1. Data Standards in Public Health IT
The health care industry is working toward interoperability of health information among different entities. In order to do this, entities need to understand data standards, information systems, and the architecture of those systems. Organizations will also need to understand the organizations that develop and enforce associated standards.
The goal of health information exchange can be complex due to the variety of existing systems. There is a variety of differences among infrastructure, hardware, software, data standards, and communication methods. In order for different health care providers to exchange information, there must be a level of uniformity.
Data Standards in Public Health IT
This material (Comp13_Unit3) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC

2. Data Standards in Public Health IT Learning Objectives
Identify the architecture categories for information systems and explain the differences
Summarize objectives of an enterprise architecture plan
Identify the objectives of data standards for public health
The next few slides describe the objectives that students should be able to achieve after this presentation.
By the end of this unit, students will be able to:
1. Identify the architecture categories for information systems and explain the differences
2. Summarize objectives of an enterprise architecture plan
3. Identify the objectives of data standards for public health
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3. Data Standards in Public Health IT Lecture Objectives
Describe the different types of standards required (e.g., information, clinical data representation, technical, medication terminology, and privacy and security)
Identify the factors involved in grammar data standards for communicating in public health informatics
Identify the principles of context regarding data standards for communicating public health informatics
In addition, students should be able to:
4. Describe the different types of standards required (e.g., information, clinical data representation, technical, medication terminology, and privacy and security)
5. Identify the factors involved in grammar data standards for communicating in public health informatics
6. Identify the principles of context regarding data standards for communicating public health informatics
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4. Data Standards in Public Health IT Lecture Objectives
Identify universal vocabularies and classification systems applicable to public health (CPT, ICD-0)
Identify and compare associations and/or organizations developing standards (e.g., CCHIT, HL7, American Society for Testing and Materials)
Lastly, students should be able to:
7. Identify universal vocabularies and classification systems applicable to public health
8. Identify and compare associations and/or organizations developing standards
9. Identify universal vocabularies and classification systems applicable to public health (CPT, ICD-0)
10. Identify and compare associations and/or organizations developing standards (e.g., CCHIT, HL7, American Society for Testing and Materials)
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5. Architecture of Information Systems
Configuration, structure, and relationships of hardware
Input, output, storage devices
The functions of a system will determine the architecture. What are the expectations of the software or hardware? This will determine the input, output, etc.
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6. Architecture of Information Systems (cont.)
Refers to the use of information technology, totality of data, processes, and technology
Includes:
Databases
Applications
Standards
Procedures
Information use
Understanding the components of a system has several benefits such as increasing efficiency and the ability to communicate with other systems.
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7. Public Health IT Data Standards in Public Health IT
Architecture Plans
Information architecture describes the key elements of an information system Image: Integration + Data + Applications are interrelated
It’s important to spend time looking at the functions specific to a unit, the types of applications and data that would be utilized, and how they can be combined. It’s also important to assess the needs of the system outside of a unit or department; to look at the big picture regarding data, functions, and the organizational wide activities.
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8. Technology Architecture
Infrastructure
Hardware
Software technologies
Focuses on
The technology architecture that will be utilized is based on the information architecture.
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9. Public Health IT Data Standards in Public Health IT
Architectures…
Business architecture
Serves as the foundation for information and technology architecture
Information and technology architecture
Is based on the business process, the workflow of the organization
The business architecture refers to the specific functions performed by a unit or agency. For example, what type of hardware or software is needed to electronically report a notifiable disease to the Centers for Disease Control and Prevention?
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10. Benefits of Architecture
Simplifies systems by decreasing redundancy
Promotes efficiency and interoperability through incorporation of standards
Understanding the functions performed and utilizing the appropriate software and hardware technology increases the capabilities of interoperability and efficiency of services provided.
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11. Enterprise Architecture Plan
Comprehensive framework used to manage and align an organization's Information Technology assets, people, operations, and projects with its operational characteristics
The technology should support the business operations and provide benefit for the business
Promotes planning and clarifies business processes
When referring to enterprise architecture we’re talking about a plan that is comprehensive, it includes all of the functions for an organization and the technology that supports those functions.
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12. Public Health IT Data Standards in Public Health IT
Necessary to collect, maintain, and transfer healthcare data elements between information systems securely
Define the structure (width of a data field) and the content (type of data collected in a field)
One of the challenges of developing information systems that communicate with each other is the variety of different types of systems and communication methods available. Data standards work to address differences and provide a level of uniformity.
