National Interoperability Standards and USHIK

1. National Interoperability Standards and USHIK Public Health Data Consortium’s 2009 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality November 12, 2009

2. Does anything exist? • Cogito, Ergo Sum • Rene Descartes

3. When I think of all the HITSP products • My brain hurts—so many “constructs” • How do I grasp the power of what HITSP has done? • USHIK.ahrq.gov

4. USHIK—a National Metadata Registry US Health Information Knowledgebase AHRQ-USHIK 4

5. USHIK—a National Metadata Registry • AHRQ-USHIK is an AHRQ-funded and managed metadata registry of • Data elements endorsed, accepted, and recognized by the HHS Secretary for federal agencies’ use • An organized collection of data elements and their characteristics (metadata)—ISO/IEC 11179 • USHIK contains data elements from National Interoperability Standards for • HIPAA transactions • Consolidated Health Informatics Domains • Health Information Technology Standards Panel (HITSP)

6. AHRQ-USHIK • Mission: To represent AHRQ with excellent service • Specific Goal: To be an organized set of repositories that coordinates the data elements and their metadata from health data standards that the HHS Secretary has endorsed, accepted, and recognized, including ARRA data elements, plus AHRQ’s patient safety elements • Why: To improve the uniformity, accuracy, and computerization of health data for researchers and decision makers, including providers, patients, plans, and payers • Improves clinical and administrative data used for research • Speeds applications of research tools developed from these data

7. Bridge: Normal Deck of 52 Cards • Data element name(1 of 52): 4 of spades • Attributes (Metadata): • Definition playing card • Number 4 • Suit spades • Odd/even even • Picture card No • Authority You, or Hoyle • Version or date effective 12-14-1917 • Bridge deck member Yes • Pinochle deck member No • Euchre deck member No • Poker deck member Yes

8. Card Metadata Registry • Each game master is the authority for its game’s cards • The same card can be used in different games • The same metadata about a card can be reused many times, in a metadata registry • Bridge: all 52 cards • Euchre: 24 cards, all higher than an 8 • Pinochle: 48 cards, all higher than an 8, duplicated • Poker: all 52 cards • In total, it would take 176 cards for each of you to display the cards for your games with separate decks

9. What cards are needed to play? Bridge Euchre Pinochle Poker Deck of 52 CARDS Not 176

10. AHRQ-USHIK Data Element • Data Element: Gender code • Attributes (Metadata): • Definition For eligibility, id gender of the individual member • Context NCPDP Data Dictionary • Registration. Authority NCPDP • Effective date 2001-11-27 • Data type Numeric extended • Represent. Layout X(1) • Value Domain Gender, coded_VD • Codes M (male), F (female), U (unknown)

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

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

13. 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

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

15. ARRA Incentive Payments to Providers • American Recovery and Reinvestment Act of 2009 (Feb. 17, 2009) provides • Up to $44,000 starting in 2011 through 2015 for Meaningful Use of Certified EHRs by eligible Providers • Meaningful Use --- so that patients will get value • Certified --- to reduce market risk to EHR purchasers about the EHR’s capabilities for them to engage in Meaningful Use activities

16. Simple Hypothetical Diagram Standards Recommendations for Meaningful Use and 8 other areas ARRA Health providers HHS Secretary CMS/ONC ONC Meaningful use definition HITSP HITPolicy HIT Standards

17. Simple Hypothetical Diagram ARRA Federal Agencies HHS Secretary ONC ONC HITSP Other bodies CCHIT Other bodies HITPolicy HIT Standards

18. Simple Hypothetical Diagram AHRQ USHIK ARRA Federal Agencies HHS Secretary ONC ONC CCHIT Other bodies HITSP Other bodies HITPolicy HIT Standards

19. Simple Hypothetical Diagram AHRQ USHIK ARRA Federal Agencies HHS Secretary ONC ONC CCHIT Other bodies HITSP Other bodies HITPolicy HIT Standards

20. Federal Agencies • As required by ARRA, when federal agencies implement, acquire, or upgrade HI systems for exchanging personal health information, they must use systems that meet standards adopted by the HHS Secretary under ARRA. • Federal agencies are similarly bound by Executive Order 13410 (Aug. 2006) to use standards recognized by the HHS Secretary.

