chapter 13

Healthcare Data Standards

Standards 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.

Standards can be further categorized:

Those that support the generic
infrastructure and are not domainspecific
Support the exchange of information
and are domain-specific
Support activities and practices within
a specific domain

Healthcare is fundamentally a process

of communication

The term data standards is generally

used to describe those standards
having to do with the structure and
content of health information.

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 linked.

It is necessary to have prior agreement

on the syntax of the messages to be
exchanged.

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
Clinical data exchange

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.

Institute of Electrical and

Electronic Engineers

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.

802.11- most widely known standard and commonly

referred to as Wi-Fi, allows to connect to the Internet
wirelessly through a myriad access points installed.

Many healthcare organizations are currently

evaluating and implementing wireless solutions that
support point-of-care technology.

National Electrical
Manufacturers Association

In collaboration with the American

College of Radiologists(ACR) and others,
the NEMA formed the DICOM to develop a
generic digital format and a transfer
protocol for biomedical images and
image-related information.

DICOM standard is the dominant

international data interchange message
format in biomedical imaging.

Accredited Standards
Committee X12N/Insurance

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 transaction as
claims, enrollment, and eligibility in health plans, and
first report of injury under the requirements of the
HIPAA.

The policies for protection of personal health

information from country to country are primarily
used in the United States due to the uniqueness of
health insurance.

Standards Coordination
Efforts

It has become clear to both public and

private sector standards development
efforts that no one entity has the
resources to create an exhaustive set
of health data standards that will meet
all needs.

International Organization of
Standardization

ISO is an organization that develops

and publishes standards
internationally.

Developed from standards brought

forth by member countries, and
through liaison activities with other
SDOs.

European Technical Committee for

Standardization

CEN TC 251 works to develop a wide

variety of standards in the area of
healthcare data management and
interchange.

CEN standards are adopted by its

member countries in Europe and are
also submitted for development into
ISO standards.

American National
Standards Institute

ANSI serves as the coordinator for

voluntary standards activity in the U.S.

1991- the ANSI Healthcare Informatics

Standards Planning Panel was
convened to act as a coordinating
forum for both SDOs and other
stakeholders in the area of health
information standards.

Object Management Group

OMG is an international consortium of

over 800 organizations, primarily forprofit vendors of information systems
technology, who are interested in the
development of standards based on
object-oriented technologies.

Health Insurance Portability and

Accountability Act

Administrative overhead includes:

Tasks as enrolling an individual in a health plan

Paying health insurance premiums
Checking insurance eligibility
Getting authorization to refer a patient to a specialist
Filing a claim for insurance reimbursement for
delivered healthcare
Requesting additional information to support a claim
Coordinating the processing of a claim across
different insurance company
Notifying the provider about the payment of a claim

The healthcare industry has been

attempting to develop standards to allow
these transactions to be accomplished
electronically, but it has been very
difficult to get voluntary agreement from
all of the competing parties involved to
adopt a uniform set of such standards.

The administrative simplification subtitle

of the HIPAA represents the first time that
the federal government has mandated
health data standards on a national level.

National Committee on Vital and Health

Statistics Subcommittee on Standards
and Security
o

The administrative simplification

provisions also begin the process of
addressing the broader standards issues
of electronic healthcare records in general.

Consolidated Health
Informatics

The goal of this project is to develop and

implement a standard means of
exchanging and managing health
information across federal health
providers.

It is focusing on creating interoperability

between health information systems in
terms of how data are defined, structured,
and exchanged.

Framework for Strategic Action

Dr. Brailer has submitted a report that outlines a

framework for a strategic plan that will help the
nation to realize a new vision for healthcare made
possible through the use of information technology.
These goals convey the vision for consumer-centric
and information-rich healthcare.

Goal 1: Inform clinical practice

Incentive EHR adoption
Reduce risk of EHR investment
Promote EHR diffusion in rural and underserved
areas
Goal 2 : Interconnect clinicians
Foster regional collaborations
Develop a national health information network
Coordinate federal health information systems

Goal 3: Personalize care

Encourage use of PHRs
Enhance informed consumer choice
Promote use of telehealth information systems
Goal 4: Improve population health
Unify public health surveillance architectures
Streamline quality and the health status monitoring
Accelerate research and dissemination of evidence

The Business Value of

Data Standards

Having data standards for data

interchange and information modeling
will provide a mechanism against which
deployed systems can be validated.

Defining information exchange

requirements will enhance the ability to
automate interaction with external
partners which in turn will decrease a
costs.