CHAPTER 13

HEALTHCARE DATA STANDARDS

Joyce Sensmeier

OBJECTIVES

Discuss the need for data standards in healthcare.

Describe the standards development process
Identify standards development organizations (SDOs).
Describe healthcare data standards initiatives.
Explore the business value of data standards.

KEY WORDS

 Standards
 Health data interchange
 Terminology
 Knowledge representation

S TANDARDS are critical components in the development and implementation of an

electronic health record (EHR).The effectiveness of healthcare delivery is dependent on the
ability of clinicians to access critical health information when and where it is needed.

-The ability to exchange health information across organizational and system boundaries,
weather between multiple departments within a single institution or among a varied cast of
providers, payers, regulators, and others is essentials

 HEALTHCARE DATA STANDARDS is examine in terms of the following:

 Need for healthcare data standards
 Healthcare data interchange standards
 Healthcare terminologies
 Knowledge representations
 Healthcare data standards development
 Healthcare data SDOs
 Healthcare data standards initiatives
 Business value of data standards

 NEED FOR HEALTHCARE DATA STANDARDS

 -Data standards is applied to healthcare include the “methods, protocols, terminologies,
and specifications for the collection , exchange, storage, and retrieval of information
associated with healthcare applications, including medical records, medications,
radiological images, payment and reimbursement, medical devices and monitoring system,
and administrative processes”(Washington Publishing Company 1998).

-Standards can be further categorized as those that supports the generic infrastructure and
are not domain-specific, those that support the exchange of information and are domain-specific,
and those that support activities and practices within a specific domain.

 EXAMPLES:
 1ST TYPE OF STANDARD
-includes equipment specifications such as processor type or network transmissions
protocols such as Ethernet or token ring.

 2ND TYPE OF STANDARD

-typically involves the specification of data structures and content and would include
such standards as message formats and core data sets.

 3RD TYPE OF STANDARD

-addresses the interpretation of that data as information, including how should be it
acted on within a particular context. An example of this type of standard would be
professional practice guidelines. It is the second class standards.

-Healthcare is fundamentally a process of communication .Verbal communication

between a patient and a healthcare provider characterized this process. The temporal and
physical proximity of the communicators provided ample opportunity to clarify any
ambiguity regarding the intended meaning of what was being communicated.
-Data standards are an attempt to reduce the level of ambiguity in the communication
of data so that actions taken based on the data are consistent with the actual meaning of
the data.
-The term “data standards” is generally used to describe those standards having to do
with the structure and content of health information, it may be useful to differentiate
data, information, and knowledge. Data are the fundamental building blocks on which
healthcare decisions are based. Data are collections of unstructured, discrete entities
(facts) that exist outside of any particular context. When data are interpreted within a
given context and given meaningful structure within that context, they become
information. When information from various contexts is aggregated following a
 defined set of rules , it becomes knowledge and provides the basis for informed action
(Saba and McCormick,2000).

 HEALTHCARE DATA INTERCHANGE STANDARDS

-Data interchange standards address, primarily the format of messages that are
exchanged between computer systems, document architecture, clinical templates,
user interface, and patient data linkage (committee on data standards for patient safety,
2004).
-The following section describes some of the major organizations invoved in the
development of data interchange standards.

 MESSAGE FORMAT STANDARDS

-Four broad classes of message format standards have emerged in the healthcare
sector: medical device communications, digital imaging communications,
administrative data exchange, and clinical data exchange.
-The National Committee on Vital and Health Statistics (NCVHS) was called on to
“study the issues related to the adoption of uniform data standards for patient medical
record information (PMRI) and the electronic exchange of such information.” This
public-private partnership has recommended that several message format standards be
adopted for federal healthcare services programs including Health Level Seven (HL7)
(v2.2 and later), Digital Imaging Communication in Medicine Standards Committee
(DICOM), National Council for Prescription Drug Programs (NCPDP), SCRIPT and
Institute of Electrical and Electronic Engineers (IEEE) 1073.

