evoluzione, riorganizzazione, reti

Transcript

1 SIMeL 2008 Rimini 30 Ottobre 2008 Auditorium Ore Workshop CISMEL-IHE con il GdS Informatica della SIMeL Codifiche e indicazioni normative: LOINC e alternative Codifiche informatiche per i risultati di laboratorio Moderatori: G. Guidi (Verona), P. Cappelletti (Pordenone) Marco Pradella Asolo TV evoluzione, riorganizzazione, reti da documento a record codifiche?

2 riorganizzazione modernizzazione? H L H L L H L H codifiche? reflex, notification, PH report, repository consolidating records Health Information Exchange Purpose Speaker: Pam Banning. 3M HIS, Salt Lake City, UT The Languages of Information Technology in Laboratory Medicine Originally presented during the AACC Annual Meeting on July 26, 2008

3 Standard dei documenti, dal PDF al CDA IHE XDS Ministero della Salute Sommario Autore Gregorio Mercurio Roma, 08 Luglio 2004 Invece di inviare referti in PDF, perché non inviarli strutturati? In questo caso, perché utilizzare HL7 CDA? Come trasformare i propri sistemi per supportare HL7 CDA nella maniera più semplice possibile? Aderite al gruppo HL7 CDA che sta ballottando la Guida all implementazione italiana!!! Schema relazioni tra standard (da NCCLS AUTO3-A 2000) HL7 ASTM E1394 NCCLS AUTO3-A ASTM JSCC ASTM E1989 "LECIS"

4 E Standard Specification for Transferring Clinical Observations Between Independent Computer Systems Developed by ASTM Subcommittee: E Record dei risultati 10.1 contenuti tipo record: R sequenza: numero del paziente nel messaggio ID dell'esame codice internazionale nome (associato al codice) schema di codificazione codice locale o del produttore risultato: uno per record (di regola) unità: ISO intervallo di riferimento: da XX a YY (precedente: XX-YY) intervalli multipli: delimitatori di ripetizione (\) con descrizione (sottosottocampo: ^) segno di normalità (N, A, >, <, H, L, HH, LL, U, D, B, W) tipo di intervallo di riferimento: età (A), sesso (S), razza stato del risultato: finale F, preliminare P, correzione C, non eseguibile X, parziale S, ripetizione R, per reflex N, MIC M, su richiesta Q, validato V, dubbio W data di variazione dell'intervallo di riferimento operatori: esecutore validatore ora inizio dell'analisi ora completamento dell'analisi identificativo strumento Shannon o teorema 2o teorema

5 nomenclatura problemi di nomenclatura? standard per nomenclatura e codifica applicazioni delle codifiche problemi di nomenclatura? validazione trasmissione R? R? visualizzazione R? documentazione prelievo analisi R? cumulativo archivio R? ritiro R? copia R?

6 nomenclatura problemi di nomenclatura? standard per nomenclatura e codifica applicazioni delle codifiche geografia della normazione ISO UNI ANSI ASTM CLSI CEN

7 CISMEL Comitato Italiano per la Standardizzazion e dei Metodi Ematologici e di Laboratorio w w w. C I S M E L. i t sommario ISO/FDIS 17115:2007Vocabulary for terminological systems ISO/DTS 22789:2006 Conceptual framework for patient findings and problems in terminologies ISO/IS 17113:2004 guida per lo sviluppo di messaggi, pren 12435:2005 "Expression of results of measurements in health sciences" ISO/DIS 21090:2008 Harmonized data types for information interchange EN 1614:2006 "Representation of dedicated kinds of property in laboratory medicine"

8 sommario ISO/FDIS 17115:2007Vocabulary for terminological systems ISO/DTS 22789:2006 Conceptual framework for patient findings and problems in terminologies ISO/IS 17113:2004 guida per lo sviluppo di messaggi, pren 12435:2005 "Expression of results of measurements in health sciences" ISO/DIS 21090:2008 Harmonized data types for information interchange EN 1614:2006 "Representation of dedicated kinds of property in laboratory medicine" ISO/DTS Health informatics Conceptual framework for patient findings and problems in terminologies Closing date for voting The objective of the Technical Specification is to express a core categorial structure of clinical findings based upon existing schemes including the World Health Organisation ICD-10, NHS Clinical Terms Version 3, College of American Pathologist s SNOMED Clinical Terms and the WONCA 2001 International Classification of Primary Care. [...] referencing a set or sets of characterising concepts such as anatomy and causative organisms. utilises the ISO Health informatics Vocabulary for terminological systems [...].

