HEALTHCARE DATA STANDARDSISSUES IN INFORMATICS

Standards are critical components in the development and implementation of an electronic health care 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 others is essential.

▫ A common set of rules and definitions , both at the level of data meaning as well as at the technical level of data exchange is needed to make this possible.

▫ A sociopolitical structure in place that recognizes the benefits of shared information and supports the adoption and implementation of such standards.

Need for Healthcare Data Standards

Data standards as applied to healthcare includes:•Methods•Protocols•Terminologies•specifications

FOR

•Collection•Exchange•Storage•Retrieval

INFORMATION ASSOCIATED WITH HEALTHCARE APPLICATIONS:

•Medical records•Radiological images•Payment and reimbursement•Medical devices and monitoring systems•Administrative processes

Standards in information management•First type of standards

▫Includes equipment specifications such as processor type or network transmission protocols such as ethernet or token ring.

•Second type of standards▫Involves the specification of data structures and

content and would include such standards as message formats and core data sets.

•Third type of standards▫Addresses the interpretation of that data as

information, including how it should be acted on within a particular context. This type of standard can be a professional practice guidelines.

Data Standards•Are an attempt to reduce the level of

ambiguity in the communication of data so that the actions taken based on the data are consistent with the actual meaning of the data.

•This term 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.

•It represents both data and their transformation into information. Analysis generates knowledge, which is the foundation of professional practice standards.

DATA

INFORMATION

KNOWLEDGE

Are collections of unstructured,

discrete entities that exist outside of any

context.Are interpreted data within a given context

that are given meaningful structure within that context.Are information from

various contexts that are aggregated following a

defined set of rules which provides basis for informed action.

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.

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▫Clinical data exchange

•The National Committee on Vital and Health Statistics (NCVHS) was called on to study the issues related to the adoption of uniform data standards for patient medical record information (PMRI) and the electronic exchange of such information.

Organizations that have developed Message Format Standards that was Adopted

for Federal Healthcare Services Programs

Institute of Electrical and Electronic Engineers•The IEEE has developed a series of

standards known collectively as P1073 Medical Information Bus (MIB)▫This standards support real-time,

continuous, and comprehensive capture and communication of data from bedside medical devices such as those found in ICUs, ORs, and ERs.

▫These data include physiologic parameter measurements and device settings

▫These standards are used internationally.

•Current activities include efforts to develop standards that support wireless technology

•The IEEE 802.xx suite of wireless networking standards, 802.11, 802.15 and 802.16, has stirred up developments in an otherwise sluggish communications market

National Electronic Manufacturers Association•In collaboration with the American

College of Radiologists and others formed the DICOM▫This is to develop a generic digital format

and a transfer protocol for biomedical images and image related information.

▫The specification is usable on any type of computer system and supports transfer over the internet.

▫It is the dominant international data interchange message format in biomedical imaging.

Accredited Standards Committee X12N/insurance

•Has developed a broad range of electronic data interchange (EDI) standards to facilitate electronic business transaction.▫This standards have been adopted as

national standards for such administrative transactions as claims, enrollment, and eligibility in health plans, and first report of injury under the requirements of the HIPAA

National Council for Prescription Drug Program• The NCPDP develops standards for information

processing for the pharmacy services sector of the healthcare industry

• NCPDP’s Telecommunication Standard Version 5.1 was named the official standard for pharmacy claims within HIPAA.

• NCPDP standards are forming the basis for electronic prescription transaction.

• Electronic prescription transaction are defined as EDI messages flowing between healthcare providers that are concerned with prescription orders.

•HL7 standards focus on facilitating the interchange of data to support clinical practice both within and across institutions. The major areas covered by the standard include:▫Medical orders▫Clinical observations▫Test results▫Admission, transfer and discharge▫Document architecture, clinical templates, user

interface, HER, and charge and billing information•HL7 is widely supported by health information

systems vendors worldwide and there are over a dozen foreign affiliates, which have adapted the basic standards for use in their particular settings.

TerminologiesA fundamental requirement for

effective communication is the ability to represent concepts in an unambiguous fashion between both the sender and receiver of the message.

Standardized terminologies enable data collection at the point of care, and retrieval of data, information, and knowledge in support of clinical practice

Several examplesof

Major systems

International Statistical Classification of Diseases and Related Health Problems: Ninth Revision and Clinical Modifications (ICD-9-CM)•Is the latest version of a mortality and

morbidity classification that originated in 1893.

•It is widely accepted and used in the healthcare industry and has been adopted for a number of purposes including data collection, quality-of-care analysis, resource utilization, and statistical reporting.

•It is the basis for the diagnostic related groups, which are used extensively for hospital reimbursement.

International Statistical Classification of Disease and Related Health Problems: Tenth Revision•Is the most recent revision of ICD

classification system for mortality and morbidity, which is used worldwide.

•A study of the costs and benefits of moving to the ICD-10 code sets determined that switching to both ICD-10-CM and IDC-10-PCS has the potential to generate more benefits than costs.

Current Procedural Terminology: Fourth Revision

•Is a listing of descriptive terms and codes for reporting medical services and procedures, modifiers, notes and guidelines to facilitate correct usage.

Systemized Nomenclature of Human and Veterinary Medicine International, Clinical Terms• Is a comprehensive , multiaxial nomenclature and

classification system created for indexing human and veterinary medical vocabulary, including signs and symptoms, diagnosis, and procedures

• It is being used by a number of professional specialty groups, and a subset of SNOMED is used in the DICOM imaging standard.

• SNOMED-CT is an inventory of medical and nursing terms and concepts for human and veterinary medicine arranged in multi-hierarchal structure with multiple levels of granularity and relationships between concepts

•NCVHS has recommended SNOMED-CT as one of several core terminologies to be adopted for federal healthcare service programs.

•There has been an agreement to use government funds to promote a common terminology in healthcare. The government will pay license fees for users of the terminology, thus removing some of the financial roadblocks to adoption of SNOMED-CT controlled clinical language in the U.S.

Local Observation Identifiers Names and Codes•LOINC provides a set of universal names

and numeric identifier codes for laboratory and clinical observations and measurements in a database structure.

•It represents laboratory data in terms of names for tests and clinical observations.

RxNorm•Is a clinical drug nomenclature produced

by NLM.•It provides standard names for clinical

drugs and for dose forms as administered.•It provides links from clinical drugs to

some related brand names.•NODS for specific drug product that

deliver the clinical drug are stored as attributes of the clinical drug in RxNorm.

Unified Medical Language System•Consists of a metathesaurus of terms and

concepts from dozens of vocabularies; a semantic network relationships among the concepts recognized in the metathesaurus; and an information sources map of the various biomedical database s referenced.