 INSTITUTE of ELECTRICAL and ELECTRONIC ENGINEERS

-The IEEE has developed a series of standards known collectively as P1073
Medical Information Bus (MIB), which support real-time, continuous, and
comprehensive capture and communication of data from bedside medical devices
such as those found in intensive care units, operating rooms, and emergency
departments. This data include physiologic parameter measurements and data
settings.
-The IEEE 802.xx suite of wireless networking standards, 802.11, 802.16, has
stirred up developments in an otherwise sluggish communications market. The most
widely known standard, 802.11, commonly referred to as Wi-Fi, allows anyone with
computer and either a plug-in card or built-in circuitry to connect to the internet
wirelessly through a myriad access points installed in offices, hotels , and among other
locations.
 NATIONAL ELECTRICAL MANUFACTURERS ASSOCIATION
-The National Electrical Manufactures Association (NEMA), in collaboration with
the American College of Radiologist (ACR) and others, formed the DICOM to develop
a generic digital format and a transfer protocol for biomedical images and image-related
information.
-The DICOM standard is the dominant international data interchange message
format in biomedical imaging.
-Joint NEMA/ The European Coordination Committee of the Electro medical
Industry/Japan Industries Association of Radiological Systems (COCIR/JIRA) Security
and Privacy Committee (SPC) has recently issued a white paper which provide a guides
for the vendors and users on how to protect medical information systems against viruses,
Trojan horses, denial of service attacks, internet worms, and related forms of so called
“malicious software.”

 ACCREDITED STANDARDS COMMITTEE X12N/INSURANCE

-Accredited standard committee (ACL) X12N has developed a broad range of
electronic data interchange (EDI) standards to facilitate electronic business transactions.
-X12N standards have been adopted as national standards for such administrative
transactions as claims, enrolment, and eligibility in health plans, and first report of
injury under the requirements of the HIPAA.

 NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS

-The NCPDP develops standards for information processing for the pharmacy
services sector of the healthcare industry.

 TERMINOLOGIES
-A fundamental requirement for effective communication is the ability to
represent concepts in an unambiguous fashion between both the sender and receiver of
the message.
-Standardized terminologies enable data collection at the point of care, and
retrieval of data, information, and knowledge in support of clinical practice.

 EXAMPLES THAT DESCRIBE SEVERAL OF THE MAJOR SYSTEMS

International Statistical Classification of Diseases and Related Health

Problems: Ninth Revision and Clinical Modifications
- (ICD-9-CM) is the latest version of a mortality and morbidity
classification that originated in1893 (WHO, 1980).
International Statistical Classification of Diseases and Related Health
Problems: Tenth Revision
- (ICD-10) is the most recent revision of the ICD classification system
for mortality and morbidity, which is used worldwide. The ICD-10 also
encompasses nomenclature structures (WHO, 1992)

Current Procedural Terminology, Fourth Revision

- (CPT-4) is a listing of descriptive terms and codes for reporting
medical services and procedures.

Systemized Nomenclature of Human and Veterinary Medicine International,

Clinical Terms
-(SNOMED) is a comprehensive, multiaxial nomenclature and
classification system created for indexing human and veterinary medical
vocabulary, including signs and symptoms, diagnoses, and procedures (College
of American Pathologists, 1993)

Logical Observation Identifiers Names and Codes

-(LOINC) provides a set of universal names and numeric identifier
codes for laboratory and clinical observations and measurements in a database
structure.

RxNorm
-is a clinical drug nomenclature produced by NLM, in consultation with
the Food and Drug Administration (FDA), the Department of Veterans Affair
(VA),and HL7 SDO. RxNorm provides standard names for clinical drugs (active
ingredient + strength + dose form) and for dose forms as administered. It
provides links from clinical drugs to their active ingredients, drug components
(active ingredients +strength), and some related brand names.

Unified Medical Language System

-Currently the (UMLS) consist of a metathesaurus of terms and
concepts from dozens of vocabularies; a semantic network of relationships
among the concepts recognized in the metathesaurus; and an information sources
map of the various biomedical databases referenced.

Data Content Standards

-The concept of a minimum data set is that of “ a minimum set of items
with uniform definitions and categories concerning a specific aspects or
dimension of the healthcare system which meets the essential needs of multiple
users.” A related concept is that of a core data element. It has been defined as “ a
standard data element with a uniform definition and coding convention to collect
data on persons and on events or encounters”

National Uniform Claim Committee Recommended Data Set for a

Noninstitutional Claim
-The NUCC was organized in 1995 to develop, promote, and
maintain a standard data set for use in noninstitutional claims encounter
information. The current NUCC data set forms the basis for the proposed for
national adoption under HIPAA.

Standard Guide for Content and Structure of the Computer-Based Patient

Record (ASTM E1384-96)
- (E1384-96) provides a framework vocabulary for the computer-
based patient record (CPR) content. It proposes a minimum essential content
drawn from a developing annex of dictionary elements.
- A new work item being proposed by the E31 subcommittee is the
continuity of care record (CCR). The CCR is a core data set of the most relevant
and timely facts about a patient’s healthcare. It is to be prepared by a practitioner
at the conclusion of a healthcare encounter in order to enable the next
practitioner to readily access such information.