Healthcare Informatics Standards Board United States Health Information Knowledgebase (USHIK) Metadata Registry Project

1. Healthcare Informatics Standards BoardUnited States Health Information Knowledgebase (USHIK)Metadata Registry Project Health Level Seven May 8, 2001 Glenn M. Sperle 410 786-4610 / gsperle@hcfa.gov

2. Preview • Provide Status of Metadata Registry Project • Review • Vision • Current Status • Metadata Registry Overview • Health Insurance Portability and Accountability Act (HIPAA) Perspective

3. Metadata Registry Project Vision: To provide and maintain a metadata registry of health information data element definitions, values, and information models which will enable browsing, comparison, synchronization, and harmonization within a uniform query and interface environment.

4. Metadata Registry Project Scope: The Knowledgebase will be initially populated with the data elements and information models of Standards Development Organizations (SDO), in such as way that public and private organizations can harmonize their information formats with SDO driven standards.

5. Current Status (i) • The Healthcare Informatics Standards Board (HISB), seven Standards Development Organizations (SDOs), and six other organizations are participating loading and enhancing a metadata registry. • The Mayo Foundation is managing a HISB work unit that oversees the USHIK project.

6. Current Status (ii) • The Health Care Financing Administration and the Department of Defense, Health Affairs are providing operational support. • The National Institute of Health, National Cancer Institute has offered to host the USHIK (www.ushik.org).

7. Current Status (iii) • Participating SDOs are: • Accredited Standards Committee - X12 Subcommittee N - Insurance (X12N) • American Dental Association (ADA) • American Society for Testing and Materials Committee E31 on Healthcare Informatics (ASTM E31)

8. Current Status (iv) • Participating SDOs are: • Health Industry Business Communications Council (HIBCC) • Health Level Seven (HL7) • Medical Device Communications Industry Group (IEEE 1073) • National Council for Prescription Drug Programs (NCPDP)

9. Current Status (v) • Other participating organizations are: • Centers for Disease Control and Prevention (CDC) • Department of Defense, Health Affairs (DoD HA) • National Institute of Health, National Cancer Institute • National Committee on Vital and Health Statistics (NCVHS)

10. Current Status (vi) • Other participating organizations are: -- Government Computer-Based Patient Record Project (G-CPR - Department of Defense, Health Affairs (DoD HA), Department of Veteran Affairs (VA), and Indian Health Service (IHS)) • Health Care Financing Administration, End Stage Renal Disease Program (HCFA ESRD)

11. Metadata Loading Progress

12. Metadata Registry Overview • A metadata registry is a place to keep facts about characteristics of data that are necessary to clearly describe, inventory, analyze, and classify data. • A metadata registry supports data sharing with cross-system and cross-organization descriptions of common units of data. • A metadata registry assists users of shared data to have a common understanding of a unit of data’s meaning, representation, and identification.

13. Methods of Finding Data Elements References to Authoritative Sources Metadata Registry Overview Data Elements NCPDP (National Council for Prescription Drug Program) ABCDEFGH.. Identifying and Definitional Attributes: Data Element ID : 07-329-4837.00000692.v1 Name : Gender Code Context : X12 Data Dictionary Definition : Code indicating the sex of the individual Status : Received as of 01/19/1999 Example : Synonyms/Keywords : Comment : Data Collection Methods : Relational and Representational Attributes: Data Type : ID Representational Form : Representational Layout : Minimum Size : 1 Maximum Size : 1 Unit Of Measure : Precision : Minimum Range : Maximum Range : Data Domain: Permissible value Domain Meaning Name Domain Meaning Definition Text A Not Provided B Not Applicable F Female M Male N Non-sexed U Unknown X Unsexable Related Data References: Object Relationship Related Item Type Gender Code is composite part of X12 Data Dictionary Standards Alternate Names and Contexts: Name Context Gender Code X12 Data Dictionary 1068 X12 Data Element Number Data Element Initiatives X12(American Standards Committee) Health Insurance Portability and Accountability Act... Transaction Set -Data Element -Composite Data Element Data Collections … Person_Sex Gender Sex_Category Code ... … Birth Date Hair Color Eye Color Sex ... HL7(Health Level Seven) HCFA Long Term Care BRFSS Reference Information Model -Subject Area -Class -Attributes Data Agreements What data elements areused? Where are data elements defined? X12 NCVHS Core Data NCPDP NHIM (National Health Information Model of Australia) Organizations Model -Model Subtype -Information Model Subtype -Data Element -Data Concept -Composite Data Element -Derived Data Element CDC AHCPR NCVHS Models Data elements are described in common format. HL7-RIM DoD HA FAM-D AIHW Codes can be downloaded for use in applications.