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13. Data Standards Categories
Information
Clinical data representation
Technical
Medication terminology
Privacy and security
Currently there are five categories of data standards; information, clinical data representation, technical, medical terminology, and privacy and security.
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14. Public Health IT Data Standards in Public Health IT
Information
Content and structure of electronic health record (EHR) and message format
Information standards focus the on the content and structure of messages between systems and the appropriate format required to send those messages securely.
(Public Domain, 2011.)
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15. Public Health IT Data Standards in Public Health IT
Information (cont.)
Extensible markup language (XML)
Hypertext markup language (HTML) converts text documents into Internet-compatible format
There is a variety of different platforms for sending and retrieving messages such as the internet that utilizes HTML.
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16. Communication & Internet Technologies
Networks
Intranet
Extranet
Ethernet
Fiber-optic
Wireless
The advances in technology have provided additional Internet technologies for communication between systems, each of which has advantages and disadvantages.
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17. Clinical Data Representation
Vocabularies
ICD-9-CM
ICD-10-CM/PCS
Clinical classification systems
Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT)
Terminologies
In order to speak the same language, medical diseases and procedures are assigned values for billing purposes. These vocabularies represent clinical data.
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18. Technical Electronic data interchange E-commerce
Healthcare is not the only industry that utilizes the capabilities of the Internet; it is used for purchasing products, banking, as well as providing information.
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19. Medication Used to prevent and treat medical conditions
Adverse effects of medication illustrates the need to utilize information technology to ensure accurate and accessible regarding treatment options
Research is conducted to test the efficacy of medication
Used to prevent and treat medical conditions
This is an example of how technology can improve patient care. Every year patients die due to errors in type or dosage of medication. Technology can ensure proper spelling of a medication and alert the physician regarding dosage or contraindications to allergies or current patient medication. The physician can also send the prescription electronically to a pharmacy saving the patient time and energy by not having to go to the office to pick it up. If medication is ordered on the internet, the patient can be notified via that it is time for a renewal and request the drug company contact the doctor directly.
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20. Organizations Relevant to Medication Standards
Food and Drug Administration
FDA
FDA Center for Drug Evaluation and Research Data Standards Manual
CDER
National Council for Prescription Drug Programs
NCPDP
Semantic Clinical Drug of RxNorm
SCD
LOINC Clinical Special Product Labeling
SPL
This brings the country one step closer to a health record that is available wherever the patient is. If you live in New York and travel to Oregon for a vacation and become sick, the doctors would be able to access your health information via this identifier.
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21. Public Health IT Data Standards in Public Health IT
Identifier Standards
Recommendations for assigning unique identification numbers to patients and healthcare providers
National Provider Identifier (NPI) is a HIPAA Administrative Simplification Standard
As with all standard development there are many organizations involved. The potential benefits of assigning unique patient identifiers are documented in a report by the Department of Health and Human Services. Some of the benefits include access from different providers, support of population-based research and development, cost effectiveness, timely delivery of care, and prevention of fraud and abuse.
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22. Identifier Standards (cont.)
Reliable Patient Identification Project
Costs and concerns regarding privacy have impacted the implementation of a universal patient identifier. The Robert Wood Johnson Foundation awarded a grant to the Western Health Information Network to pilot a project utilizing unique patient identifiers. Resources regarding the recommended standards and challenges are available at the end of this presentation.
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23. Public Health IT Data Standards in Public Health IT
Security
HIPAA
Standards that ensure privacy and security of patient information
The security of medical information is vital to exchanging information across different IT systems and assuring patients that standards are in place to protect their medical information. 
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24. Public Health IT Data Standards in Public Health IT
Grammar Standards
The way you put words together for a conversation
As a data standard:
The order and structure of data for storing or messaging
In information systems, the order and structure of information is very important. For interoperability purposes, there must be uniformity so different systems can translate information.
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25. Public Health IT Data Standards in Public Health IT
Context
The environment where you have a conversation
As a data standard:
The infrastructure that supports the exchange of data
Software, hardware, data security, confidentiality requirements, staff needed for communication, etc.
The context is where that “data” conversation is going to happen.
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26. Messaging Health Information
HL7 (Health Level 7) provides the format for numerous types of information exchanges among healthcare computer systems
Defines the sequence and data types
Health Level 7 is an organization that develops the format regarding the exchange of information among systems.
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27. Vocabulary Catalogued lists of words that are used repeatedly Local:
Generally for a specific purpose or proprietary application
Universal:
Designed for broad use in disparate systems
Vocabularies can be utilized for specific functions at different levels.
