Community Updates

CEN TC 251

CEN TC 251 is following its remit to consider European issues and requirements related to health informatics in the wider global context. As part of this on-going commitment, Robert Stegwee, the Chairman, has presented on the value, relevance and applicability of the standards work in CEN to new and existing initiatives both in Europe and internationally.

CEN TC 251 made an active contribution to the Joint Initiative Council in Chicago in October and used the open forum to voice the need for all SDOs to consider the use and usability of their standards as part of considering the whole life cycle of standards development. JIC has agreed to take this discussion forward as a matter of urgency.

In keeping with the stance of supporting the development of standards in a more effective and agile way, CEN TC 251 also took part in the Clinical Information Models Initiative (CIMI). This is currently a loosely-coupled consortium that is independent of any one SDO but will provide important and speedier inputs in an area that requires coherent and aligned specifications to be of global, practical use. CIMI sees its role as delivering fast results but will look to all of the SDO’s as a means of providing sustainable benefits. This activity is particularly relevant for the CEN initiated 13606 multipart standard which is maturing and needs to be taken forward; and in ISO we have asked that the revision of all parts be undertaken together so as to capitalize upon implementation experience and to harmonise its content with that of other architectures in the same records/terminologies space.

From the combined presentations over the summer, the TC251 management team have expressed a number of key criteria that should be used to assess whether or not a standard can be regarded as being ‘good’:

• The standard can be found and is accessible
• The standard is being used in practice (i.e. It actually helps solve a real problem!)
• Education is available to learn to use the standard
• There is a forum for questions and maintenance of the standard
• The community using the standard participates in the maintenance, guidance and education processes
• The benefits outweigh the costs (including the risks involved)

With this important notion of feedback and practicality of standards, the TC secretariat has sent a questionnaire to the national member bodies to understand better how our standards are being implemented and used. The current areas in which we are looking to apply the above criteria, include the following:

• System of Concepts to support the Continuity of Care (there have already been a number of applications of the committee draft, and further work is being undertaken to evaluate and showcase its benefits)
• ISO/CEN – EN13606; its Revision coming up, chances to harmonize and support cross-SDO activity
• CEN – ENV13607 / HL7 – Pharmacy; Building on the success of the IDMP work. Cross-border ePrescription interoperability is a European requirement that is being developed as part of this work

Robert is on the standards panel session which will take place on 15 December 2011 in Brussels ‘eHealth & Equity in the Global Health Communities’. This is an initiative of the eHealth Unit, DG INFSO, European Commission. The CEN contribution will build upon work started within the JIC to support emerging and developing countries with appropriate health informatics standards.

DICOM

For imaging workflow integration, DICOM has had two network services, Modality Worklist (MWL) and Modality Performed Procedure Step (MPPS). These specify respectively distribution of image acquisition tasks, and reporting on task status. While quite effective for classical imaging workflow, they were somewhat limited with regard to recent emerging requirements. For instance, advanced image analysis using shared high performance computational servers was not amenable to control through the MWL/MPPS service. Similarly, radiation therapy requires integration of imaging, therapy planning, simulation, delivery, monitoring, and control systems in a fairly complex series of workflows.

This year, DICOM adopted a new set of network services called Unified Worklist and Procedure Step, intended for more complex workflow integration among devices and information systems. It does not replace the older MWL/MPPS services, which continue as the mainstay of radiology workflow. However, it is an adaptation and evolution of those capabilities for a new domain of use cases, based on over a decade of implementation experience. The Unified Worklist and Procedure Step allows systems to place items onto a worklist, pull items off of a worklist and update them, monitor a worklist item, and transmit status events. Depending on the deployment of client and server applications, it supports a variety of both push and pull control approaches in the expanding world of imaging-related clinical workflow.

MedBiquitous

As the year comes to a close, MedBiquitous begins new standards development work in support of performance assessment and continues important work related to competency-based education, curriculum reform, and credentialing.

New project: Performance Framework

MedBiquitous has begun work on a Performance Framework standard that describes expected levels of performance related to a competency or set of competencies. This supports one component of the competency-based learning model, often called Milestones in residency training and medical school. A common technical format for performance frameworks would facilitate the dissemination of performance frameworks and their implementation in curricula and performance assessment systems. Technical standards would also make it easier to connect assessments to performance and competencies. See http://www.medbiq.org/sites/default/files/files/Performance_framework_pr...

Ongoing standards development: Competencies, Curricula, and Credentialing

MedBiquitous working groups continue development of three specifications to support health professions education: Competency Framework, Educational Achievements, and Curriculum Report. The Competency Framework specification allows educators to define the relationships among a set of interrelated competencies. The competencies can then be mapped to learning resources, curriculum, educational achievements, etc. The Educational Achievements specification will document learner competency and make that data portable across the continuum of health professions education, allowing learners to maintain lifelong portfolios of their educational achievements. The Curriculum Report specification provides a common format for core data about health professions curricula, enabling the dissemination of curricular innovations and best practices. The MedBiquitous Professional Profile Working group is working on version 2 of the Healthcare Professional Profile American National Standard. The standard provides a common format for profile data on healthcare professionals, including data used for credentialing. Version 2 of the standard will support the evolving Maintenance of Certification, Osteopathic Continuous Certification, and Maintenance of Licensure processes.

A working draft of the specifications and XML schemas are available for the Competency Framework, Curriculum Report, and Healthcare Professional Profile version 2.

