CHAPTER 13 HEALTHCARE DATA STANDARDS

Joyce Sensmeier

OBJECTIVES Discuss the need for data standards in healthcare. Describe the standards development process Identify standards development organizations (SDOs). Describe healthcare data standards initiatives. Explore the business value of data standards. KEY WORDS     Standards Health data interchange Terminology Knowledge representation

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TANDARDS 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, weather between multiple departments within a single institution or among a varied cast of providers, payers, regulators, and others is essentials y HEALTHCARE DATA STANDARDS is examine in terms of the following:  Need for healthcare data standards  Healthcare data interchange standards  Healthcare terminologies  Knowledge representations  Healthcare data standards development  Healthcare data SDOs  Healthcare data standards initiatives  Business value of data standards

discrete entities (facts) that exist outside of any particular context. -Data standards are an attempt to reduce the level of ambiguity in the communication of data so that actions taken based on the data are consistent with the actual meaning of the data. and specifications for the collection . and knowledge. y 2ND TYPE OF STANDARD -typically involves the specification of data structures and content and would include such standards as message formats and core data sets. An example of this type of standard would be professional practice guidelines. medications. they become y . storage. It is the second class standards. medical devices and monitoring system. NEED FOR HEALTHCARE DATA STANDARDS -Data standards is applied to healthcare include the ³methods. including medical records. Data are the fundamental building blocks on which healthcare decisions are based. exchange. -The term ³data standards´ is generally used to describe those standards having to do with the structure and content of health information. terminologies. The temporal and physical proximity of the communicators provided ample opportunity to clarify any ambiguity regarding the intended meaning of what was being communicated. it may be useful to differentiate data. -Healthcare is fundamentally a process of communication . When data are interpreted within a given context and given meaningful structure within that context. and those that support activities and practices within a specific domain. and retrieval of information associated with healthcare applications.  EXAMPLES: y 1ST TYPE OF STANDARD -includes equipment specifications such as processor type or network transmissions protocols such as Ethernet or token ring. information. 3RD TYPE OF STANDARD -addresses the interpretation of that data as information. Data are collections of unstructured. and administrative processes´(Washington Publishing Company 1998). radiological images. those that support the exchange of information and are domain-specific. -Standards can be further categorized as those that supports the generic infrastructure and are not domain-specific.Verbal communication between a patient and a healthcare provider characterized this process. including how should be it acted on within a particular context. payment and reimbursement. protocols.

it becomes knowledge and provides the basis for informed action (Saba and McCormick. The most widely known standard. 802. 2004). Digital Imaging Communication in Medicine Standards Committee (DICOM).  HEALTHCARE DATA INTERCHANGE STANDARDS -Data interchange standards address.  MESSAGE FORMAT STANDARDS -Four broad classes of message format standards have emerged in the healthcare sector: medical device communications. and emergency departments. National Council for Prescription Drug Programs (NCPDP). y INSTITUTE of ELECTRICAL and ELECTRONIC ENGINEERS -The IEEE has developed a series of standards known collectively as P1073 Medical Information Bus (MIB). continuous.´ This public-private partnership has recommended that several message format standards be adopted for federal healthcare services programs including Health Level Seven (HL7) (v2. allows anyone with computer and either a plug-in card or built-in circuitry to connect to the internet . -The National Committee on Vital and Health Statistics (NCVHS) was called on to ³study the issues related to the adoption of uniform data standards for patient medical record information (PMRI) and the electronic exchange of such information.11. 802. has stirred up developments in an otherwise sluggish communications market. document architecture. -The IEEE 802. administrative data exchange. This data include physiologic parameter measurements and data settings. and comprehensive capture and communication of data from bedside medical devices such as those found in intensive care units.xx suite of wireless networking standards.16. 802. user interface. digital imaging communications. clinical templates. -The following section describes some of the major organizations invoved in the development of data interchange standards.information. primarily the format of messages that are exchanged between computer systems. which support real-time. and patient data linkage (committee on data standards for patient safety.2 and later).2000). When information from various contexts is aggregated following a defined set of rules . SCRIPT and Institute of Electrical and Electronic Engineers (IEEE) 1073. and clinical data exchange.11. operating rooms. commonly referred to as Wi-Fi.