21. Federal Agencies must use these Standards per ARRA • a) SPENDING ON HEALTH INFORMATION TECHNOLOGY SYSTEMS.—As each agency … implements, acquires, or upgrades health information technology systems used for the direct exchange of individually identifiable health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet standards and implementation specifications adopted under [ARRA] ... • (b) FEDERAL INFORMATION COLLECTION ACTIVITIES.—With respect to a standard or implementation specification adopted under [ARRA] … , the President shall take measures to ensure that Federal activities involving the broad collection and submission of health informationare consistent with such standard or implementation specification, respectively, within three years after the date of such adoption.

22. Vendors of Certified EHR Systems • The standards and certification criteria are forthcoming in the Federal Register by December 31, 2009, as mandated by ARRA.

23. ushik.ahrq.gov promotes • One-stop shopping for HITSP data elements • Reduced resources for implementing HITSP standards • And for reporting patient safety events in hospitals • Defined authorities for data elements’ meanings • Uniformity of certified EHR content • Movement toward identical data elements • Reconciling inconsistencies within and among HITSP documents and SDO standards • Making available data information from other sources in USHIK for HITSP comparisons and choices • Federal agency and private sector comparisons of their program and product data needs with HITSP data elements

24. What’s New in USHIK • As of July 15, 2009, every HITSP-specified data element is in USHIK and linked to every HITSP construct (document) in which it appears • Developing new, faster data loader • Updating SDO information: X12, NCPDP, HL7 • X12 data elements are being updated in USHIK • 4010 in the USHIK staging server now • 4050 and 5010 generic elements developed next week for loading the following week [Thank you, Steve Bass]

25. What’s New in USHIK • X12 is taking responsibility for properly loading its data elements into USHIK; HITSP should reference them there • NCPDP and HL7 are proposed to follow • **USHIK has a preliminary view of HITSP’s Capabilities and Services Collaborations** • Within IS 07 – EHR Centric Context with links to capabilities, service collaborations, all constructs, data elements, value sets • Not official, but presented for improving understanding and obtaining user comments

26. What’s New in USHIK • AHRQ has recently funded USHIK to: • Develop a State All-Payer Data (SAPD) Metadata Portal • Develop a Meaningful Use Metadata Measure (MUMM) Metadata Analysis and Portal (with Abt Associates, Inc.) • Continue developing AHRQ’s Patient Safety Common Formats Portal • Put HITSP T66 compliant web services in place for external queries of/by USHIK • AHRQ and VA will continue their USHIK partnership—HITSP data elements  Quality Measure domain

27. Where is Value? • Publishing in one place the data elements from the standards’ processes ONC has developed • Being a source for what is required by the President’s and HHS Secretary’s Interoperability Standards—Federal Agencies, Federal Contracts • Supporting federal and private sector efforts to match their programs and products’ data elements with those of Federal Interoperability Standards

28. Finale • See the HITSP Portal Information Models at Ushik.ahrq.gov • See also CDC’s PHIN VADS for public health data value set information at Phinvads.cdc.gov

29. National Interoperability Standards and USHIK Public Health Data Consortium’s 2009 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality November 12, 2009

30. X12 ASTM NCPDP SCRIPT, Batch, Data Dictionary American Dental Association HIPAA HL7 MHS Functional Area Model Public Health Care Data Standards  LOINC IEEE: Medical Device Communications Industry Group (IEEE/ISO 11073) DoD Military Health System NCVHS Clinical Care Classification (Nursing Taxonomy) HITSP AHRQ Patient Safety Events Other sources USHIK Metadata Registry Contents, data elements from