Learn more about these standards development projects at the MedBiquitous Annual Conference 2012: http://medbiq.org/conference2012 or visit the MedBiquitous website: www.medbiq.org

ISO TC /215

ISO TC215 on Health Informatics has been participating in the highly successful CIMI (Clinical Information Model Initiative), aligning what TC215 refers to as Detailed Clinical Models (DCM’s) with HL7 templates, CEN TC251 and openEHR Archetypes, CDISC (Clinical Data Interchange Standards Consortium) research profiles, NHS Clinical Statements, and of course the Intermountain Healthcare Clinical Element Models (CEMs). This international harmonization effort is being led by Stan Huff from Intermountain in Utah, with strong participation and enthusiasm by virtually all players. TC215 is delighted to participate in this effort, and sees it as potentially another significant coordination process with large influence on Health Information Standards throughout the world; we expect the CIMI output will be proposed for TC215 adoption. Meanwhile, ISO TC215 anticipates completing its reorganization process by our next plenary in the spring of 2012, details of its new configuration will appear in the next update.

LOINC

Regenstrief Institute and HL7 Sign Statement of Understanding

Building on their already strong relationship, Regenstrief Institute and Health Level Seven (HL7) International have signed an agreement to create a complementary process to develop and extend comprehensive standards in the healthcare industry. Regenstrief has been a long-standing contributor to the standards developed by HL7, and likewise, LOINC has been enhanced by its adoption in HL7's standards. When used in conjunction with the data exchange standards developed by HL7, LOINC's universal observation identifiers make it possible to combine test results, measurements, and other observations from many independent sources. Together, they facilitate exchange and pooling of health data for clinical care, research, outcomes management, and other purposes.

With this agreement, Regenstrief and HL7 will develop an even closer collaboration that improves the semantic interoperability of health data exchange worldwide.

LOINC, SNOMED CT, and RxNorm Endorsed for Quality Reporting

In September, the Health IT Standards Committee endorsed a single set of vocabulary standards for clinical concepts in quality measures. The recommendations were based on the joint work of the Clinical Quality Measures Workgroup and Vocabulary Task Force and covers 23 categories, including the domains of medications, labs and allergies. Across all of the domains that include a measurement or observation focus (diagnostic studies, functional status, patient preferences, etc), the Committee recommended LOINC as the terminology for the observation (question) and SNOMED as the observation value (answer) for non-numeric results. RxNorm was recommended as the standard for medications. These recommendations were approved by the HIT Standards Committee and sent to the National Coordinator for Health Information Technology of DHHS on September 9, 2011 (http://bit.ly/twFMTo).

LOINC Content Updates and Other Developments

In June 2011, Regenstrief Institute, Inc and the LOINC Committee released the 47th edition of the LOINC terminology, version 2.36, which contained more than 65,000 terms. With more than 3,700 new concepts added, this represents the largest increment for a single release yet. Some of the content highlights from this release includes additional PhenX terms, measures for many kinds of nuclear antibodies, special chemicals, and DNA testing for organisms and resistance genes. The RELMA program features a much-improved Auto Mapper program that automatically produces a ranked list of candidate LOINC terms for each local term in your master file. The Auto Mapper program is now available “on-demand” for a single local term from the search screens. Additionally, RELMA’s common test search limits are now based on the empirically-derived Top 2000+ list (also available at http://loinc.org/usage) to make it easy to find the most commonly reported lab tests. Stay tuned for the upcoming release scheduled for the end of December 2011.

CDISC

CDISC has been very busy during the past few months. A few highlights are listed below.

a) The CDISC Board has agreed on a new set of Strategic Goals for 2012-2015. They center around support of data aggregation, development of therapeutic area standards, continuing to link healthcare and research (see the article in this edition of AMIA’s Standards Stanard on using EHRs for research), and a launch of the Shared Health and Research Electronic Library (SHARE). Of course, ensuring the resources and infrastructure to support these and communicating about them is also key.

b) CDISC participated in a number of activities organized through the Japan CDISC Coordinating Committee (J3) in November. These included a presentation at Kyushu University and meeting with opinion leaders there on 11 November; a luncheon meeting on 12 November with the leadership of the Translational Research Informatics (TRI) Institute that is based in Kobe; a pre-conference workshop (entitled ‘CDISC Makes you Happy’) on 13 November for the Global Quality Assurance Conference in Kyoto; and a workshop on 14 November on Legacy Data Conversion, with associated training on the CDISC SDTM standard in Tokyo.

c) CDISC collaborated with FDA and the Critical Path Institute on an exciting meeting in Silver Spring, MD on 30 November and 1 December, and CDISC held its own CDISC Interchange with Colloquia around 6 Therapeutic Areas in October in Baltimore.

Watch for device standards to be out for open review in mid-December!

Please see our blogs and website for further details (www.cdisc.org).

IHTSDO

SNOMED CT Implementation

The IHTSDO held a well attended annual conference and implementation showcase in Sydney, Australia during October 2011. A variety of vendors and innovators demonstrated effective applications of SNOMED CT. The next annual event in Stockholm, Sweden 25-26 October 2012 will also include a large showcase focused on implementation.

Terminology Delivery

The biannual release of SNOMED CT is now being edited, maintained and produced using an Open Source Workbench developed by the IHTSDO. SNOMED CT is now available in a new extensible format that includes fully versioned data allowing dynamic access to every version of SNOMED CT ever released.

Harmonization with other Standards

As part of the strategy for interoperability, the IHTSDO is cooperating with various organizations. A meeting was held in London December 2011 continuing the joint work between WHO and IHTSDO to build linkages between SNOMED CT and the WHO Family of International Classifications. IHTSDO and the Global Medical Device Nomenclature (GMDN) Agency have recently finalized the business principles that will form the basis of a long term cooperation. IHTSDO continues to work with HL7 on use of SNOMED CT within its Standards. The IHTSDO is also pursuing similar initiatives with many other health informatics standards groups.