Use of Healthcare Standards and Metadata Registries in the U'S' Government

1
Use of Healthcare Standards and Metadata
Registries in the U.S. Government
Marco Johnson Director, e-Business Architecture
e-Business Policy and Standards Assistant
Secretary of Defense Health Affairs Chief
Information Office 5109 Leesburg Pike Suite
817 Falls Church, VA 22041 marco.johnson_at_tma.osd.
mil [phone]
2
Agenda

• Introduction
• Collaboration Team
• Consolidated Health Informatics (CHI) Support
• Health Level 7
• HIPAA Compliance

3
Introduction

• Basis -- Federal data management and information
  sharing predicated on implementation of ISO 11179
• Forums facilitating implementation of healthcare
  standards and metadata registries in the U.S.
  Government
• Health Level 7 (HL7) Government SIG
• Consolidated Health Informatics (CHI)
• DAMA
• DOD CIO Council
• OpenForum

4
Introduction

• Health Affairs Chief Information Office active
  participant providing registry components
• American National Standards Institute (ANSI)
• Health Informatics Standard Board (HISB)
• Consolidated Health Informatics (CHI) offers one
  of most comprehensive forum within U.S.
  Government to adopt federal health information
  interoperability standards for health data
  segments
• HL7
• ANSI-accredited Standards Developing
  Organizations (SDOs) operating in the healthcare
  arena.
• Domain -- clinical and administrative data.
• Application level
• Addresses definition of data to be exchanged,
  timing of interchange, and communication of
  errors to application.

5
Introduction (Cont.)

• Interoperability Standards Issues in the health
  environment include
• Clinical documentation
• Orders and results reporting (e.g. laboratory,
  radiology, pharmacy physical examinations and
  procedures)
• Metadata registries under development reaping
  some early benefits
• Metadata registries will be used to support these
  activities.
• USHIK Data Registry Development accomplished as
  partnership among government agencies
• USHIK will be implemented within DoD Health as
  Military Health System Data Registry

6
Collaboration Team

• Glenn Sperle HHS/Centers for Medicare and
  Medicaid Services
• Marco Johnson OASD/HA (Chief Information
  Office) IMTR Information Management
• CDR Sam Jenkins HIPAA Privacy Training
• Laura J. Reece, PhD. CMS/Knowledge Solutions,
  LLC

• Accredited Standards Committee - Healthcare
  (X12N)
• American Dental Association (ADA)
• American Society for Testing and Materials
  Committee E31 on Healthcare informatics (ASTM
  E31)
• Health Industry Business Communications Council
  (HIBCC)
• Health Level (HL7)
• Medical Device Communications Industry Group
  (IEEE 1073)
• National Council for Prescription Drug Programs
  (NCPDP)

7
Consolidated Health Informatics (CHI) Elements

• CHI Elements
• Data Standards
• Communications Standards
• Model Health Information Systems
• Build around achieving national architecture
  standards for data, communications, security,
  systems, technical

• CHI Elements
• Standards Jointly develop/set/use data,
  communications, architecture, security,
  technical, system standards
• Systems Develop/use model information systems
• Continuing enhanced system development by each
  agency. Joint procurement/build, sharing,
  standards when applicable
• Exchange Two way VA/DoD two way VA/HIS

8
CHI Support (Cont.)

• CHI Objective Adopt health information
  Interoperability standards

• USHIK Version 2.0
• Capable of providing functionality necessary for
  information interoperability
• Due to nature of program, inherent flexibilities
  built in for further adaptations.
• Version 2.1 Further adaptations customized based
  on needs of data formatting, data integrity and
  data standardization.

• Vocabulary that includes specific health data
  models and communication standards
• Through comparative analysis with other registry
  entries
• Through Collaboration with other Registration
  Authorities and Standards Development
  Organizations

9
CHI Support (Cont.)

• CHI Objective Assure alignment with HIPAA
  administrative transaction records and code sets

• USHIK Version 2.0
• Compare transaction record concepts and code sets
  through Comparison Matrix Usage reporting.
• Align through comparative analysis with other
  certified registry entries

• Through Comparative Analysis with other certified
  registry entries
• Through mapping of comparable entities to records
  and code sets defined within the HIPAA Standards

10
CHI Support (Cont.)

• CHI Objective Assure alignment with HIPAA
  administrative transaction records and code sets

• USHIK Version 2.0
• Align through mapping of comparable entities to
  records and code sets defined within the HIPAA
  Standards
• Version 2.1 - Requirements for ability to map
  elements scheduled for early completion in
  Version 2.1
• New requirements defined addressed as part of
  on-going project.

• Through Comparative Analysis with other certified
  registry entries
• Through Mapping of comparable entities to records
  and code sets defined within the HIPAA Standards

11
CHI Support (Cont.)

• CHI Objective Assure alignment with HIPAA
  security and privacy solutions

• USHIK Version 2.0
• Assures alignment with HIPAA security and privacy
  solutions.
• Provide functionality to implement detailed
  security and privacy solutions.
• Expansion of current security and proprietary
  constraints augmented as CHIs security
  requirements defined.
• Data security technology constantly updated with
  consideration to emerging technology, function
  benefit.

• Through Comparative Analysis with other certified
  registry entries
• Through Mapping of comparable entities to records
  and code sets defined within the HIPAA Standards

12
USHIK Version 2.0 - CHI Summary

• USHIK resides on staging server for quick
  implementation at any facility.
• Many reports already exist
• New reports are planned to contain finer grain of
  details in the comparisons.
• Direct comparison of conceptual items will be
  extended from existing data element matrix and
  usage reports.
• Concrete developmental requirements for data
  exchange and sharing will be required for
  complete understanding of these enhancements.

• Provide needed CHI Data Registry Functions
• Provide functionality to compare and analyze the
  elements of the two models/systems
• USHIK data registry provides open exchange of
  ideas and concepts through comparative analysis
  and interaction.
• Geared towards helping with need for global
  resource in data standardization, including
  medical scope .
• Customizable reports can be created to help
  facilitate comparison and validation of data sets
  across various organizations.

13
Health Level 7 (HL7)

• HL7 has been actively working with XML technology
  since the formation of the SGML/XML Special
  Interest Group
• XML Data Bridge
• Plans for implementation will allow for separated
  registries to exchange data loads.
• Delivery targeted for prototyping by early
  FY2003.
• XML data schema derived from the ISO 11179 data
  model currently used by the USHIK.
• XML formatting will be developed once model in
  final release.
• Customization of particular features may need
  attention on review of certified medical facility
  with special needs.

14
Metadata Registry Support HIPAA Capabilities
Requirements
15
Metadata Registry Support HIPAA Capabilities
Requirements
16
Accommodate Interoperability USHIK Communication
Facilities

• Database driven bulletin board system
• Newsgroup software for voting and consensus
  development
• Web interface shows all the messages with the
  applicable threads (replies) and more user
  features
• Unlimited Forums / Messages / Categories
• Posting and registration - check new posts
• Edited/deleted/moved/locked tracking
• User email notification of answered posts
• User profiles
• Marked posts since last visit

17
Data Registry Support Summary
Legend a Required or Implemented a/p Partially
Implemented x Not Required or Not Addressed
18
Questions