Improving the Population’s Health Through Standards

1. Improving the Population’s Health Through Standards National Center for Health Statistics 2004 Data Users Conference July 14, 2004 Marjorie S. Greenberg, Chief Classifications and Public Health Data Standards National Center for Health Statistics Centers for Disease Control and Prevention

2. Presentation Agenda • The Case for Data Standards • National Committee on Vital and Health Statistics • Clinical Modification of ICD-10 • Dr. David Berglund • International Classification of Functioning, Disability and Health (ICF) • Dr. Paul Placek • Public Health Data Standards Consortium • Dr. Anna Orlova

3. What are Data Standards? • Essential Building Blocks of Information Systems • Classification Systems and Terminologies (e.g., ICD, ICF, SNOMED) • Core Data Sets (vital statistics, hospital discharge data) • Identifiers (provider, plan, individual) • Message formats (e.g., HL-7 and X12) • Implementation Guides • Privacy and Security

4. Why do we Need Data Standards? • Data Standards are the common language that allows: • exchanging information • sharing information • communicating across disciplines and settings • integrating disparate data systems • making comparisons (national, regional and international) • linking data in a secure environment

5. The Case for Data Standards • Data Standards are the fundamental building blocks for : • an effective and efficient health care system • disease surveillance • monitoring the health and health care of the nation • performing outcomes research • providing information for decision making and policy development

6. The Vision • Enhancing the comparability, quality, integrity and utility of health information from a wide variety of public and private sources - at the local, national and international levels - through more uniform data policies and standards

7. The Challenge • Participate in the standards development process • Influence evolution of standards to assure that they meet the needs of public health, health services research and health policy • Comply with standards to reduce provider burden and improve comparability of data • Seize the opportunities for enhanced information capabilities provided by standardization

8. Standards Momentum • Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification Provisions • National Committee on Vital and Health Statistics (NCVHS) work on HIPAA, NHII and ePrescribing • Public Health Data Standards Consortium established in 1999 and evolved into a not-for-profit organization in 2003, growing in membership and scope

9. Standards Momentum • Public Health Information Network (PHIN) • NCHS and States reengineer vital records • Consolidated Health Informatics (CHI) Initiative recommends standards for adoption by the federal enterprise • Secretary Thompson names National Coordinator for Health Information Technology (Dr. David Brailer) • Second annual NHII Conference this month

10. Brief Introduction to Classifications and Public Health Data Standards • Classifications (ICD, ICF and departmental representative to SNOMED CT Editorial Board) • Informatics, Standards Development Organizations and Public Health Data Standards Consortium • Executive Secretariat for National Committee on Vital and Health Statistics

11. Classifications Activities • Maintain ICD-9-CM and develop and implement ICD-10-CM • Promote and implement International Classification of Functioning, Disability and Health (ICF) • WHO Collaborating Center for the Family of International Classifications for North America • Participate in CHI Work Groups • http://www.cdc.gov/nchs/icd9.htm

12. WHO Collaborating Centres for International Classifications • ICD and ICF are maintained and promoted by an international network of WHO Collaborating Centres for the Family of International Classifications • Centres are established by language and geography; North American Center was established at NCHS in 1976 • http://www.who.int/whosis/icd10/collabor.htm

13. The WHO Family of International Classifications Associated ProductsMain Classifications Adaptations

14. Informatics and Public Health Data Standards Consortium • Represent NCHS at Standards Development Organizations (HL-7 and ANSI X12) and Data Content Committees (e.g., National Uniform Billing Committee) • Represent NCHS on American National Standards Institute – Health Informatics Standards Board • Participate in HHS Data Council • Founding members and on Board of Public Health Data Standards Consortium

15. National Committee on Vital and Health Statistics (NCVHS) • Established in 1949 • Legislatively authorized since 1974 • Advisory to Secretary of HHS on national health information policy • History of involvement in • classifications • uniform and core data sets • surveys, vital statistics, population-based data • data for populations at special risk • http://www.ncvhs.hhs.gov/

