1. Chapter 13 HEALTHCARE DATA STANDARDS

2. OBJECTIVES Discuss the need for data standards in healthcare.
Describe the standards development process.
Identify standards development organizations (SDOs).
Describe the healthcare data standards initiatives.
Explore the business value of data standards.

3. Standards are critical components in the development and implementation of an electronic health record (EHR).
The effectiveness of healthcare delivery is dependent on the ability of clinicians to access critical health information when and where it is needed.
The ability to exchange health information across organizational and system boundaries, whether between multiple departments within a single institution or among a varied cast of providers, payers, regulators, and other is essential.
There must be sociopolitical structure in place that recognizes the benefits of shared information & supports the adoption and implementation of such standards.

4. This chapter examines healthcare data standards in terms of the ff:
Need for healthcare data standards
Healthcare data interchange standards
Healthcare terminologies
Knowledge representation
Healthcare data standards development
Healthcare data SDOs
Healthcare data standards initiatives

5. I. Need for Healthcare Data Standards
Data standards as applied to healthcare include the “methods, protocols, terminologies, and specifications for the collection, exchange, storage, and retrieval of information associated with healthcare applications, including medical records, medications, radiological images, payment and reimbursement, medical devices and monitoring systems, and administrative process”.

6. Standards can be further categorized as those that support the generic infrastructure and are not domain- specific, those that support the exchange of information and are domain-specific. And those that support activities and practices within a specific domain.
The first type of standard would include equipment specifications such as processor type or network transmission protocols such as token ring.
The second type of standard typically involves the specification of data structures and content and would include such standards as message formats and core data sets.
The third type of standard address the interpretation of that data as information, including how it should be acted on within a particular context. Example is professional practice guidelines.

7. Healthcare is fundamentally a process of communication
Healthcare is fundamentally a process of communication. For much of history, verbal communication between a patient and a healthcare provider characterized this process.
Healthcare delivery is far more complex, and a single episode may frequently take place across multiple settings and involve numerous parties.
The information about patients and their care is used not only for the direct care process but also for many other purposes including reimbursement, research, public health, education, policy development, and litigation.

8. It is this tremendous increase in the need for health information exchange and management systems in the healthcare domain.
While current information technology is able to move and manipulate large amounts of data.
Data standards are an attempt to reduce the level of ambiguity in the communication of data.
The term data standards is generally used to describe those standards having to do with the structure and content of health information, it may be useful to differentiate data, information, and knowledge.
Data are the fundamental building blocks on which healthcare decisions are based.

9. II. Healthcare Data Interchange Standards
Data interchange standards address, primarily, the format of messages that are exchanged between computer systems, document architecture, clinical templates, user interface, and patient data linkage.
To achieve data compatibility between systems, it is necessary to have prior agreement on the syntax of the messages to be exchanged.

10. The ff section describes some of the major organizations involved in the development of data interchange standards:
A. Message Format Standards
Four broad classes of message format standards have emerged in the healthcare sector: medical device communications, digital imaging communications, administrative data exchange, and clinical data exchange.
The Nat’l Committee on Vital & Health Statistics (NCVHS) is the advisory committee established to make recommendations on health information policy to the Dept. of Health & Human Services (HHS) and Congress.

11. B. Institute of Electrical and Electronic Engineers
The IEEE has developed a series of standards known collectively as P1073 Medical Information Bus (MIB), which support real-time, continuous, and comprehensive capture and communication of data from bedside medical devices such as found in ICU, OR, and ED.
The most widely known standard, , 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 wirelessly through a myriad access points.

12. C. Nat’l Electrical Manufactures Association
The NEMA, in collaboration with the American College of Radiologist (ACR) and others, formed the DICOM to develop a generic digital format and a transfer protocol for biomedical images and image-related information.
D. Accredited Standards Committee X12N/Insurance
The ASC X12N has developed a broad range of electronic data interchange (EDI) standards to facilitate electronic business transactions.
E. Nat’l Council for Prescription Drug Programs
The NCPDP develops standards for information processing for the pharmacy services sector of the healthcare industry.

