TMU – HCA Pharm. Dr. Alexander Bermudez Rubashkyn

HEALTH INFORMATION STANDARDS

Outline

Explain Health Care Data Sets and their purpose UHDDS, UACDS, MDS, OASIS, DEEDS and EMDS. Explain the standardization data collection

efforts. Explain the five type of standards that need to

be in place to implement the Nationwide Health Information Network (NHIN).

Standard Development Organizations Evolving and Emerging Health Information

Standards Conclusions

Terminology

Data (Data element): Representation of a single fact of measurement.

Information: Data that have been collected, combined, analyzed, interpreted, and/or converted into a form that can be used for a specific purpose.

Aggregate data: De-identified data extracted from health records and combined eg. AMI patient

Data Set: A collection of recommended data elements that have uniform definitions.

Standards

Simplification, Unification, Uniform, Specification. Ensure that there is coupling and integration

between different elements. a. An acknowledged measure of comparison for

quantitative or qualitative value; criterion, measure, guideline, example, model, guide, pattern, sample, par, norm, gauge, benchmark.

b. An object that under specified conditions defines, represents, or records the magnitude of a unit.

c. Widely recognized or employed model or pattern.

History Health Information Standards

XVII – London bills of mortality. 1960 technology and computers Hospital Discharge Data Sets Nowadays, hospitals and Health Care

Organizations collect more data and develop more information.

The extensive use of information within and across organizational boundaries demands standards that promote interoperable electronic interchange of data information.

Standardized Healthcare Data Sets

Purposes of data sets Identify the data elements that should be

collected for each patient. Uniformity in definitions.

The Standardization makes possible Compare data from multiple facilities Comparison of data for:

External accreditation Internal performance improvement Statistical studies Research activities

Standardized Data Sets in Health Care

Uniforms Hospital Discharge Data Set (UHDDS)

Uniform Ambulatory Care Data Set (UACDS)

Minimum Data Set for Long-term Care and Resident Assessment Protocols (MDS 2.0)

Outcomes Assessment Information Set (OASIS)

Data Elements for Emergency Department Systems (DEEDS)

Essential medical Data Set (EMDS)

Uniform Hospital Discharge Data Set (UHDDS)

1969 Conference NCHS, National Center for health services and research and Development and John Hopkins University. All short-term general hospitals in US must collect

minimum set of patient data element UHDDS. 1974 Federal government adopted the UHDDS

for Medicare and Medicaid programs. 1983 The UHDDS definitions were incorporated

to the new prospective payment DRG. 1986 All federal health programs adopted the

UHDDS

UHDDS

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Uniform Ambulatory Care Data Set (UACDS)

Set information about ambulatory care, or outpatient.

Approved by the National Committee on Vital and Health Statistics.

Some information is similar to UHDDS. Several information is specific, and focuses in

describe living conditions of patients. The goal of UACDS is to be incorporated in

federal regulations, UACDS has not been incorporated, that is why is recommended its used but not required.

UACDS

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Minimum Data Set for Long-term care (MDS 2,0)

Uniform data important in the long-term care setting

Federally mandated. Standardized assessment form for nursing home

resident. MDS organizes data in 20 main categories, each

category includes list of choice and responses. MDS are used to develop a Resident Assessment

Protocol (RAP) Department of Health and Human Services

(HHS) implemented in 2009 the MDS 3,0.

Minimum Data Set for Long-term care (MDS 2,0)Categories

1 .Demographic Information 11. Health conditions

2. Identification and background information

12. Oral/nutritional status

3. Cognitive Patterns 13. Oral/dental status

4. Communication/hearing patterns

14. Skin condition

5. Vision patterns 15. Activity pursuit patterns

6. Mood and behavior patterns

16. Medications

7. Psychosocial well-being 17. Special treatments and procedures

8. Physical functioning and structural problems

18. Discharge potential and overall status

9. Continence in past 14 days

19. Assessment information

10. Disease diagnoses 20. Therapy supplement for Medicare PPS

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Outcomes Assessment Information Set (OASIS)

Sponsored by the Health Care Financing Administration (HCFA).

Used for Medicare beneficiaries in home health industry.

This Data Set Include set of data items collected on all adult home health patients.

Data are used to assess the outcome and measure the quality of the health care services given to the patient.

OASIS

1. Demographics and Patient History2. Living Arrangements

3. Supportive Assistance

4. Respiratory

5. Neurological

6. Psychological

7. Integument

8. Pain

9. Activities of Daily Living /Instrumental Activities of Daily Living10. Medications

11. Elimination Status

12. General Information

13. Emergent Care Back

Data Elements for Emergency Department Systems (DEEDS)

Developed by the Centers for Disease Control and Prevention (CDC) and National Center for Injury Prevention and Control (NCIPC).