9 sommario ISO/FDIS 17115:2007Vocabulary for terminological systems ISO/DTS 22789:2006 Conceptual framework for patient findings and problems in terminologies ISO/IS 17113:2004 guida per lo sviluppo di messaggi, pren 12435:2005 "Expression of results of measurements in health sciences" ISO/DIS 21090:2008 Harmonized data types for information interchange EN 1614:2006 "Representation of dedicated kinds of property in laboratory medicine" sommario ISO/FDIS 17115:2007Vocabulary for terminological systems ISO/DTS 22789:2006 Conceptual framework for patient findings and problems in terminologies ISO/IS 17113:2004 guida per lo sviluppo di messaggi, pren 12435:2005 "Expression of results of measurements in health sciences" ISO/DIS 21090:2008 Harmonized data types for information interchange EN 1614:2006 "Representation of dedicated kinds of property in laboratory medicine"

10 DRAFT INTERNATIONAL STANDARD ISO/DIS Health Informatics Harmonized data types for information interchange ISO/TC 215 Secretariat: ANSI Voting begins on: Voting terminates on: ISO/DIS codesystem scheme for representing concepts using (usually) short concept identifiers to denote the concepts that are members of the system; defines a set of unique concept codes EXAMPLES: ICD-9, LOINC and SNOMED

11 ISO/DIS <value code="j21.8 B95.6" codesystem=" " codesystemname="icd-10 Dual Code Expression"> <originaltext value="staph aureus bronchiolitis"/> </value> The ICD-10 code J21.8 is "Acute bronchiolitis due to other specified organisms" and the code B95.6 is "Staphylococcus aureus as the cause of diseases classified to other chapters". sommario ISO/FDIS 17115:2007Vocabulary for terminological systems ISO/DTS 22789:2006 Conceptual framework for patient findings and problems in terminologies ISO/IS 17113:2004 guida per lo sviluppo di messaggi, pren 12435:2005 "Expression of results of measurements in health sciences" ISO/DIS 21090:2008 Harmonized data types for information interchange EN 1614:2006 "Representation of dedicated kinds of property in laboratory medicine"

12 CEN-TC 251: EN 1614:2006 Representation of dedicated kinds of property in laboratory medicine... bisogno di comunicazioni affidabili ta sistemi informatici di laboratorio e altri sistemi informatici. Gli strumenti precedenti... finalizzati a scopi specifici come il tariffario,... mancano di una analisi critica dei concetti base e delle relazioni con gli standard esistenti e le raccomandazioni... CEN-TC 251: EN 1614:2006 Representation of dedicated kinds of property in laboratory medicine C-NPU IFCC / Committee on Nomenclature, Properties and Units IUPAC / Subcommittee on Nomenclature, Properties and Units Properties and Units in the Clinical Laboratory Sciences LOINC LOINC Committee, The Regenstrief Institute, Indianapolis, Indiana, USA Logical Observation Identifier Names and Codes

13 JULY 26, :30pm - 8:30pm RENAISSANCE WASHINGTON DC HOTEL The Languages of Information Technology in Laboratory Medicine Originally presented during the AACC Annual Meeting on July 26, 2008 Welcome and Introductions Introduction: Albert Jekelis, PhD, LISMI Chair Health Information Exchange Purpose Speaker: Pam Banning. 3M HIS, Salt Lake City, UT The Languages of Information Technology in Laboratory Medicine: SNOMED Speaker: Elva Knight, 3M HIS, Salt Lake City, UT The Languages of Information Technology in Laboratory Medicine: LOINC Speaker: Pam Banning. 3M HIS, Salt Lake City, UT The Languages of Information Technology in Laboratory Medicine: HL7 Speaker: Riki Merrick, Connect Consulting, Sacramento, CA

14 Pam Banning. 3M HIS, Salt Lake City, UT Elva Knight, 3M HIS, Salt Lake City, UT Riki Merrick, Connect Consulting, Sacramento, CA LOINC voci, di laboratorio (versione 2.24) RELMA REgenstrief LOINC Mapping Assistant (RELMA , released October 8, 2003)

