Health Data Standards Assignment Paper
Like other industries, health care organizations exchange information according to a set of standards. Standards are agreed-upon methods for connecting systems together. Standards may pertain to security, data transport, data format or structure, or the meanings of codes or terms.Health Data Standards Assignment Paper
Standards are defined, updated, and maintained by standards development organizations (SDOs) through a collaborative process involving the audience that will be using the standards.
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Health care organizations can reduce implementation costs, accelerate integration projects, and take advantage of common tooling by making an effort to use standards whenever possible.
ONC is working to enable the health IT community to convene and rapidly prioritize health IT challenges and subsequently develop and harmonize standards, specifications and implementation guidance to solve those challenges. ONC is also responsible for curating the set of standards and specifications that support interoperability and ensuring that they can be assembled into solutions for a variety of health information exchange scenarios.Health Data Standards Assignment Paper
ONC publishes the Interoperability Standards Advisory (ISA) as a way of recognizing interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs.
Our health care advocates help employees navigate the health care system and become better, more informed consumers. We assist employees and their family members with questions about their health care coverage as well as flexible spending accounts (FSAs), health reimbursement accounts (HRAs) and health savings accounts (HSAs).Health Data Standards Assignment Paper
We make sure your insurance is working the way it’s meant to and that your employees are engaged. Access to knowledgeable and experienced advocates who can help employees shop for their health care, answer benefit questions, locate in-network providers, and resolve claims issues helps employees make better decisions about their care and enables employers to reduce administrative and health care costs.Health Data Standards Assignment Paper
Employees can’t be true health care consumers if they don’t know how to “shop” for health care. Our advocates provide employees with up to three options for a medical test or procedure, along with quality and cost data, enabling them to make informed decisions about where to find cost-effective care. Armed with this critical information employees, on average, save $400 out-of-pocket per request and employers save more than $1,400 per request.
Working with Direct Path advocates:
Drives significant claims savings
Creates better health care consumers
Reduces administrative burdens
Improves employee satisfaction with company benefits
Types of open standards for data
There are thousands of open standards for data in use every day around the world. To help make sense of them, we grouped standards according to their main purpose and products.Health Data Standards Assignment Paper
With open standards for data, you can:
share vocabularies and common language using common models, attributes and definitions, with outputs like: registers, taxonomies, vocabularies and ontologies
exchange data within and between organizations and systems using common formats and shared rules, with outputs like: specifications, schemas and templates
provide guidance and recommendations for sharing better quality data, understanding processes and information flow, with outputs like: models, protocols, and guides
All open standards share common features, for example being available for anyone to access, use or share. Depending on the purpose and products of a given open standard, some features are more relevant than others. For example, it is important when using a data exchange standard to check that data has been produced correctly by checking the data against the standard’s rules.Health Data Standards Assignment Paper
This isn’t necessary for standards focused on guidance or a shared vocabulary because using these standards doesn’t produce new data.
Standards to share vocabulary
A shared vocabulary helps people and organizations communicate the concepts, people, places, events or things that are important to meet their needs or solve their problems.
A good shared vocabulary focuses on a specific area and uses clear, unambiguous definitions of the words and concepts it contains.
Shared vocabularies range from simple lists of words and their meaning to more complex products. The complexity of a vocabulary depends on the complexity of the problem being solved.Health Data Standards Assignment Paper
Executives and IT managers at healthcare facilities across the country—along with suppliers of health IT systems—agree that interoperability is critically important to ensure the collection, storage and communication of patient data when and where it’s needed. The ultimate goal is to improve patient care by equipping clinicians with a comprehensive view of each patient’s history as well as data related to the patient’s current condition.
However, it takes more than a dramatic increase in adoption of electronic health record (EHR) systems to create interoperability, especially in a heterogeneous environment created by mergers or acquisitions. Healthcare facilities must have a strategic plan and the technology to support health information exchange, both within the organization and to external providers.
The 2016 Interoperability Standards Advisory notes significant steps have been made: approximately 41% of hospitals nationwide routinely have electronic access to necessary clinical information from outside providers or sources when treating a patient; about 78% of hospitals electronically sent a summary of care document; and 56% received a summary of care document.Health Data Standards Assignment Paper
Unfortunately less than half of hospitals integrate the data they receive into an individual’s record—which represents an area that requires significant improvement. And only a small percentage of ambulatory providers share electronic health information with providers outside of their organization, according to the interoperability report.
