eHR Sharable Data Vicky Fung Senior Health Informatician eHR Information Standards Office
eHR ‐ Vision eHR Vision HA HA DH DH ePR ePR PPP PPP EHR EHR CMS CMS onramp onramp Repository Repository Clinics Clinics Clinics Clinics Private Private softwa softwa software software Private Private Private Private Hospit Hospit re re Hospitals Hospitals als als Access Portal Access Portal
Standardisation for eHR Standardisation for eHR • Ensure accurate interpretation of health data by all parties y p • Support reuse of data • Reduce duplicated efforts in data entry R d d li d ff i d • Facilitate interoperability of systems for data p y y captured at different platforms • Improve efficiency of healthcare services I ffi i f h lth i • Assist in protection of public health
Information Architecture Every medical fact has a concept Every medical fact has a concept What the data means What the data means Every medical fact has a context Every medical fact has a context Every medical fact has a context Every medical fact has a context How data should be interpreted How data should be interpreted Every medical fact has a presentation Every medical fact has a presentation H How data are organized & presented How data are organized & presented H d d i d & i d & d d Analyze Reuse Display Store Capture Design
Standards for eHR Standards for eHR • Identification – Registry g y – Healthcare provider – Healthcare staff Healthcare staff • eHR content • Terminology • Message standard • Message standard
Standards Compliance Standards Compliance p 1 1 3 3 Automated paper Problem : Diagnosis diab. mellitus 3983 Diabetes Mellitus Fully Interoperable eHR eHR Content Standards 2 Guidebook Diagnosis g HKCTT (Diagnosis) HKCTT (Diagnosis) DM 3983 Diabetes Mellitus 3985 Type II Diabetes Data Integration Data Integration Mellitus 3987 Type I Diabetes Mellitus
Phased Approach – A Proposal 2012 Jun eHR Section Level 1 Level 2 Level 3 eHR eHR Participant Participant Encounter Referral Clinical Clinical note note / / summary summary Adverse reaction / allergy Clinical Clinical alert alert Problem Problem Procedure Birth Birth record record Assessment / physical exam Assessment / physical exam Social history Past medical history Family history y y Drug – prescription record Drug – dispensary record Immunization Clinical request Diagnostic test result – Laboratory Diagnostic test result – Radiology Diagnostic test result – Other investigation Di ti t t lt Oth i ti ti Care & treatment plan Key : Phase 1 Phase 2 Phase 3 Phase 4 Phase 5
eHR Phase 1 eHR Phase 1 Based on PPI ‐ ePR
eHR Implementation – Phase 1 2012 Jun eHR Section Level 1 Level 2 Level 3 eHR Participant Encounter Referral Clinical note / summary Adverse reaction / allergy Clinical alert Problem Problem Procedure Birth record Assessment / physical exam Assessment / physical exam Social history Past medical history Family history y y Drug – prescription record Drug – dispensary record Immunization Clinical request Diagnostic test result – Laboratory Diagnostic test result – Radiology Diagnostic test result – Other investigation Di ti t t lt Oth i ti ti Care & treatment plan
Workflow to Prepare Domain Dataset Workflow to Prepare Domain Dataset Study and refer: references, local & Study and refer: references, local & Study and refer: references, local & Study and refer: references, local & international standards international standards international standards international standards Develop initial set of eHR content, code Develop initial set of eHR content, code Develop initial set of eHR content, code Develop initial set of eHR content, code sets (tables), interoperability standards sets (tables), interoperability standards sets (tables), interoperability standards sets (tables), interoperability standards Gap analysis: HA Gap analysis: HA Gap analysis: HA ‐ ePR Gap analysis: HA ‐ ePR ePR, eHR on ePR, eHR on , eHR on ‐ ramp, eHR , eHR on ‐ ramp, eHR ramp, eHR ramp, eHR adaptation, proposed eHR viewer adaptation, proposed eHR viewer adaptation, proposed eHR viewer adaptation, proposed eHR viewer adaptation proposed eHR viewer adaptation proposed eHR viewer adaptation proposed eHR viewer adaptation proposed eHR viewer Seek consultation from Domain Groups, Seek consultation from Domain Groups, Seek consultation from Domain Groups, Seek consultation from Domain Groups, E Expert advice group Expert advice group Expert advice group Expert advice group E E E d i d i d i d i Briefing on eHR Content B i fi B i fi Briefing on eHR Content Briefing on eHR Content – 20 Jul 2012 Briefing on eHR Content – 20 Jul 2012 B i fi B i fi HR C HR C HR C HR C 20 Jul 2012 20 J l 2012 20 J l 2012 20 J l 2012 20 J l 2012 20 Jul 2012
