Presented at Cambridge Semantic Web Monthly Meetup on September 8, 2015
http://www.meetup.com/The-Cambridge-Semantic-Web-Meetup-Group/events/223161012/
2. Tomasz
Adamusiak
MD
PhD
• Chair
AMIA
Knowledge
RepresentaEon
and
SemanEcs
WG
• Past:
postdoc
at
NLM,
bioinformaEcian
at
EBI
3. Conflict
of
interest
disclosure
• Pre-‐sales
and
post-‐sales
support
for
Thomson
Reuters
Data
Fusion
4. Learning
ObjecEves
• Describe
the
Meaningful
Use
requirements
and
its
data
standards
• Recognize
the
value
of
structured
clinical
informaEon
• IdenEfy
challenges
in
interoperability
of
clinical
informaEon
systems
5. $30
880
000
000
Total
payments
for
Medicare
and
Medicaid
Electronic
Health
Record
(EHR)
IncenEve
Programs
(2011
-‐
July
2015)
8. US.
health
care
system
is
the
most
expensive
and
underperforms
on
most
dimensions
of
performance
AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US
OVERALL RANKING (2013) 4 10 9 5 5 7 7 3 2 1 11
Quality Care 2 9 8 7 5 4 11 10 3 1 5
Effective Care 4 7 9 6 5 2 11 10 8 1 3
Safe Care 3 10 2 6 7 9 11 5 4 1 7
Coordinated Care 4 8 9 10 5 2 7 11 3 1 6
Patient-Centered Care 5 8 10 7 3 6 11 9 2 1 4
Access 8 9 11 2 4 7 6 4 2 1 9
Cost-Related Problem 9 5 10 4 8 6 3 1 7 1 11
Timeliness of Care 6 11 10 4 2 7 8 9 1 3 5
Efficiency 4 10 8 9 7 3 4 2 6 1 11
Equity 5 9 7 4 8 10 6 1 2 2 11
Healthy Lives 4 8 1 7 5 9 6 2 3 10 11
Health Expenditures/Capita, 2011** $3,800 $4,522 $4,118 $4,495 $5,099 $3,182 $5,669 $3,925 $5,643 $3,405 $8,508
COUNTRY RANKINGS
Top 2*
Middle
Bottom 2*
EXHIBIT ES-1. OVERALL RANKING
Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010.
Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health
Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).
14. InformaEon
exchange
is
at
the
heart
of
Meaningful
Use
h_ps://www.cms.gov/RegulaEons-‐and-‐Guidance/LegislaEon/EHRIncenEvePrograms/Downloads/EHR_Medicaid_Guide_Remediated_2012.pdf
Stage
2
Core
Measures:
12.
Provide
paEents
with
an
electronic
copy
of
their
health
informaEon,
upon
request
13.
Provide
clinical
summaries
for
paEents
for
each
office
visit
14.
Capability
to
exchange
key
clinical
informa>on
Menu
Measure:
8.
The
EP
(…)
should
provide
summary
care
record
for
each
transiEon
of
care
or
referral
15. “unstructured
document”
is
explicitly
prohibited
in
transiEon
of
care
Electronic
Access
Clinical
Summaries
InformaEon
exchange
in
MU
Stage
2
PaEents
Referring
provider
Receiving
provider
Receiving
provider
16. Blue
Bu_on
Get
It
• Find
out
what
kinds
of
health
informaEon
are
available
via
Blue
Bu_on
and
which
providers
offer
it
.
Check
It
• Get
advice
about
what
to
look
for
in
your
health
record,
and
your
right
to
correct
it.
Use
It
• Discover
what
you
can
do
with
your
health
informaEon
and
ways
to
safeguard
and
protect
your
health
informaEon
17.
18. Structured
Summary
of
Care
Problem
lists
• SNOMED
CT
MedicaEons
• RxNorm
Laboratory
tests
• LOINC
Procedures
• SNOMED
CT
• HCPCS
+
CPT-‐4
• CDT
• ICD–10–PCS
19. Consolidated
CDA
provides
templates
for
care
summaries
Medication Information
ManufacturedProduct
Medication Activity
SubstanceAdministration
Medication Supply Order
ManufacturedProduct
Immunization
SubstanceAdministration
By ﺍاﻝلﺏبﻱيﻁطﺍاﺭر ﺇإﺏبﻥن own work - [Public domain], via Wikimedia Commons
20. Only
structured
informaEon
allowed
in
MU
TransiEon
of
Care
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code
code="310965"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="Ibuprofen
200
MG
Oral
Tablet">
</code>
</manufacturedMaterial>
</manufacturedProduct>
21. Only
structured
informaEon
allowed
in
MU
TransiEon
of
Care
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.23"/>
<manufacturedMaterial>
<code
code="310965"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm"
displayName="Ibuprofen
200
MG
Oral
Tablet">
</code>
</manufacturedMaterial>
</manufacturedProduct>
MedicaEon
InformaEon
Template
RXCUI
Normalized
Drug
Name
22. Fast
Healthcare
Interoperability
Resources
• Aims
to
simplify
implementaEon
without
sacrificing
informaEon
integrity
• Derived
from
HL7
RIM
and
other
important
content
models
• Intended
to
address
the
most
common
(80%)
interoperability
needs
of
implementers
• Because
v3
is
hard
26. CDS
is
difficult
because
computers
do
not
understand
text
very
well
HISTORY
OF
PRESENT
INQUIRY:
Mr.