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The ability to efficiently exchange information among systems will equip individuals, families and healthcare providers to send, receive, find and use electronic health information in a secure and timely manner. If the right information is available at the right time, patients and care providers can be active partners in healthcare decisions, which can improve decision-making and help deliver better care.Health Data Standards Assignment Paper
Creating a cohesive view of the patient requires the exchange of both structured and unstructured data. Metadata currently is being used to allow users to communicate this context along with pieces of structured data. As the health IT ecosystem pulls structured information out of unstructured narrative to support a variety of analyses and user needs, a format for this metadata will prevent information loss that can hamper the comprehensive view needed for making diagnostic and treatment decisions.
Next-generation standards enable interoperability
Healthcare organizations need to act now to implement interoperable systems that take advantage of industry standards, protocols and technologies. While this is a challenging project, achieving greater interoperability is made possible by the IHE (Integrating the Healthcare Enterprise) initiative for improved use of computer systems in healthcare, the standards developed by the international HL7 organization and the DICOM standard widely used in imaging departments.Health Data Standards Assignment Paper
These standards and profiles address data capture, storage, integration, discovery and presentation challenges within a healthcare organization:
Acquisition and capture: The IHE Web-Based Image Capture (WIC) profile provides a simple, lightweight, mobile-friendly mechanism to encode and send captured images, videos and evidence documents from the capture device to the platform’s Image Manager so that these objects can be easily integrated into the rest of the imaging workflow.
Data formats and protocols: The IHE Cross-Enterprise Document Sharing (XDS) profile provides native support for many different file formats such as DICOM, CDA, PDF, JPEG and more. It offers a consistent way to communicate, index and access data in department-specific formats using standard, secure web services.
Enterprise data discovery: DICOMweb provides the web-based APIs QIDO-RS, WADO-RS and STOW-RS to enable query, retrieval and storage of patient and exam data. These DICOMweb APIs offer a simple way to implement standard methods for data providers and consumers to store, find and access clinical imaging information without being constrained by incompatible or proprietary systems.Health Data Standards Assignment Paper
Cross-enterprise data discovery: The IHE Cross-Community Access (XCA-I) profile provides the means to query and retrieve patient-centered medical data held by multiple facilities and enterprises, enabling a unified patient record to be created and delivered across communities of care. In addition, an IHE Imaging Object Change Management (IOCM) profile can facilitate the synchronization of image data when it’s stored in multiple locations such as a local PACS, an enterprise repository or the EMR.
Patient demographic data discovery: The IHE Patient Demographics Query (PDQ) profile provides a very simple means for searching patient demographic information associated with acquisition data. The Patient Demographics Query for Mobile (PDQm) Profile defines an interface to a patient-demographics supplier using standard technologies already available to mobile applications and lightweight browser-based applications.Health Data Standards Assignment Paper
EHR integration: FHIR (Fast Healthcare Interoperability Resources), the next-generation standard from HL7, enables advanced web capabilities for providing and consuming patient-centric health records. FHIR uses existing logical and theoretical models to offer a consistent, easily implemented method for exchanging data between healthcare applications, such as between the EHR and vendor-neutral archive (VNA).
Achieving efficient data exchange
These standards and others will play important roles in achieving efficient data exchange. In the next few years FHIR will become a crucial standard for bringing diverse and complex systems together under a simple, shared framework, while eliminating many of the implementation challenges and delays that have hampered interoperability projects in the past.
Whether healthcare systems are federated or fully integrated—or whether a combination of the two approaches is used to accommodate the needs of multiple disciplines and facilities—these are the crucial standards to consider when evaluating solutions that promise to deliver clinical data interoperability.Health Data Standards Assignment Paper
Care stream and other IT systems suppliers can play a vital role in helping providers achieve interoperability by working with executives and IT managers to deploy standards that help expedite information exchange. Executives need to select systems providers that can demonstrate their ability to support interoperability by participating in industry Connectathon events, such as those conducted by IHE and other groups that promote the use of established standards to address clinical needs and help support delivery of optimal patient care.
