Health Care Information System Standards

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Health Care Information System Standards

• Chapter 9

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Outline

• Standards Development Process
• Standards that support Health Care Information
  System Interoperability
• Classification, Vocabulary and Terminology
  Standards
• Data Interchange Standards
• Health Record Content Standards
• Impact of HIPAA
• National Health Information Infrastructure

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Standards Development Process

• Four Methods (Hammond Cimino, 2001)
• Ad hocno formal adoption process
• De factovendor or other has a very large segment
  of the market
• Government mandate
• Consensusvolunteers from organizations come
  together to reach a formal agreement

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Formal Standards Development

• Organizations
• International Organization for Standardization
  (ISO) www.iso.org
• American National Standards Institute (ANSI)
  www.ansi.org
• Standards Development Organizations (SDOs)
• ASTM International www.astm.org
• Health Level 7 www.hl7.org
• ANSI ASC X12 www.x12.org

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ISO

• Facts
• Members are national standards bodies from many
  countries
• ANSI is the US national body member
• Oversees the flow of documentation and
  international approval of standards developed by
  its member bodies

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ANSI

• Facts
• US member of ISO
• Accredits SDOs from a wide range of industries
  (including health care)
• Oversees work of SDOs
• Does NOT develop standards
• Publishes the 10,000 standards developed by SDOs

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SDOs

• Facts
• Must be accredited by ANSI
• Develops standards in accordance with ANSI
  criteria
• Can use the label Approved American National
  Standard
• 270 ANSI-accredited SDOs representing many
  industries, including health care

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Classification, Vocabulary and Terminology
Standards

• To date no single vocabulary has emerged
• Common coding and classification systems
• ICD-9-CM (chapter 1)
• CPT (chapter 1)
• DRGs (chapter1)

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Classification, Vocabulary and Terminology
Standards

• National Committee on Vital and Health Statistics
  identified a core set of patient medical record
  information (PMRI) terminology standards
• SNOMED CT
• LOINC
• Several federal drug terminology including RxNorm

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SNOMED CT

• Systemized Nomenclature of Medicine Clinical
  Terms
• 340,000 concepts with unique meanings
• 900,000 English language descriptions or
  synonyms
• 1.3 million semantic relationships
• Maps to other systems, such as ICD-9-CM, ICD-10,
  LOINC, and others

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LOINC

• Logical Observation Identifiers Names and Codes
• Developed to facilitate the electronic
  transmission of laboratory results
• 32,000 observational terms
• Applies to equivalent tests, not unique to
  companies

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RxNorm

• RxNorm is a developing project within the
  National Library of Medicine Unified Medical
  Language System (UMLS)
• Purpose is to define a nonproprietary drug
  vocabulary

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Data Interchange Standards

• Examples of Data Interchange standards that
  impact health care
• Health Level 7 standards (HL7)
• Digital Imaging and Communications in Medicine
  (DICOM)
• National Council for Prescription Drug Programs
  (NCPDP)
• ANSI X12N standards

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HL7

• HL7 is an ANSI-accredited SDO
• develops HL7 messaging standards to allow
  interoperability among health care applications
• Involved in other standards activities, but the
  messaging standard is referred to as HL7

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HL7

• Other HL7 standards
• Clinical Context Management (CCM) specifications
• Arden Syntax for Medical Logic Systems
• Electronic Health Record functional model
  (discussed later)

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DICOM

• American College of Radiology and the National
  Electrical Manufacturers Association published
  the first standard in 1985
• Promotes communication of digital image
  information regardless of device manufacturer
• Works with picture archiving and communications
  systems (PACS)

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NCPDP

• ANSI accredited SDO
• Developed a standard for the electronic
  submission of third party drug claims

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ASC X12N

• X12N is the subcommittee of ASC X12 that deals
  with EDI for the insurance industry
• The health care task group is TG2
• X12N/TG2 develops and maintains standards for
  health care EDI

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Health Record Content Standards

• Functional standards for electronic health record
  content
• HL7 EHR Functional Model
• ASTM Healthcare Informatics subcommittees
  Continuity of Care (CCR) standard

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HL7 EHR Functional Model

• Second draft adopted in 2004
• Three components
• Direct care
• Supportive
• Information infrastructure

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CCR

• Currently being developed by the ASTM Healthcare
  Informatics subcommittee
• Intent is to provide a core data set of the most
  relevant and timely facts about a patients
  health care
• Completed when patient is transferred to another
  provider
• Version 3 included eight elements

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Impact of HIPAA

• HIPAA electronic transaction standards are
  primarily from ASC X12N
• HIPAA designated standard code sets include
• ICD-9-CM
• CDT (Code on Dental Procedures and Nomenclature)
• HCPCS
• CPT-4

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HIPAA DSMOs

• HIPAA also identified designated standards
  maintenance organizations to develop, maintain,
  and modify relevant EDI standards
• ACS X12
• Dental Content committee of the ADA
• HL7
• NCPDP
• NUBC
• NUCC

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National Healthcare Information Infrastructure

• NHII is not simply a set of health information
  standards
• NHII is not a government agency
• NHII is not a centralized database for medical
  records

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National Healthcare Information Infrastructure

• NHII (when realized) will be
• a comprehensive knowledge-based network of
  interoperable systems of clinical, public health,
  and personal health information that would
  improve decision-making by making health
  information available when and where it is
  needed (NCVHS, 2001)

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National Healthcare Information Infrastructure

• NHII will include
• Technologies
• Standards
• Applications
• Systems
• Values
• Laws

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National Healthcare Information Infrastructure

• NHII has three overlapping dimensions (HHS, 2004)
• Personal Health
• Health Care Delivery
• Public Health
• In 2001 NCVHS outlined a three-stage, ten-year
  plan for achieving the vision of NHII

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National Healthcare Information Infrastructure

• NHII stage one was realized in April 2004 with
  the creation of the Office of the National
  Coordinator for Health Information Technology

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National Health Information Network

• Authors Note in 2005 the title NHII is not
  longer used. It has been replaced by National
  Health Information Network (NHIN)
• Local network components are Regional Health
  Information Organizations (RHIO)
• For More information go to
• http//www.hhs.gov/healthit

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Summary

• Standards Development Process
• Formal Standards Development Organizations
• ISO
• ANSI
• SDOs

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Summary (cont.)

• Classification, Vocabulary and Terminology
  Standards
• SNOMED CT
• LOINC
• RxNorm
• Data Interchange Standards
• HL7
• DICOM
• NCPDP
• ASC X12N

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Summary (cont.)

• Health Record Content Standards
• HL7 EHR Functional Model
• CCR
• Impact of HIPAA on standards
• NHII (now NHIN)