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December, 2014

The importance of standards

What made me so jubilant in my previous post about the fact that the NLM launched MedlinePlus Connect? A remark from my friend @epatientdave, the observation of various other news items covering the launch as well as Prof Sarkar’s blog post made me realize that I should spend some more words on it.

Standards and ontologies are recognized as the key elements for interoperability and health information exchange. Standards are seen as a tool for physicians in their use of EHRs:

Healthcare providers and organizations that purchase and implement any HIT technology should not only verify that the technology is “certified,” but also that it is fully LOINC capable in receiving, displaying and transmitting clinical lab-related data. Because, at the end of the day, clinical data helps make informed healthcare decisions possible.
Elhanan G. Lost in Translation? Clinical Decision Making and the Need for Lab Data Standards, Healthcare IT News, Jun 7 2011

Recently 2.500.000 diagnostic data collected in electronic patient records throughout 2006 within the County Council of Stockholm and coded in ICD10 (Swedish primary care version) have been mapped to SNOMED CT. The use of Is_a relationships in SNOMED CT aggregated the diagnostic data to 2861 concepts, showing a new, multidimensional view of different specific medical aspects, where every view can be further explored. The authors conclude SNOMED CT provides a different view of diagnoses and health problems on a chapter level, and adds significant new views of the clinical data with aggregations generated from SNOMED CT.
Jamoulle M. Some views about SNOMED-CT by a General Practitioner [Internet]. SEMINOP; Jul 2010. p.19

But as Swamy Laxminarayan and I realized in 2005, there is more to it. As I have said in many occasions, what we are implementing now in HIT is the realization of visions we had 10 years ago. But to do the implementation the right way, we have to have a vision of what we want to do with it 10 years from now. Our vision was (and mine still is) that EHRs should also be a tool for patients, to serve them with the correct information concerning their health problems at various literacy levels.

The lack of recognizable validated information on the internet made us think of setting up health information platforms, done by professionals and based on the same (ontological) standards as are used for EHRs. And we realized that it would mean a re-evaluation of the ICD code away from being a billing code only and have it combined with SNOMED (and possibly LOINC) (see also Lau F, Lee D. An Exploratory Review of the National Health Service SNOMED CT to ICD-10 Cross Map. ElectronicHealthcare. 2009;7(4):e1-e25). Hence my joy about a year ago when the cooperation between WHO (ICD) and the IHTSDO (SNOMED) was announced.

According to Prof. Sarkar

Internet-based patient portals allow patients to access their health information, including their diagnostic test results, to perform health-related tasks such as making medical appointments and requesting refills of prescription medications, and to interact with providers through secure email messages. Such patient portals are considered a core component of “meaningful use” of health information technology under federal health reform legislation, and will be rapidly implemented across U.S. health care settings in the coming years.
Sarkar U. Patient-facing Health IT: Bridging or Widening the Digital Divide? Informatics for Consumer Health. Jun 21 2011

However, portals can be much more than just a medical data or a patient-physician communication tool, as the recent NLM move shows. Unfortunately, none of the news articles I have seen so far really get the point of what makes this move so unique.

When a person sends a request for information about a diagnosis, medication, or lab test, MedlinePlus Connect receives the request, sorts through the information and returns relevant MedlinePlus information.
Lewis N. EHRs Get Help Meeting ‘Meaningful Use’. InformationWeek. Jun 22 2011

Unfortunately the information given by the NLM does not make clear whether the information requests have to be made manually, this page seems to indicate that’s the case.

If the patient portal or EHR is using MedlinePlus Connect, that text could be linked. Clicking on the link brings the user to a MedlinePlus Connect response page displaying up to three MedlinePlus topic summaries and selected links, if available. From that page, a user may continue to the complete MedlinePlus health topic page, or to any of the individual links on the response page.
MedlinePlus Connect: Web Application

If so, this still is a major step in the right direction. However, the final goal should be an automated system, which allows you to click on a diagnosis or medication within the EHR or portal and automatically see the related information.

When using the same coding for both health information websites and EHRs, the codes in the EHRs can, will and must become the search engine towards the health information pages.

Please let me know in the below comments if my interpretation of the NLM information is mistaken.

Lodewijk Bos

24 June 2011 | Categories: Blog.
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One Comment

  1. This may not be related to your topic but I’ve wanted to ask someone but didn’t know who. What is the possibility of GP’s having interactive web sites including Informational Therapy and then for each patient having their own learning platform ( in actual fact their EHR) to access what they need to manage their condition. As I see it it would be their mini website within the Practice one, with it’s own address and so accessable to anyone to whom they gave the link. (including when travelling overseas) Not sure about the security issues. This is being done in education in the UK.

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