A view from inside the HealthVault
October 21st, 2011 — Vocabularies
This a next installment of the Understanding terminologies series.
I’ll try to keep this post short, give a general overview of International Statistical classification of Disease (ICD), talk a little about ICD-9 & ICD-10 and leave your folks will links to practical advise on converting from ICD-9 to ICD-10, and SNOMED-CT to ICD-10.
January 27th, 2010 — Vocabularies
Connectivity of Care Document (CCD) is a collaborative standard driven by HL7 & ASTM for exchanging summary format clinical information.
For ease of understanding one can think of CCD standard comprising of several elements in an hierarchical fashion:
Fig 1. Components of CCD Standard
Related articles in this series :
October 27th, 2009 — HealthVault, Vocabularies
Update: Fixed typos, added links to related tools and articles, updated the example.
CCR or Continuity of Care Record is a standard meant to ease the exchange of clinical information with a relatively easy to read and practical data-format and schema. There is ton of great information about CCR on its resource site. CCR document format is supported by majority of personal Health clouds, both – Microsoft HealthVault & Google Health.
The CCR specification comprises an implementation guide, XML schema definition and a guidance spreadsheet for each data element that makes up the standard. These resources can be bought from ASTM.
The document format of CCR is very straight forward, consisting of a header, body and a footer with the following top-level elements:
| Header | Body | Body | Footer |
|
|
|
|
|
Google Health supports only a limited set of entities from the above, while HealthVault supports the entire standard and also allows transformation of some of these entities in to native HealthVault types. You can read more about working with CCR in HealthVault and various input mappings, output mappings, and CCR vocabularies.
Here are some illustrative CCR figures from Dr. Waldren’s presentation (see end of article).
Using the SNOMED-CT concepts one can write the Systolic Blood pressure reading in CCR as the following (UPDATE: Well-formatted the CCR to include source, object-id and actors, thanks to Matt Wagner):
<?xml version="1.0" encoding="utf-8"?> <ContinuityOfCareRecord xmlns='urn:astm-org:CCR'> <CCRDocumentObjectID>Doc</CCRDocumentObjectID> <Language> <Text>English</Text> </Language> <Version>V1.0</Version> <DateTime> <ExactDateTime>2008</ExactDateTime> </DateTime> <Patient> <ActorID>Patient</ActorID> </Patient> <Body> <VitalSigns> <Result> <CCRDataObjectID>0001</CCRDataObjectID> <Description> <Text>Blood Pressure</Text> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <Test> <CCRDataObjectID>0002</CCRDataObjectID> <Description> <Text>Systolic</Text> <Code> <Value>163030003</Value> <CodingSystem>SNOMEDCT</CodingSystem> </Code> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <TestResult> <Value>120</Value> <Units> <Unit>mmHg</Unit> </Units> </TestResult> </Test> <Test> <CCRDataObjectID>0003</CCRDataObjectID> <Description> <Text>Diastolic</Text> <Code> <Value>163031004</Value> <CodingSystem>SNOMEDCT</CodingSystem> </Code> </Description> <Source> <Description> <Text>Unknown</Text> </Description> </Source> <TestResult> <Value>75</Value> <Units> <Unit>mmHg</Unit> </Units> </TestResult> </Test> </Result> </VitalSigns> </Body> <Actors> <Actor> <ActorObjectID>Patient</ActorObjectID> <Person> <Name> <CurrentName> <Given>John</Given> <Family>Doe</Family> </CurrentName> </Name> </Person> <Source> <Description> <Text>Unknown</Text> </Description> </Source> </Actor> </Actors> </ContinuityOfCareRecord>
Note CodingSystem element. It allows CCR to interpret various medical vocabularies.
Relevant Tools:
(Thanks to Kathleen Connor)
Related Article(s):
In this series:
October 9th, 2009 — HealthVault, Vocabularies
I have previously posted about Understanding Health Ontologies and Standards. In this post I’ll focus on SNOMED-CT (Systematized Nomenclature of Medicine Clinical Terms). SNOMED-CT is the most comprehensive vocabulary to express clinical terms – it spans languages, specialties and geographic borders.
SNOMED-CT includes:
To give you a taste here is an example of Blood pressure reading represented using SNOMED-CT from the linked paper (“Towards semantic interoperability in healthcare: ontology mapping from SNOMED-CT to HL7 version 3”, Amanda Ryan):
In addition to having a model to represent concepts and linkages the biggest draw of SNOMED CT is a staggering number of coded qualifiers (which belong to one concept or other). According to IHTSO there are about 311,000 actively used SNOMED CT concepts.
You can register for SNOMED CT here. Its free for companies and individuals in United States, however your registration is processed by NLM and it might take over 3 days to receive a confirmation and access.
Once you are through with registration and have an account, start by downloading the core subset of SNOMED CT concepts here, this list consists of about 5000 most frequently used terms by institutions across US. Its a good set to get familiar with, it consists of the following concept area:
We can use BCP to copy the files from SNOMED CT Core in to our local database, and do more interesting queries & data analysis like find distribution on these terms, co-relate problems vs. findings and of course work on the larger SNOMED CT database to find synonyms etc.; but I’ll keep that for another day. Here very quickly I’ll show how one can use a web-based browser, Snowflake, http://snomed.dataline.co.uk/ (requires registration) to lookup a SNOMED code and see what else it relates to. We can see that in line 3 above SNOMED CT concept 10085004 is marked as Metatarsalgia (finding), however using the Snowflake browser we can see in that in addition to being a finding this concept is a problem as well.
