Transcript Applied Informatics

Health IT Standards
Unit 2 Lesson 1
Lesson Overview
Lesson Objectives
At the end of this lesson, you will be able to:
 Recognize the needs for HIT standards
 Give examples of four major methods by which
standards are developed – ad hoc, de facto,
government mandate and consensus.
 List different HIT Standards
 Explain different facets of standards
Why do we need Standards?
 Provide the ability for systems to communicate with
each other regardless of the industry
 Standards help achieve:
 Interoperability
 Portability
 Data exchange
Standards Development Methods
 Four methods used to establish health care IT
standards
 Ad hoc
 De facto
 Government mandate
 Consensus
Standards Development Methods
 Ad hoc
 A group of interested people or organization agrees on
certain specifications, without any formal adoption
process
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Standards Development Methods
 De facto
 A vendor or other commercial enterprise controls such a
large segment of the market that its product becomes
the recognized norm
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Windows for example
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Standards Development Methods
 Government Mandate
 When the government states that an industry needs to
adopt something. This would apply not only to health
care but any other industry.
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Standards Development Methods
 Consensus
 Representatives from various interested groups come
together to reach a formal agreement on specifications
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Generally open
Involves considering comment and feedback from the
industry
Most health care information standards are developed by this
method
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Classification, Vocabulary, and
Terminology Standards
 Five (5) main categories of Standards
 Classification,
 Most widely recognized coding and classification
systems
 ICD-9-CM (New ICD-10 mandated for Jan. 2012)
 Current Procedural Terminology (CPT)
 Diagnosis related groups (DRGs)
 Vocabulary,
 Terminology
 Data interchange
 Health record content
Classification, Vocabulary, and
Terminology Standards
 The National Committee on Vital and Health Statistics
(NCVHS)
 Responsibility under HIPAA to recommend uniform
data standards for patient medical record information
(PMRI)
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Classification, Vocabulary, and
Terminology Standards
 In 2003…
 Department of Health and Human Services (HHS)
identified a core set of PMRI terminology standards
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Systemized Nomenclature of Medicine – Clinical terms
(SNOMED-CT)
Logical Observation Identifiers Names and Codes (LOINC)
laboratory subset
Several federal drug terminologies, including RxNorm
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Classification, Vocabulary, and
Terminology Standards
 System Nomenclature of Medicine – Clinical Terms
 SNOMED CT is a comprehensive clinical terminology
developed specifically to facilitate the electronic storage
and retrieval of detailed clinical information
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Result of the collaboration between the College of American
Pathologists (CAP) and the United Kingdom’s National
Health Service (NHS).
 Owned, maintained and distributed by the
International Health Terminology Standards
Development Organization (IHTSDO)
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Nonprofit association in Denmark
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Standards
 Systems Standards
 SNOMED-CT
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Systemized NOmenclature of MEDicine – Clinical Terms
Developed by the College of American Pathologists (CAP)
An international standard
Designed for use in and support of electronic health record
(EHR)
It provides the core general terminology for an EHR
National Center for Health Statistics (NCHS) recommended
the adoption of SNOMED-CT as the general terminology
standard for patient medical record information
Standards
 SNOMED-CT Cont’d
 The process of assigning SNOMED-CT codes is fully
automated
 Codes are embedded in the EHR
 Codes are assigned during the course of patient care
 SNOMED works behind the scene in the EHR - it uses
all the available data and clinical information that the
EHR contains
Classification, Vocabulary, and
Terminology Standards
 Logical Observation Identifiers Names and Codes
 LOINC
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Developed to facilitate the electronic transmission of
laboratory results to hospitals, physicians, third-party payers,
and other users of laboratory data
Provides a standard set of universal names and codes for
identifying individual laboratory and clinical results
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Classification, Vocabulary, and
Terminology Standards
 Unified Medical Language System
 Developed to aid the development of systems that help
health professionals and researchers retrieve and
integrate electronic biomedical information from a
variety of sources
 Three components = knowledge sources
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UMLS Metathesaurus
Specialist Lexicon
UMLS Semantic Network
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Data Interchange Standards
 Four (4) Grouping Standards
 Health Level Seven Standards (HL7)
 Digital Imaging and Communications Medicine
(DICOM)
 National Council for Prescription Drug Programs
(NCPDP)
 ANSI X12N Standards
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Data Interchange Standards
 HL7
 Developed with the purpose to support the “exchange,
management, and integration of data that support
patient care.”
