Dialogix, LOINC and Healthcare IT Standards

Dialogix: A System for Rapidly Designing, Deploying, and Analyzing Survey Instruments:

http://www.dialogix.org

Summary

The Dialogix project provides a rapid and reliable platform for converting paper assessment instruments into standardized, semantically interoperable data capture tools. This project is aligning and transforming the efforts of multiple national standards bodies, and will make it possible to quickly and easily discover new best practices and deploy them in the community.

Background

Within behavioral health, the dearth of information standards poses a critical barrier to clinical quality improvement and creating a rapidly adaptive healthcare environment. Although there are thousands of psychometrically standardized measurement instruments for topics including diagnoses, outcomes and quality of life, none of these instruments have data, messaging, or semantic interoperability standards. Thus, although individual hospitals or research centers can collect data from such instruments, they cannot reliably share those data across settings or with electronic health records. Moreover, many clinicians customize these instruments, thereby voiding the psychometric standardization and posing further barriers to the information sharing needed for chronic disease management, continuity of care, and public health. Additionally, it takes months to years to develop, validate, and computerize new instruments; and barriers to re-using content from older instruments hinder efforts to have new ones build upon the best knowledge in the field.

Vision

A future where the nation has a comprehensive, longitudinal, privacy-preserving database containing all clinical and services data needed by researchers, including all data derivable from assessment instruments. With such a database, automated algorithms can discover clusters of symptoms and clusters of treatments which are correlated with good outcomes, thus facilitating the discovery of new best practices and enabling personalized healthcare. In order to get to that end-point, there must be a library of computerized assessment instruments conforming to all national interoperability standards; a library of semantically organized items (questions + answers), tools to streamline the development of improved instruments; easy mechanisms to interface those data with electronic health records.

Successes

• Dialogix has supported over $100 million in NIH-funded grants and still bests most commercial systems in its support for multi-lingual, highly branched and tailored, HL7-compliant surveys.

• Extensions to Dialogix have become the national standard for representing survey instruments.

Alignment with Regional and National Health IT Initiatives

• LOINC adopted extensions of the Dialogix model as its means of representing survey instruments

• This modeling was integral to the standardization of the CMS-mandated Nursing Home Minimum Data Set (http://aspe.hhs.gov/daltcp/reports/2006/MDSHIT.htm)

• Through partnership with LOINC, SNOMED, HL7, and NLM, there is now a federally accepted standard for representing and messaging assessment instrument, using LOINC for content and structure, SNOMED for clinical meaning, and HL7 for messaging

• NCVHS endorsed this process, stating that, "these standards will be used by all Federal agencies in implementing new, and as feasible, when updating existing health information technology systems".

• December2007HHSFederalRegisterNotice , referring to this process, states that the "Federal Government will require all future federal health information acquisitions to be based on CHI standards when applicable and as permitted by law, whether system development occurs within the Agency or through use of contractor services".

• The 2008 HIMSS IHE process demonstrated that these standards and process can be used to let functional status content be communicated across EHR and PHR systems via the HL7 Continuity of Care Document (CCD)

Publications and Presentations

1. White, T.M. and M.J. Hauan, The capture and use of detailed process information in the Dialogix system for structured web-based interactions. Proc AMIA Symp, 2001: p. 761-5.
2. Choi, J., et al., Toward semantic interoperability in home health care: formally representing OASIS items for integration into a concept-oriented terminology. J Am Med Inform Assoc, 2005. 12(4): p. 410-7.
3. White, T.M. and M.J. Hauan, Extending the LOINC conceptual schema to support standardized assessment instruments. J Am Med Inform Assoc, 2002. 9(6): p. 586-99.
4. White, T.M. and M.J. Hauan. Dialogix: A Framework for Improving the Accessibility and Quality of Measurement Instruments. in 15th Annual NIMH conference on Mental Health Services Research. 2002. Washington, D.C.
5. McDonald, C.J., et al. LOINC Update Extended Clinical Observation, Performance Measures, Attachments, Mapping and Translations (Spanish and Simplified Chinese). in Proc AMIA Symposium. 2005.
6. McDonald, C.J., et al. New Developments in the LOINC Coding World. in Proc AMIA Symposium. 2006.
7. White, T.M. Web-Enabling Complex, Multi-Lingual Structured Interviews using Dialogix. in CoGENT BaDMaN Workshop. 2001. New York Psychiatric Institute.
8. White, T.M. Web-Enabling Assessment Instruments: Lessons from Dialogix. in Columbia Department of Biomedical Informatics Faculty Seminar. 2001.
9. White, T.M. Web-Enabling Complex, Multi-Lingual Structured Interviews using Dialogix. in Eleventh Annual Institute on Mental Health Management Information. 2001. Albany, NY.
10. White, T.M. Dialogix: Computerized Collection of Complex Behavioral and Relational Data. in HIV-Center Grand Rounds. 2002. New York State Psychiatric Institute.
11. White, T.M. Enhancing LOINC Support for Assessment Instruments. in Third Public Clinical LOINC® Meeting. 2002. Salt Lake City, UT.
12. White, T.M. Implementing Survey Instruments in LOINC. in Fourth Public Clinical LOINC® Meeting. 2003. Salt Lake City, UT.
13. White, T.M. and C.J. McDonald. Survey Instruments. in Clinical LOINC® Meeting. 2004. Big Sky, MO.
14. White, T.M. Update on Survey Instruments and Questions. in Clinical LOINC® Meeting. 2004. Salt Lake City, UT.
15. White, T.M. and C.J. McDonald. Update on Survey Instruments and Questions. in Clinical LOINC® Meeting. 2004. Salt Lake City, UT.
16. White, T.M., et al. LOINC-ification of the Nursing Home Minimum Data Set. in Seventh Public Clinical LOINC® Meeting. 2006. Salt Lake City, UT.
17. White, T.M. LOINC: Supporting Interoperability for MDS and Survey Instruments in General. in HL7 Long Term Care EHR Profile Workgroup. 2006.
18. White, T.M. Assessment Instruments: Need Better Coordination Among LOINC, SNOMED, UMLS and HL7 - Implications for Patient Care. in HL7 Working Group Meeting: Patient Care and Orders and Observations Technical Committees. 2007. San Diego, CA.
19. White, T.M. Assessment Instruments: Need Better Coordination Among LOINC, SNOMED, UMLS and HL7 - Implications for Vocabulary. in HL7 Working Group Meeting: Vocabulary Technical Committee. 2007. San Diego, CA.
20. White, T.M. Assessment Instruments: Need Better Coordination Among LOINC, SNOMED, UMLS and HL7 - Implication for Templates. in HL7 Working Group Meeting: Templates Technical Committee. 2007. San Diego, CA.
21. White, T.M. Update on Survey Instruments. in Clinical LOINC® Meeting. 2007. Salt Lake City, UT.
22. White, T.M. Standardizing Assessment Instruments using LOINC, SNOMED and HL7. in Survey Question & Response: Methodologies Towards Standardization and Reuse Workshop. 2007. Atlanta, GA.