Smith
is
a
34-‐year
old
gentleman
who
presents
at
our
branch
to
obtain
a
car
loan
secondary
to
growing
maintenance
costs
of
his
current
vehicle.
He
otherwise
reports
doing
well.
His
past
financial
history
is
insignificant.
28. Target
isn't
just
predicEng
pregnancies:
expect
more
savvy
data-‐mining
tricks
(Hill,
K.
2012,
February
24)
29. Mining
associaEons
in
Electronic
Health
Records
Diabetes
mellitus
Yes
No
Glucohemoglobin
measurement
Yes
1509
5442
No
881
99
PosiEve
associaEon
Background
reference
EHR-‐based
phenome
wide
associaEon
study
in
pancreaEc
cancer.
Adamusiak
T,
Shimoyama
M,
AMIA
Jt
Summits
Transl
Sci
Proc.
2014
Apr
7;2014:9-‐15
40. Expansion
in
UMLS
across
MU
sources
41
Diabetes
mellitus
without
menEon
of
complicaEon,
type
II
or
unspecified
type,
not
stated
as
uncontrolled
ICD-‐9
ICD-‐10
SNOMED
CT
NDF-‐RT
SituaEon
with
explicit
context
Metabolic
diseases
roots:
41. Ontological
six
degrees
of
Kevin
Bacon
Acute
myocardial
infarcEon
Myocardial
ischemia
Vascular
Diseases
Disorder
of
so€
Essue
Collagen
Diseases
ConnecEve
Tissue
Diseases
Epidermal
and
dermal
condiEons
Skin
and
subcutaneous
Essue
disorders
Dermatologic
disorders
42. Open
issue:
reconciling
lab
orders
with
results
Clinical
Laboratory
Hemoglobin
A1c/
Hemoglobin
.total
in
Blood
by
HPLC
LOINC:17856-‐6
Hemoglobin;
glycosylated
(A1C)
CPT-‐4:83036
43
43. ExtracEng
geneEc
informaEon
out
of
EHR
is
a
major
challenge
44
• PLEASE
INFORM
**NAME[ZZZ]
OF
MTHFR
MUTATION.
• WE
WILL
NEED
ADDITIONAL
TESTING:
FOR
NOW,
FOLATE,
SAME,
MTHFR.
• MARGINAL
PLACENTA
PREVIA
MTHFR
MUTATION,
HETERO
X
2
C677T
AND
A1298C
• UTI
COMPLICATING
PREGNANCY
HOMOZYGOUS
FOR
C677T
POLYMORPHISM
OF
MTHFR
1
COPY
OF
MTHFR
MUTATION
A1298C
DETECTED
45. LOINC
is
an
ideal
candidate
for
DL
because
of
its
composiEonal
structure
46
Part
Type
Part
Name
Component
Crea>nine
Property
MCnc
Time
Pt
System
Ser/Plas
Scale
Qn
2160-‐0
CreaEnine
[Mass/volume]
in
Serum
or
Plasma
(has_component
some
Crea>nine)
and
(has_property
some
MCnc)
and
(has_5me_aspect
some
Pt
)
and
(has_system
some
Ser/Plas)
and
(has_scale
some
Qn)
Code:
Parts:
DL
defini>on:
46. Used
SNOMED
CT
to
enrich
LOINC
hierarchy
47
Urine
78014005
Body
fluid
32457005
Body
Fluids
C0005889
Urine
C0042036
owl:EquivalentTo
owl:EquivalentTo
ISA
Body
fluid
LP30504-‐2
Urine
LP7681-‐2
47. MulEaxial
Inferred
OBS
Glucose
OBS
Glucose|
Urine
Separated
codes
and
parts
and
defined
corresponding
observaEons
48
Protein
&
Glucose
panel
in
Urine
by
Test
strip
Glucose
Glucose
|
Urine
Urine
≡
≡
Glucose
in
10
hour
Urine
Glucose
in
Urine
by
Test
strip
≡
≡
≡
48. 1.
Created
logical
definiEons
2.
Classified
the
ontology
with
a
reasoner
49
OBS
Glucose
|
Urine
≡
Glucose
in
10
hour
Urine
≡
has_component
some
Glucose
and
has_property
some
Arbitrary
Concentra5on
and
has_Eme_aspect
some
Point
in
5me
(spot)
and
has_system
some
Urine
and
has_scale
some
Ord
and
has_method
some
Test
strip
has_component
some
Glucose
and
has_system
some
Urine
DL
definiEon
DL
definiEon
Inferred
50. 9
006
concepts
693
256
connecEons
Quality
assurance
in
LOINC
using
descripEon
logic
PMID:23304386
51. SNOMED CT as possible universal
language of healthcare
• Updated
Technology
Preview
of
the
LOINC-‐SNOMED
CT
CooperaEve
Project
–
September
2015
15k
LOINC
–
SNOMED
CT
expressions
h_p://www.nlm.nih.gov/research/umls/licensedcontent/
snomedciiles.html
• Integration with ICD-11
h_p://www.ncbi.nlm.nih.gov/pubmed/23920573