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Networking and Health Information ExchangeNational and International Standards
Developing Organizations
Lecture cThis material Comp9_Unit3c was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
National and International Standards Developing Organizations
Learning Objectives
2
1. Explain why standards related to networking and health information exchange are important in the current environment (Lecture a)
2. Standards development (Lecture a)a. How standards are developedb. Who develops themc. How standards are accreditedd. How standards are selected
Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
National and International Standards Developing Organizations
Learning Objectives
3. Understand different kinds of standards being developed and for what purpose (Lectures a, b)
4. Learn about Standards Developing Organizations and the standards they create (Lectures b, c)
5. Demonstrate how to find, obtain, and use standards that are needed to facilitate networking and health information exchange (Lectures b, c)
3Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
International Health Terminology Standards Development Organization (IHTSDO)
• Purpose is to develop and promote use of SNOMED CT to support the safe, accurate, and effective exchange of health information
4Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
• Formed by American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) in 1983
• Purpose: Create a standard for the transmission of medical images and their associated information
5Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Digital Imaging and Communications in Medicine
– Cardiology– Dentistry– Endoscopy– Mammography– Ophthalmology
DICOM
• DICOM addresses images in: – Orthopedics– Pathology– Pediatrics– Radiation therapy– Surgery – Others
6Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing Organizations
Lecture c
DICOM Functionality• Transmission and persistence of objects
– Images, waveforms, and documents• Query and retrieval of such objects• Performance of specific functions
– Printing images on film, etc.• Workflow management
– Support of worklists and status information• Quality and consistency of image appearance
for display and print
7Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Integrating the Healthcare Enterprise (IHE)
• Purpose is to create a framework for passing health data seamlessly – application to application.
• Does not create standards but drives adoption of existing standards to meet specific needs.
• Supports Connectathon each year at HIMSS
http://ihewiki.wustl.edu/wiki/index.php/Main_Page
8Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
IHE Products
• Integration profiles• Integration statements• Technical frameworks• Connectathon• Showcases
http://ihewiki.wustl.edu/wiki/index.php/Main_Page
9Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
IHE Domains
• Anatomic Pathology• Cardiology• Dental• Endoscopy• Eye Care• IT Infrastructure• Laboratory
http://ihewiki.wustl.edu/wiki/index.php/Main_Page
• Patient Care Coordination
• Patient Care Device• Pharmacy• Quality, Research
and Public Health• Radiation Oncology• Radiology
10Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
ASTM E31 Healthcare Informatics
• Develops standards related to: – Architecture– Content– Storage– Security– Confidentiality– Functionality– Communication of information used within
healthcare 11Health IT Workforce Curriculum
Version 3.0/Spring 2012Networking and Health Information Exchange
National and International Standards Developing Organizations Lecture c
ASTM E31 Key Standards• Continuity of Care Record (CCR) is a core
dataset sent to the next provider whenever a patient is referred, transferred, or uses a different clinic, hospital or other provider
• Standards for medical transcription• Content and structure of the EHR
12Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
ASTM E31 Key Standards• Confidentiality, privacy and security;
authentication and authorization• Guideline Elements Model (GEM)• Quality Indicators• Voluntary Universal Healthcare
Identification System
13Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
ASC X12N• Chartered by ANSI in 1979 to develop
electronic data interchange (EDI) standards.
• Responsible for insurance/ claims/ reimbursement standards.
• HIPAA requires the use of a number of X12N standards.
14Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
X12N Key Standards• 835 – Health Care Claim Payment/Advice• 837 – Health Care Claim• 274 – Health Care Provider Information• 275 – Additional Payer Health Care Information• 277 – Health Care Claim Acknowledgement• 276 – Health Care Claim Status Report• Claims attachment standards – co-developed
with HL7
15Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
National Council for Prescription Drug Programs
(NCPDP)• Create and promote data interchange
standards for the pharmacy services industry.
• NCPDP standards have been named in HIPAA legislation in Medicare Prescription Drug, Improvement, and Modernization Act (Medicare, Part D).
16Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
NCPDP Key Standards• Script (v10.10) – allows communication
between physician and pharmacist• Telecommunication (vD.3) – addresses
data format and content, transmission protocol
• Data dictionary – names and definitions of data elements used in all NCPDP standards
17Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
NCPDP Key Standards• Batch Standard Implementation Guide (IG) (v1.2)• Billing Unit Standard IG (v3.0)• Formulary and Benefit IG (v2.1)• Prescription File Transfer IG (v2.0)• Universal Claim Form (v1.1)
18Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
SDO Charter OrganizationsObjectives
• Create common information model• Define common method for expressing stakeholder
commitments• Leveraging current terminology and data types work• Use common approach to achieve interoperability across
healthcare community• Recognizing roles and responsibilities of stakeholders
and creating an effective outreach to subject matter experts
19Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Standards Categories, Examples, and SDOs (1/2)
3.1 Table Standards Categories, Examples, and SDOs 1/2
20Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Category Examples SDOsGeneric, broad use XML, TCP/IP, Web services,
OCL, OWL, CCOW, GISW3C, IETF, OMG, HL7.
Data definition RIM, data elements, data types, terminology, templates, archetypes, clinical statements
HL7, CEN, ISO, NCPDP, X12N, IEEE, SNOMED, LOINC, RxNorm, SPL, openEHR
Data exchange Structured and free form documents, images, CDA, CCR
HL7, DICOM, ASTM, NCPDP, IEEE, X12N. ISO
Knowledge representation
Guidelines and protocols, Arden Syntax, GLIF, GEM, PRODIGY, PROTIGE, vMR, GELLO, disease management
HL7, ASTM, CEN, openEHR, ISO
Standards Categories, Examples, and SDOs (2/2)
Category Examples SDOs
Electronic Health Record Functional requirements, content data sets, minimum data sets, EHR models, architecture
HL7, ASTM, CEN, openEHR, ISO
Security and Privacy Encoding, encryption, authentication, authorization, integrity, digital signature
IETF, OMG, ASTM, HL7, ISO
Application Identifiers, resource registries, tool sets, conformance requirements, certification, SOA, simulation, implementation manuals
HL7, ASTM, IHE, ISO, CEN
3.2 Table Standards Categories, Examples, and SDOs 2/2
21Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Summary View of Standards
22Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
PlanningPhase Data Data
ExchangeDataStore
Reposi-tories
Collec-tion
DecisionSupport
EHR Applica-
tions
Presen-tation
ISO, CEN, HL7, CDISC, DICOM, IEEE, IHTSDO,LOINC, GS1, IHE, NCPDP, X12, openEHR, WHO/ICD, …
ReportsAudits
Story boardsUse cases
Data modelsRIMMDFDAM
BRIDGSOA
Data Elements
Data typesTerminology
UnitsCMETS
TemplatesArchetypesTemplates
Clinical Statements
CDACCDCTS
CDASH
XFORMTemplates
CDA
HL7 v2HL7 v3CEN 13606IEEE
DICOM ISO
EHR FMPHR FMCCOWGeno-micsISO
Arden SyntaxGELLO
GLIFInfo
buttons
Privacy and Security Standards
Identifiers
Profiles
QueriesFilters
Medical Devices
PHD
New Needs
Supply Chain
DemLabMedsProbsAE
CDW
Getting access to standards
• Standards Knowledge Management Tool– JIC/ISO project sponsored by Université de
Sherbrooke– www.skmtglossary.org– Most major standards listed
• Duke Center for Best Practices – www.ctnbestpractices.org/standards-inventory/
23Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
Getting involved• HIT data standards will continue to evolve, and
new standards will be introduced.• Most standards are created by a consensus
process by individuals interested in influencing, developing and using the resulting standards. To participate, join the SDO and participate in the work groups.
• Most SDOs provide tutorials and educational opportunities to learn about the standards.
24Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
National and International Standards Developing Organizations
Summary
• This unit has provided an introduction to health data standards; how standards are made and by whom; types and categories of standards; and has discussed briefly the process, domains and authorization of standards.
25Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c
National and International Standards Developing Organizations
References – Lecture cReferences•Main Page - IHEWiki.wustl.edu: Support of IHE Connectathons. (n.d.). Retrieved January 10, 2012, from http://ihewiki.wustl.edu/wiki/index.php/Main_Page •Joint Initiative for Global Standards Harmonization Health Informatics Document Registry and Glossary . (n.d.). Retrieved January 10, 2012, from www.skmtglossary.org•Clinical Trials Networks Best Practices - Standards Inventory. (n.d.). Retrieved January 10, 2012, from www.ctnbestpractices.org/standards-inventory/
ImagesSlide 22: courtesy of Dr. Ed Hammond
Tables3.1 Table: created by Dr. Ed Hammond3.2 Table: created by Dr. Ed Hammond
26Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange National and International Standards Developing
Organizations Lecture c