Uniform the collection of data in hospital based emergency departments.

DEEDS recommends the collection of 156 data elements organized in 8 sections.

DEEDS incorporates national standards for electronic data interchange so its implementation in an HER system facilitate communication with other systems.

DEEDS

Patient identification data

Facility and practitioner identification data

Emergency department payment dataEmergency department arrival and first-assessment data

Emergency department history and physical examination data

Emergency department procedure and result data

Emergency department medication dataEmergency department disposition and diagnosis data. Back

Essential Medical Data Set (EMDS) Developed by the National Information

Infrastructure Health Information Network Program NII-HIN

Enhance effectiveness of emergency care Complement the DEEDS information, create a

health history for an individual patient. Emergency care has a critical impact on patient

survival, that is why is important collect standardized and comparable data to assess and improve the efficacy of emergency treatment.

Standardized Data Collection Efforts

Health Plan Employer Data and Information Set (HEDIS)

Core Measures for (ORYX)

National Health Information Network (NHIN)

Health Plan Employer Data and Information Set (HEDIS)

Sponsored by the National Committee for Quality Assurance (NCQA).

Standard performance measures designed to provide purchasers and consumers of healthcare to compare managed healthcare plans.

The information collected about specific health – related conditions is used to analyze and assess outcomes of treatment.

One of the goals of HEDIS is to encourage the performance improvement for health plans and practices, that is why HEDIS developed the physician profile. Examples: Diabetes care, Adolescent Immunizations,

Smoking cessation programs, breast cancer screening etc. Back

Core Measures for ORYX

Sponsored by Joint Commission. Integrate outcomes data and other

performance measurements data into accreditation process about the core measures (Selected diagnoses and conditions where the outcomes can be improved by standardizing care.

ORYX initiative uses nationally standardized performance measures to improve the safety and quality of healthcare.

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National health Information Network (NHIN)

NCVHS explore the feasibility of a National health Information Infrastructure NHII, that would allow the electronic exchange of HI.

This technology would increase patient safety, reduce medical errors, increase efficiency and effectiveness of healthcare, and contain costs.

Under NHIN initiative efforts are focused on creating standards and defining a universal language of health information, accelerating implementation of EHR.

Besides technologies NHII includes values practices, relationships, laws, standards, systems, and applications that support all facets of individual health, healthcare, and public health.

Core data elements and Data content Standards

Support the development of networked health information systems.

Interdependent dimensions NCVHS 2000 – Toward a National Health

Information Infrastructure. These three dimensions described, are a

useful division for considering health data management requirement in HIM roles and the future environment and practices for health record management.

Healthcare Provider Dimension

•Patient record elements outlook of provider.•Clinical orders•Practice guidelines•Decision-support program•Contextual information

Personal Health Dimension

•Personal health record•Non shared personal info•Other elements as (Self-care track- ers, instructions, communications)•Audit-logs•Personal library

•Patient ID•Patient industry•Patient insurance•Consent forms•Medication alert

•De-identified information•Mandatory reporting•Community directories•Public health services•Survey data •Inspection reports

•Public education materials•Neighborhood environmental hazards

•Vital statistics•Population health •risks•Communicable diseases•Socioeconomic conditions•Registries

Population Health Dimension

•Infrastructure data•Planning and policy documents•Surveillance systems•Health disparities data © NCVHS 2000b

The previous standards were created for use in paper-based health record, that is why can no be longer accommodate for the current healthcare delivery systems.

FHA and HIE, have identified the need to develop standards to support the CONECTIVITY and INTEROPERABILITY.

Data needs in an Electronic Environment. Health Organizations must integrate data. The goals only can be accomplished when every

system is using common data standards.

Healthcare Information Standards

Def: Describe accepted methods for collecting, maintaining and transferring healthcare data elements between computer systems. These standards provide a common language that facilitates and supports:

Healthcare Information Standards (cont)

Exchanging information.

Sharing Information

Communicating within and

across disciplines and

settings

Integrating disparate

data systems.

Comparing information at a

regional, national, and international

level

Linking data in a secure

environment.

“The long term vision for Optimal Health Care exchange is to enhance the comparability, quality, integrity and utility of health information management from a wide variety of public sources through uniform data policies and standards”

NCVHS 2001

Imagine follow a recipe: no standard measurements, no instructions, nor specific order etc….

Healthcare Information Standards (cont)

Healthcare Information Standards

Information Standards

Clinical Data Representation Standards

Technical Standards

Medication Standards

Data Privacy and Security Standards

Information Standards

Content and Structure of HER. Structure and Content Standards establish

and provide, uniform definitions of data elements.

