Adoption of clinical data standards paving the road to better healthcare
By Dr. Sanji de Sylva, Director – Clinical Adoption and Informatics, Malaffi
27 January 2022
The basic premise of digital transformation of healthcare is the availability of centralised and high-quality data. This would seem quite easily available in 2022, especially in a world where we are all connected via smartphones to instantly accessible and shareable information.
Traditionally, however, we have seen how healthcare systems struggle to exchange information, which leaves silos of fragmented data across the many different healthcare touchpoints. This hampers the continuum of care, slows efficiencies, and increases costs, which is frustrating to both patients and clinicians.
The real-world implications of this scenario are profound. For example, around 80 per cent of serious medical errors result from miscommunication between healthcare providers, particularly during the transfer of patients from one provider to another.
In 2019, the Department of Health – Abu Dhabi (DOH) established Malaffi as the region’s first health information exchange (HIE) platform, allowing public and private healthcare providers in the Emirate to exchange key patient health information in real-time. When clinicians have access to a longitudinal medical record and 360° view of the patients, they are empowered to make quicker and better-informed decisions, avoiding duplication and medical errors, thereby improving patient safety, experience and outcomes.
This January, Malaffi celebrates its 3rd anniversary, during which in record breaking time it has connected all hospitals in Abu Dhabi, 99% of all patient episodes and collated 660 million unique clinical records of medical information, from patient visits and lab results to radiology reports, vital signs, medications and more. Over 45,640 doctors, nurses, pharmacists and other members of staff from the 1,919 healthcare facilities across Abu Dhabi have secure access to Malaffi and are empowered to make better-informed, safer, and more efficient decisions.
Nevertheless, the implementation of Malaffi surfaced the globally known challenges related to sharing and exchanging patient data between different systems and issues with interoperability, data standardisation, and data quality. Their negative impact on both the delivery of clinical care and actionable insights was potentially significant and could result in poor patient outcomes. In other words, the more the data is standardised, the systems are more interoperable, the quality of data is better and so is the quality of care and the population health insights.
Pandemic-accelerated data standardisation
The pandemic–when it was critical to centralise, share, and analyse data in a meaningful way to enable an effective pandemic response–further escalated this issue. But it also presented an opportunity to expedite the introduction of data and interoperability standards and develop supporting processes to monitor and improve data quality.
One of the first challenges faced while collecting pandemic related data was the lack of patient identifiers to enable patients matching. The DOH took immediate steps to tackle this challenge and mandated all laboratories to capture patients’ Emirates ID details and key demographic information for each sample they tested so that the patient records can be accurately matched within Malaffi.
Further, working closely with DOH, we ensured a standardised data format from all contributing participants which enabled the quick centralisation of all pandemic related data such as PCR tests, and later vaccination. For instance, the DOH enforced the use of COVID-19 CPT codes for PCR tests and standardised the result formats to enable reporting. Following this, we extended the use of CPT codes to COVID-19 and all other immunisation records and vital signs.
During the pandemic, Malaffi centralised over 83 million PCR test and 10,7 million vaccination records. The DOH had real-time insights and was able to make data-driven critical pandemic decisions to protect its residents, and globally the Emirate has been recognised for its effective and successful response.
The current state of data standards and quality
Going back in time, during the early phases of the implementation of Malaffi, due to the urgency to connect the sector, there was no opportunity to define and introduce data quality and clinical terminology standards in all areas. This resulted in a range of data quality problems.
To address the issue, in 2021, the Malaffi team performed a structured analysis of the current state of data standards and data quality of the clinical information contributed by the healthcare providers. This included patient demographics and clinical data (e.g. diagnoses, allergies, procedures, chronic conditions, lab and radiology reports, and medications).
The results proved what was already apparent - while some domains had consistently coded data (e.g. diagnoses, procedures), there were significant gaps in other demographic and clinical domains (e.g. allergies, chronic conditions), as well as data quality issues in the data being captured (e.g. acute conditions captured as chronic problems).
Therefore, in November 2021, the DOH issued guidance on coding standards to healthcare providers in Abu Dhabi (such as SNOMED CT and LOINC), the adoption of which is expected to improve interoperability significantly, increase the clinical value of the data and improve the accuracy and scope of population health insights.
As it is a continuum process, to continue monitoring the progress and identify issues for remediation, we created dashboards that will be available to the DOH and soon to the participants.
In parallel, we welcomed the decision of the Ministry of Health and Prevention to introduce the adoption of SNOMED as a clinical terminology of choice for the capture and exchange of data between the HIEs in the UAE, which significantly impacts the interoperability on a federal level.
The wide adoption of data standards by healthcare providers is expected to render multiple benefits. On the clinician level, it impacts the accuracy, completeness, clinical value and meaningfulness of the data, which allows them to make better-informed and safer decisions for their patients. It also impacts the way that data is presented. For example, repeated laboratory results can be graphically presented as trends, allowing clinicians to better communicate and educate the patients about their condition.
On a population health level, benefits are far-reaching. High quality data allows for better actionable insights, which during COVID-19, for example, provided vital real-time population health insights that helped support the government to form a coherent and effective plan to contain the outbreak.
More widely, the information allows us to do population risk profiling using applied artificial intelligence (AI) and machine learning on two-year historical data. This applies to different categories, including emergency room visits or in-patient admissions and re-admission risks, and the risk for the development of chronic conditions such as diabetes and hypertension.
And finally, it automates our quality measures, with dashboards that monitor the quality and performance of facilities. This information also conforms with the DOH’s JAWDA measures by leveraging the data being shared by participants to automate the JAWDA calculations that were manually submitted by providers.
Building an integrated HIE platform has done much to transform the model of healthcare in Abu Dhabi. It’s exciting that digital data has been the main factor for change because the foundations have been laid for so many more future developments. But best of all, this data is ultimately saving lives.
Visit Malaffi at the booth of the Department of Health Abu Dhabi for a demonstration of a data quality monitoring dashboard and an image exchange platform.
 Effects of Poor Communication in Healthcare (hipaajournal.com)