13. F. Terminologies
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.
G. International Statistical Classification of Diseases and Related Health Problems: Ninth Revision and Clinical Modifications
The ICD-9-CM is the latest version of a mortality and morbidity classification that originated in 1893.
H. International Statistical Classification of Diseases and Related Health Problems: Tenth Revision
The ICD-10 is the most recent revision of the ICD classification system for mortality and morbidity, which is used worldwide.

14. I. Current Procedural Terminology, Fourth Revision
The CPT-4 is a listing of descriptive terms and codes for reporting medical services and procedures.
J. Systemized Nomenclature of Human and Veterinary Medicine International, Clinical Terms
The SNOMED is a comprehensive, multiaxial nomenclature and classification system created for indexing human and veterinary medical vocabulary, including sign and symptoms, diagnoses, and procedures.

15. K. Local Observation Identifiers Name and Codes
The LOINC provides a set of universal names and numeric identifier codes for laboratory and clinical observations and measurements in a data base structure.
L. RxNorm
RxNorm is a catalog of the standard names given to clinical drugs and drug delivery devices in the United States to enable interoperability and clear communication between electronic systems, regardless of software and hardware compatibility.
M. Unified Medical Language System
The UMLS is a compendium of many controlled vocabularies in the biomedical sciences (created 1986). There are specialized vocabularies, code sets, and classification systems for almost every practice domain in healthcare.

16. N. Data Content Standards
The concept of a minimum data set is that of “a minimum set of items with uniform definitions and categories concerning a specific aspect or dimension of the healthcare system which meets the essential needs of multiple users”.
O. National Uniform Claim Committee Recommended Data Set for a no institutional Claim
The NUCC was organized in 1995 to develop, promote, and maintain a standard data set for use in no institutional claims and encounter information.
P. Standard Guide for Content and Structure of the Computer-Based Patient Record

17. III. The Standards Development Process
The development and adoption of data standards is not sociopolitical context. Initially, there must be recognition that potential ambiguity exist at a level that would significantly impair communication and that this impairment is unacceptable within the social context.
At the core of such systems is the concept of a secure, patient-centered EHR that (1) safeguards personal privacy (2) uses standardized medical terminology that can be correctly read by any care provider and incorporated into computerized tools to support clinical decision making, (3) eliminates the danger of illegible handwriting and missing patient information, and (4) can be transferred as a patient’s care requires over a secure communications infrastructure for electronic information exchange .

18. IV. Integrating the Healthcare Enterprise
IHE is an initiative that provides a detailed framework for implementing standards, filling the gap between standards, and their implementation.
IHE is not a standards body and does not create standards, it offers a common framework available in the public domain, to understand and address critical integration needs.

19. V. Standards Coordination Efforts
The following is a brief description of some of the major international, regional, and national organizations involved in broad-based standards development and coordination:
International Organization of Standardization
European Technical Committee for Standardization
American National Standard Institute
Object Management Group
Health Insurance Portability & Accountability Act
National Committee on Vital & Health Statistics Subcommittee on Standards & Security

20. VI. Consolidated Health Informatics
The goal of CHI is to develop and implement a standard means of exchanging and managing health information across federal health providers.

21. Vii. Framework for Strategic Action
In fulfilling the requirements of the executive order, Dr. Brailer has submitted a report that outlines a framework for a strategic plan that will help the nation to realize a new vision for healthcare made possible through the use of IT.
Goal convey the vision for consumer- centric and information-rich healthcare:
GOAL 1: Inform clinical practice
GOAL 2: Interconnect clinicians
GOAL 3 Personalize care
GOAL 4: Improve population health

22. VIII. The Business Value of Data Standards
The importance of data standards to enhancing the quality and efficiency to healthcare delivery is being recognized by our national leadership.
Reviewing the business value of defining and using data standards is critical for driving the implementation of these standards into applications and systems.
Reducing manual intervention will increase worker productivity and streamline operations.
Considering the value proposition for incorporating data standards into products, applications & systems should be a part of every organization’s information technology strategy.

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