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Highest level in the Open Systems Interconnection (OSI)
network
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HL7 Standards
 Health Level Seven International (HL7) is the global
authority on standards for interoperability of
health information technology with members in
over 55 countries.
 HL7's vision is to create the best and most widely used
standards in healthcare
 Designed for clinical and administrative data
HL7
 7 levels of the Open Systems Interconnection (OSI) model.
Level 7 is the application model.
 Mission:
HL7 provides standards for interoperability that improve
care delivery, optimize workflow, reduce ambiguity and
enhance knowledge transfer among all of out stakeholders,
including healthcare providers, government agencies, the
vendor community, fellow SDOs and patients. In all our
processes we exhibit timeliness, scientific rigor and
technical expertise without compromising transparency,
accountability, practicality, or our willingness to pur the
needs of our stakeholders first.
HL7 - Definitions
 Standard
 A standard is a document, established by consensus that
provides rules, guidelines or characteristics for activities
of their results (ISO/IEC Guide 2:1996).
 Interoperability
 Refers to the ability of two or more computer systems to
exchange information, and to use information that has
been exchanged
Data Interchange Standards
 Digital Imaging and Communications Medicine (DICOM)
 Gave rise as a result of the growth of digital diagnostic
imaging
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CAT Scans and MRIs
 Purpose
 Promote communication of digital image information
regardless of device manufacturer
 Facilitate the development and expansion of picture archiving
and communication systems (PACS)
 Allow the creation of diagnostic information databases that
can interface with a wide variety of devices
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Data Interchange Standards
 DICOM continued
 Accomplished by
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Set of protocols for network communication
The syntax and semantics of commands that can be used
Set of media storage services to followed including a file
format and medical directory structure
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National Council for Prescription
Drug Programs (NCPDP)
 Definition
 Creates and promotes standards for the transfer of data
to and from the pharmacy services sector of the
healthcare industry
 Allow for electronic submission of third party drug
claims
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Standards include
 Batch transaction standard, billing unit standard, pharmacy ID
Card and many more
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ANSI X12N Standards
 Developed in 2 formats
 X12
 XML
 Use
 Electronic exchange of business information
 Committee devoted to deal with electronic data
interchange (EDI) standards
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ANSI X12N Standards cont.
 Health care business data includes functions such as
 Eligibility
 Referrals
 Authorizations
 Claims
 Claim status
 Payment and remittance advice
 Provider directories
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Health Record Content Standards
 HL7 EHR
 Provides a reference list of over 160 functions that may
be present in an EHR system
 Enables standardized descriptions of functions by
health care setting
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Health Record Content Standards
 CCR Purpose
 Aggregate essential health care data from multiple
sources in order to provide an overall clinical picture of a
patient’s current and past health status
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Health Record Content Standards
 Key features
 Core data set of the most relevant administrative,
demographic, and clinical information
 Summary of the patients health status and basic
information about insurance, advance directives, care
documentation, and patients care plan
 May be prepared, displayed and transmitted on paper or
electronically
 Primary use is to provide a snapshot in time containing
pertinent clinical, demographic, and administrative data
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Federal Initiatives on Health Care IT
Standards
 HIPAA
 Government mandated that health care organizations
adopt certain standards for electronic transactions.
 Majority of the standards were taken from ASC X12N
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Health Care Claims or equivalent encounter information ( 837)
Eligibility for a health plan (270/271)
Referral Certification and Authorization (278)
Health Care Claim Status (276/277)
Enrollment and Disenrollment (834)
Health care payment and remittance (835)
Health Plan Premium Payments (820)
Coordination of Benefits (837)
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Standards Cont.
 Standard codes set
 International Classification of Diseases, clinical
modifications (ICD-9-CM)
 Code on Dental Procedures and Nomenclature (CDT)
 Healthcare Common Procedure Coding System
(HCPCS)
 Current Procedural Terminology (CPT)
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Centers for Medicare and Medicaid
(CMS) and Medicaid e-prescribing
 E-prescribing
 Defined as the prescribers ability to electronically send
accurate, error-free, and understandable prescription(s)
directly to a pharmacy for the point of care
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Medicare Modernization Act of 2003
 Tools to be used as outlined by CMS
 Formulary and benefit transactions
 Medication history transactions
 Fill status notifications
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