# Medical Informatics Standard Application Consortium (MISAC)

## Purpose
- Addressing medical informatics standard specifications basing on real world use cases
- And simplify the specifications for understanding, adoption, and implementation

## Why we start MISAC
Medical Informatics Standards (HL7, DICOM, IHE) are the foundation of integrated healthcare (personal healthcare, tele-healthcare, and precision medicine, etc.). In the past few years, both HL7 and DICOM have purposed new web specifications (FHIR and DICOMweb) for system integration. Lots of countries and venders in Europe and North America are advancing the new standards and constructing novel healthcare systems. Conventionally, medical informatics standards were established and promoted by experts in standard organization. However, in Taiwan and emerging Asian countries, they lack of the experts of Medical Informatics (MI) standard, and the detailed specifications (standards) in various clinical domains still need to be addressed. In Taiwan, most of healthcare systems were constructed by small companies or hospitals. The companies and hospitals usually fall short of human resources to promote standardization. It is more appropriate to be led by academic organizations and scholars to deliver and promote MI standards. Researchers in universities and clinical physicians in hospitals may cooperate for addressing the details of domain specific standard. And the standard can be accelerated by a series of processes systematically.

Since 2016, Medical Image Standard Association in Taiwan (MISAT) has established MI-TW Connectathon for discussion, addressing, training, developing, testing, and promoting MI standards. In 2020, 19 development teams and 30 systems participated in MI-TW Connectathon for testing the interoperability of their systems. In 2021, 31 development teams and 53 systems participated in MI-TW Connectathon. MI-TW Connectathon has 7 Working Groups (WGs) to address and simplify the specifications. Currently, we have delivered simple and easy specifications for implementation about patient administration, bio-signal, medication, medical image, digital pathology, genomics, and exam workflow based on FHIR and DICOM. We are looking forward to initiating the new work groups for financial, knowledge management, and code system. Based on the MI standard foundations mentioned above, lots of integrated usages can be created. The standardized systems may be adopted worldwide and improve the processes of healthcare globally. Still, lots of healthcare standards issues need to be clearly addressed and tons of training and promoting activities need to be fulfilled aggressively and effectively. Our mission is teaming up with an international consortium by volunteers to explore the evolution of medical informatics standard and the roles they play in the healthcare industry.

In the real world, creating a novel healthcare information system is a huge and sophisticated task. Based on MI standard, the system may be divided into sub-systems that might be much easier for analysis and development. Some sub-systems might also be used in other healthcare. As we have addressed in [MISAC foundation WGs](https://hackmd.io/Q1sPmblxTBK59OVeitzyzg?view#Foundation-working-groups), the information in healthcare system might be classified into several different types. And each foundation WG can create some profound general-purpose profiles (building blocks) that may be adopted in lots of healthcare usages. For example, we may have a general-purpose patient and appointment information standard for most of healthcare activities. And we may have an integration framework with standard cyber security for sharing clinical documents, medical image, and vital signals. Some domain specific standard may also be modified and leveraged for another clinical domain. Such as HL7 intentional has announced [breast radiology reporting]( https://build.fhir.org/ig/HL7/fhir-breast-radiology-ig/). This drafting specification has a [detail specification for mammography mass](https://build.fhir.org/ig/HL7/fhir-breast-radiology-ig/StructureDefinition-AbnormalityMass.html) . However, tons of image report specifications require for defining. MISAC has bunch of projects for defining medical image reports and integration specifications for other healthcare usages. As the described details in planning activities for the consortium, the processes for developing and promoting a novel standard MI system has many processes. These processes for each novel healthcare usage are accomplished by the open, aggressive, and profound activities executed in MISAC.

