www.ushik.org

United States Health Information Knowledgebase Meeting the Challenge of Health Care Information Integration

May 16, 2007

Laura Reece, Ph.D.FDA Data Management Council

May 16, 2007

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What is national health information?

National health information is information that either is national in coverage or has national relevance and relates to:

• the health of the population• the determinants of the population’s health, including

external factors and those internal to individuals • health programs or health services, covering

information on the nature of the services provided and their management, resourcing, accessibility, use and effectiveness

• the relationships among these elements

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Why is it needed?

• To enable informed decision making• To guide consumers’ decisions • To provide needed information about the needs of

the populations, the effectiveness of their interventions and for whom, and the acceptability of these interventions

• To compare the effectiveness and efficiency of healthcare

• To make decisions in health industry and governments need information about how to provide services equitably, efficiently and effectively

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Content

• Introduction

• Background

• Standards

• Capabilities & Value

• Accomplishments

• Questions

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Introduction

USHIK Goals:• To provide and maintain a metadata registry of health

information data element definitions, values, and information models which will enable browsing, comparison, synchronization, and harmonization within a uniform query and interface environment.

• Build, populate, demonstrate, and make available for general use a data registry to assist in cataloging and harmonizing data elements across multiple organizations.

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Facilitate comparison and crosswalk with existing standards and development of new metrics

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Background

• Nearly a decade in existence• Collaborative effort from a changing mix of

federal organizations• Based on earlier implementations• Based on national and international

standard

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USHIK Registry Contents• ANSI HL7 2.4, 2.5• ANSI X12N• ANSI ASTM• NCPDP SCRIPT,

Batch, Data Dictionary• American Dental

Association Specif. 2000

• HIPAA• MHS Functional Area

Model (FAM-A)

• Public Health Care Data Standards  

• IEEE: Medical Device Communications Industry Group (IEEE 1073)

• NCVHS• Clinical Care

Classification (Nursing Taxonomy)

• DICOM (Imaging)

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The USHIK is an Implementation of ISO/IEC 11179 – Information technology--Metadata registries (MDR)

• ISO/IEC 11179 a standardized way of describing information.

• Data Elements and their component parts• Relationships among Data Elements• Includes both Conceptual and Logical

(Representational) level objects

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• Data Element Concept• Conceptual Domain

• Classification Scheme • Related Documents and URLs •Value Domain

• Conceptual Domain• Data Type• Min/Max Length• Low/High Value• Format• Unit of Measure• Precision• Valid Values –Value Meanings

• Preferred Name/Context/Language• Alternative Names/Context/Language• Preferred Definition/Context/Language• Alternative Definitions/Context/Language• Example• Related Data Elements• Derived and Composite Data Elements•Registration Information

• Registration Authority, Registrar• Unique Registration ID

• Reg. Authority, Data ID, Version ID

• Registration Status• Submitter Org, Submitter

• Assigned Steward• Administrative Status and Notes

ISO/IEC 11179 Data Element (DE) Standard Attributes & Relationships

Important for Data Governance

Important for Data Interoperability

Important for Semantic Understanding

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ISO/IEC 11179 Core Meta-Model

DataElementConcept

ValueDomain

DataElement

ConceptualDomain

PerceptionRepresentation

ObjectClass Property

Represen-tation

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ISO/IEC 11179 Core Meta-Model

DataElementConcept

ValueDomain

DataElement

ConceptualDomain

PerceptionRepresentation

1..1

0..*

1..1

0..*

0..*

0..*

1..1

1..1Sexes • Male• Female• Other

Sex_Code (Census)• 01 – Male• 02 - Female

Person.Sex

Person.Sex:Code

ObjectClass Property SexPerson

Gender_Type (NIH)• XY - Male• XX – Female• XXY – Underdeveloped Male• XYY – Overdeveloped Male• X – Underdeveloped Female

Person.Gender:Code

Gender_Code (HHS)• M - Male• F – Female• O - Other

Person.Gender:Type

1..1 1..1

0..* 0..*

HypotheticalExample

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The USHIK is an Implementation of ISO/IEC 11179 – Information technology--Metadata registries (MDR)

• ISO/IEC 11179 a standardized way of describing information.

• Data Elements and their component parts• Relationships among Data Elements• Includes both Conceptual and Logical

(Representational) level objects

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Capabilities

• Data elements are described in common format

• High Level Information Model Assists in Grouping Data Elements

• Data Elements are Linked to Model Views

• Data Elements Linked by Different Organizations Appear Together

• Uniform, objective comparison across multiple standards

• Comparison Matrix Aids in Harmonizing Data Elements

• Data Element Usage Shows Linkages Between Data Elements

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New Capabilities

• Related Data References shows relationships among data elements

• Links to external sources for immediate reference and viewing “native” format

• Pre-built downloadable query results updated regularly

• Examples illustrating data element usage provided by the SDOs (in process)

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Methods of Finding Data Elements

Data Registry Overview

…Birth DateHair ColorEye ColorSex...

Data Elements

ABCDEFGH..

Initiatives

Health Insurance Portability and Accountability Act...

Data Collections

HCFA Long Term CareBRFSS

Data Agreements

X12NCVHS Core DataNCPDP

Organizations

CDCAHCPRNCVHS

Models

HL7-RIMDoD HA FAM-DAIHW

What data elements are used?

Data elements are described in common format.

References to Authoritative Sources

NCPDP (National Council for Prescription Drug Program)

Data Element

X12 (American Standards Committee)

Transaction Set

-Data Element

-Composite Data Element

HL7 (Health Level Seven)

Reference Information Model

-Subject Area

-Class

-Attributes

AIHW (Australian Institute of Health and Welfare)

Model -Model Subtype -Information Model

Subtype

-Data Element

-Data Concept

-Composite Data

Element

-Derived Data

Element

…Person_SexGenderSex_Category Code...

