HEALTHCARE DATA HEALTHCARE DATA STANDARDSSTANDARDS

This chapter examines healthcare data standards in This chapter examines healthcare data standards in terms of the following:terms of the following:

Need for healthcare data standardsNeed for healthcare data standardsHealthcare data interchange standards Healthcare data interchange standards Healthcare terminologiesHealthcare terminologiesKnowledge representationKnowledge representationHealthcare data standards developmentHealthcare data standards developmentHealthcare data SDOsHealthcare data SDOs

Need for Healthcare Data StandardsNeed for Healthcare Data Standards Data standards as applied to healthcare include : Data standards as applied to healthcare include : methods, protocols, methods, protocols,

terminologies, and specifications for the collection ,exchange, storage, and terminologies, and specifications for the collection ,exchange, storage, and retrieval of information associated with healthcare applications, including retrieval of information associated with healthcare applications, including medical records,medications,radiological images, payment and medical records,medications,radiological images, payment and reimbursement,medical devices and monitoring systems and reimbursement,medical devices and monitoring systems and administrative processes.administrative processes.

In the domain of information management, standards can be further In the domain of information management, standards can be further categorized as:categorized as:

1.those that support the generic infrastructure and are not domain 1.those that support the generic infrastructure and are not domain specific specific

2.those that support the exchange of information and are domain 2.those that support the exchange of information and are domain specificspecific

3.those that support activities and practices within a specific domain3.those that support activities and practices within a specific domain

Healthcare Healthcare is fundamentally a process of communication.is fundamentally a process of communication.Data Standards Data Standards is generally used to describe those standards having to do is generally used to describe those standards having to do

with the stucture and content of health information, it may useful to with the stucture and content of health information, it may useful to differentiate data,information and knowledge.differentiate data,information and knowledge.

DataData are collections of unstructured discrete entities(facts) that exist outside are collections of unstructured discrete entities(facts) that exist outside of any particular context. of any particular context.

Data interchange standards adress,primarily,the format of messages that are exchanged Data interchange standards adress,primarily,the format of messages that are exchanged between computer systems, document architecture,clinical templates,userinterface, and between computer systems, document architecture,clinical templates,userinterface, and patient data linkage.patient data linkage.

The following section describes some of the major organizations involved in the development of The following section describes some of the major organizations involved in the development of data interchange standards:data interchange standards:

Message Format StandardsMessage Format Standards four broad classes of message format standards have emerged in the healthcare sector: four broad classes of message format standards have emerged in the healthcare sector: 1. medical devise communications1. medical devise communications 2. digital imaging communications2. digital imaging communications 3. administratve data exchange3. administratve data exchange 4. clinical data exchange4. clinical data exchange

The National Committee on Vital and Health Statistics (NCVHS) is the advisory committee The National Committee on Vital and Health Statistics (NCVHS) is the advisory committee established to make recommendations on health information policy to the Department of established to make recommendations on health information policy to the Department of Health and Human Services (HHS) and Congress. Health and Human Services (HHS) and Congress.

Institute of Electrical and Electronic EngineersInstitute of Electrical and Electronic Engineers The IEEE has developed a series of standards known collectively as P1073 Medical The IEEE has developed a series of standards known collectively as P1073 Medical

Information Bus(MIB) which support real-time,continous,and comprehensive capture and Information Bus(MIB) which support real-time,continous,and comprehensive capture and communication of data from bedside medical devices such as those found in intensive care communication of data from bedside medical devices such as those found in intensive care units, operating rooms and emergency departments.units, operating rooms and emergency departments.

The most widely known standard, 802.11, commonly referred to as Wi-Fi, allows anyone The most widely known standard, 802.11, commonly referred to as Wi-Fi, allows anyone with a computer and either a plug-in card or built-in circuitry to connect to the Internet with a computer and either a plug-in card or built-in circuitry to connect to the Internet wirelessly through a myriad access points installed in offices, hotels, airports, coffeehouses, wirelessly through a myriad access points installed in offices, hotels, airports, coffeehouses, convention centers and even parks,ammong other locationsconvention centers and even parks,ammong other locations

National Electrical Manufactures AssociationNational Electrical Manufactures Association in collaboration with the American College of Radiologists and others, formed the in collaboration with the American College of Radiologists and others, formed the

DICOM to develop a generic digital format and a transfer protocol for biomedical images DICOM to develop a generic digital format and a transfer protocol for biomedical images and image-related information.and image-related information.

