Applied Informatics

1. Applied Informatics Health IT Standards Unit 2 Lesson 1

2. Lesson Overview

3. 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

4. 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

5. Standards Development Methods • Four methods used to establish health care IT standards • Ad hoc • De facto • Government mandate • Consensus

6. Standards Development Methods • Ad hoc • A group of interested people or organization agrees on certain specifications, without any formal adoption process

7. 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 • Windows for example

8. 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.

9. Standards Development Methods • Consensus • Representatives from various interested groups come together to reach a formal agreement on specifications • Generally open • Involves considering comment and feedback from the industry • Most health care information standards are developed by this method

10. 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

11. 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)

12. Classification, Vocabulary, and Terminology Standards • In 2003… • Department of Health and Human Services (HHS) identified a core set of PMRI terminology standards • Systemized Nomenclature of Medicine – Clinical terms (SNOMED-CT) • Logical Observation Identifiers Names and Codes (LOINC) laboratory subset • Several federal drug terminologies, including RxNorm

13. 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 • 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) • Nonprofit association in Denmark

14. Standards • Systems Standards • SNOMED-CT • 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

15. 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

16. Classification, Vocabulary, and Terminology Standards • Logical Observation Identifiers Names and Codes • LOINC • 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

17. 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 • UMLS Metathesaurus • Specialist Lexicon • UMLS Semantic Network

18. 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

19. Data Interchange Standards • HL7 • Developed with the purpose to support the “exchange, management, and integration of data that support patient care.” • Highest level in the Open Systems Interconnection (OSI) network

20. 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

21. 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.

22. 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

23. Data Interchange Standards • Digital Imaging and Communications Medicine (DICOM) • Gave rise as a result of the growth of digital diagnostic imaging • 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

24. Data Interchange Standards • DICOM continued • Accomplished by • 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

25. 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 • Standards include • Batch transaction standard, billing unit standard, pharmacy ID Card and many more

26. 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

27. ANSI X12N Standards cont. • Health care business data includes functions such as • Eligibility • Referrals • Authorizations • Claims • Claim status • Payment and remittance advice • Provider directories

28. 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

29. 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

30. 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

31. 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 • 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)

32. Federal Initiatives on Health Care IT 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)

33. 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 • Medicare Modernization Act of 2003 • Tools to be used as outlined by CMS • Formulary and benefit transactions • Medication history transactions • Fill status notifications