14. Data elements are described in common format (i)

15. Data elements are described in common format (ii)

16. Data elements are described in common format (iii)

17. Data elements are described in common format (iv)

18. Data elements are described in common format (v)

19. Data elements are described in common format (vi)

20. Data elements are described in common format (vii)

21. Data elements are described in common format (viii)

22. High Level Graphics Provide Owners Perspective of Data Elements (i) National Council for Prescription Drug Programs Version 1.2

23. High Level Graphics Provide Owners Perspective of Data Elements (ii) National Committee on Vital and Health Statistics Core Health Data Elements - August 1996

24. High Level Graphics Provide Owners Perspective of Data Elements (iii) Accredited Standards Committee - X12 Subcommittee N - Insurance (X12N)

25. High Level Graphics Provide Owners Perspective of Data Elements (iv) Government Computer-based Patient Record (G-CPR) Reference Terminology Model - February 2001

26. High Level Graphics Provide Owners Perspective of Data Elements (vi) ADA/ANSI 1000 Specification Subject Areas

27. Another Perspective High Level Graphics Provide Owners Perspective of Data Elements (vii)

28. USHIK Uses NIHM to Group Data Elements National Health Information Model of Australia(NIHM) (Version 2)

29. USHIK Data Elements are Mapped to NHIM Model Views National Health Information Model of Australia (Version 2) Model Views Person Characteristic State of Health and Wellbeing ... Person View ... Data Elements ... Legal Characteristic Demographic Characteristic Belief Attitude Race or Ethnicity Code Sex Code Gender code Citizenship Status Code

30. Data Elements Mapped by Different Organizations Appear Together X12 Data (0060-07-329- Element 4837 Registration Authority) NCPDP Data Element (0060-02-166-0014 Registration Authority)

31. Comparison Matrix Aids in Harmonizing Data Elements

32. Heath Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Provisions Overview The USHIK focuses on the data elements that are used in the transactions and code sets covered by the HIPAA legislation from the following perspectives: Transaction Implementation Guides Medical Data Code Sets Transaction Users

33. Heath Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Provisions Designated Standard Maintenance Organizations manage HIPAA data element change requests through the HIPAA Transaction Standard Change Request System. For HIPAA policy and regulations see the Health and Human Services Administrative Simplification Web Site.

34. Data Elements from the HIPAA Standard Transaction Implementation Guides - Overview NCPDP (National Council for Prescription Drug Programs) X12N (Accredited Standards Committee X12 Subcommittee N -Insurance) HL7 (Health Level Seven) Data Element Dictionary 270/271: Health Care Eligibility/ Benefit Inquiry and Information Response 276/277: Health Care Claim Status Request and Response 278: Health Care Services Review -- Request for Review and Response 820: Payroll Deducted and Other Group Premium Payment for Insurance Products 834: Benefit Enrollment and Maintenance 835: Health Care Claim Payment / Advice 837: Health Care Claim: Institutional 837: Health Care Claim: Dental 837: Health Care Claim: Professional Telecommunication Standard Format 5.1 Batch Standard, Version 1 Release 0 277/275: DRAFT Health Care Claim Request for Additional Information and Response / HL7 Implementation Guide for Additional Information to Support a Healthcare Claim or Encounter

35. HIPAA Standard Medical Data Code Sets (i) • Overview • International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), Volumes 1 and 2 for:diseases, injuries, impairments, other health related problems...,causes of injury... • International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), Volume 3 Procedures for: prevention, diagnosis, treatment, management

36. HIPAA Standard Medical Data Code Sets (ii) • National Drug Codes (NDC) for: drugs, biologics • Code on Dental Procedures and Nomenclature (www.ada.org) for: dental services

37. HIPAA Standard Medical Data Code Sets (iii) • Combination of Health Care Financing Administration Common Procedure Coding System (HCPCS) and Current Procedural Terminology, Fourth Edition (CPT4) (www.ama-assn.org)for: physician services, other health related services • HCPCS for: all other substances, equipment, supplies…

38. Provider Information Subscriber Information Health Service Review Req Add’l Info Claim/Encounter Information Req Add’l Info ClaimStatus HIPAA Transaction Users Overview Providers Health Plans Sponsors Pharmacy 274 Provider Information Provider Information 274 834 270 277 Subscriber Information Subscriber Information 271 275 271 Premium Bill Premium Bill 820 278 Enrollment Health Service Review 277 E1 B1 C1 N1 Eligibility Verification Attachment 275 P1 P4 837 Prior Authorization Claim/Encounter Information 835 B3 Attachment 277 N3 275 C3 Claim or Service or Information Acceptance Adjudication History (& Plan Parameters 276 ClaimStatus P3 277 835 COB Claim/Encounter Professional Services Attachment

39. HIPAA Designated Standards Maintenance Organizations Overview ANSI Standards Development Organizations Data Content Organizations Accredited Standards Committee X12 NationalUniform Claim Committee National Uniform Billing Committee Health Level Seven Dental Content Committee American Dental Association National Council for Prescription Drug Programs Workgroup for Electronic Interchange (consultant to the Secretary) HIPAA Transaction Change Request System

40. Future • Loading of metadata into USHIK is continuing. • Policy recommendation on downloading capability and versioning are being formulated. • New capabilities are being documented via Use Cases. • HISB will manage the release of the new USHIK.