Enterprise imaging platforms, vendor-neutral archives, universal clinical viewers, clinical collaboration platforms and other systems need to support IHE profiles and data-sharing standards that can allow healthcare providers to identify and share diverse patient clinical data to help clinicians make diagnostic and treatment decisions. The goal is to achieve efficient, standards-based sharing of data and images that is agnostic to applications, data formats, protocols or geography.Health Data Standards Assignment Paper
Stepping stone to HIE integration
An enterprise imaging strategy using standards-based workflows can be a stepping stone to HIE (health information exchange) integration. HIEs can improve care by expediting sharing of patient data among providers—thereby reducing duplicate imaging exams while eliminating the associated costs.
A recent study conducted by the University of Michigan and published in the journal Medical Care, reported that adoption of an HIE is associated with a decrease in repeat imaging in emergency departments (EDs). Authors Eric J. Lammers, PhD, and colleagues looked at data from early adopters of HIE in California and Florida that compared 37 HIE-affiliated EDs with 410 unaffiliated EDs.Health Data Standards Assignment Paper
When patients had visits at two unaffiliated hospitals that took part in an HIE, they were 59% less likely to have a redundant CT scan, 44% less likely to get a duplicate ultrasound and 67% less likely to undergo a duplicate chest X-ray.
Lammers and his colleagues suggested that if all hospital-based EDs in California and Florida participated in HIE, it would result in nearly $3 million in annual savings from potentially unnecessary ED ultrasounds, chest X-rays and CT scans. Additional savings could come from sharing of data from other departments across the enterprise.
Healthcare executives and managers are acutely aware of the roadblocks presented by their current infrastructure of aging departmental systems. Everyone agrees that patient data needs to be efficiently managed, stored and shared so authorized clinicians can gain a holistic view of a patient’s health. The challenge is to deploy industry standards, protocols and technologies that equip physicians with all the data needed to accurately assess and treat each patient. Adoption of the latest standards, profiles and exchange technologies make this goal attainable.Health Data Standards Assignment Paper
Cost and security are the two biggest data headaches for healthcare providers like you, so we’re here to help you address them both in one fell swoop.
Improving your network is the fastest way to adopt electronic health records and provide better care to your patients, in particular by meeting the new federal requirements for your healthcare network solutions. But putting off healthcare managed IT services will quickly turn into a competitive disadvantage as other providers grow in your area. It’s time for better healthcare network solutions.Health Data Standards Assignment Paper
Partnering with a leading provider of outsourced healthcare IT services is one of the fastest ways for you to:
Collaborate with health providers
Integrate across pay systems for better tracking and financial management
Ensure robust communications as records move between facilities and care settings, with the patient as the common link
Insert healthcare disaster recovery services and loss prevention services into your practice
Monitor and track advanced metrics or chronic conditions, bolstering care by improving provider access to data about the patient from multiple care settings
These are the core elements of a proper healthcare network, especially when considering your HIPAA compliance and cybersecurity requirements. Any of these improvements or IT changes can be daunting, especially if you’re one of the 80% of small hospitals with less than 100 beds, rural hospitals or critical access hospitals who have only adopted a basic electronic health record system.Health Data Standards Assignment Paper
How do you address those healthcare network solutions and concerns? You partner with Worldwide Supply and free up your budget and your team to provide more resources and focus on patient needs.
You’ll save money by accessing Worldwide Supply’s network of tested and certified telecom and wireless products at discounts up to 90% off of OEM pricing, with additional healthcare managed IT services and support.
Worldwide Supply is the preferred IT partner of healthcare providers just like you because we can help you meet ACA requirements for data capture, file transfer and storage. Our HIPAA-certified experts know exactly how to help healthcare brands meet the challenge of collecting and leveraging data while optimizing healthcare managed IT service costs and keeping operations secure.
We’re here because we have deep experience in healthcare network solutions and understand the unique challenges you face.Health Data Standards Assignment Paper
Hospitals Face Unique Challenges
Many hospitals and healthcare service providers have moved to electronic health records (EHRs) or are on the path to doing so. If you’ve had a troubled path forward or are facing increased penalties due to a slow transition, it’s time to work with a healthcare network support team.
We’ve helped care providers just like you overcome a wide range of issues and concerns with custom healthcare network solutions. Our outsourced healthcare IT services have supported customers in many different situations, including:
Hospital management departments feeling strained and overextending their budgets to make room for the technological upgrades required by EHRs.
Rural hospitals and small, independent physician practices having a harder time meeting the requirements affordably and understanding the technology required to meet EHR regulations.
Safety net providers needing financial incentives and technical assistance to implement IT improvements.
