# Presentation: 230492

## NCVHS Subcommittee on Standards and SecurityHearings on Message Format standards, 3/29/99

**NCVHS Subcommittee on ****Standards and Security**Hearings on Message Format standards, 3/29/99

**Mark Shafarman**
**Clinical Information Architect**
**Oacis Healthcare Systems, San Rafael, CA**
**   **

## Paradigm for "comparability" discussion

**Messaging/object method interfaces must have**
**a common information model **
**and **
**a common vocabulary model **
**with the standard vocabulary applied  to the standard information model (e.g. HL7 templates).**
**The model supports the addition of new specializations of clinical data objects as needed**
**adds new master file instances of a given specialization rather than new attributes (data driven)**

## PMRI (patient medical record information)

**Any information needed by a clinician to care for a patient under his/her professional responsibility.**
**Also includes financial/insurance/related to what services, medications, procedures, treatments a clinician needs to order to care for a patient.**
**Excludes financial/admin information not contributing to patient care (e.g. payroll information details about staff).**
**Includes permissions based on credentials/license (and other factors relating directly and indirectly to the care of the patient: social/family/work/environmental).**

## PMRI (patient medical record information)

**Comparability based on information and vocabulary models**
**Interoperability depends on:**
**Comparability at this level is the basis for clinical decision support, research, and clinical data sharing.**
**Model-based paradigms are extensible via specialization**
**without invalidating existing parts of the model**
**They are never “done” since knowledge is not static**

## Syntaxes

**Not all syntaxes are message based **
**object**
**RPC**
**A syntax does not, de facto, support information standards**
**requirement is to support the granularity levels specified in the models and vocabularies**
**Use HL7 approach of “technology neutral/implementation neutral” information standards**
**Let market decide “for now”, not “for ever”**

## Technologies

**Since technology is evolving so rapidly (capacity doubles every 18 months; new media included), concentrate on information modeling and structure and vocabulary standards rather than technology standards.**
**As above, it's important not to mistake ”technology" level standards with information modeling standards. **
**Use HL7 approach of “technology neutral/implementation neutral” information standards**
**For binary (image etc.) ensure that specifications are not bound to a particular technology.**
**E.g. JPEG**

## Federal Government’s role

**Encourage development of models and vocabulary standards:**
**Extension/evolution of HL7 RIM.**
**Vocabulary“base level” vocabularies for problems, signs/symptoms, drugs, labs, procedures at the “clinical granularity” level.**
**HL7 Clinical Templates: standard vocabulary constraints applied to information model-derived structures.**
**For each of the above, extend by clinical domain (not all at once).**

## Federal Government’s role

**Encourage standards for rules and data warehousing also**
**see relevant HL7 TC’s**
**Current examples of governmental participation:**
**CDC’s ELR project**
**HL7 Claims attachment SIG (with x12N)**
**HL7 Government SIG**

## Federal Government’s role

**Suggestion: for each new project**
**Interface specification done as “technology neutral” model+vocabulary standard section, plus specific ITS**
**Use current available standards (see previous current examples)**
**Builds infrastructure for interoperability**
**Creates “level playing field” for clinical knowledge-based applications**
**Motto:**
**Don’t let the perfect interfere with the good**

## Questions???

*Contact:*
*Mark Shafarman*
*415-482-4570*
*mshafarm@oacis.com*