This is a text written by Jon Berg <jon.berg|a|turtlemeat.com> spring 2005 in the Computer Science course Medical Informatics at Tromsø University, Norway.
Current and future possibilities of Medical Informatics
6. Standards in Medical Informatics
Standards have been considered a benefit for a long time in many areas also outside computer science and medicine. Standards make it easier to build large systems. When connecting together parts the interfaces between the parts must agree to how they will connect and share information. Also when building something out of parts that already have been made, it is important to know how they operate since they will build a fundament for other functionality.
Standards are the way to archive interoperability. The main benefits of adopting universally adopted standards (Technology Administration. 2004. Innovation, Demand and Investment in Telehealth.):
Further business benefits of standardization are: lowering purchasing cost, increasing quality, lower trade barriers, decreasing design time and ensuring interoperability. Standardization can also improve competition advantages by promoting innovation, shortening the time to bring new technology to the market and enabling compliance with international codes, specifications and standards.
The need for standards in medical informatics is motivated by the same reasons that standards are needed in other areas. Standards are needed in collection, manipulation and transmission of information in medical informatics systems. The problems that are special for medicine is that there are that the health organization is decentralized in many independent units. Medicine is also practiced in a diversified field and the systems that are used also cover many different areas of medicine. There is little coordination of data flow between the various organizations. When a patient visits one specialist, the data used in that consultation is most often data that is based on data from prior visits to that particular specialist. If data is collected from other systems it is largely incomplete. A patient would benefit if all the data could flow with the patient and be used in all the settings where he got in the many health care organizations. Today this is largely impossible because of the diversity of systems that are used, and the lack of unifying the data exchange and storage with standards. For some systems that are required to have interoperability ad-hoc solutions have been made that formats the data from one particular system to another system. To create such a special connections for each system is largely impractical and a bad design for the long term.
Creating standards are hard work. One problem with developing standards and getting them deployed is “The philosophy trap” (Medical Informatics Group, University of Manchester. Who needs standards? ). “The philosophy trap” is the work done in a committee trying to work out a standard, but the work is done too far away from the problems that need to be solved. It becomes an argumentation in the abstract on specific details, instead of working with real prototypes.
For standards to be accepted the timing is also important. If a standard gets laid out before it’s time it is often not used. If the standard comes too late it is difficult to get acceptance for it since it is difficult to change systems that already have been implemented.
Standard development organizations (SDOs) are organizations that solely work on developing standards. Some countries have representatives in several of the standardization groups.
HL7 (Health Level 7. URL: https://www.hl7.org/ ) is the organization that is developing the HL7 standard. Both the organization and the standard are named HL7.
CEN is a European organization consisting of 20 countries. It develops standards for all sorts of things, not just medical informatics. In CEN the CEN TC251 group handles standardization for medical informatics. It is further divided in four sub groups; CEN WG1, CEN WG2, CEN WG3 and CEN WG4. New standards developed by ISO independently of CEN will usually be accepted as a de facto CEN standard, provided CEN thinks it needs a standard in that area at all.
ANSI (American National Standards Institute) founded in 1918. It was founded to coordinate the U.S coordinate the U.S. voluntary census standard systems. ANSI does not write standards, instead they assists the groups to agree on consensus on a standard.
ISO is an international standardization organization. It creates standards for all sorts of things. The medical informatics is developed in the Technical Committee number 215 (TC215). ISO have also split the groups in four subgroups (WG1, WG2, WG3 and WG4) similar to CEN.
Medical standards and Medical Informatics Standards
HL7 stands for Health Level 7, and is the highest level of the ISO communication model. It is a standard for data interchange. The model’s purpose is to archive OSI (Open Systems Interconnections), a way to get different systems to work together. The OSI model is not specific to medical informatics. HL7 is specific to the health care domain.
ICD is a specific standard for terminologies. It was first published in 1893 and has been revised at roughly every 10 year. The revisions are under laid the World Health Organization. The tenth edition was published in 1992. The coding consists of a core classification of three digits. A forth digit (the decimal) is used for further detail. The terms are arranged in a hierarchy based on the digits. For ICD-9 a clinical modification to support greater details exist ICD-9-CM. A clinical modification for ICD-10 is not been released.
DICOM (DICOM homepage. URL: https://medical.nema.org/) is a standard for exchanging medical images.
ASTM (ASTM homepage. URL: https://www.astm.org/) is a standard for message exchange about clinical observations, medical logic, and electro physiologic signals.
ADA is a standard for data exchange and processing in the dental health care sector.
ANA is a standard for data exchange and processing for nursing services.
LOINC (The Logical Observation Identifiers Names and Codes) provides a standard for a set of universal names and codes, clinical observations, and diagnostic study observations.
EDIFACT is a set of standards for interchange of data between independent computer-based systems.
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