More and Better Data for More and Better Data for Research:Research:

Federal Health Information Federal Health Information Technology DevelopmentsTechnology Developments

Vivian A AuldVivian A AuldSenior Specialist for Health Data StandardsSenior Specialist for Health Data Standards

National Library of MedicineNational Library of Medicine

AcademyHealthAcademyHealthAnnual Research MeetingAnnual Research Meeting

June 25, 2006June 25, 2006

Federal Health IT Federal Health IT MilestonesMilestones

1996 1996 HIPAAHIPAA –Administrative Simplification section of Health –Administrative Simplification section of Health

Insurance Portability and Accountability Act of 1996Insurance Portability and Accountability Act of 1996

NCVHSNCVHS - National Committee on Vital and Health - National Committee on Vital and Health Statistics, a long-standing (50+ years) advisory committee Statistics, a long-standing (50+ years) advisory committee to HHS, which was strengthened and expanded by HIPAAto HHS, which was strengthened and expanded by HIPAA

20012001 CHICHI - Consolidated Health Informatics project, an HHS-VA- - Consolidated Health Informatics project, an HHS-VA-

DOD eGov initiative which designated 1DOD eGov initiative which designated 1stst U.S. gov’t-wide U.S. gov’t-wide clinical data standards clinical data standards

20032003 US-wide license for US-wide license for SNOMED CTSNOMED CT - Systematized - Systematized

Nomenclature of Medicine Clinical Terms Nomenclature of Medicine Clinical Terms

MMAMMA – Medicare Modernization Act of 2003 – mandated e- – Medicare Modernization Act of 2003 – mandated e-prescribing and a time-limited Commission on Systemic prescribing and a time-limited Commission on Systemic Interoperability (January-October 2005)Interoperability (January-October 2005)

Executive Order, April 27, 2004“..to provide leadership for the development

and nationwide implementation of an interoperable health information technology

infrastructure to improve the quality and efficiency of health care…”

State of the Union Address, January 31, 2006 “We will make wider use of electronic health

records and other health information technology infrastructure to improve the

quality and efficiency of health care.”

Recent EventsRecent EventsSeptember 2005September 2005

American Health Information Community – advisory American Health Information Community – advisory committee of industry leaders & federal agency heads committee of industry leaders & federal agency heads – HHS Sec. chair– HHS Sec. chair

October 2005October 2005 Office of National Coordinator for Health Information Office of National Coordinator for Health Information

Technology (ONC), HHS awards contracts for Technology (ONC), HHS awards contracts for (1) (1) **standards harmonizationstandards harmonization(2) compliance certification(2) compliance certification(3) privacy/security solutions(3) privacy/security solutions

**Commission on Systemic Interoperability releases Commission on Systemic Interoperability releases final reportfinal report

**NLM involved at HHS requestNLM involved at HHS request

Strategy for Adoption and Strategy for Adoption and Implementation of StandardsImplementation of Standards

endingthedocumentgame.gov/

Recent EventsRecent Events

November 2005November 2005 Medicare e-prescribing foundation standards namedMedicare e-prescribing foundation standards named ONC awards 4 contracts for National Health ONC awards 4 contracts for National Health

Information Network (NHIN) architecture Information Network (NHIN) architecture prototypesprototypes

January 2006January 2006 Interagency Health Information Technology Policy Interagency Health Information Technology Policy

Council Council **HHS Health Information Technology Policy CouncilHHS Health Information Technology Policy Council

**NLM involved at NLM involved at HHS requestHHS request

The Community (AHIC)The Community (AHIC)

U.S. Gov’t U.S. Gov’t ANSI ANSI Standards Selection and Standards Selection and CoordinationCoordination

HIPAA - National HIPAA - National Committee on Vital & Committee on Vital & Health Statistics , 1996 Health Statistics , 1996 --

Consolidated Health Consolidated Health Informatics eGov Informatics eGov Project, 2002-Project, 2002-

Medicare Medicare Modernization Act of Modernization Act of 20032003

ANSI Healthcare Info. ANSI Healthcare Info. Standards Planning Standards Planning Panel (HISPP) – 1991-Panel (HISPP) – 1991-19951995

ANSI Healthcare Info. ANSI Healthcare Info. Standards Board Standards Board (HISB) – 1996-2005(HISB) – 1996-2005

ANSI Healthcare Information Technology Standards Panel (HITSP), 2005-ANSI Healthcare Information Technology Standards Panel (HITSP), 2005-•Established in response to HHS Request for Contract Proposals for:Established in response to HHS Request for Contract Proposals for:

Sustainable Standards Harmonization Process, Cross-Standard Specs for Key Use CasesSustainable Standards Harmonization Process, Cross-Standard Specs for Key Use Cases

www.hhs.gov/healthinformationtechnology/

HHS Secretary Leavitt’s 500-Day HHS Secretary Leavitt’s 500-Day Plan to Transform Health Care Plan to Transform Health Care

SystemsSystems Expressing a clear vision of health information Expressing a clear vision of health information

technology that conveys the benefits to patients, technology that conveys the benefits to patients, providers and payersproviders and payers

Convening national collaboration re: developing setting, Convening national collaboration re: developing setting, and certifying HIT standards and outcomes for and certifying HIT standards and outcomes for interoperability, privacy and data exchangeinteroperability, privacy and data exchange

Realizing the near-term benefits of health information Realizing the near-term benefits of health information technology in: adverse drug-incident reporting, e-technology in: adverse drug-incident reporting, e-prescribing, lab and claims-sharing data, clinic prescribing, lab and claims-sharing data, clinic registrations, insurance formsregistrations, insurance forms

