Health Care Information System Standards Chapter 9

Learning Objectives Identify the major types of health care information standards and the organizations that develop or approve them, including Messaging standards Content and coding standards Network standards Standards for electronic data interchange Electronic health record standards Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Learning Objectives Give examples of the four major methods by which standards are developed—ad hoc, de facto, government mandate, and consensus. Identify and discuss the role of organizations that currently have a significant impact on the adoption of health care information standards in the United States. Discuss the relationships among health information exchanges, regional health information networks, and the Nationwide Health Information Network. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Outline Standards Development Process Standards that support Health Care Information System Interoperability Classification, Vocabulary and Terminology Standards Data Interchange Standards Health Record Content Standards Federal Initiatives on Health Care IT

Standards Development Process Four Methods (Hammond & Cimino, 2001) Ad hoc—no formal adoption process De facto—vendor or other has a very large segment of the market Government mandate Consensus—volunteers from organizations come together to reach a formal agreement

Formal Standards Development Organizations International Organization for Standardization (ISO) www.iso.org American National Standards Institute (ANSI) www.ansi.org Standards Development Organizations (SDOs) ASTM International www.astm.org Health Level 7 www.hl7.org ANSI ASC X12 www.x12.org

ISO Facts Members are national standards bodies from many countries ANSI is the US national body member Oversees the flow of documentation and international approval of standards developed by its member bodies

ANSI Facts US member of ISO Accredits SDOs from a wide range of industries (including health care) Oversees work of SDOs Does NOT develop standards Publishes the 10,000+ standards developed by SDOs

SDOs Facts Must be accredited by ANSI Develops standards in accordance with ANSI criteria Can use the label “Approved American National Standard” 270+ ANSI-accredited SDOs representing many industries, including health care

Classification, Vocabulary and Terminology Standards To date no single vocabulary has emerged Common coding and classification systems ICD-9-CM (chapter 1) CPT (chapter 1) DRGs (chapter1)

Classification, Vocabulary and Terminology Standards National Committee on Vital and Health Statistics identified a core set of patient medical record information (PMRI) terminology standards SNOMED CT LOINC Several federal drug terminologies including RxNorm

SNOMED CT Systemized Nomenclature of Medicine– Clinical Terms comprehensive clinical terminology developed specifically to facilitate the electronic storage and retrieval of detailed clinical information collaboration between the College of American Pathologists (CAP) and the United Kingdom’s National Health Service (NHS)

LOINC Logical Observation Identifiers Names and Codes Developed to facilitate the electronic transmission of laboratory results Examples of Fully Specified LOINC Names Sodium:SCnc:Pt:Ser/Plas:Qn Sodium:SCnc:Pt:Urine:Qn Sodium:SRat:24H:Urine:Qn Creatinine renal clearance:VRat:24H:Ur+Ser/Plas:Qn Glucoseˆ2H post 100 g glucose PO:MCnc:Pt:Ser/Plas:Qn Gentamicinˆtrough:MCnc:Pt:Ser/Plas:Qn ABO group:Type:Pt:Bldˆdonor:Nom Body temperature:Temp:8Hˆmax:XXX:Qn Chief complaint:Find:Pt:ˆPatient:Nar:Reported Physical findings:Find:Pt:Abdomen:Nar:Observed Binocular distance:Len:Pt:Headˆfetus:Qn:US.measured

UMLS UMLS Metathesaurus– all the common health information vocabularies, including SNOMED CT, ICD, and CPT, along with approximately 100 other vocabularies SPECIALIST Lexicon--contains information for many terms, component words, and English language words that do not appear in the metathesaurus UMLS Semantic Network--contains information about the categories to which metathesaurus concepts are assigned and outlines relationships among the categories

Data Interchange Standards Examples of Data Interchange standards that impact health care Health Level 7 standards (HL7) Digital Imaging and Communications in Medicine (DICOM) National Council for Prescription Drug Programs (NCPDP) ANSI X12N standards

HL7 HL7 is an ANSI-accredited SDO develops HL7 messaging standards to allow interoperability among health care applications Involved in other standards activities, but the messaging standard is referred to as HL7

DICOM American College of Radiology and the National Electrical Manufacturers Association published the first standard in 1985 Promotes communication of digital image information regardless of device manufacturer Works with picture archiving and communications systems (PACS)

NCPDP ANSI accredited SDO Developed a standard for the electronic submission of third party drug claims

ASC X12N X12N is the subcommittee of ASC X12 that deals with EDI for the insurance industry The health care task group is TG2 X12N/TG2 develops and maintains standards for health care EDI

Health Record Content Standards Functional standards for electronic health record content HL7 EHR Functional Model ASTM Healthcare Informatics subcommittee’s Continuity of Care (CCR) standard

HL7 EHR Functional Model Three components Direct care Supportive Information infrastructure

CCR The ASTM Continuity of Care Record (CCR) standard is designed as a standard healthcare data summary. Its purpose is to aggregate essential health care data from multiple sources to provide an overall clinical picture of a patient’s current and past health status. It was developed jointly by ASTM International, the Massachusetts Medical Society, the Healthcare Information and Management Systems Society, the American Academy of Family Physicians, the American Academy of Pediatrics, and other health care organizations.

Federal Initiatives on Health Care IT Standards HIPAA CMS e-Prescribing ONC (Office of the National Coordinator for Health Information Technology) Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Impact of HIPAA HIPAA electronic transaction standards are primarily from ASC X12N HIPAA designated standard code sets include ICD-9-CM CDT (Code on Dental Procedures and Nomenclaure) HCPCS CPT-4

HIPAA DSMOs HIPAA also identified designated standards maintenance organizations to develop, maintain, and modify relevant EDI standards ACS X12 Dental Content committee of the ADA HL7 NCPDP NUBC NUCC

CMS e-Prescribing Prescriber’s ability to electronically send an accurate, error-free, and understandable prescription directly to a pharmacy for the point of care Mandate applies to Medicare Part D transactions Formulary and benefit transactions Medication history transactions Fill status notifications Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

ONC ONC identified two major goals (HHS, 2008). Enable the transformation to higher quality, more cost-efficient, patient-focused health care through electronic health information access and use by care providers, and by patients and their designees. Enable the appropriate, authorized, and timely access and use of electronic health information to benefit public health, biomedical research, quality improvement, and emergency preparedness. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

ONC Healthcare Information Technology Standards Board (HITSP)– Purpose is to identify and harmonize data and technical standards for healthcare National Health Information Network (NHIN)-- conceived as a “Network of Networks” to provide a secure, nationwide, interoperable infrastructure that will connect providers, consumers, and others involved in supporting health and health care Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

NHII Related Terms Health information exchange (HIE) refers to the technology, standards, and governance that enables the exchange of data between the information systems of various health care stakeholders A regional health information organization (RHIO) is an organization that provides an HIE to health care stakeholders in a specific region Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

NHIN The NHIN is the technology, standards, and governance that could connect all HIEs & RHIOs. Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Summary Standards Development Process Formal Standards Development Organizations ISO ANSI SDOs Classification, Vocabulary and Terminology Standards SNOMED CT LOINC RxNorm Data Interchange Standards HL7 DICOM NCPDP ASC X12N

Summary (cont.) Health Record Content Standards HL7 EHR Functional Model CCR Federal Initiatives for HIT HIPAA E-Prescribing ONC HITSP NHIN