This was just tip of the ice-berg, please leave comments for future posts / areas to consider in the Ontology domain.
Further reading / relevant links:
In this series:
July 10th, 2009 — HealthVault, Vocabularies
In my last article in the vocabulary category, I described the need for semantically enabled data and how different categories of health data have different standard vocabulary / ontology associated with them. In the following table I attempt to summarize the recommended vocabularies for different HealthVault types.
Disclaimer: Please note this is not a definitive or complete list, and I will update the table as I discover inconsistencies. The definitive source are the XSDs associated with HealthVault data types.
| HealthVault Type | Type Schema | HV Recommended vocabulary related to this type | Comments |
| Advance Directive | 822a5e5a-14f1-4d06-b92f-8f3f1b05218f | None |
Examples include living wills and power of attorney for healthcare. |
| Allergy | 52bf9104-2c5e-4f1f-a66d-552ebcc53df7 | icd9cm, icd9cm-reactions | Details on ICD-9 Codes |
| Basic Demographic Information | bf516a61-5252-4c28-a979-27f45f62f78d | ISO-3166 | Country of residence |
| Blood Glucose Measurement | glucose-measurement-type | ||
| Blood Oxygen Saturation | blood-oxygen-saturation-measurement-method | ||
| Body Composition | body-composition-measurement-methods | ||
| Body Dimension | dd710b31-2b6f-45bd-9552-253562b9a7c1 | body-dimension-measurement-names, body-dimension-measurement-names-pediatric | |
| Calorie Guideline | calorie-guideline-names | ||
| Concern | aea2e8f2-11dd-4a7d-ab43-1d58764ebc19 | concern-description | Concerns are more general than conditions |
| Condition | 7ea7a1f9-880b-4bd4-b593-f5660f20eda8 | ||
| Continuity of Care Document (CCD) | |||
| Continuity of Care Record (CCR) | http://www.ccrstandard.com/ | ||
| Daily Medication Usage | a9a76456-0357-493e-b840-598bbb9483fd | dose-purpose, usage-schedule, x12-de-1330, prescription-type, x12-d3-355, | |
| Diabetes Insulin Injection Use | insulin-types, | ||
| Discharge Summary | icd9cm | ||
| HbA1C Measurement | HbA1C-assay-method | ||
| Health Assessment | health-assessment-name, health-assessment-value-sets, health-assessment-groups, health-assessment-category | ||
| Heart Rate | b81eb4a6-6eac-4292-ae93-3872d6870994 | heart-rate-measurement-conditions | |
| HL7 Clinical Document Architecture, Release 2 | |||
| Immunization | vaccines-cvx, vaccine-manufacturers-mvx, medication-routes, | ||
| Insulin Injection | insulin-types | ||
| Insurance Plan | coverage-types | ||
| Lab Test Results | LOINC, lab-status, lab-results-flag, | More on LOINC here. | |
| Medication | 30cafccc-047d-4288-94ef-643571f7919d | Rxnorm, NDC, medication-prescribed | |
| Medication Fill | Rxnorm, NDC | ||
| Personal Demographic Information | blood-types, ethnicity, marital-status, religion, education-level, | ||
| Pregnancy | 46d485cf-2b84-429d-9159-83152ba801f4 | delivery-complications, anesthesia-methods, delivery-methods, pregnancy-outcomes, gender-types, conception-methods, | |
| Question Answer | 55d33791-58de-4cae-8c78-819e12ba5059 | question-sets, answer-choice-sets | |
| Sleep Related Activity |
November 2005, "Your Guide to Healthy Sleep", ISBN 1-933236-05-1 |
||
| Sleep Session |
November 2005, "Your Guide to Healthy Sleep", ISBN 1-933236-05-1 |
||
| Vital Signs | lab-results-units, lab-results-flag, |
As you can notice above we recommend ICD-9, RxNorm, LOINC, NDC. x12-de-1130, x12-de-335. We do prefer SNOMED-CT as well, however the application using it need to have license for it.
Having written the above I would like to match that with what Dr. Halamka recommends in his post. Note that I mention content column for completeness, however its not useful for comparison.
| Data | Content | Vocabulary |
| Demographics | HL7 2.x for messaging, CCD for document summaries | HITSP Harmonized code sets for gender, marital status |
| Problem List | HL7 2.x for messaging, CCD for document summaries | SNOMED-CT |
| Medications | NCPDP script for messaging, CCD for document summaries | RxNorm and Structured SIG |
| Allergies | HL7 2.x for messaging, CCD for document summaries | UNII for foods and substances, NDF-RT for medication class, RxNorm for Medications |
| Progress Notes and Other Narrative Documents (History and Physical, Operative Notes, Discharge Summary) | HL7 2.x for messaging, CCD for document summaries | CDA Templates (interesting note) |
| Departmental Reports (Pathology/Cytology, GI, Pulmonary, Cardiology etc.) | HL7 2.x for messaging, CCD for document summaries | SNOMED-CT |
| Laboratory Results | HL7 2.x for messaging, CCD for document summaries | LOINC for lab name, UCUM for units of measure, SNOMED-CT for test ordering reason |
| Microbiology | HL7 2.x for messaging, CCD for document summaries | LOINC for lab name/observation |
| Images | DICOM | |
| Administrative Transactions (Benefits/Eligibility, Referral/Authorization, Claims/Remittance) | X12 | X12, CAQH CORE |
Next Time: I’ll try to update the above tables with more details and try to come with recommendations of which clinical type (in the Data column above) would potentially match with which HealthVault type.
As usual leave your suggestions in the comments.
