United States Health Information Knowledgebase

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May 16, 2007
United States Health Information Knowledgebase
Meeting the Challenge of Health Care Information
Integration
Laura Reece, Ph.D. FDA Data Management
Council May 16, 2007
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What is national health information?

• National health information is information that
  either is national in coverage or has national
  relevance and relates to
• the health of the population
• the determinants of the populations health,
  including external factors and those internal to
  individuals
• health programs or health services, covering
  information on the nature of the services
  provided and their management, resourcing,
  accessibility, use and effectiveness
• the relationships among these elements

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Why is it needed?

• To enable informed decision making
• To guide consumers decisions
• To provide needed information about the needs of
  the populations, the effectiveness of their
  interventions and for whom, and the acceptability
  of these interventions
• To compare the effectiveness and efficiency of
  healthcare
• To make decisions in health industry and
  governments need information about how to provide
  services equitably, efficiently and effectively

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Content

• Introduction
• Background
• Standards
• Capabilities Value
• Accomplishments
• Questions

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Introduction

• USHIK Goals
• To provide and maintain a metadata registry of
  health information data element definitions,
  values, and information models which will enable
  browsing, comparison, synchronization, and
  harmonization within a uniform query and
  interface environment.
• Build, populate, demonstrate, and make available
  for general use a data registry to assist in
  cataloging and harmonizing data elements across
  multiple organizations.

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Facilitate comparison and crosswalk with
existing standards and development of new metrics
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Background

• Nearly a decade in existence
• Collaborative effort from a changing mix of
  federal organizations
• Based on earlier implementations
• Based on national and international standard

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USHIK Registry Contents

• ANSI HL7 2.4, 2.5
• ANSI X12N
• ANSI ASTM
• NCPDP SCRIPT, Batch, Data Dictionary
• American Dental Association Specif. 2000
• HIPAA
• MHS Functional Area Model (FAM-A)

• Public Health Care Data Standards  
• IEEE Medical Device Communications Industry
  Group (IEEE 1073)
• NCVHS
• Clinical Care Classification (Nursing Taxonomy)
• DICOM (Imaging)

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The USHIK is an Implementation of ISO/IEC 11179
Information technology--Metadata registries (MDR)

• ISO/IEC 11179 a standardized way of describing
  information.
• Data Elements and their component parts
• Relationships among Data Elements
• Includes both Conceptual and Logical
  (Representational) level objects

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ISO/IEC 11179 Data Element (DE) Standard
Attributes Relationships
Important for Semantic Understanding

• Data Element Concept
• Conceptual Domain
• Classification Scheme
• Related Documents and URLs
• Value Domain
• Conceptual Domain
• Data Type
• Min/Max Length
• Low/High Value
• Format
• Unit of Measure
• Precision
• Valid Values Value Meanings

• Preferred Name/Context/Language
• Alternative Names/Context/Language
• Preferred Definition/Context/Language
• Alternative Definitions/Context/Language
• Example
• Related Data Elements
• Derived and Composite Data Elements
• Registration Information
• Registration Authority, Registrar
• Unique Registration ID
• Reg. Authority, Data ID, Version ID
• Registration Status
• Submitter Org, Submitter
• Assigned Steward
• Administrative Status and Notes

Important for Data Interoperability
Important for Data Governance
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ISO/IEC 11179 Core Meta-Model
Object Class
Property
Data Element Concept
Conceptual Domain
Perception
Representation
Value Domain
Data Element
Represen- tation
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ISO/IEC 11179 Core Meta-Model
Object Class
Property
Sex
Person
1..1
1..1
0..
0..
Data Element Concept
Conceptual Domain

• Sexes
• Male
• Female
• Other

0..
1..1
Person.Sex
Hypothetical Example
1..1
1..1
Perception
Representation

• Sex_Code (Census)
• 01 Male
• 02 - Female

0..
0..