15 Esempi di codici LOINC per laboratorio LOINC code LOINC name (component:property:timing:specimen:scale) SODIUM:SCNC:PT:SER/PLAS:QN SODIUM:SCNC:PT:UR:QN SODIUM:SRAT:24H:UR:QN CREATININE RENAL CLEARANCE:VRAT:24H:UR:QN GLUCOSEˆ2H POST 100 G GLUCOSEPO:MCNC:PT:SER/PLAS:QN GENTAMICINˆTROUGH:MCNC:PT:SER/PLAS:QN CALCIUM.IONIZED:MCNC:PT:SER/PLAS:QN ALBUMIN:MCNC:PT:SNV:QN:ELECTROPHORESIS... SNOMED Terminologia clinica... ANSI standard 19 axes terms since 2002 new version every 8 months items not deleted, deactivated The Languages of Information Technology in Laboratory Medicine: SNOMED Elva Knight, 3M HIS, Salt Lake City, UT AACC July 28, 2008

16 SNOMED Clinical Terms aggiunti a UMLS Metathesaurus Tommy G. Thompson, Secretary of Health and Human Services, announced on July 1, 2003, (press release) an agreement with the College of American Pathologists (CAP) that will make SNOMED Clinical Terms (SNOMED CT ) available to U.S. users at no cost through the National Library of Medicine's Unified Medical Language System (UMLS). Produced by the College of American Pathologists (CAP), SNOMED CT (Systematized Nomenclature of Medicine--Clinical Terms) was formed by the convergence of SNOMED RT and the United Kingdom's Clinical Terms Version 3 (formerly known as the Read Codes). With terms for more than 344,000 concepts, SNOMED CT is the most comprehensive clinical terminology available. It is being implemented throughout the National Health Service in the United Kingdom. International Health Terminology Standards Development Organization (IHTSDO) Launched April 26, a not for profit organization established under Danish law with headquarters in Copenhagen to acquire, own and administer the rights to SNOMED CT to develop, maintain, promote and enable the correct use of its terminology products around the world. [...] Prior to April 26, 2007 the College of American Pathologists owned the rights to SNOMED CT SNOMED-CT and LOINC Delegation Meeting 2007

17 ... SNOMED Terminologia clinica...? SNOMED RT Integration with LOINC Standardize data dictionary variables using SNOMED Encode clinical findings, diagnoses, and other results using SNOMED Encode the name of tests and test attributes using LOINC, if desired Retrieve using SNOMED functionality

18 LOINC Test Codes Subset for Laboratory Technical Framework Integrating the Healthcare Enterprise LOINC Test Codes Subset for Laboratory Technical Framework Jean-Christophe Cauvin, MEDASYS Co-Chair Vendor IHE-France Connect-a-thon Participant Workshop Berlin, 7-8 February LOINC Test Codes Subset for Laboratory Technical Framework The Solution A237 A237= B246= B LCSD : Laboratory Code Sets Distribution 5

19 IHE International Integrating the Healthcare Enterprise Laboratory Technical Framework Volume 4 (LAB TF-4) LOINC Test Codes Subset Revision 2.1 Final Text August 8, 2008 LOINC Test Codes Subset for Laboratory Technical Framework codes ==> codes (IHE) ==> codes (SFIL) 6

20 LOINC Test Codes Subset for Laboratory Technical Framework Chemistry Hematology Toxicology and Drug Monitoring Virology and Serology Parasitology and Mycology Bacteriology Immunology and Cell Mark Patient and Specimen Total LOINC Test Codes Subset for Laboratory Technical Framework Example MSH ^~\& OF Cytology ORT OUL^R22^OUL_R T 2.5 USA EN PID ^^^Abbeville Hospital^PI ILL^JOHN^^^^^L M PV1 1 I SPM 1 456_1^Cytology BLD P Y 1 OBR ^Urology 456^Cytology 85027^Hemogram and platelet count, automated^cpt4 ^COLLECT^JOHN P ^URO^^^^DR F &CYTO&JANE^ ORC SC ^Urology 555^Urology CM ^NURSE^JANET Urology^^^^^^FI^^^UR01 TQ1 1 R OBX 1 NM ^LEUKOCYTES^LN *3/mm N F OBX 2 NM ^ERYTHROCYTES^LN *6/mm N F OBX 3 NM ^HEMOGLOBIN^LN 13.4 g/dl N F OBX 4 NM ^HEMATOCRIT^LN 39.7 % N F OBX 5 NM ^MCV^LN 97 fl N F OBX 6 NM ^MCH^LN 33.0 pg N F OBX 7 NM ^MCHC^LN 33.8 % N F OBX 8 NM ^PLATELETS^LN *9/L N F

21 conclusioni codifiche standard della nomenclatura standard dei sistemi di codifica integrazione dei sistemi di codifica applicazione dei sistemi di codifica Codifiche e indicazioni normative: LOINC e alternative riferimenti informatica laboratorio medico simel.it GdS Informatica www. cismel.it labmedico.it bitmedico ihe.net