Customer-driven healthcare models are critical to your future success because now patients must foot more of their own healthcare expenses than ever, and many practices are playing catch-up in terms of putting customers first.Health Data Standards Assignment Paper
Patient engagement is now a survival skill for hospitals and small practices in this new customer-facing, high-deductible, accountable care era. It’s especially true when you look to outsourced healthcare IT services and partners.
By pairing network infrastructure and EHR support with healthcare disaster recovery services, you’ll have a single partner that can help you save money on initial purchases, regular maintenance and in case of an emergency. Patients, power outages and new platform requirements no longer have to be a headache for you and your staff thanks to our healthcare disaster recovery services.
Most of industry countries are turning their healthcare system towards integrated care paradigms for improving quality, efficiency, and safety of patients’ care. Integrated care has to be supported by extended communication and cooperation between the involved healthcare establishments’ information systems. The required interoperability level goes beyond technical interoperability and simple data exchange as it has been started in the early world of electronic data exchange (EDI). For realizing semantic interoperability, series of standards must be specified, implemented and enforced. The paper classifies standards for health information systems needed for enabling practical semantic interoperability.Health Data Standards Assignment Paper
Why health informatics needs data standards
As the government ramps up its efforts to make a more connected and proactive national healthcare system, numerous technological challenges have presented themselves. Not the least of which is getting disparate electronic health record (EHR) systems to communicate patient data across provider networks.
I recently answered several questions about the need for data standards in health informatics. Here are my insights into the present landscape as well as the exciting future that a better-connected healthcare system can offer.
Is there a good starting point that can be standardized first?
In simple terms, data standards are agreed upon terms and definitions for how we capture information. Data standards are important in our quest to achieve nationwide interoperability. The Office of the National Coordinator for Health Information Technology has set forth a strategic roadmap entitled, “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap” (ONC, 2015). As noted in report, we have not achieved adequate standardization to achieve flawless and secure exchange of information – interoperability. However, a roadmap to achieving interoperability is an excellent starting point.Health Data Standards Assignment Paper
Another great starting place on the road to achieving this dream is consistent formats, definitions, and vocabularies. Imagine for a minute you have a room full of healthcare professionals caring for the same patient, but all speak different languages. Then imagine everything they say is transformed into their native language and seamless communication was possible. Thus, the words irregular heartbeat in one language are easily transformed and means the same thing in the other language.
To put the United States, and the world, on the path to standardization, standards development organizations were formed. For example, Health Level Seven (HL7) and the American Society for Testing and Materials (ASTM), focus on clinical data standards. Other groups, such as Accredited Standards Committee (ASC) (who focus on images) and the National Council for Prescription Drug Programs (NCPDP) (who focus on pharmacy related items), have been formed to enhance standardization across specialties.Health Data Standards Assignment Paper
Who will benefit most from data standardization?
Our patients will benefit most from data standardization through improved quality, safety, and health outcomes. Imagine being cared for in an emergency department (ED). Your discharge instructions seamlessly flow to your primary care provider. Your prescriptions are waiting for you at your pharmacy. The entire team is able to see real time information to provide you with optimal care and seamless care transitions.
At present, we depend on patients to keep track of countless pieces of paper and to transport this information (data) between different providers and services. They should not have to. As a nurse practitioner, I should be able to pull up their complete ED visit information (data) and be able to follow through on next steps for the patient. I should know before my patient walks through the clinic doors what needs to happen to provide optimal, safe and seamless care = interoperability. If for some reason, this same patient was taken to a different emergency department or provider’s office, they should be able to do the same. As a country and a world, we will all benefit from improved outcomes and safety through efficient and safe care transitions.Health Data Standards Assignment Paper
How has data (organized or unorganized) impacted the development of technology? Are there any industry-changing examples?
I think the next big thing on the horizon is patient contributed health information. For example, I wear a Fit bit and use health related apps, such as My Fitness Pal. Both collect rich organized and unorganized data that could assist my healthcare provider in making informed decisions about my health and treatment plan. Thus, technology and industry must consider patient contributed data and uploads into the system. Therefore, ensuring mobile technology applications have a standardized way of communicating this type of data to a patient’s electronic health record is essential for data interchange. Other exciting examples of technology being developed to enhance real-time, actionable data includes info-gathering asthma inhalers (e.g. smart-tech inhaler), smart packaging and patches, appointment scheduling, Google Glass in hospitals and clinics, watches, telehealth, and precision diagnostic tools.