Creating an integrated network of population data, Creating an integrated network of population data, genetic information, and medical records to accelerate genetic information, and medical records to accelerate discoverydiscovery

Improving the clinical research networkImproving the clinical research network

Providing early warning of threats through improved Providing early warning of threats through improved domestic and international surveillancedomestic and international surveillance

Congress Drafting Health Congress Drafting Health IT BillsIT Bills

www.himss.org/advocacy/cross_walk.asp

ONCONC

www.hhs.gov/healthit

NLM HIT Standards NLM HIT Standards ActivitiesActivities

Support, license, develop, and distribute standard Support, license, develop, and distribute standard clinical vocabularies (LOINC, SNOMED, RxNorm) in clinical vocabularies (LOINC, SNOMED, RxNorm) in UMLSUMLS

**Distribute FDA-approved structured product labels via Distribute FDA-approved structured product labels via “Daily Med” “Daily Med”

**Direct efforts to map clinical terminologies to HIPAA Direct efforts to map clinical terminologies to HIPAA administrative code setsadministrative code sets

**Direct contract to align HL7 with standard Direct contract to align HL7 with standard vocabularies and to define HL7 mechanism for vocabularies and to define HL7 mechanism for exchange of entire EHRsexchange of entire EHRs

Work with NIH to promote use of standards in the Work with NIH to promote use of standards in the clinical research enterpriseclinical research enterprise

* Partially supported by funds from * Partially supported by funds from AHRQ AHRQ

and the Office of the Secretary, HHSand the Office of the Secretary, HHS

Mapping Projects Mapping Projects planned/underwayplanned/underway

CHI standards to HIPAA code setsCHI standards to HIPAA code sets SNOMED CT – ICD-9-CM, ICD-10-CMSNOMED CT – ICD-9-CM, ICD-10-CM SNOMED CT – CPTSNOMED CT – CPT LOINC – CPTLOINC – CPT

SNOMED CT to “other” vocabulariesSNOMED CT to “other” vocabularies Medical Dictionary for Regulatory Affairs (MedDRA)Medical Dictionary for Regulatory Affairs (MedDRA) International Classification of Primary Care (ICPC)International Classification of Primary Care (ICPC) Medcin Medcin ICFICF

Will require:Will require: Robust testing/validationRobust testing/validation Alignment of update schedulesAlignment of update schedules

Draft mappings available for testing via the Draft mappings available for testing via the UMLS soonUMLS soon

Key NLM Assumptions about Key NLM Assumptions about MappingsMappings

Participants must include:Participants must include: Producers of vocabularies on both ends; prospective users Producers of vocabularies on both ends; prospective users

and recipients of the output, e.g., health care providers, and recipients of the output, e.g., health care providers, payers, as testers and validatorspayers, as testers and validators

Mapping may/will prompt changes/corrections to Mapping may/will prompt changes/corrections to content and adjustment to update schedulescontent and adjustment to update schedules

Mappings must be updated every time either end is Mappings must be updated every time either end is updatedupdated

Mappings will be distributed in the UMLS (not Mappings will be distributed in the UMLS (not exclusively); use will be governed by terms exclusively); use will be governed by terms applicable to both endsapplicable to both ends

Mapping is still an R & D problem - it will take Mapping is still an R & D problem - it will take iteration to build highly functional mapsiteration to build highly functional maps

NLM- HL7 Contract NLM- HL7 Contract ArrangementArrangement

September 2004 – August 2007September 2004 – August 2007 Align HL7 message standard with standard Align HL7 message standard with standard

vocabularies (vocabularies (NLM-initiated)NLM-initiated) Specify which subsets of standard vocabularies are Specify which subsets of standard vocabularies are

valid for particular message segmentsvalid for particular message segments Replace HL7-maintained lists of coded values with Replace HL7-maintained lists of coded values with

subsets of standard vocabularies, where feasiblesubsets of standard vocabularies, where feasible

Conduct pilot transfer of EHR data using HL7 Conduct pilot transfer of EHR data using HL7 Messaging and Implementation guides Messaging and Implementation guides independent of source and destination independent of source and destination architectures architectures (on behalf of HHS)(on behalf of HHS) Two NHIN prototype contractors participating in Two NHIN prototype contractors participating in

pilots pilots

Broaden participation: Clinical Broaden participation: Clinical ResearchResearch

nihroadmap.nih.gov

privacyruleandresearch.nih.gov

Resources for Resources for ResearchersResearchers

Broaden participation: Broaden participation: Public HealthPublic Health

www.phdatastandards.info

Take Home MessagesTake Home Messages Emphasis has shifted from health data Emphasis has shifted from health data

standards to the broader picture of HIT and standards to the broader picture of HIT and EHR.EHR.

Will take time to put in place but ultimately Will take time to put in place but ultimately will affect health care, public health will affect health care, public health functions, and the data available for HSRfunctions, and the data available for HSR

It’s not too early (It’s not too early (or too lateor too late) to get involved:) to get involved: to contribute to standards development, testing, to contribute to standards development, testing,

and refinementand refinement to study the impact of standards on health care, to study the impact of standards on health care,

public health, and clinical researchpublic health, and clinical research

If you work with HIT investigate the use of If you work with HIT investigate the use of the UMLS and other NLM resources at the UMLS and other NLM resources at http://www.nlm.nih.govhttp://www.nlm.nih.gov