Global healthcare needs to speak a common language to tackle the challenge of COVID-19
Atif Al Braiki, Abu Dhabi Health Data Services, Chief Executive Officer
COVID-19 has revealed a lot about the world we live in. It has reinforced the possibilities that open when we collaborate and come together, united towards a common cause; in this case, of defeating the spread of SARS-CoV-2.
The pandemic has drawn attention toward the inadequacies of the world’s data sharing frameworks. It has highlighted the lack of interoperability (the ability of computer systems to exchange information and operate in conjunction with each other) of many medical systems used by public and private providers, laboratories, and pharmacies globally. As a result, data exchange within a healthcare system, which utilises different data sharing frameworks, is not as streamlined as it should be. From the number of beds to the level of occupancy, the world is struggling to pool data from disparate and complex systems into one centralised location. By reshaping the way this crucial data is collated, analysed and disseminated into a coherent and easily accessible system we will give healthcare professionals the tools they need to tackle the current crisis and any we may face in the future.
Speaking the same language
Effective communication is the road network that transports information between locations. By speaking the same language, important data can move and lead to solutions much faster. Introducing better data standardisation will allow the health industry to speak a common language, with all the parameters used and understood in the same way. The Emirates ID, for example, is critical to our lives in the UAE. For our essential services to function effectively, it is imperative that we are all able to record and read the Emirates ID data in the same way. If there is no common standard set between different entities, data sharing becomes a challenge.
Systems must be interoperable; however, data sharing must also be governed. We can learn much from the vast experience of our colleagues in the banking sector in this regard. Modern banking technology allows us to easily transfer money across borders from one bank to another in the knowledge that the required security and controls are in place to enable this to happen. In addition to governance that allows the exchange, the systems are interoperable. This vital element is sometimes lacking in the healthcare sector. Transferring encrypted personal medical data from one healthcare provider to another within a secure network, can be challenging, because data is not always recorded in a way that it can be allow an easy exchange of medical records in a universal clinical language.
During a pandemic, as we witnessed, information needs to be shared efficiently, for the authorities to be able to make quick and scientifically sound decisions based on accurate data. In Abu Dhabi, the Department of Health (DOH) and Malaffi have started the journey of making the exchange of data possible. Malaffi, the region’s first Health Information Exchange (HIE) platform, is on its way to connect all public and private healthcare providers in the Emirate, allowing them to exchange in real-time important patient health information.
The platform has a strong foundation. Through Malaffi, we have been able to help tackle the COVID-19 pandemic by gaining better insights about the spread of the disease in Abu Dhabi. This centralised platform has enabled the DOH to strengthen its COVID-19 response. It has allowed the identification and tracing of newly diagnosed cases in real-time and helped policymakers to more efficiently allocate resources for better capacity utilisation and care coordination in the Emirate. Yet this is only the first step; the standardisation of clinical data sets will help improve the interoperability and exchange of information between the different systems through Malaffi.
Taking standardisation further
Today, there are some data sets that are properly standardised, while others do not have a standardised coding system. This seriously hinders interoperability. For example, in the UAE, laboratories use different coding systems for orders and results, which are a combination of CPT codes (Current Procedural Terminology) and their own local codes. The CPT is a procedural code used by healthcare providers or laboratories to bill insurance companies for procedures or medical tests rendered to patients. While CPT codes can be used to refer to laboratory services, the LOINC coding system is more appropriate to specifically describe lab results. LOINC (Logical Observation Identifiers Names and Codes) is the world’s most widely used terminology standard for lab tests and results1. By fostering this kind of interoperability, LOINC can help healthcare organisations achieve better patient care and improved revenue in the years to come. In the near future, laboratories should adopt the LOINC terminology.
Another example of standardisation is how EMR (electronic medical records) systems capture allergies. This is important to enhancing the quality of documentation and data. Some EMR systems will have a free text field for the recording of allergies instead of providing a drop-down menu of standardised allergy terminology, which is much easier to match and exchange. Recording allergies in the HIE platform in a standardised way brings immeasurable value. Having this information is critical to making all the difference between prescribing medicines that might cause an allergic reaction and others that won’t, which can ultimately save lives, especially in an emergency.
In Abu Dhabi, diagnoses are linked to a coding standard in the healthcare industry, known as ICD. This coding standard is used by healthcare providers to refer to diagnoses when sharing patients’ medical claims with insurance companies. However, for medical procedures providers use a different coding system, called CPT, in insurance claims to communicate information relating to the procedures.
Now, during a pandemic, it is also important for doctors to have access to patients’ medical history in order to be able to assess the risk level of the COVID-19 positive patients. This is where the standardised recording of chronic problems in patients’ HIE file becomes more important than ever. Currently, the market is using a combination of ICD10 and SNOMED codes, but there are also a number of EMRs which don’t support recording of chronic conditions as structured and coded data elements.
The accuracy of the reported pandemic’s indicators is by all means affected by the above – in other words, the better the data standards are, and the more accurate and qualitative the HIE data, the better standard of patient care and more reliable reporting to authorities are.
Mandating coding standards needs to come from the authorities, and we have the support of the DOH who has taken steps to tackle these challenges. During the pandemic the DOH have mandated for all labs to capture a patient’s Emirates ID details and key demographic information for each sample they test, so that the record of the patient can be easily matched within Malaffi. The long-term plan is to support the DOH and work with them to have standards, such as SNOMED, across the Emirate.
We’re all in this together
Data standardisation is not the onus of one entity or institution or organisation. The regulatory bodies will need to mandate it, however the change cannot happen on its own unless everyone is on board and collaborates.
Bottom line: it is critical for all of these systems to be interoperable for data to be easily shared between different systems.
This pandemic has opened up the discussion of having more interoperable systems to allow the easy exchange of data for specific uses and scenarios where it is needed. The big question that the healthcare sector around the world now faces is: Are we ready to take the big steps that will allow us to truly collaborate in the best interests of humankind?