Where are data elements defined?

Codes can be downloaded for use in applications.

•A data registry is a place to keep facts about characteristics of data that are necessary to clearly describe, inventory, analyze, and classify data.

•A data registry supports data sharing with cross-system and cross-organization descriptions of common units of data.

•A data registry assists users of shared data to have a common understanding of a unit of data’s meaning, representation, and identification.

Identifying and Definitional Attributes: Data Element ID : 07-329-4837.00000692.v1

Name : Gender Code Context : X12 Data Dictionary Definition : Code indicating the sex of the individual Status : Received as of 01/19/1999 Example : Synonyms/Keywords : Comment :Data Collection Methods :Relational and Representational Attributes: Data Type : ID Representational Form : Representational Layout : Minimum Size : 1 Maximum Size : 1 Unit Of Measure : Precision : Minimum Range : Maximum Range :Data Domain: Permissible value Domain Meaning Name Domain Meaning Definition Text A Not Provided B Not Applicable F Female M Male N Non-sexed U Unknown X UnsexableRelated Data References: Object Relationship Related Item Type Gender Code is composite part of X12 Data Dictionary Standards Alternate Names and Contexts: Name Context Gender Code X12 Data Dictionary 1068 X12 Data Element Number

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Accomplishments

• HIPAA – The Health Insurance Portability and Accountability Act

• CHI – Consolidated Health Informatics

• HITSP - Healthcare Information Technology Standards Panel

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Initiatives• HIPAA – The Health Insurance Portability and

Accountability Act Title II of HIPAA requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

• CHI – Consolidated Health InformaticsAdopts a portfolio of existing health information interoperability standards (health vocabulary and messaging) enabling all agencies in the federal health enterprise to “speak the same language” based on common enterprise-wide business and information technology architectures.

• HITSP - Healthcare Information Technology Standards Panel - The mission is to serve as a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional and national health information network for the United States.

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Value• Government programs can use this tool:

– To compare their data elements with those in USHIK for harmonization

– To develop data elements for new programs based on those in USHIK, and

– To stay current with standards developing organizations (SDO’s) changes in their standards

– To aid in harmonization among States & Territories

• Certification authorities can use this tool:– To verify that data elements in a given EHR system are

interoperable with the data elements in:• A specific interoperability criterion, • A specified data standard, or • Another specific system

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USHIKStrategic Federal & Business Use

• Contributes to President’s eGov initiative support (Consolidated Health Informatics initiative-CHI)

• Value to Health Information Technology Standards Panel (HITSP)

• Using USHIK in each HITSP lifecycle Phase 1: Gap Analysis & Standards SelectionPhase 2: Standard SpecificityPhase 3: Interoperability Specifications

• Clinger-Cohen Act mandates facilitation of eGovernment – Citizen business relationships

• USHIK is a focal point to publish federally designated health standards, data elements and definitions (metadata) online

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USHIK use by HITSP Technical Committees

• To support a mapping analysis– E.g., do two standards have the same demographic variables and

representations

• To support the gap analysis after the standards have been selected by the Technical Committee– For comparing the required data elements of the use case with what

the chosen standard contains

• To objectify the standards selection process by providing a neutral, identical presentation of the candidate standards

• To support giving feedback to the SDOs for improving a standard to fit the needs of the use case– Ask the SDO if some specific changes are possible to improve

interoperability (cross-organizational, cross-system data sharing)

• Publish choices and document for long-term maintenance

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• Viewpoint for the implementation of HITSP and ANSI Technical Committee use case • Focal point to examine Technical Committee standards, data model relationships• Uniform environment to compare, synchronize, harmonize standards overlaps – gaps

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How AHRQ and CMS Support HITSP

• By providing a USHIK health information specialist assigned to the Technical Committee for one use case– To learn the standards selection process of the HITSP

TC– To provide expertise at using USHIK to answer TC

questions– To provide expertise at using USHIK to present

comparisons across standards requested by the TC– To display choices made by the TC in a standard

metadata registry format

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How AHRQ and CMS Support HITSP (cont.)

• By providing a potential method for comparing the standards choices made by a HITSP TC with those choices made by another HITSP TC

• By providing an opportunity for helping HITSP to streamline the processes of standards screening, selection, and gap analysis

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Comparison Matrix Aids in Harmonizing Data Elements

www.USHIK.org

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Summary

USHIK• Is a Well-advanced Metadata Registry for

Healthcare Information Standards• Provides Opportunity to “manage” a myriad of

Standards Data Elements • Offers a Platform from which to closely examine

Relationships, Overlaps, Gaps• Forms a Navigable Platform for Browsing and

Viewing• Has demonstrated utility for integrating and

harmonizing healthcare information standards• Built to an internationally-recognized standard

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Demonstration

• Model-based navigation• Comparison matrix tool• Linkage to SDO sites

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Contacts for www.USHIK.org

Michael Fitzmaurice, PhD, AHRQMichael.Fitzmaurice@ahrq.hhs.gov

Senior Science Advisor for Information Technology Office of the Director, Agency for Healthcare Research and Quality

Laura J. Reece, Ph.D.ljreece@knowsol.com

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Discussion

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Links to external sites by individual element

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Links to parent generic element on WPC site

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Related Data References example

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Administration screen

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Relationships to other models, agreements, collections, initiatives

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Role-based Access

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Secure Administrative Interface

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Easy editing interface