DICOM standard is the dominant international data interchange message format in DICOM standard is the dominant international data interchange message format in biomedical imaging.biomedical imaging.

Accredited Standards Committee X12N/InsuranceAccredited Standards Committee X12N/Insurance has developed a broad range of electronic data interchange(EDI) standards to facilitate has developed a broad range of electronic data interchange(EDI) standards to facilitate

electronic business transactions.electronic business transactions. National Council for Prescription Drug ProgramsNational Council for Prescription Drug Programs develops standards for information processing for the pharmacy services sector of the develops standards for information processing for the pharmacy services sector of the

healthcare industry.healthcare industry. HL7 standards focus on facilitating the interchange of data to support clinical practice HL7 standards focus on facilitating the interchange of data to support clinical practice

both within and across institutions.both within and across institutions. The major areas covered by the standard include:The major areas covered by the standard include: 1. medical orders1. medical orders 2. clinical observations2. clinical observations 3. test results3. test results 4. admission4. admission 5. transfer and discharge5. transfer and discharge 6. document architecture6. document architecture 7. clinical templates7. clinical templates 8. user interface8. user interface 9. EHR9. EHR 10. charge and billing information10. charge and billing information

TerminologiesTerminologies A fundamental requirement for effective communication is the ability to represent concepts in an A fundamental requirement for effective communication is the ability to represent concepts in an

unambiguous fashion between both the sender and receiver of the message.unambiguous fashion between both the sender and receiver of the message. 1. International Statistical Classification of Diseases and Related Health Problems: Ninth 1. International Statistical Classification of Diseases and Related Health Problems: Ninth

Revision and Clinical ModificationsRevision and Clinical Modifications -the latest version of a mortality and morbidity classification that originated in 1893-the latest version of a mortality and morbidity classification that originated in 1893 2. International Statistical Cassifications of Diseases and Related Health Problems: Tenth 2. International Statistical Cassifications of Diseases and Related Health Problems: Tenth

Revision Revision - most recent revision of the ICD classification system for mortality and morbidity, which - most recent revision of the ICD classification system for mortality and morbidity, which

is used worldwideis used worldwide 3. Current Procedural Terminology, Fourth Revision3. Current Procedural Terminology, Fourth Revision - listing of descriptive terms and codes for reporting medical services and procedures - listing of descriptive terms and codes for reporting medical services and procedures 4. Systematized Nomenclature of Human and Veterinary Medicine International, Clinical Terms 4. Systematized Nomenclature of Human and Veterinary Medicine International, Clinical Terms - comprehensive, multiaxial nomenclature and classification system created for indexing - comprehensive, multiaxial nomenclature and classification system created for indexing

human and veterinary medical vocabulary, including signs and symptoms, diagnosis and human and veterinary medical vocabulary, including signs and symptoms, diagnosis and procedures.procedures.

LOINC- Logical Observation Identifiers Names and CodesLOINC- Logical Observation Identifiers Names and Codes - provides a set of universal names and numeric identifier codes for laboratory and clinical - provides a set of universal names and numeric identifier codes for laboratory and clinical

observations and measurements in a database structure.observations and measurements in a database structure.RxNorm-a clinical drug nomenclature produced by NLM, in consultation with the Food and Drug RxNorm-a clinical drug nomenclature produced by NLM, in consultation with the Food and Drug

Administration, Department of Veterans(VA) and HL7 SDO. Administration, Department of Veterans(VA) and HL7 SDO.

Unified Medical LanguageUnified Medical Language

speciaized vocabularies, code sets, and classification system for speciaized vocabularies, code sets, and classification system for almost every practice domain in healthcare.almost every practice domain in healthcare.