16. National Committee on Vital and Health Statistics (NCVHS) • Provides a bridge between government and the health industry, research and public health communities and connections to those working on health information policy in other countries. • Eighteen members who have distinguished themselves as researchers, educators and practitioners in a number of fields

17. NCVHS Structure • Executive Subcommittee • Workgroup on National Health Information Infrastructure (NHII) • Subcommittee on Standards and Security • Subcommittee on Privacy and Confidentiality • Subcommittee on Populations • Workgroup on Quality

18. NCVHS Standards Visions • Report on NHII • Standards for Administrative Transactions and Patient Medical Record Information • Standards for Privacy • Vision for 21st Century Health Statistics • Reports on Classifying and Reporting Functional Status (2001) and on Data for Measuring and Eliminating Health Disparities (forthcoming)

19. National Health Information Infrastructure (NHII) Report

20. NHII Dimensions

21. NCVHS Report NHII • NHII includes not just technologies but values, practices, relationships, laws, standards, systems and applications that support all facets of individual health, health care, and public health • It is not a centralized data base but an infrastructure • Broad goal is to deliver information to individuals when and where they need it

22. NCVHS Report on NHII • Equal importance is attached to personal (consumer), healthcare provider (clinical) and population health dimensions • The recommended strategy gives the U.S. Department of Health and Human Services a key leadership role at the center of a broadly collaborative process for the public and private sectors

23. National Committee on Vital and Health Statistics • Administrative standards • Transactions (e.g., claim) • Code sets (e.g., ICD-9-CM, ICD-10-CM) • Identifiers (e.g., provider) • Security • http://aspe.hhs.gov/admnsimp/ • In November 2004, recommended U.S. begin rulemaking to migrate to ICD-10-CM and ICD-10-PCS

24. Standards for Patient Medical Record Information (PMRI) • HIPAA required NCVHS to study issues and report to Secretary by August 2000 on recommendations and legislative proposals for • Uniform data standards for patient medical record information • Electronic exchange of such information • First report issued in 2000

25. Standards for PMRI and Electronic Health Records • NCVHS held hearings on message format standards in 2000-2001 and issued specific recommendations in February 2002: • Recognize HL7 as core PMRI standard • HL7 versions 2.2+ are current standard • HL7 version 3 is emerging standard • Recognize DICOM, NCPDP SCRIPT and IEEE 1073 as standards for specific market segments • CHI adopted these standards in 2003

26. Standards for PMRI and Electronic Health Records • Hearings held on PMRI Terminology Standards in 2003 – 2004 • Report to Department in Nov. 2004 recommended a “core set” of terminology standards • SNOMED CT • LOINC • Federal Drug Terminologies, including RxNorm • CHI adopted many of these recommendations

27. Standards for PMRI and Electronic Health Records • Medicare Modernization Act of 2003 required NCVHS to submit recommendations to DHHS on ePrescribing standards by June 2005 • NCVHS is holding hearings, will have preliminary recommendations in 2004

28. Vision for 21st Century Health Statistics • Collaborative project of NCVHS, NCHS and HHS Data Council • Final vision includes ten guiding principles and an overarching conceptual framework • Compatible standards serving multiple purposes is one of guiding principles • NCVHS has approved recommendations for implementing principles and framework

29. Other NCVHS Recommendations in 2003-2004 • Several letters on implementing the HIPAA Privacy Rule, including implications for public health and research • Work Group Report on measuring quality • Letters on collection of racial and ethnic data by health plans and surveys • Letters on HIPAA implementation readiness and related standards

30. Resources • http://www.cdc.gov/nchs.icd9.htm • http://www.ncvhs.hhs.gov • http://www.phdatastandards.info • http://aspe.os.dhhs.gov/admnsimp • http://www.hl7.org • http://www.ansi.org/ • http://www.whitehouse.gov/omb/egov/gtob/health_informatics.htm