Telemedicina e eSaúde [d cc] Telemedicine Standards Telemedicina e e-Saúde 2018/19 Pedro Brandão References 2 • Sources are indicated by [RefSource] where the complete citation will be at the end • Insite citations will be From: CitationSource ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 1 Telemedicina e eSaúde 3 [d cc] Standards TeleSaude 18/19 - Standards - pbrandao 4 [d cc] Standards Based on Digital Imaging and Communications in Medicine (DICOM) Part 1: Introduction and Overview, National Electrical Manufacturers Association, 2018 [DICOM-INTRO] TeleSaude 18/19 - Standards - pbrandao Telemedicine Standards 2 Telemedicina e eSaúde Objectives 5 • Facilitate imaging medical devices interoperability by specifying: o A set of protocols for network communication o The syntax and semantics of Commands and the protocol information o Data storage services that should be implemented by devices that implement the standard . Includes file formats and directories structure • Reuse international standards as possible • Define the requirements to be conformant with the standard ] TeleSaude 18/19 - Standards - pbrandao [d cc DICOM – Does not specify 6 • Implementation details; • Set of capabilities and functionalities that a system with compliant devices should provide; • The test procedure or validation to be compliant with the standard o Only the requirements o Some other consortiums do (e.g.: Wi-Fi Alliance) ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 3 Telemedicina e eSaúde 7 ] TeleSaude 18/19 - Standards - pbrandao [d cc DICOM – Standard parts 8 7. Message Exchange 8. Network Communication Support for Message Exchange ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 4 Telemedicina e eSaúde Protocol Architecture 9 [DICOM-NET] Medical imaging application DICOM Application Upper Layer Message exchange Service Boundary DICOM Upper Layer HTTP Protocol for TCP/IP TCP/IP Network ] TeleSaude 18/19 - Standards - pbrandao [d cc Association request example 10 [DICOM-NET] SAP – Service Access Point UL – Upper Layer ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 5 Telemedicina e eSaúde PACS 11 • Picture Archiving and Communication Systems • Composed of : o Acquisition device(s); o Communication network (secure); o Archive system(s); o Visualization stations; • DICOM is the standard that defines the communication and storage. ] TeleSaude 18/19 - Standards - pbrandao [d cc 12 [d cc] UMLS Unified Medical Language System Standards Based on UMLS Basics (tutorial) [UMLS-TUTORIAL] TeleSaude 18/19 - Standards - pbrandao Telemedicine Standards 6 Telemedicina e eSaúde UMLS [UMLS-Tutorial] 13 • Enable the development of applications that understand biomedical language; ] TeleSaude 18/19 - Standards - pbrandao [d cc UMLS Sources of data [UMLS-Tutorial] 14 • The Meta-Thesaurus has more than 100 vocabularies; o ~71.44% in English, with 25 other languages (including PT, 2.08%) (stats) o Concepts: 3,822,832 • Example: Atrial fibrillation ICD-9-CM AF NCI Thesaurus AFib MedDRA Atrial fibrillation (disorder) SNOMED Clinical Terms atrium; fibrillation ICPC2-ICD10 Thesaurus ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 7 Telemedicina e eSaúde Categories [UMLS-Tutorial] 15 • Most important categories of the used dictionaries; data from 2016 ] TeleSaude 18/19 - Standards - pbrandao [d cc Entry example [UMLS-Tutorial] 16 • Concept Unique Identifiers (CUI): a meaning of something. Associated with the several names of the concept. Identifier starts with C + 7 digits. C0018681 in the figure. • Lexical (term) Unique Identifiers (LUI): lexical variants. Identifier L+7 digits, example has 3 LUIs. • String Unique Identifiers (SUI): each “name” for the unique concept or string has a unique permanent identifier with S+7 digits. • Atom Unique Identifiers (AUI): sources of the strings/concepts from where the MetaThesaurus is built. Identifier A + 7 digits. ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 8 Telemedicina e eSaúde Semantic [UMLS-Tutorial] 17 • Semantic types o High level categories o Ex.: Physiologic Function • Semantic relations o Relation between types o Ex.: disrupts ] TeleSaude 18/19 - Standards - pbrandao [d cc Specialist Lexicon and tools [UMLS-Tutorial] 18 • English lexicon that includes biomedical terms and current words. With the information on: o Syntax o Morphology o Spelling • Tools: o Lexical variants generator o String normalizer o Word indexer ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 9 Telemedicina e eSaúde 19 [d cc] SNOMED CT Systematized Nomenclature of Medicine Clinical Terms Standards Based on SNOMED Clinical Starter Guide July 2017 International Release, The International Health