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. enrolment. information. y NATIONAL ELECTRICAL MANUFACTURERS ASSOCIATION -The National Electrical Manufactures Association (NEMA). hotels . and retrieval of data.wirelessly through a myriad access points installed in offices. Trojan horses. -Joint NEMA/ The European Coordination Committee of the Electro medical Industry/Japan Industries Association of Radiological Systems (COCIR/JIRA) Security and Privacy Committee (SPC) has recently issued a white paper which provide a guides for the vendors and users on how to protect medical information systems against viruses. NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS -The NCPDP develops standards for information processing for the pharmacy services sector of the healthcare industry. in collaboration with the American College of Radiologist (ACR) and others. and first report of injury under the requirements of the HIPAA. internet worms. formed the DICOM to develop a generic digital format and a transfer protocol for biomedical images and image-related information. and knowledge in support of clinical practice. -X12N standards have been adopted as national standards for such administrative transactions as claims. -The DICOM standard is the dominant international data interchange message format in biomedical imaging. and related forms of so called ³malicious software. and among other locations.´ ACCREDITED STANDARDS COMMITTEE X12N/INSURANCE -Accredited standard committee (ACL) X12N has developed a broad range of electronic data interchange (EDI) standards to facilitate electronic business transactions. denial of service attacks. EXAMPLES THAT DESCRIBE SEVERAL OF THE MAJOR SYSTEMS International Statistical Classification of Diseases and Related Health Problems: Ninth Revision and Clinical Modifications y y y y . -Standardized terminologies enable data collection at the point of care. and eligibility in health plans.

and procedures (College of American Pathologists. diagnoses. drug components (active ingredients +strength). and an information sources map of the various biomedical databases referenced. RxNorm -is a clinical drug nomenclature produced by NLM. which is used worldwide. Clinical Terms -(SNOMED) is a comprehensive. and some related brand names. International Statistical Classification of Diseases and Related Health Problems: Tenth Revision . The ICD-10 also encompasses nomenclature structures (WHO. including signs and symptoms.(ICD-9-CM) is the latest version of a mortality and morbidity classification that originated in1893 (WHO. RxNorm provides standard names for clinical drugs (active ingredient + strength + dose form) and for dose forms as administered. Unified Medical Language System -Currently the (UMLS) consist of a metathesaurus of terms and concepts from dozens of vocabularies. multiaxial nomenclature and classification system created for indexing human and veterinary medical vocabulary. . in consultation with the Food and Drug Administration (FDA). 1992) Current Procedural Terminology.(CPT-4) is a listing of descriptive terms and codes for reporting medical services and procedures. Systemized Nomenclature of Human and Veterinary Medicine International. 1993) Logical 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.(ICD-10) is the most recent revision of the ICD classification system for mortality and morbidity..and HL7 SDO. Fourth Revision . It provides links from clinical drugs to their active ingredients. the Department of Veterans Affair (VA). 1980). a semantic network of relationships among the concepts recognized in the metathesaurus.

It is to be prepared by a practitioner at the conclusion of a healthcare encounter in order to enable the next practitioner to readily access such information. The CCR is a core data set of the most relevant and timely facts about a patient¶s healthcare. It has been defined as ³ a standard data element with a uniform definition and coding convention to collect data on persons and on events or encounters´ National Uniform Claim Committee Recommended Data Set for a Noninstitutional Claim -The NUCC was organized in 1995 to develop. Standard Guide for Content and Structure of the Computer-Based Patient Record (ASTM E1384-96) . promote. It proposes a minimum essential content drawn from a developing annex of dictionary elements.(E1384-96) provides a framework vocabulary for the computerbased patient record (CPR) content.A new work item being proposed by the E31 subcommittee is the continuity of care record (CCR).´ A related concept is that of a core data element. The current NUCC data set forms the basis for the proposed for national adoption under HIPAA. . .Data Content Standards -The concept of a minimum data set is that of ³ a minimum set of items with uniform definitions and categories concerning a specific aspects or dimension of the healthcare system which meets the essential needs of multiple users. and maintain a standard data set for use in noninstitutional claims encounter information.

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