May 2010

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Purpose: Standards development can take three or more years before adoption for use. The purpose of this paper is to describe the analysis portion in the development of an HL7 V3 standard. The International Health Terminology Standards Development Organisation (IHTSDO), which owns and maintains SNOMED CT, and the HL7 Anesthesia working groups along with a senior informaticist at Duke University have begun such an analysis by using a Domain Analysis Model (DAM). A DAM and its artifacts or deliverables are the products of the Domain Analysis Process as described in the HL7 Health Development Framework (HDF). The HDF is a framework of modeling and administrative processes, policies and deliverables used by HL7 to produce specifications for a proposed standard. The project’s intent is the creation of a new standard for Preoperative Anesthesia Assessment Terminology with metadata for terms as appropriate in SNOMED CT and HL7 V3. The results of this project will be part of a subsequent project that will ultimately map the terms to the HL7 V3 Reference Information Model (RIM). Information on standards is difficult to assemble and synthesize. As such to the average healthcare professional, the subject of healthcare information standards can seem abstract, confusing and cluttered with acronyms. Therefore, in addition to describing the Domain Analysis Process, a secondary purpose is to provide an introductory overview, a primer, on 1:interoperability, 2: standards: what they are, what they mean, their development and their relevancy to key current US Government electronic health record initiatives, 3: HL7 V3, and 4: SNOMED CT. With the increase in adoption of electronic health record (EHR) systems, there will be an increasing requirement for professional experts from every clinical domain to assist in EHR systems development. The intended audience for this paper is that clinician who is interested in furthering the standards development process but has little knowledge surrounding that said process. The intent of the paper is to give that clinician a jump start into the subject of standards and interoperability. The true benefit from electronic health record (EHR) adoption will come from interoperability. Simply, interoperability is the sharing of accurate health information within organizations, between organizations and between organizations and patients. In order to achieve interoperability between diverse systems, interoperability standards are employed to define vocabulary, protocols, presentation and other features of health information. In addition to the known benefits of electronic information sharing, standards and interoperability has become even more urgent as it is one of the main foci of the American Recovery and Reinvestment Act of (ARRA) and the HITECH Act of 2009, which has authorized the Centers for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for eligible professionals and hospitals who become successful ‘meaningful users’ of electronic record technology beginning in 2011. In addition to being two of the most successful and important standards used internationally for healthcare information systems, Health Level Seven Version 3 (HL7 V3) and the Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) have been identified by the Office of the National Coordinator for Health Information Technology (ONC) as two of the standards future EHRs must incorporate in their design in order meet ‘meaningful use’ criteria.




School of Medicine



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