chapter 5 - standards n interoperability

What’s a standard

• agreed upon way of doing something so there’s consistency for optimum degree of order(ISO, 2004)

  • repeated rules, guidelines, characteristics

• established by consensus, approved by recognized body

consensus

• people/groups agree on the standard

interoperability

• ability of diff systems to communicate, share data, work tg

• standards make it possible

level 1 interoperability

• no interoperability

  • computers can’t do all the work, ppl need to step in

    • mail, fax, phone

level 2 interoperability

• machine-transportable (structural)

  • info can’t be manipulated

    • bits , bytes of data transmitted

level 3 interoperability

• machine-organizable (syntactic)

  • sender n receiver must understand vocab

    • email, scanned docs, image, pdfs

level 4 interoperability

• machine-interpretable (semantic)

  • structured messages with standardized n coded data

    • coded results from structured notes, labs, problem list

approaches to standard development

• Ad hoc

• De facto

• government mandate

• consensus

Ad hoc

• groups agree to informal specifications

De facto

• single vendor (company) controls industry

government mandate

• gov agency creates standard n mandates its use

consensus

• interested parties work in open process

types of health standards

• identifier

• transaction

• messaging

• imaging

• terminology

identifier standards

• easy linkage of records (identifying right patient n provider even in different places)

• can compromise privacy and confidentiality (need to protect from unauthorized users)

• reduce duplicate n overlaid issue

duplicate records

• more than one record exist for same patient

overlaid records

• more than one patient mapped to same record

national provider identifier (NPI)

• assign 10-digit ID to all physicians

• center for medicare n medicaid services (CMS) won’t process claims without this

employer identification number (EIN)

• identifies employer

• assigned by IRS (internal revenue service)

health plan identifier (HPI) or other entity identifier (OEID)

• created to provide standardized identifiers for health plans and other entities

• no longer required

transaction standards

• standards for exchanging specific data electronically

  • ex: ASC X12N (common format followed by everyone)

    • to encourage electronic commerce for health claims

HIPAA legislation

• required healthcare businesses to use ASC X12N under the guise of administrative simplification

administrative simplification

• make healthcare administrative more consistent by reducing diff formats

ASC X12 version 5010 identifier numbers

• tells the system what kind of transaction being sent

ASC X12 ID: 837

• health claims n equivalent encounter info

ASC X12 ID: 834

• enrollment n dis-enrollment in a health plan

ASC X12 ID: 270 (request) n 271 (response)

• eligibility for healthcare plan

ASC X12 ID: 835

• healthcare payment n remittance advice

  • info that comes back explaining the payment

ASC X12 ID: 820

• health plan premium payments

ASC X12 ID: 276 (request) n 277 (response)

• health claim status

messaging standards

• how healthcare info is packaged and sent between healthcare systems

• focus on diff types of messages n data

  • generic rather than specific transactions

health level 7 international (HL7)

• develops n supports standards for systems to exchange info consistently

• name from OSI 7-layer model of network communications

• focus on clinical n administrative data transmission

main HL7 versions

• v2 , v3 , FHIR (fast healthcare interoperability resources)

interfaces

• connection that allows 2 separate computer systems to exchange info automatically

clinical document architecture (CDA)

• give clinical documents a standardized structure while keeping them readable by ppl

• defines XML- based standard structure n metadata for clinical docs

metadata

• info abt document itself

CDA templates

• reusable

• computable components

unstructured documents

• can be “wrapped” in CDA framework

  • have pre-text info for person to read while placing standardized structure around document

3 levels of CDA

• level 1 - general document specification

• level 2 - adds document types with allowable structures

• level 3 - addition of mark-up expressible in RIM (HL7 reference info model)

extensible markup language (XML)

• data packaging standard for sharing

• human n machine readable

  • elements-envelop data

    • piece of identifiable data

  • attributes-describe the data (elements)

    • gives additional info describing element

XML messaging

• have headings n message bodies

• info packed by wrapping in layers of tags (info organized inside other info)

fast healthcare interoperability resources (FHIR)

• messaging standard to facilitate interoperability

  • make it easier for health IT systems to exchange n use info

• developed by HL7 international

• adds more semantics (meaning/defined) than HL7 v2, less complex than v3

• first normative content

normative content

• stable parts of the standard that organizations can rely on

imaging standards

• medical images to be moved, viewed, archived

digital imaging and communications (DICOM) standard

• for transporting images

• developed by American College Of Radiology n Narional Electrical Manufacturers Association (NEMA)

terminology standards

• establish consistent n reliable clinical terms for computer systems (normalization)

why terminology standard needed

• clinical language can be vague, while computers need info to be precise n consistent

normalized clinical data used for

• aggregation of patient data (combining info from multiple patients)

• clinical decision support

• clinical research

medical coding

• process of assigning alphanumeric characters to standardize the descriptions of patient visits (encounters) between HCP n patients

coding

• language of reimbursement methodologies

  • providers being paid

• provides rich data

inpatients

• use diagnosis related groups (DRGS)

outpatients

• use ambulatory patient classifications (APCs)

  • procedure driven

physician practice billing

• “superbill”

  • list of common codes used in practice

• coding specialist bills out the claim

coding certification exams by AHIMA

• offers diff coding n health info credentials depending on person’s role n level of training

certified coder associate (CCA)

• entry level expertise

certified coder specialist (CCS)

• expert at inpatient n outpatient coding

certified coder specialist (CCS-P)

• physician or nurse who is expert at coding

registered health info administrators (RHIA)

• need bachelor’s degree in health info administration or management

registered health info technician (RHIT)

• need associate degree in health info tech or management

international classification of diseases (ICD) standard

• published by WHO

• tracks morbidity (disease/illness) n mortality

• updated annually in oct

• modified in US bc used for reimbursement

ICD-11

• international version

• current standard used for coding

• reflects newer med knowledge n digital care

• US still use ICD-10

national council for prescription drug programs (NCPDP)

• standards for pharmacy claims benefits

SCRIPT

• NCPDP standard for electronic communication between prescriber n pharmacy

EHR-lab interoperability n connectivity standard (ELINCS)

• to standardize lab ordering from n reporting to EHRs

continuity of care record (CCR)

• set of basic patient info w/ relevant n timely facts abt patient condition

logical observation identifiers names n codes (LOINC)

• started as standard for lab tests n names

• extended into other types of measures (ex radiology)

EHR platform / operating sys

• other applications can connect to it instead of being built into it