This chapter examines healthcare data standards in terms of the following: Need for healthcare data standards Healthcare data interchange standards Healthcare terminologies Knowledge representation Healthcare data standards development Healthcare data SDOs
Need for Healthcare Data Standards • Data standards as applied to healthcare include : 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 processes. • In the domain of information management, standards can be further categorized as: 1.those that support the generic infrastructure and are not domain specific 2.those that support the exchange of information and are domain specific 3.those that support activities and practices within a specific domain Healthcare is fundamentally a process of communication. Data Standards is generally used to describe those standards having to do with the stucture and content of health information, it may useful to differentiate data,information and knowledge. Data are collections of unstructured discrete entities(facts) that exist outside of any particular context.
Standards Data interchange standards adress,primarily,the format of messages that are exchanged between computer systems, document architecture,clinical templates,userinterface, and patient data linkage. The following section describes some of the major organizations involved in the development of data interchange standards: • Message Format Standards four broad classes of message format standards have emerged in the healthcare sector: 1. medical devise communications 2. digital imaging communications 3. administratve data exchange 4. clinical data exchange The National Committee on Vital and Health Statistics (NCVHS) is the advisory committee established to make recommendations on health information policy to the Department of Health and Human Services (HHS) and Congress. • 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,continous,and comprehensive capture and communication of data from bedside medical devices such as those found in intensive care units, operating rooms and emergency departments. The most widely known standard, 802.11, 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 installed in offices, hotels, airports, coffeehouses, convention centers and even parks,ammong other locations
National Electrical Manufactures Association in collaboration with the American College of Radiologists and others, formed the DICOM to develop a generic digital format and a transfer protocol for biomedical images and image-related information. DICOM standard 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 transactions. • National Council for Prescription Drug Programs develops standards for information processing for the pharmacy services sector of the healthcare industry. 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: 1. medical orders 2. clinical observations 3. test results 4. admission 5. transfer and discharge 6. document architecture 7. clinical templates 8. user interface 9. EHR 10. charge and billing information
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. 1. International Statistical Classification of Diseases and Related Health Problems: Ninth Revision and Clinical Modifications -the latest version of a mortality and morbidity classification that originated in 1893 2. International Statistical Cassifications of Diseases and Related Health Problems: Tenth Revision - most recent revision of the ICD classification system for mortality and morbidity, which is used worldwide 3. Current Procedural Terminology, Fourth Revision - listing of descriptive terms and codes for reporting medical services and procedures 4. Systematized Nomenclature of Human and Veterinary Medicine International, Clinical Terms - comprehensive, multiaxial nomenclature and classification system created for indexing human and veterinary medical vocabulary, including signs and symptoms, diagnosis and procedures. LOINC- Logical Observation Identifiers Names and Codes - provides a set of universal names and numeric identifier codes for laboratory and clinical observations and measurements in a database structure. RxNorm-a clinical drug nomenclature produced by NLM, in consultation with the Food and Drug Administration, Department of Veterans(VA) and HL7 SDO.
Unified Medical Language speciaized vocabularies, code sets, and classification system for almost every practice domain in healthcare. • Data Content Standards • National Uniform Claim Committee Recommended Data Set for a Noninstitutional Claim - was organized in 1995 to developed,promote and maintain a standard data set for use in noninstitutional claims and encounter information. • Standard Guide for Content and Structure of the Computer-Based Patient Record(ASTM E1384-96) - one of the largest SDOs in the world and publishes over 9,000 standards covering all sectors in the economy.
Standards Development Process • Proprietary Standards - can often be developed quickly and are supported by available implementations and tools. • Legislated,government-developed standards - are able to gain widesread acceptance by virtue of their being required by either regulation or in order to participate in large, government-funded programs ,such as Medicare. • Standards developed by SDOs are consensus-based and reflect the perspectives of a wide variety of interested stakeholders.
Integrating the Healthcare Enterprise Is an initiative that provides a detailed framework for implementing standards, filling the gap between standards and their implementation.
Standards Coordination Efforts • The following is a brief description of some of the major international,regional, and national organizations involved in broadbased standards development and coordination: • International Organization of Standardization -an organization that develops and publishes standards internationally. • European Technical Committee for Standardization - works to developed a wide variety of standards in the area of healthcare data management and interchange. • American National Standards Institute - serves as the coordinator for voluntary standards activity in the United States • Object Management Group - representative of a different approach to standards development • Health Insurance Portability and Accountability Act • National Committee on Vital and Health Statistics Subcommittee on Standards and Security
Framework for Strategic Action These goals convey the vision for consumer-centric and information-rich healthcare: Goal 1: Inform clincal practice Incentivize EHR adoption Reduce risk of HER investment Promote EHR diffusion in rural and underserved areas Goal 2: Interconnect clinicians Foster regional collaborations Developed a national health information network Coordinate federal health information systems Goal 3: Personalize care Encourage use of PHRs Enhanced informed consumer choice Promote use of telehealth systems
Goal 4: Improved population health Unify public health surveillance architectures Streamline quality and health status monitoring Accelerate research and dessimination of evidence