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28. Classification & Nomenclatures
The arrangement of similar diseases and procedures
Nomenclature:
A system of names or terms used for a particular discipline to facilitate communication
Terms are used interchangeably
As was mentioned early, there needs to be a common language when exchanging data in the healthcare industry. Nomenclatures and classification systems are the language utilized.
The diagnosis and treatment of patients utilizes hospital resources such as medical staff, nurses, and supplies; the facility wants to be reimbursed for the services it provides. Classification systems assign numbers to these diseases and treatments to bill the insurance companies.
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29. Classification & Nomenclatures (cont.)
International Classification of Diseases 9th Version Clinical Modification
ICD-9-CM
ICD-10-CM
ICD-10-PCS (Procedural Coding System)
ICD-10
International Classification of Diseases for Oncology
ICD-0
Current Procedural Terminology
CPT
Healthcare Common Procedure Coding System
HCPCS
Currently hospitals utilize the ICD-9-CM system for inpatient services, but it will be converting to ICD-10 in 2013.
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30. Standards Development Organizations (SDOs)
Private organization
Government agencies
American National Standards Institute (ANSI) coordinates the development of standards
Organizations that develop standards for information technology can be private or governmental agencies.
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31. Public Health IT Data Standards in Public Health IT
SDOs (cont.)
Accredited Standards Committee X12
Electronic data interchange for billing transactions
Focus is on computer to computer communications between healthcare providers and third-party payers
Standards can focus on specific functions within the industry.
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32. Public Health IT Data Standards in Public Health IT
ACR-NEMA
American College of Radiology National Electrical Manufactures Association
Exchange of digital images
An important component of assessing a patient’s medical condition is the use of imaging such as magnetic resonance imaging or MRI and the ability to transmit that image to another facility.
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33. Public Health IT Data Standards in Public Health IT
ASTM
American Society for Testing & Materials
Informatics standards such as clinical content of patient records, exchange of messages about clinical observations, data security and integrity, clinical laboratory systems, data modeling, and data identifiers
The security and integrity of any system that contains patient information is one of the most important standards
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34. Public Health IT Data Standards in Public Health IT
HL7
Health Level 7
Electronic interchange of:
Clinical
Financial
Administrative information among healthcare computer systems
HL7 is a standards developing organization that provides standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.
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35. Public Health IT Data Standards in Public Health IT
IEEE
Institute of Electrical and Electronics Engineers
Medical device information and general informatics format
As medical devices continue to evolve, data collection on the effectiveness can be incorporated into future device designs.
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36. Public Health IT Data Standards in Public Health IT
NCPDP
National Council on Prescription Drug Programs
Data interchange and processing standards for pharmacy transactions
The National Council on Prescription Drug works to develop business solutions and guidance for promoting information exchanges related to medications, supplies, and services within the healthcare system.
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37. Public Health IT Data Standards in Public Health IT
CCHIT
Certification Commission for Health Information Technology
Development of criteria and evaluation process to certify electronic health records (EHR)
A Recognized Certification Body (RCB)
This is the organization that is responsible with certifying electronic health records to ensure they meet specific systems requirements.
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38. Public Health IT Data Standards in Public Health IT
Information Exchange
HIE- the secure sharing of electronically stored information among different information systems and providers
RHIOs- A Regional Health Information Organization is responsible for the exchange of information within a specific area
Current terminology generally involves the terms HIE and RHIOs and they may be used interchangeably. It’s important to know that they are not the same. Additional resources for the differences are included at the end of the presentation.
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39. National Health Information Network (NHIN)
The goal is to provide a secure environment where health information can be exchanged between diverse entities across the United States
The development of a national network has been under way for several years with the goal of exchanging information across the nation. The Office of the National Coordinator for Health Information Technology is leading this effort along with the involvement of many government and state organizations.
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40. Current HIE Activities
Verizon Medical Data Exchange
The Direct Project
The eHealth Initiative
This and the following slide list several HIE activities.
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41. Current HIE Activities (cont.)
Markel Foundation
National Health Information Network Exchange
An important focus of the Markel Foundation is transmitting health information in a secure environment and protecting patient information.
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42. Public Health IT Data Standards in Public Health IT
Public Health & HIE
The development of one system that collects individual data on chronic diseases could be utilized to understand the continuum of disease prevention, progression, treatment, and outcomes
The linking of current public health registries to patient data
The Institute of Medicine recommended the development of a system that collects data on chronic diseases such as cardiovascular and chronic lung diseases. The Institute of Medicine recommended specific data be collected including incidence and prevalence, primary, secondary, and tertiary prevention efforts, health outcomes of increased disease surveillance, racial, ethnic, socioeconomic, and geographic disparities in heart and lung disease, associated risk factors, and care delivery. Although the recommendation is for two specific diseases, other chronic diseases such as diabetes, obesity, and high blood pressure would certainly benefit from such a data collection system.