• Gender_Code (HHS)
• M - Male
• F Female
• O - Other

Value Domain
Data Element
Person.SexCode
Person.GenderCode

• Gender_Type (NIH)
• XY - Male
• XX Female
• XXY Underdeveloped Male
• XYY Overdeveloped Male
• X Underdeveloped Female

1..1
0..
Person.GenderType

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The USHIK is an Implementation of ISO/IEC 11179
Information technology--Metadata registries (MDR)

• ISO/IEC 11179 a standardized way of describing
  information.
• Data Elements and their component parts
• Relationships among Data Elements
• Includes both Conceptual and Logical
  (Representational) level objects

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Capabilities

• Data elements are described in common format
• High Level Information Model Assists in Grouping
  Data Elements
• Data Elements are Linked to Model Views
• Data Elements Linked by Different Organizations
  Appear Together
• Uniform, objective comparison across multiple
  standards
• Comparison Matrix Aids in Harmonizing Data
  Elements
• Data Element Usage Shows Linkages Between Data
  Elements

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New Capabilities

• Related Data References shows relationships among
  data elements
• Links to external sources for immediate reference
  and viewing native format
• Pre-built downloadable query results updated
  regularly
• Examples illustrating data element usage provided
  by the SDOs (in process)

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Data Registry Overview
Methods of Finding Data Elements
References to Authoritative Sources

• A data registry is a place to keep facts about
  characteristics of data that are necessary to
  clearly describe, inventory, analyze, and
  classify data.
• A data registry supports data sharing with
  cross-system and cross-organization descriptions
  of common units of data.
• A data registry assists users of shared data to
  have a common understanding of a unit of datas
  meaning, representation, and identification.

Data Elements
NCPDP (National Council for Prescription Drug
Program)
ABCDEFGH..
Data Element
Initiatives
Identifying and Definitional Attributes
Data Element ID 07-329-4837.00000692.v1
Name Gender Code
Context X12 Data
Dictionary Definition
Code indicating the sex of the individual
Status Received as of
01/19/1999 Example
Synonyms/Keywords
Comment Data Collection Methods Relational
and Representational Attributes
Data Type ID Representational Form
Representational Layout
Minimum Size 1 Maximum Size 1
Unit Of Measure
Precision Minimum Range
Maximum Range Data Domain
Permissible value Domain Meaning Name
Domain Meaning

Definition Text A
Not Provided B
Not Applicable F
Female M Male
N Non-sexed
U Unknown X
Unsexable Related Data
References Object Relationship
Related Item Type
Gender Code is composite part of X12 Data
Dictionary Standards Alternate Names and
Contexts Name
Context Gender Code X12 Data
Dictionary 1068 X12 Data
Element Number
X12 (American Standards Committee)
Health Insurance Portability and Accountability
Act...
Transaction Set -Data Element
-Composite Data Element
Data Collections
Person_Sex Gender Sex_Category Code ...
Birth Date Hair Color Eye Color Sex ...
HCFA Long Term Care BRFSS
HL7 (Health Level Seven)
Reference Information Model -Subject Area
-Class -Attributes
Data Agreements
What data elements are used?
Where are data elements defined?
X12 NCVHS Core Data NCPDP
AIHW (Australian Institute of Health and Welfare)
Organizations
Model -Model Subtype -Information Model
Subtype -Data Element -Data
Concept -Composite Data Element
-Derived Data Element
CDC AHCPR NCVHS
Data elements are described in common format.
Codes can be downloaded for use in applications.
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Accomplishments

• HIPAA The Health Insurance Portability and
  Accountability Act
• CHI Consolidated Health Informatics
• HITSP - Healthcare Information Technology
  Standards Panel

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Initiatives

• HIPAA The Health Insurance Portability and
  Accountability Act
• Title II of HIPAA requires the establishment of
  national standards for electronic health care
  transactions and national identifiers for
  providers, health insurance plans, and employers.
• CHI Consolidated Health Informatics
• Adopts a portfolio of existing health
  information interoperability standards (health
  vocabulary and messaging) enabling all agencies
  in the federal health enterprise to speak the
  same language based on common enterprise-wide
  business and information technology
  architectures.
• HITSP - Healthcare Information Technology
  Standards Panel - The mission is to serve as a
  cooperative partnership between the public and
  private sectors for the purpose of achieving a
  widely accepted and useful set of standards
  specifically to enable and support widespread
  interoperability among healthcare software
  applications, as they will interact in a local,
  regional and national health information network
  for the United States.