Hong Kong eHR Standards Hong Kong eHR Standards eHR Standards Guide • eHR Content Standards Guidebook eHR Data Interoperability Standards HR D I bili S d d • R f References • ASTM E1384 Content & structure of electronic health record E1384 Content & structure of electronic health record E2369 Continuity of care record (CCR) • HL7 standards SNOMED CT • • HA data structure for electronic patient record (ePR)
eHR Content: 21 Domains eHR Content: 21 Domains 1. 1 eHR Participant HR P ti i t 11 S 11. Social history i l hi t 2. Encounter 12. Past medical history 3. 3. Referral Referral 13. Family history 13. Family history 4. Clinical note / summary 14. Drug – prescribing record 5. Adverse drug reaction / 15. Drug – dispensing record allergy ll 16. Immunisation 6. Clinical alert 17. Clinical request 7. 7 Problem Problem 18 Laboratory Result 18. Laboratory Result 8. Procedure 19. Radiology Result 9. Birth Record 20. Other Investigation 20. Other Investigation 10. Assessment / physical 21. Care & Treatment Plan exam Managed by Domain Groups Managed by Co-ordinating Groups
Immunisation Immunisation Dataset Dataset
Immunisation Immunisation Dataset Dataset
Data Schema
Data Schema Definition • Definition of the Entity ID y entity • Unique identifier for each Entity • Issued by eHRISO Entity Name Name of data field, e.g. • [Date of birth] • [Report title]
Data Schema Repeated Data Whether multiple entry for Whether multiple entry for Data Type (code) / (description) same entity is allowed Section Entity Repeated Data storage format g data Participant Date of N Code Description Definition birth CE Coded element Coding systems/tables specified by eHR project Prescription Prescribed Y Encapsulated l d Record drug ED Encapsulated data, e.g. PDF document data ST String data Text data upto 1,000 characters Date and time TS Time stamp Permits varying degrees of granularity from days, hours, to decimal seconds TX Text Text data upto 65536 characters, for display purpose
Data Schema Validation Rules Code Table For data quality, e.g. • Name of the code table from • Section : Birth Record which the data value for a • Entity : [Apgar Score ] E tit [A S ] particular entity is referenced to • Validation : value is 0 to 10 • In Codex – around 80 tables Section Section Entity Entity Code Table Code Table Participant Sex Sex Encounter Specialty Specialty
Laboratory Category Table Code Tables Code Tables TermID eHR Value eHR Description CHEM Chemical Pathology Laboratory HAEM Haematology Laboratory IMMUN Immunology Laboratory MICRO MICRO Microbiology Laboratory Microbiology Laboratory e assigned VIRO Virology Laboratory PATH Anatomical Pathology Laboratory TRL Toxicology Reference Laboratory To be BLDBK Blood Bank T&I Transplantation & Immunogenetic Laboratory MOLPATH Molecular Pathology Laboratory LAB Clinical Laboratory Certified Laboratory Laboratory Category Laboratory Category Laboratory Level Level Category Code Category Code Description Description Local Description Local Description A Level 2 ‐‐‐ ‐‐‐ Chem Chemical Pathology Chemical Pathology B Level 3 Chem ChemPath Laboratory Haematology Haematology C C Level 3 Level 3 HAEM HAEM Laboratory Laboratory
Recognised Terminologies for eHR Recognised Terminologies for eHR • Compendium of Pharmaceutical Products • Hong Kong Clinical Terminology Table (HKCTT) • International Classification of Diseases, 10th Revision (ICD 10) • International Classification for Primary Care 2 nd Edition (ICPC2) • International Classification for Primary Care, 2 Edition (ICPC2) • Logical Observations, Identifiers Names and Codes (LOINC) • Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT)
Set of 5 Set of 5
Set of 5 Di Diagnosis – Level 2 Compliance i L l 2 C li optional mandatory Example Diagnosis Local Code Diagnosis Local Description 1 ‐‐‐‐ Haemorrhoid 2 HM Hemorrhoid 3 3 123 123 Pil Piles
Set of 5 Di Diagnosis – Level 3 Compliance i L l 3 C li mandatory mandatory optional mandatory Example Rcg T Name Rcg T ID Rcg T Des Local Code Local Description 1 SNOMED CT 233604007 Pneumonia ‐‐‐‐ Pneumonia 2 2 ICD 10 ICD 10 J18.9 J18 9 Pneumonia Pneumonia PN PN Pneumonia Pneumonia 3 HKCTT 8471 Pneumonia 123 Chest infection 4 HKCTT C 8 8471 Pneumonia i ‐‐‐ ‐‐‐ Pneumonia
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