3M™ Healthcare Data Dictionary (3M HDD)

Product Overview

  • ­    Allows multiple legacy information systems to effectively share information
  • ­    Maps legacy terminologies to standards and provides services and strategies for keeping them synchronized
  • ­    Facilitates communication between application and reference terminology via standard services
  • ­    Enables users to perform outcomes analysis and reporting by individual patient or across enterprise populations
  • ­    Helps provide healthcare decision support logic at the point of care

Lots of Data, Very Little Information
Huge amounts of healthcare data are gathered by legacy information systems, but very little of that data is shared between systems. Even less of it is useful in the format it is received in. A caregiver can seldom rely on it to justify treatment, and an administrator cannot analyze it for outcomes. Most importantly, an enterprise cannot create comprehensive, electronic, longitudinal patient records until it can accurately aggregate all of John Doe’s glucose test results—no matter when or where they were performed—into his uniquely identified record. Even the so-called “one solution” or “one vendor” systems sold today do not interpret and integrate the data that users enter into their various application modules. Before computerized healthcare data can be put to work, it must be concretely defined and consistently translated into a common, meaningful language.

What is the 3M™ Healthcare Data Dictionary (HDD)
The 3M HDD is a vocabulary server that allows you to translate and integrate healthcare data. It does this by:

  • ­    Providing a road map to the content and structure of patient data
  • ­    Defining and translating every data element and healthcare concept that can possibly occur in a computerized patient record
  • ­    Removing ambiguity by including all possible names/numbers healthcare professionals use for a clinical or administrative concept in any language

Accessing the 3M HDD via HL7 Common Terminology Services (HL7 CTS) allows point of service applications and clinical databases to exchange, compare, query, and report on meaningful data.  The 3M Healthcare Data Dictionary (3M HDD) has the rich content and flexible data structure that make it one of the gold standards of the industry. The 3M HDD is built with standard healthcare data sources as well as selected, specific vocabularies. It provides coded, computable data that people can understand and applications can use and process in real-time.

What is HL7® Common Terminology Services (HL7 CTS)?
HL7 CTS is a functional specification standard that describes the functionality to be supported by terminology service implementations to enable client applications to query and access terminological content.  3M HDD implements CTS standard to enable communication between the HDD and other applications that are not required to have an understanding of the HDD data structure. This approach allows a wide variety of terminological content and functions to be integrated across multiple applications and in messaging without the need for significant migration or rewrite. This also frees the EMR application developers from being locked in to a specific terminology server implementation, and allows them to develop applications that are neutral to the internal machinery of the terminology service implementation as long as they both support the CTS standard. CTS also provides specific functionality to ease the adoption of HL7 v3 messaging.

You Need Interfaces, But You Need Data Mapping Even More
Every healthcare enterprise and integrated delivery network understands the importance of interfacing their information systems, but the value that a powerful data dictionary brings to the process of information integration and data mapping is often overlooked. Unless a data dictionary is robust enough to “translate” data elements, interpret data relationships, and map each data element to an actual concept, data as basic as vital signs cannot be shared between systems or integrated into a patient’s record. The data dictionary must “know” how vital signs are expressed and stored in each of the enterprise’s information systems and be able to reconcile and relate those expressions. When the data dictionary can do this, an enterprise decreases the time and costs of adding, supporting, and maintaining interfaces. Data mapping also brings the value of ad hoc reporting capabilities to a healthcare enterprise. For example, during its strategic planning, an enterprise can perform population studies by facility to see how and where resources and specialties (e.g., cardiology) are best deployed.  3M provides 3M Terminology Consulting Services (3M TCS) to help organization perform both initial and maintenance mapping of their legacy data to reference terminologies.

Why Do You Need Coded Data?
Coded data is the key to communicating healthcare data between information systems and disseminating medical knowledge and expertise throughout an enterprise. The value of the 3M HDD is that it allows data to be stored in a coded format. Because the 3M HDD defines and codes data consistently—

  • ­    Information can be gathered from and made available to all types of users, ranging from caregivers to administrators. Coded data can be clinical (diagnosis, lab test, medication), encounter-related (insurance), or demographic (gender, religion).
  • ­    Data gathered from diverse sources can be stored and reviewed in one consistent form
  • ­    Data can be “normalized.” The 3M HDD provides unique identifiers and meanings for unique concepts. It clearly defines healthcare terms so they can be used correctly by the computer system and provided in a meaningful form to the user.
  • ­    The data’s content can be preserved. The 3M HDD provides a method of defining data that captures its context in time, space, and in relationship with other data. This means:
    • Legacy information systems can remain viable data sources for a longer period of time.
    • A data record can be provided to the user in its original context.
    • Clinical information can be displayed in a meaningful way to the caregiver.
  • ­    Both clinical and administrative decision support can be based on either individual patients or populations.
  • ­    Care management (guidelines, pathways, etc.) can be more easily implemented.
  • ­    Outcomes research (data warehousing, population queries, etc.) can be performed.

