Using Health IT Standards: Learning from USHIK

1. Using Health IT Standards: Learning from USHIK Public Health Data Consortium’s 2010 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality November 4, 2010

2. Agency for Healthcare Research and Quality (AHRQ) Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

3. New Redskins Wide Receiver • A Turkey?

4. Agenda • What is USHIK • A metadata registry • Supporting the HHS Secretary’s Initiatives • Why is it important? • To AHRQ • For Quality Measures • Who developed it? • How is USHIK relevant to Quality Measures

5. What is a Metadata Registry? • Metadata is data about data—data element information such as semantics and representations • A metadata registry is a central location where data elements and their metadata (names, definitions, representations, other characteristics) are stored and maintained in a controlled method. For example, birth date may have the following metadata: • AttributesExamples • Names Birth date • Definitions Year, day, time of a person’s birth • Representations 201008132137 or YYYYMMDDHHMM • Contextual meaning When was your baby born? • Other information e.g., When is it in effect? Who is the authority? • ISO/IEC 11179 is an international standard for metadata registries, and widely used • Metadata registries are used [and desirable] whenever data must be used consistently within an organization or group of organizations

6. What is the US Health Information Knowledgebase (USHIK)? • AHRQ-USHIK is an AHRQ-funded and managed metadata registry of • Data elements endorsed, accepted, and recognized by the HHS Secretary for federal agencies’ uses, plus more • USHIK contains data elements from: • The President’s National Interoperability Standards • HIPAA transactions • Consolidated Health Informatics domains • HITSP • Quality Measures • Meaningful Use Performance Measures • HITSP Quality Measures • State All Payer Claims Data Metadata • USHIK is publicly available at ushik.ahrq.gov

7. Brief History of USHIK • USHIK was developed by DoD and CMS as a clone to DoD’s metadata registry (MDR), with AHRQ monitoring its progress • From its inception in1998 to the present, USHIK has been supported at times by CMS, DoD, AHRQ, NCI, and VA • It is currently managed and financed (since 2004) by AHRQ • With CMS and VA as partners • USHIK is based on metadata registry implementations at DoD, EPA, and the Australian Institute of Health and Welfare • That correspond to ISO/IEC 11179 Pt. 3, Ed. 2

8. Why is USHIK important to AHRQ? • Good health research requires—and USHIK promotes— uniform, accurate, valid, computerized health data • Improving health data improves the quality of AHRQ’s health research • More specifically, improving health data improves • Communication about patient care • Quality of AHRQ’s health research findings • Robustness of tools developed by AHRQ to use these findings • Uniform and consistent application of quality and other performance measures throughout our health system • Ability of health practitioners to integrate AHRQ’s research findings and tools in their daily practice 8#

9. What does USHIK have: 3 Portals, 2 Pilot Portals • USHIK:Contains all the data elements in all USHIK’s portals • HITSP:ANSI-HITSP data elements linked to all use cases, interoperability specifications, and other documents—as of July 15, 2009 and beyond • Patient Safety Common Formats: Specifications for electronically reporting patient safety events among AHRQ-designated Patient Safety Organizations • Meaningful Use (pilot): Example quality measures and the data elements associated with their numerators, denominators, inclusions, and exclusions, Incentive payment performance measures • State All-Payer Claims Data (pilot): Data element specifications from two states’ all payer data bases

10. What is the Relevance of USHIK to Quality Measures? • When Quality Measures (QM’s) and their metadata are loaded expertly into USHIK • Their specifications are made public • Their specifications are made clear • What is fully specified • What is not • Specific data elements with the same name can be compared accurately across QM’s for consistency—of meaning and representation • Data elements of multiple QM’s can be easily compared to see if “they” are identical • The QM’s • The data elements • The exclusion criteria • The source standards for the data elements, e.g., do they use the same coding system? • QM data elements can be compared with those in existing EMRs to determine if a specific EMR can validly produce a specified QM

11. What data elements are needed for ARRA meaningful use? AHRQ Patient Safety X12N HL7 NCPDP HITSP USHIK

12. Do the data elements in my EHR fit HITSP specifications? X12N HL7 NCPDP HITSP Are My EHR data defined the same as HITSP’s? USHIK

13. How does each authority express gender? X12N HL7 NCPDP HITSP USHIK Gender

14. Do the data elements in my EHR fit HITSP specifications? Meaningful Use X12N HL7 NCPDP HITSP Are My EHR data defined the same as in Meaningful Use? USHIK

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

16. In FY 2011 • USHIK.AHRQ.GOV will remain publicly available • ACPD portal will be expanded with data elements from more states • Patient Safety Common Formats portal will • Be updated as the formats are enhanced • Include common formats for reporting adverse device events • AHRQ will work with CMS and ONC to • improve Health IT data element uniformity • Promote one-stop-shopping for required data elements • Reduce work effort for researchers and other Health IT data users • AHRQ will develop more working relationships with HHS agencies

17. Using Health IT Standards: Learning from USHIK Public Health Data Consortium’s 2010 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality Michael.fitzmaurice@ahrq.hhs.gov November 4, 2010