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43. Public Health & HIE (cont.)
Electronic laboratory reporting
Screening of reported physician-based diagnoses
Accessing additional information during public health investigations
Consolidation of data for biosurveillance
Antibiotic-resistant organism surveillance
Population-level quality monitoring
Additional benefits to public health include access to information that might enhance the understanding of disease progression in the population. The exchange of patient information between physicians, clinics, laboratories, emergency departments, and insurance companies can lead to enhanced understanding of diseases in populations. This increased level of understanding can assist policymakers in making decisions regarding public health.
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44. Data Standards in Public Health IT Summary
The challenges and barriers to HIE include different types of information systems and data requirement
As technology continues to evolve, so will the benefits and uniformity
Public heath professionals need to be aware of how their current IT will adapt to future requirements
This presentation briefly discussed the impact of architecture, types of data, associated organizations, and benefits of HIE for public health. Public health professionals need to be aware of current IT systems and future requirements in order to benefit and should seek opportunities to be involved with activities on a local, state, and national level .
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45. Data Standards in Public Health IT References
Public Health Informatics and Information Systems edited by Patrick W. O’Carroll, William A. Yasnoff, M. Elizabeth Ward, Laura H. Ripp, & Ernest L. Martin, 2003 ISBN
Accredited Standards Committee X12. Retrieved on July 10th, 2010 from
American College of Radiology national Electrical Manufactures Association (ACR-NEMA). Retrieved on July 10th, 2010 from
HL7. Retrieved on July 10th, 2010 from
CCHIT. Retrieved on July 10th, 2010 from
Institute of Electrical and Electronics Engineers. Retrieved on July 10th, 2010 from
American Society for Testing & Materials. Retrieved on July 10th, 2010 from
National Council for Prescription Drug Programs. Retrieved on July 10th, 2010 from
Public Health Informatics Institute. Retrieved on July 10th, 2010 from
Mapping and Public Health. Retrieved on July 10th, 2010 from
Agency for Toxic Substances & Disease Registry. Retrieved on July 10th, 2010 from
Office of Surveillance, Epidemiology, and Laboratory Services. Retrieved on July 10th, 2010 from
National Institute of Standards and Technology. Retrieved on July 10th, 2010 from
Computer Security Division Community Security Resource Center. Retrieved on July 10th, 2010 from
Nationally Notifiable Diseases Surveillance System. Retrieved on July 10th, 2010 from
No audio
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46. Data Standards in Public Health IT References
Clinical and Laboratory Standards Institute (CLSI). Retrieved on July 10th, 2010 from
Clinical Data Interchange Standards Consortium. Retrieved on July 10th, 2010 from
Designated Standard Maintenance Organization (DSMO). Retrieved on July 10th, 2010 from
Health Industry Business Communications Council (HIBCC). Retrieved on July 10th, 2010 from
International Organization for Standardization (ISO). Retrieved on July 10th, 2010 from
National Information Standards Organization (NISO). Retrieved on July 10th, 2010 from
National Uniform Billing Committee (NUBC). Retrieved on July 10th, 2010 from
Analysis of Unique Patient Identifier Options Final report. Retrieved on July 10th, 2010 from
Reliable Patient Identification Project. Retrieved on July 10th, 2010 from
Global Patient Identifiers. Retrieved on July 10th, 2010 from
Sample Universal Healthcare Identifier. Retrieved on July 10th, 2010 from
Gartner Healthcare Presentation. Retrieved on July 10th, 2010 from
White Paper Unique Health Identifier for Individuals. Retrieved on July 10th, 2010 from
AHIMA Industry Standards and Activities. Retrieved on July 10th, 2010 from
No audio
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47. Data Standards in Public Health IT References
HIMSS Health Information Exchange
Institute of Medicine Recommendation for a National Chronic Disease Surveillance System
Shapiro, J. S. Evaluating Public health uses of health information exchange.
HIMSS Overview of HIE & RHIOs. Retrieved on July 10th, 2010 from
Association for Information and Image Management:. Retrieved on July 10th, 2010 from
American Dental Association. Retrieved on July 10th, 2010 from
Images
Slide 14: Public Domain, 2011.
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