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Adopt healthcare standards to be successful with informatics

Healthcare standards are essential to many initiatives such as interoperability. However, as an expert from the VA explains, they are also important to informatics.

Informatics in healthcare has the potential to improve patient care by enabling providers to understand a patient based on the population they serve.

But this can only truly be achieved with the adoption of healthcare standards, Scott DuVall, associate director of the Veterans Affairs (VA) Informatics and Computing Infrastructure (VINCI), said at Health Datapalooza in Washington, D.C. VINCI is an initiative aimed at improving researchers' access to VA data and to facilitate analysis of that data.

DuVall explained that medical informatics can help answer questions such as:

  • How does your patient fit into the population?
  • If you want to make a treatment decision, how does that compare with other treatment decisions that other providers made for similar patients?
  • If you decided on a treatment for this particular patient, what were the outcomes?
  • What was the range of outcomes and how likely does this person fit into the groups that have had different outcomes?

"This is the power of what informatics can bring as a medical specialty," DuVall said.

Healthcare standards enable informatics

Before DuVall explained how standards in healthcare play an enabling role when it comes to informatics, he first explained what a standard is and what it does.

We needed ... something that could support broad needs for comparative effective research with minimal data fidelity loss.
Scott DuVallassociate director of the Veterans Affairs Informatics and Computing Infrastructure

"It's where form equals function," he said.

DuVall defines "form" as a data or information model. Essentially, what the data looks like. He sees "function" as mapping that data to national terminologies so that a common meaning is established across all healthcare organizations.

DuVall said standards in healthcare provide value to informatics in three ways.

First, standards allow for taking information from many different data sources and putting them in a common place.

"It can provide standardized mappings, which means that when you call something a concept so does everybody else," DuVall said. "It also allows for custom concepts to be added for things that aren't in national terminologies or standards."

Second, it allows for embedding best practices.DuVall explained that the VA has 1,700 points of care because there are over 300,000 people who provide care and services.

"All of these different places across geography, across provider types, across different implementations of medical centers, all of these can be rolled in; the best practices can be rolled into the data itself and so each person doesn't need to reinvent the wheel," he said, further clarifying that this means, "the best practice or what's been decided upon is the default and that's shown."

Third, "along with that you can link back to the source data for validation or for additional variables," DuVall said. "You can combine data from multiple sources, you can support data sharing or federated analysis ... and you can leverage a community."

Why the VA chose the OMOP standard

To move forward with healthcare standards and informatics, the VA and DuVall chose the Observational Medical Outcomes Partnership (OMOP) data model.

"We needed ... something that could support broad needs for comparative effective research with minimal data fidelity loss," he said. "Even though we chose OMOP, we knew that the investment and getting there and standardizing and mapping the concepts, if we had to choose something else in the future, move to something else in the future, this would get us ... there."

The VA has 16 different tables for inpatient and outpatient infusion medication procedures, services provided inside and outside the VA, and more. "All of these are data sources that map to one table," DuVall said. "You don't need to be looking all over the VA to make sure you've covered everybody who's on a particular medication. You can go to one place."

DuVall added that OMOP allows the VA to embed best practices, as he stated before.

"For example, there's a drug error table where you can take prescription data and fill data and maybe even inpatient order data and administration data and you can create these drug errors," he said. "You can define or describe what an active prescription might be."

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