## Planning activities for the consortium
- Tele-conferences: Clinical and healthcare domain experts provide their requirements of integrated systems and MI standard experts could address the specifications for the integration.
- Education and training: on-line course and training material includes Elementary courses of MI standard, the special topic training, etc.
- Research cooperation: Especially for constructing international working groups for addressing MI standards that can be used worldwide.
- Virtual hospital and sandbox for implementation
- MI Connectathon: test the interoperability of healthcare systems
- Funding and Incubating: encourage young student for joining the activities of the consortium and career in the realm of medical informatics

## How to join the Consortium (free for join the Consortium)
- Login the application web site and provide your contact information
- Fill an application form and choose your interested working groups
- Take the on-line courses. Will receive a certificate of the elementary knowledge of MI standard after you finish the courses.
- Attend the open discussions of WGs.
- Participate the activities of the open projects
-- There are many projects in each WGs, and some projects are open to everyone. We encourage student throughout the world to join the open projects by contacting the project manager to be a volunteer.
-- After you are familiar with the processes of how to running an open project, you may able to create new projects after submitting application to WGs chairs. WGs chairs will help with creating the new projects.

## Applications
- 以下連結，有中文或英文的應用情境概述，會進一步整理
- IoT and Tel-healthcare:[IoT on FHIR](https://hackmd.io/2QFjeso0QF6w0QiR9WiXxA?view), [ECG](https://hackmd.io/at2EK3PiSBSVKTgSp0EOrw?view), [Bio-signal analysis for sleep disorder](https://hackmd.io/26qcRbfLRbSXu01XVkETXw?view), Motion analysis, human motion analysis
- Healthcare chart and form: Initial and summary notes, [questionnaire](https://build.fhir.org/questionnaireresponse-examples.html), [ECOG Performance](https://build.fhir.org/ig/HL7/fhir-mCODE-ig/StructureDefinition-mcode-ecog-performance-status.html)
- Medical image and structured reporting: [image report](https://hackmd.io/y3HAfYBoS-qT3gdwxDp3jQ?view), [FHIR breast report](https://build.fhir.org/ig/HL7/fhir-breast-radiology-ig/), [lesion management](https://hackmd.io/xw8wX7e3RvqxlhbJN9vlVA?view),[QIBA](https://www.rsna.org/research/quantitative-imaging-biomarkers-alliance)
- Colonic disease healthcare: [Care or treatment planning](https://www.hl7.org/fhir/careplan-examples.html), [Sleep disorder](https://hackmd.io/26qcRbfLRbSXu01XVkETXw?view),COPD, coronary artery disease, diabetes, [Patient social activity management](https://patient.info/doctor/social-isolation-how-to-help-patients-be-less-lonely), [Family-Centered Health Promotion](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278332/), Sports Medicine, palliative care, [patient activity tracking](https://github.com/Lorex/refused-to-scan-1922-qrcode), [Holistic Health Care:全人照護](https://hackmd.io/Uo9hD_JUSvq9DE0cywrzAg?view)
- Cancer: [Oncology on FHIR](https://hackmd.io/dYSsU5plQhKZQYv9fJCjJA?view
), [mCode](http://hl7.org/fhir/us/mcode/STU2/)
- Virtual slide and multimedia
- Genomics
- Workflow management and auditing: Exam referral, emergency referral (EMS), [image exam cooperation](https://hackmd.io/S8CrTQGxS4irYN2lH7SKvQ?view)
- Financial and accounting
- Clinical Decision Support: [knowledge management](https://hackmd.io/-0tgKXi0RpKGv1eafc8Okw?view)
- Security
- Other applicaton and brief description

## Foundation working groups
1. Administration and security: managing organizations, persons, devices. Standardized secure integration.
2. Diagnosis and evaluation: FHIR condition, observation, Questionnaire, and diagnosticReport
3. Order, [healthcare planning](https://hackmd.io/I7T2PcbNQNiGI5sXaMW3Nw?view0), procedure,and medication
4. DICOM
5. Virtual slide and multimedia
6. Genomics
7. Workflow management and auditing: Schedule, appointment, encounter,and task management
8. Financial and accounting
9. Clinical [knowledge management]((https://hackmd.io/-0tgKXi0RpKGv1eafc8Okw?view)) and clinical decision support
99. Code system