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Value

• Government programs can use this tool
• To compare their data elements with those in
  USHIK for harmonization
• To develop data elements for new programs based
  on those in USHIK, and
• To stay current with standards developing
  organizations (SDOs) changes in their standards
• To aid in harmonization among States
  Territories
• Certification authorities can use this tool
• To verify that data elements in a given EHR
  system are interoperable with the data elements
  in
• A specific interoperability criterion,
• A specified data standard, or
• Another specific system

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USHIKStrategic Federal Business Use

• Contributes to Presidents eGov initiative
  support (Consolidated Health Informatics
  initiative-CHI)
• Value to Health Information Technology Standards
  Panel (HITSP)
• Using USHIK in each HITSP lifecycle Phase
  1 Gap Analysis Standards Selection Phase 2
  Standard Specificity Phase 3 Interoperability
  Specifications
• Clinger-Cohen Act mandates facilitation of
  eGovernment Citizen business relationships
• USHIK is a focal point to publish federally
  designated health standards, data elements and
  definitions (metadata) online

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USHIK use by HITSP Technical Committees
www.ushik.org

• To support a mapping analysis
• E.g., do two standards have the same demographic
  variables and representations
• To support the gap analysis after the standards
  have been selected by the Technical Committee
• For comparing the required data elements of the
  use case with what the chosen standard contains
• To objectify the standards selection process by
  providing a neutral, identical presentation of
  the candidate standards
• To support giving feedback to the SDOs for
  improving a standard to fit the needs of the use
  case
• Ask the SDO if some specific changes are possible
  to improve interoperability (cross-organizational,
  cross-system data sharing)
• Publish choices and document for long-term
  maintenance

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• Viewpoint for the implementation of HITSP and
  ANSI Technical Committee use case
• Focal point to examine Technical Committee
  standards, data model relationships
• Uniform environment to compare, synchronize,
  harmonize standards overlaps gaps

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How AHRQ and CMS Support HITSP

• By providing a USHIK health information
  specialist assigned to the Technical Committee
  for one use case
• To learn the standards selection process of the
  HITSP TC
• To provide expertise at using USHIK to answer TC
  questions
• To provide expertise at using USHIK to present
  comparisons across standards requested by the TC
• To display choices made by the TC in a standard
  metadata registry format

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How AHRQ and CMS Support HITSP (cont.)

• By providing a potential method for comparing the
  standards choices made by a HITSP TC with those
  choices made by another HITSP TC
• By providing an opportunity for helping HITSP to
  streamline the processes of standards screening,
  selection, and gap analysis

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Comparison Matrix Aids in Harmonizing Data
Elements
www.USHIK.org
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Summary

• USHIK
• Is a Well-advanced Metadata Registry for
  Healthcare Information Standards
• Provides Opportunity to manage a myriad of
  Standards Data Elements
• Offers a Platform from which to closely examine
  Relationships, Overlaps, Gaps
• Forms a Navigable Platform for Browsing and
  Viewing
• Has demonstrated utility for integrating and
  harmonizing healthcare information standards
• Built to an internationally-recognized standard

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Demonstration

• Model-based navigation
• Comparison matrix tool
• Linkage to SDO sites

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• Contacts for www.USHIK.org
• Michael Fitzmaurice, PhD, AHRQ
• Michael.Fitzmaurice_at_ahrq.hhs.gov
• Senior Science Advisor for Information Technology
  Office of the Director, Agency for Healthcare
  Research and Quality
• Laura J. Reece, Ph.D.
• ljreece_at_knowsol.com

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Discussion
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Links to external sites by individual element
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Links to parent generic element on WPC site
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Related Data References example
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Administration screen
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Relationships to other models, agreements,
collections, initiatives
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Role-based Access
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Secure Administrative Interface
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Easy editing interface