1. Health Care Information System Standards
Chapter 9

2. 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

3. 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

4. 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

5. 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

6. Formal Standards Development
Organizations
International Organization for Standardization (ISO)
American National Standards Institute (ANSI)
Standards Development Organizations (SDOs)
ASTM International
Health Level 7
ANSI ASC X12

7. 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

8. 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

9. 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

10. 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)

11. 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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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)

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

19. 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

20. 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

21. HL7 EHR Functional Model
Three components
Direct care
Supportive
Information infrastructure

22. 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.

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

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