Specify type of data to be collected in each data field, width of each data field, content of each data field.I. HL7II. ASTM E31 CommitteeIII. Identifier Standards

Health Leven Seven (HL7)

HL7 is a non profit Organization. 1987 Provides comprehensive framework and related

standards for the exchange, integration, sharing, and retrieval of electronic, information.

Consist of rules for transmitting demographic data, orders, patient observations, laboratory results, history and physical observations and findings, also include message rules for appointment scheduling, referrals, etc.

CDA. Clinical Document Architecture (history, physical reports, discharge summaries, progress notes).

SPL, HL7 v2 and v3, GELLO, Arden Sintax, CCOW

Health Leven Seven (HL7)

American Society for Testing Material (ASTM) E31 Committee.

Established in 1970 ASTM develops standards related to EHR ASTM Standard E1384-02a

The scope cover all types of health care services Purposes are outlined for ASTM practitioners for

content and structure of the EHR. Logical data consistently attached to patient record

content as (Physical test, Lab test, Diagnosis, Orders, Treatments, Documentation, Patient info, orders, legal permissions)

Explain relationship of the data coming from different sources

Provide a common vocabulary Create a unique setting view Map the content to select relevant biomedical and HIS

Identifier Standards

Recommend methods for assigning “Unique identification numbers” to individual, including patients, healthcare providers, corporate providers.

Combination of numeric or alphanumeric characters. Used within one facility or a single healthcare system. There is not consensus on method. Identification number Social Security Number

(Identifier) instead DNI (not designed for being universal identifier.

Other sources for identify confirmation in health care being explored (fingerprints, iris, retinal scans)

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Clinical Representation Standards Includes clinical terminology / classification and

vocabulary system, lab and clinical data, observation codes, drug codes, metadata.

This tool encourage consistent descriptions of an individual condition. Medical terminology extremely complex, Is not easy

standardize. Use of ICD and CPT uniform the terminology for data

capture. Code Sets are often featured as HL7

There is not master set of data elements that would facilitate HIE.

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Technical Standards

Electronic Data Interchange/ e-commerce• Structured transmission of data between

organizations by electronic means. • Exchange medical, billing information• Fast and cost effective transactions. ASCX12N or X12N• Develop uniform standards for electronic

interchange of business transactions: claims/encounters, attachments, enrollment, disenrollment, eligibility.

• Payment/remittance advice, premium payments, first report injury, claim status, referral, authorization certification.

LOINC Used to provide standard set of universal names and codes

for identifying individual laboratory and clinical results. Electronic exchange of laboratory results. IEEE 1073• Provide for open systems communications in healthcare

applications.• Interoperability standard for electronic health data exchange

from medical devices and patients, optimized for the acute care setting.

DICOM• Standard which permits interchange of biomedical images.

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Technical Standards (cont)

Medication Standards

FDA National Drug Code (NDC) Drug codes and (SPL) Labeling.

FDA Center for Drug Evaluation and Research Data Standards (CDER) manual.• Several codes COMIS, DFS, CPRF, DRLS, DADS, SPOTS.• Strictly voluntary

National Council for Prescription Drug Programs,• NCPDP Transmitting prescription information between

prescribers, providers, and other organizations or agents. Addresses electronic transmission of new prescriptions, changes, refills, notifications, cancellations.

Semantic Clinical Drug (SDC) of RxForm• Provides standardized names for clinical drugs

(active ingredients) doses, forms, brand names, RxForm is produced through HL7.

• Is a subset of RxForm, provide interoperability for clinical drug nomenclature.

LOINC Clinical Special Product Labeling (SPL)• Structured product labeling, specification

purpose is to facilitate the submission, review, storage, dissemination, and access to product labeling information.

Medication Standards (cont)

Medication Standards (cont)

Electronic Prescribing

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Privacy and Security Standards Mandated by HIPAA Ensure confidentiality and protection from

unauthorized disclosure alteration or destruction effective security standards are especially important in computer-based environments because patient information is accessible to many users in many locations

ASTM and HL7 have developed security standards.

Standards development Organizations SDO. (ISO, WHO, ASTM, ANSI, HL7)

Process : Identifying, negotiating, drafting.

Organizations that coordinate standards development: ANSI

ISO, International Standards Private and government organizations

influence development of standards.

Standards Development

Healthcare Standards Landscape

© Hammond, William Edward; Jaffe, Charles; Kush Rebecca Daniels. "Healthcare

Standards Development: The Value of Nurturing Collaboration " Journal of AHIMA

80, no.7 (July 2009): 44-50.

Evolving and Emerging Health Information Standards

• HIS are far from complete.• Extensible Markup Language (XML): HTML• XML allows data to be communicated from one

computerized system to another.• No loss of integrity of data• XML combined with existing classification

systems• XML allows data in health record to be organized.• Can serve as a standard for exchange of HI over

the web.

Conclusions

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