Health Care and Data Standards

•Standards are critical components in the development & implementation of an electronic health record (EHR). These are essential for the effectiveness of healthcare delivery:- ability of clinicians to access critical health information- ability to exchange health information across boundaries- common set of rules and definition- sociopolitical structure in place that recognizes the benefits of shared information & supports adoption & implementation of those standards

•NEED FOR HEALTHCARE DATA STANDARDS

Data standards as applied to healthcare include "methods, protocols, terminologies & specifications for the collection, exchange, storage & retrieval of information associated w/ healthcare applications, including medical records, medications, radiological images, payment & reimbursement, medical devices & monitoring systems, and administrative processes. " (Washington Publishing Company, 1998)

•Standards can be further categorized as:- those that support the generic infrastracture & are not domain-specific (1st type)- those that support the exchange of information & are domain-specific (2nd type)- those that support activities & practices w/in a specific domain (3rd type)

•Examples:1st = processor types or network transmission protocols like Ethernet2nd = message formats & core data sets3rd = professional practice guidelines

While the term "data standards" is generally used to describe those standards having to do w/ the structure & content of health info, it may be useful to differentiate data, information & knowledge.

•Data - collections of unstructured, discrete entities (facts) that exist outside of any context- They became INFORMATION when data are interpreted w/in a context & given meaningful structure.- When information is aggregated following a defined set of rules, it becomes KNOWLEDGE

Data standards represent both data & their change into information.

•HEALTHCARE DATA INTERCHANGE STANDARDS

- address the format of messages that are exchanged between computer systems, documents, clinical templates, user interface & patient data linkage

To achieve compatability between systems, having prior agreement on the syntax of messages to be exchanged is necessary.

•* Message Format Standards

Four broad classes of message format standards:- medical device communications- digital imaging communications- administrative data exchange- clinical data exchange

•The National Committee on Vital and Health Statistics (NCVHS) - advisory committee established to make recommedations on health info policy to the Department of Health & Human Services & Congress- under HIPAA of 1996, NCVHS was called on to "study the issues related to the adoption of uniform data standards for patient medical record info (PMRI) and electronic exchange of these info."

•Organizations which developed the standards used by NCVHS:- Institute of Electrical & Electronic Engineers (IEEE)- National Electrical Manufacturers Association (NEMA)- Accredited Standards Committee X12N/Insurance- National Council for Prescription Drug Programs (NCPDP)

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•TERMINOLOGIES

•-ability to represent concepts in an unambiguous fashion between both the sender and receiver

Most communication between health information systems relies on the use of structured vocabularies, code sets and classifications systems.

•Examples:

- International Statistical Classification of Diseases & Related Health Problems: 9th Revision & Clinical Modifications- International Statistical Classification of Diseases & Related Health Problems: 10th Revision- Current Procedural Terminology, 4th Revision- Systemized Nomenclature of Human and Veterinary Medicine International, Clinical Terms- LOINC

•- RxNorm

•In 1986, the U.S. NLM began an ambitious long-term project to map and link a large number of vocabularies from a number of knowledge sources to allow retrieval and integration of relevant machine-readable information. Currently, a met thesaurus of terms and concepts from dozen of vocabularies; a semantic network of relationships among the concepts; an information sources map of the various biomedical databases referenced.

Unified Medical Language System

The concept of a minimum data set “a minimum set of items with uniform definitions and categories concerning a specific aspect or dimension of the healthcare system which meets the essential needs of multiple users.” Core Data Element- a standard data element with a uniform definition and coding convention to collect data on persons and on events or encounters. ~ serving as the building blocks for well-formed minimum data sets may appear in several minimum data sers.

Data Content Standards

•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 Development Process

•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