Data Content StandardsData Content Standards National Uniform Claim Committee Recommended Data Set for a National Uniform Claim Committee Recommended Data Set for a

Noninstitutional ClaimNoninstitutional Claim

- was organized in 1995 to developed,promote and maintain a standard - was organized in 1995 to developed,promote and maintain a standard data set for use in noninstitutional claims and encounter information.data set for use in noninstitutional claims and encounter information.

Standard Guide for Content and Structure of the Computer-Based Patient Standard Guide for Content and Structure of the Computer-Based Patient Record(ASTM E1384-96)Record(ASTM E1384-96)

- one of the largest SDOs in the world and publishes over 9,000 - one of the largest SDOs in the world and publishes over 9,000 standards covering all sectors in the economy.standards covering all sectors in the economy.

Standards Development ProcessStandards Development Process

Proprietary StandardsProprietary Standards - can often be developed quickly and are supported by - can often be developed quickly and are supported by

available implementations and tools.available implementations and tools.

Legislated,government-developed standardsLegislated,government-developed standards - are able to gain widesread acceptance by virtue of their - are able to gain widesread acceptance by virtue of their

being required by either regulation or in order to participate in being required by either regulation or in order to participate in large, government-funded programs ,such as Medicare.large, government-funded programs ,such as Medicare.

Standards developed by SDOs are consensus-based and reflect the Standards developed by SDOs are consensus-based and reflect the perspectives of a wide variety of interested stakeholders. perspectives of a wide variety of interested stakeholders.

Integrating the Healthcare Integrating the Healthcare EnterpriseEnterprise

Is an initiative that provides a detailed framework for Is an initiative that provides a detailed framework for implementing standards, filling the gap between standards and implementing standards, filling the gap between standards and their implementation.their implementation.

Standards Coordination EffortsStandards Coordination Efforts The following is a brief description of some of the major international,regional, and The following is a brief description of some of the major international,regional, and

national organizations involved in broadbased standards development and national organizations involved in broadbased standards development and coordination:coordination:

International Organization of StandardizationInternational Organization of Standardization -an organization that develops and publishes standards internationally.-an organization that develops and publishes standards internationally. European Technical Committee for StandardizationEuropean Technical Committee for Standardization - works to developed a wide variety of standards in the area of healthcare data - works to developed a wide variety of standards in the area of healthcare data

management and interchange.management and interchange. American National Standards InstituteAmerican National Standards Institute - serves as the coordinator for voluntary standards activity in the United States- serves as the coordinator for voluntary standards activity in the United States Object Management GroupObject Management Group - representative of a different approach to standards development- representative of a different approach to standards development Health Insurance Portability and Accountability ActHealth Insurance Portability and Accountability Act National Committee on Vital and Health Statistics Subcommittee on Standards and National Committee on Vital and Health Statistics Subcommittee on Standards and

SecuritySecurity

Framework for Strategic ActionFramework for Strategic Action

These goals convey the vision for consumer-centric and information-rich healthcare:These goals convey the vision for consumer-centric and information-rich healthcare:

Goal 1: Inform clincal practiceGoal 1: Inform clincal practice

Incentivize EHR adoptionIncentivize EHR adoption

Reduce risk of HER investmentReduce risk of HER investment

Promote EHR diffusion in rural and underserved areasPromote EHR diffusion in rural and underserved areas

Goal 2: Interconnect cliniciansGoal 2: Interconnect clinicians

Foster regional collaborationsFoster regional collaborations

Developed a national health information networkDeveloped a national health information network

Coordinate federal health information systemsCoordinate federal health information systems

Goal 3: Personalize careGoal 3: Personalize care

Encourage use of PHRsEncourage use of PHRs

Enhanced informed consumer choiceEnhanced informed consumer choice

Promote use of telehealth systems Promote use of telehealth systems

Goal 4: Improved population healthGoal 4: Improved population health

Unify public health surveillance architecturesUnify public health surveillance architectures

Streamline quality and health status monitoringStreamline quality and health status monitoring

Accelerate research and dessimination of evidenceAccelerate research and dessimination of evidence