## [Relation of Working Groups and integration standard overview ](https://hackmd.io/HVQjNG8YTdyV6auP7isLmQ?view)

## 20240903
### FHIR EMR 及 PHR 發展模式
FHIR 專病庫是大方向、智慧醫療、精準醫護、個人化醫護也是大方向，但標準化系統如何推行?

### 政府或民間主導?
- 政府
-- 各國皆有標準化大健康相關計畫，US onc health 2030、中國 2030 大健康、賴清德健康台灣
但是，會否成功? 進行中，結果未知
-- 已進行
--- 印尼 FHIR 2021-2024
--- [USAID FHIR](https://publichealth.jhu.edu/center-for-global-digital-health-innovation/empowering-digital-health-usaids-strategic-path-forward-to-2030)，如下願景，但 USAID 預算已被中止!
---- These experts discuss the evolution of digital health, key areas of focus such as person-centered care, interoperability standards, and country-led governance, as well as how USAID is working with global partners to strengthen privacy, cybersecurity, and the global digital health commons.
- 民間組織
-- 由積極、且可持續進行的組織主導，如跨國際、跨學校、跨協會、及廠商工作小組
-- 所需經費不多、但可持續進行
-- 可配合政府各式相關計畫進行

## Standard adoption processes [Chinese](https://hackmd.io/RejH9jyJQ_-3-HJMDubqAg?view) , [English](https://hackmd.io/sgRUPoISQ9OGFcf-Pah3oA?view)
- Patient portal 及 EMR PHR 整合架構
-- 有非常多應用情境
-- 可基於應用情境，討論需切分的模組及子系統
--- 情境: [FHIR PHR international specifications](https://hackmd.io/m_otn7BGSyClipmyB9NHBg?view)

### to do
- 線上及實體密集交流。
-- 近期與潭子慈濟、花慈、慈大合作進行。線上應用需求會議
- 翻轉教育
- 入門的 connectathon
糖尿病
智抗醣 IoT

## Standardized MI application
- Use case analysis
- With foundations WGs suggested general used building blocks (profiles)
- Includes cross department or PHR and EHR integrated Healthcare
- EHR(or PHR) integrated with:
-- medical and service requests (orders), [care plans](https://hackmd.io/I7T2PcbNQNiGI5sXaMW3Nw?view)
-- medical image, laboratory, and genomics exams
-- hospital and healthcare department procedures, homecare procedures
-- KM or CDS
-- Claim and finical

## Education
### Education (Established)
- **The Construction of Digital Medical Content**. -- cooperated online course with [TCU](https://ican.tcu.edu.tw/ican5/course/outer_data/ican_guestlist_show.aspx?cid=1101UMNMI1440400)
-- Introduce contents generated in healthcare: medical record(FHIR), DICOM image, bio-signal, genomics, and multi-medium
-- Provide innovating usages and requirements by healthcare domain experts
-- Demonstrate the skill, knowledge, and altitude should learn for joining healthcare system developing teams.
- **FHIR Applications** Course of [TCU](https://ican.tcu.edu.tw/ican5/course/outer_data/ican_guestlist_show.aspx?cid=1101UMNMI1440400) and may cooperate with another university for creating online course. For undergraduate school students(G2 or G3). Provide JS, C, or Python examples for handling FHIR.

- **Basic Medical Image System Development**
-- cooperated online course with [TCU](https://ican.tcu.edu.tw/ican5/course/outer_data/ican_guestlist_show.aspx?cid=1102UMNMI3564200)

## Planning education course
- FHIR financial and accounting
- Wearable device and edge AI

## References
- [Indonesia Health Service FHIR R4](https://simplifier.net/guide/FHIR%20Indonesia%20IG/Home/FHIRProfiles/Location.guide.md?version=current)
- [FHIR US Core](http://build.fhir.org/ig/HL7/US-Core/)
- [International Patient Summary](http://hl7.org/fhir/uv/ips/)
- [DDC TW](https://dccfhirig.mohw.gov.tw/ig/index.html)
- https://www.fhir.org/guides/registry/
- [MOH-TW 衛福部資訊通報專屬規格](https://hackmd.io/Q1sPmblxTBK59OVeitzyzg?view#References)