What type of impact could data standardization potentially have on the healthcare industry?
As previously mentioned, global interoperability and health information exchange. Imagine the improvement in the health of our communities and populations if healthcare professional and patients could partner through technology and data. Additionally, standardized data would allow clinicians to collect and examine multiple big data sets (e.g. clinical, financial, operational, and patient-derived) to improve quality and patient safety. Having a common data language or standardization would allow this dream to become reality.
How will domestic standards work internationally?
Internationally, health professionals have already begun the work of developing common data language. For example, the International Council of Nurses (ICN, 2015) has spearheaded the e Health initiative aimed at the development of the International Classification for Nursing Practice (ICNP), the ICN Nurselings Network, and on online forum for sharing ideas and innovations global, Connecting Nurses. The ICNP includes centers from across the globe, including the United States.Health Data Standards Assignment Paper
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Can policymakers do anything to try to reign in on vendors to enforce these standards?
The Office of the National Coordinator for Health Information Technology (2015) has set forth the Shared Nationwide Interoperability Roadmap version 1.0 and the Federal Health IT Strategic Plan: 2015-2020 (2015) to outline the vision forward. The Centers for Medicare & Medicaid Services has then outlined incentive programs, such as meaningful use, which specify key objectives and measures aimed at health information exchange. These are two instrumental policy measures focused on data standardization, exchange, and true interoperability.
Among the challenges for broad adoption of the electronic health record (EHR) is ensuring high-quality electronic data that can be effectively exchanged with other computer systems. This is critical for both an organization’s internal operations and for external cooperation with other healthcare organizations.
To efficiently and accurately share clinical information, EHRs must be interoperable—the IT systems and software applications used by various facilities and made by different vendors must be able to communicate so that usable data can be exchanged accurately, effectively, and consistently.1 Standards for capturing, defining, and transmitting data are key to interoperability.Health Data Standards Assignment Paper
A variety of organizations create standards, and additional initiatives are currently under way to align duplicative and overlapping standards. HIM professionals have an important role in that process and in the standardization of EHR content.
The Importance of Standards
In the same way that the paper health record is only as good as the documentation contained therein, the EHR is only as good as its data content. And the demands on data quality in the EHR will be great. EHRs are expected to be accessed on a much wider scale than paper records. Physicians, nurses, and other healthcare professionals within and across healthcare organizations will tap into EHR data. Even patients may get controlled access. Unaffiliated facilities such as labs, pharmacies, physician offices, and hospitals will exchange patient data. Reporting agencies will request data for compliance and comparison purposes. This ability to share electronic health information will improve quality of care, patient safety, and delivery efficiency, and it will help control rising healthcare costs.Health Data Standards Assignment Paper
However, none of these benefits can be realized if the data contained in EHRs are not accurate, complete, consistent, and universally understood by all users. In order that they are, and can be used with confidence, electronic health information must be precisely defined, captured, and communicated in a timely manner. In other words, data content must be standardized. Without standards, “information technology systems built over the coming decades will be inadequate to support the delivery of safe and effective care,” the Institute of Medicine notes.2
Standardizing EHR data content is a difficult task within an organization where the EHR system is comprised of multiple, disparate information systems and applications, as well as various types of hardware and software. Each system may call the same data element by a different name or may refer to data elements with different definitions by the same name, all while contending with differing technical requirements and constraints. Circumstances are also made complex by multiple data owners, each with individual needs. Without careful planning and management, inconsistency and lack of clarity in data content thus hinder the benefits of the EHR system.
