural and service standards that support clinical interoperability needs?

Happy LOINCing with HDD Access!

The July release of HDD Access, the open public version of the 3M Healthcare Data Dictionary, included LOINC® (version 2.50), the standard terminology for lab and clinical observations. We thank Regenstrief Institute for their active support in making this possible. LOINC was perhaps the most-requested terminology on the HDD Access discussion forums, and we hope that this release helps our users to take another big step towards clinical data interoperability. We noticed an increase in downloads after we released LOINC, many of them by new users. So, for those who are just starting out, here’s a brief overview of how to use the LOINC content within HDD Access.

LOINC Facilitates Exchange of MY Data!

A few months ago I wrote a personal blog detailing the lack of interoperability for my data after a knee replacement. The most important observations that are measured after knee replacement are pain intensity and knee flexion angle. I would have loved to see my pain levels graphed out over time as it decreased while my knee flexion graph showed an increase. This meant that my measurements from hospital, home, physical therapy and the physician’s office all needed to be in the same system. So…what needs to be done to have my data where it needs to be to track my progress?

Our Response to the ONC 2015 Standards Advisory

Earlier this year, the Office of the National Coordinator (ONC) released the 2015 Interoperability Standards Advisory which was “meant to provide the industry with a single, public list of the standards and implementation specifications that can best be used to achieve a specific clinical health information interoperability purpose.”¹ The ONC solicited comments on the advisory “to prompt dialogue, debate, and consensus among industry stakeholders.”¹ As is evident by the recent discussion in our blogs around the importance of interoperability, the 3M Healthcare Data Dictionary Team at 3M HIS drafted a response to the 2015 Advisory that we provided to the ONC this week. Our response has a few underlying themes:

We Are All “Patients” – The Reason Interoperability REALLY Matters

Last month, the Office of the National Coordinator (ONC) released A Shared Nationwide Interoperability Roadmap. A recent blog written by Amy Sheide describes the contents of the document, but I want to discuss why it really matters. The vision outlined in the roadmap is the reason I work as a terminology leader in the standards industry. It answers a common question I frequently get: “Why do you do what you do and why does it matter?” I truly believe that human beings deserve the best healthcare they can get. This means that their information, such as past medical history, medications, labs, etc., should be at the fingertips of those who are providing care.

Interoperability Matters: The ONC Interoperability Roadmap and Standards Advisory

Healthcare reform has been a hot topic over the past few days and health information technology (HIT) is at the hub. Last week, the Office of the National Coordinator (ONC) released a Shared Nationwide Interoperability Roadmap¹, setting the goal to exchange and use “a common set of electronic clinical information at the nationwide level by the end of 2017.” Also, President Obama highlighted the Precision Medicine initiative² which included funding for ONC to support the development of interoperability standards, and CMS announced that Medicare payments are moving towards a model based on value and care coordination rather than volume and care duplication (and it is well known that lack of interoperability underlies the latter)³.

AMIA 2014: RxNorm

Guest blog by Michael Totzke, 3M data analyst.

At the AMIA 2014 convention in Washington D.C., we showcased some of our processes for mapping and maintaining RxNorm drugs into the Healthcare Data Dictionary (HDD). Our poster and podium presentations emphasized the fact that with clinical data, accurate and consistent mapping of terminology standards over successive versions is critical. With the selection of RxNorm as the drug terminology standard required to meet Meaningful Use criteria, it has become necessary for the HDD to maintain RxNorm’s drug data from a longitudinal perspective. Our former process for maintaining RxNorm dealt solely with the mapping of the current version, with limited regard to managing changes in RxNorm’s data over time. However, it’s not just the initial mapping that is important; having a long term strategy for maintaining that terminology within a larger terminology server is crucial for ensuring data quality. Medical terminologies change over time, and there is no algorithm yet that can alone guarantee the level of accuracy required for exchange of clinical data.

The IHI Triple Aim and Informatics

Recently I attended the American Medical Informatics Association (AMIA) annual symposium in Washington, D.C. I focused mainly on sessions related to nursing, interoperability, or both. The keynote speaker for the nursing preconference session was Dr. Deborah Troutman, CEO of the American Association of Colleges of Nursing (AACN). Dr. Troutman spoke about the Institute for Healthcare Improvement’s (IHI) Triple Aim. This blog gives an overview of the Triple Aim, discusses how it pertains to informaticians, and ends with a discussion about where we need to focus in the future.

The Triple Aim is a framework for developing new designs to optimize health system performance and to capture social needs in healthcare. The three aims are experience of care, health of populations, and costs of health. Experience of care means that if a person gets sick, the perception of their care, including quality, effectiveness, timeliness, etc., should be high. Population health is focused on causes of illness, such as obesity, substance abuse, and heart disease. The final aim is to lower cost, not by decreasing what people receive in their care, but through process improvement and illness prevention. The desired state is person-centered and is not focusing on illness care but moving towards wellness.

Achieving Semantic Interoperability: Point-to-Point Versus Centralized Mapping

Our philosophy at 3M is to approach terminology mapping and semantic interoperability using a centralized terminology server. With a centralized source of terminology management and maintenance, each data source needs to be mapped only once. Once this single mapping occurs, all the other systems that are mapped to the centralized server can leverage the mappings so data can be translated and exchanged without losing meaning. Therefore, for n systems that need to be mapped, only n mappings need to be performed.

On the other hand, in a point-to-point mapping approach, each system is mapped directly to every other system. While this is a feasible approach when dealing with a few systems, it becomes unwieldy as the number of systems increases. For example, given three systems to map, the total number of mappings that need to be created is three. However, if we increase the number of systems to five, the point-to-point mappings increase to 10. This is illustrated in Figure 1.

Meaningful Use and Laboratory Data Management: Getting to the Next Level

I am known for having a “glass is half full” optimistic view of life, so when I was recently presented with the opportunity to be a panelist at a Meaningful Use discussion, I accepted. The discussion was held at the American Association for Clinical Chemistry (AACC) 2014 annual meeting in Chicago. This year’s Healthcare Forum session was held jointly with American Society for Clinical Laboratory Scientists (ASCLS). I pondered the best way to adequately portray the complexity (a.k.a. frustration and confusion) occurring across the industry as hospitals attempt to keep up with MU (not to mention all of the other federal mandates).