A simple case in point: unless such key data as diagnosis, allergies, medications, laboratory findings, etc., are encoded, it is impossible to combine patient data from multiple legacy systems into one coherent, concise, and integrated display for the clinician. Encoding the data also means you have the complete data “picture” needed for population reporting.

Some Source Terminologies in the HDD
In addition to multiple commercial and US Department of Defense (DoD) interface terminologies (legacy systems, local/user terms), the 3M HDD integrates standard clinical terminologies including:

  • All Patient DRGs (APDRG)
  • All Patient Refined DRGs (APRDRG)
  • Ambulatory Payment Classification (APC)
  • Common Procedural terminology (CPT®)
  • Current Dental Terminology (CDT)
  • Diagnosis-Related Group (DRG)
  • HCFA Common Procedural Coding System (HCPCS)
  • Health Level 7 (HL7®) Vocabulary
  • International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
  • Logical Observation Identifiers Names and Codes (LOINC®)
  • National Drug Code (NDC)
  • RXNorm Clinical Drug nomenclature (RXNORM)
  • SNOMED Clinical Terms® (SNOMED CT®)

Three Key Components of the HDD

Information Models
An information model describes the relationships among clinical events and terminologies in a fashion that gives them meaning and context. While it enforces accepted truths, it allows uncertainty and even errors. An information model cannot and should not prevent a clinician from making what seems to be an incorrect or uncertain diagnosis, but it will help prevent the storage of illogical or impossible findings such as “fractured hair”. Information models mediate between data gathering software and databases and are supported by terminologies. Terminologies provide the coded content for values instantiated in the patient record by the information model. In addition to being clinically correct, a good information model must be complete, flexible, extensible, supported by vocabulary, and obeyed by the data gathering software. [1] [2]

Information Model Example
The 3M Medical Information models are written in Abstract Syntax Notation 1 (ASN.1). The following is a simplified ASN.1 definition of a medication order, followed by sample instance data.

ASN.1 Definition: A MedicationOrder event is defined by a set of observations

	MedicationOrder ::= SET {
   drug                Drug,
   dose                Decimal,
   route               Route,
   frequency           Frequency, 
   startTime           DateTime, 
   endTime             DateTime,
   orderedBy           Clinician,
   orderNum            OrderNumber}

CDR Instance Data: The ASN.1 model references the HDD when a coded element is specified in the definition and stores (NCID codes)

	MedicationOrder { 
   drug                Ampicillin (NCID 1234), 
   dose                500, 
   route               Oral (NCID 5678), 
   frequency           Q6H (NCID 9123), 
   startTime           09/01/95 10:01, 
   endTime             09/11/95 23:59, 
   orderedBy           John Doe MD (NCID 8123), 
   orderNum            A234567 } 

Knowledge Base
The knowledge base defines the domains referenced by the information models. Domains are the logical sets into which concepts are grouped (example: Clinical Specimen, Lab Test). Domains are created and populated by the web of relationships among concepts. Semantic relationships fall into two broad categories: hierarchical and non hierarchical. Hierarchical relationships are parent child or "is a" types of relationships (example: Influenza is a Virus, Oral is a Route of Administration). Non hierarchical relationships are all the other meaningful ways that concepts can be linked. The HDD's knowledge base is capable of supporting multiple hierarchies. Consequently a single concept can participate in many domains. Having this capability allows the dictionary to remain concept based. Without multiple hierarchies a new concept identifier would have to be created for each domain that the concept participated in.

3M HDD KnowledgeBase

Vocabulary
The vocabulary identifies medical concepts and organizes them to support synonyms, multiple surface forms, and other lexical characteristics. The HDD is a controlled medical vocabulary that follows best medical informatics practices such as concept permanence, multiple hierarchies, and meaningless identifiers.[3] Each unique concept in the HDD is assigned a Numeric Concept Identifier (NCID) code.

References
  1. Huff SM, Rocha RA, Solbrig HR, Barnes MW, Schrank SP, Smith M. "Linking a medical vocabulary to a clinical data model using Abstract Syntax Notation 1." Methods Inf Med; Nov 1998 (Vol. 37, Issue 4-5, Pages 440-52)
  2. Huff SM, Carter JS. "A characterization of terminology models, clinical templates, message models, and other kinds of clinical information models." In: Chute C, editors. Proceedings of International Medical Informatics Association-Working Group 6 Meeting (Health Concept Representation and Natural Language Processing); 1999.
  3. Cimino JJ. "Desiderata for controlled medical vocabularies in the twenty-first century." Methods Inf Med; Nov 1998 (Vol. 37, Issue 4-5, Pages 394-403)

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