Terminology Standards Development Organisation [SNOMED-SG] TeleSaude 18/19 - Standards - pbrandao SNOMED CT 20 • Aggregation of o SNOMED Reference Terminology (SNOMED RT) by the College of American Pathologists (CAP) o Clinical Terms Version 3 (CTV3) from the UK NHS • Composed by: o Concepts, terms and relationships • Portugal is a member, represented by Centro de Terminologias Clínicas ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 10 Telemedicina e eSaúde Hierarchies (examples) 21 • Clinical finding • Substance • Physical force • Staging and scales • Procedure • Pharmaceutical/biologic product • Event • Linkage concept • Observable entity • Specimen • Environment or geographical • Qualifier value location • Special concept • Body structure • Record artefact • Social context • Physical object • Organism • Situation with explicit context ] TeleSaude 18/19 - Standards - pbrandao [d cc Granularity 22 Fonte [SNOMED-SG] ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 11 Telemedicina e eSaúde Identifiers 23 • Concepts o Numerical Identifier Semantic tag semantic category • Descriptions Uniquely o Numerical Identifier identifies a concept ConceptID 22298006: Fully Specified Name: Myocardial infarction (disorder) DescriptionID 751689013 Preferred term: Myocardial infarction DescriptionID 37436014 Synonym: Cardiac infarction DescriptionID 37442013 ] TeleSaude 18/19 - Standards - pbrandao [d cc Relationships 24 • Navigation • Kind-of-value • Aggregation • Additional • Definition • Qualification Fracture of tarsal bone (disorder) IS_A Fracture of foot (disorder) FINDING SITE Bone structure of tarsus (body structure) ASSOCIATED MORPHOLOGY Fracture (morphologic abnormality) See Summary#Relationships ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 12 Telemedicina e eSaúde Attributes define (examples): 25 • Clinical Findings • Procedures • Evaluation Procedures • Specimen • Pharmaceutical / biologic product • Explicit context • Events • Physical objects See Editorial Guide 5.1.1 ] TeleSaude 18/19 - Standards - pbrandao [d cc [d cc] Other nomenclatures TeleSaude 18/19 - Standards - pbrandao Telemedicine Standards 13 Telemedicina e eSaúde ICD 27 • International Classification of Diseases • Defined by WHO o Current version 11 (18-June-2018) • For clinical and management use; ] TeleSaude 18/19 - Standards - pbrandao [d cc ICPC-2 28 • International Classification Primary Care, 2nd Edition o 2018, 2e-v7.0 • WHO accepted the std for encounters’ reasons • It allows to classify: o Reasons for “meeting” (doctor visit) o Diagnostic o Procedure used ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 14 Telemedicina e eSaúde WHO others 29 • ICF – International Classification of Functioning, Disability and Health • ICHI – International Classification of Health Interventions ] TeleSaude 18/19 - Standards - pbrandao [d cc LOINC 30 • Logical Observation Identifiers Names and Codes o LOINC Version 2.65, 89 271 Terms • Released 2018-12-14 • Maintained by the Regenstrief institute • Defines codes to identify test results and clinical observations and measures. o On the context of HL7 and CEN TC251 messages • Allows the suggestion of new terms • Freely available. ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 15 Telemedicina e eSaúde LOINC (cont.) 31 • Used by/compatible with other standards o HL7 (used by) o UMLS (maps to) o SNOMED (used with) ] TeleSaude 18/19 - Standards - pbrandao [d cc MeSH 32 • Medical Subject Headings • Maintained by the national library of medicine from the USA • Defines an hierarchical structure of medical terms • Used to indexed medical articles; o Books, documents, audio-visuals ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 16 Telemedicina e eSaúde HL7 33 • Health Level International 7 • Defines standards for the exchange, Application integration and search of health Presentation information on an electronic format. Session • Supports the clinical practice and Transport management Network • + 2300 members Logic Physical • The 7 refers to the OSI layer ] TeleSaude 18/19 - Standards - pbrandao [d cc HL7 34 • Promotes the interoperability between systems: o Functional Int.: information exchange o Semantic Int.: information usage • Divided in several working groups; • Technical committee for EHR • Standards freely available o HL7 Standards o Some restrictions ] TeleSaude 18/19 - Standards - pbrandao [d cc Telemedicine Standards 17 Telemedicina e eSaúde Model 35 • RIM – Reference Information Model: o Object Model that identifies the life-cycle of the events carried by the messages; o Model shared by all domains, i.e., from all create their messages; o Based on the UML (Unified Modelling