Consider for example the multiple terms that may be used to describe a physician’s role in caring for a patient: attending physician, primary care provider, consultant, surgeon, and specialist, to name a few. The physician’s role typically determines which physicians receive test results and other clinical information that require follow-up care. Accurate and timely routing of this information may be critical for proper care coordination and patient safety. This concept seems simple, but the execution is not. Do the inpatient and outpatient systems work together smoothly to allow the exchange of this information? Will the outpatient system route this information to the physician designated as the attending physician in the inpatient system? Should the designation of primary care provider in the outpatient system equal the designation of attending physician in the inpatient system?Health Data Standards Assignment Paper
Any data element that may be interpreted in more than one way leaves room for misunderstanding and potential error in patient care. For example, in an integrated healthcare delivery system a patient’s medication list may reside in the patient’s renal dialysis record, the home health record, the pharmacy department record, the inpatient record, and other records. Each medication list is maintained in a separate departmental information system or module within the larger EHR. Collectively, the list of medications from multiple departments should be integrated, and these data elements should be contained in the EHR. Ideally, the medication list should be the same for a given patient if accessed in any one department’s system. However, lack of standardization in how the various systems define the medication data can create obstacles to integrating these data into one complete and accurate list. These inconsistencies can result in compromised patient safety. Significant time is required to reconcile the lists into one.Health Data Standards Assignment Paper
Standardization of data content is also critical within an organization and across organizations for reporting purposes. When data are aggregated for organizational reporting of quality indicators used for compliance reports showing quality of care levels, the organization must have confidence that its data can be compared “apples to apples” with data from other organizations. If two organizations have different definitions or values for a given field, the lack of standardization can lead to misunderstanding, incorrect data interpretation, and inability to compare results and outcomes. The result may be incorrect rates for outcome measures. This may even become a financial concern if pay-for-performance is instituted based on conformance with specified quality indicators.
If achieving standardization of data within an organization sounds formidable, it is an even more difficult task to standardize nationwide. If an organization uses only its own data definitions, it will be very difficult for it to relay critical information to a partner. Healthcare organizations constantly collaborate with other industry stakeholders in order to operate. A hospital exchanges patient information with pharmacies, labs, and outpatient clinics. For example, it exchanges claims data with health plans for reimbursement. Unless data content is standardized, the result could be difficulties and dilemmas for the healthcare industry, including compromised patient care and delayed payment collection.Health Data Standards Assignment Paper
In November 2005 the Department of Health and Human Services awarded four contracts to healthcare and technology groups to help accelerate the nationwide exchange of health information. The groups will create and demonstrate prototypes for a nationwide health information network (NHIN), the architecture that will enable secure, widespread sharing of patient clinical information within communities and across the country. The NHIN, made up of regional organizations, is often called a network of networks. At the core will be interoperable EHRs. At the core of interoperable EHRs will be data standards.Health Data Standards Assignment Paper
Current Efforts on Standardization
Over the years, dedicated standards development organizations (often referred to as SDOs), associations, government agencies, and nongovernmental organizations, working independently, have developed an array of data standards that address multiple areas in healthcare. Some of the common standards in use today are listed in the Standards Sampler below.
Different types of standards are necessary to accomplish the various functions needed for interoperability. Messaging standards, for instance, are critical for one system to communicate and transport clinical data to another system. If a hospital sends an order for a microbiology culture to a reference laboratory, the laboratory computer must receive and extract the specimen description, test type, patient ID, and accession number. Subsequently, the hospital computer receives back the result type, result description, patient ID, and accession number.Health Data Standards Assignment Paper
However, messaging standards alone are insufficient for accurate and consistent exchange of clinical data. The data structure and content within the messages must also be standardized. For example, a message transmitted according to the HL7 messaging standard follows specific formats for data structure, data type, data units, and terminology.
A data content standard may leverage a terminology standard to simplify and unify the data presentation. For example, an HL7 message sent from a reference lab may contain information encoded with LOINC. LOINC provides universal identifiers for lab and other clinical observations to present the results in a manner that can be commonly understood.
In the exchange of data between two systems, each value exchanged must be associated with a data element. Mutual understanding of exchanged data requires mutual understanding of the definitions of data elements. Mutual understanding of data element definitions requires data content standards and precise mapping between standards. A data content standard is often defined in the form of a data dictionary, a “descriptive list of the names and definitions of data elements to be collected in an information system or database whose purpose is to standardize definitions and ensure consistency of use.”3 [For more on mapping, see “Data Mapping” (Journal of AHIMA, Feb. 2006. For more on data dictionaries, see the practice brief, “Guidelines for Developing a Data Dictionary (Journal of AHIMA, Feb. 2006.]Health Data Standards Assignment Paper
The variety of data standards must work together seamlessly to facilitate the exchange and reporting of EHR data. Standards harmonization is the process that enables standards to become compatible with each other. Initiatives for standard harmonization are welcomed by many major standards development organizations, and a number of initiatives are under way, including:
HL7 and ASTM recently indicated they will work together to synchronize HL7 and CCR.
HL7 and SNOMED International, a subdivision of the College of American Pathologists, have signed an agreement to enable SNOMED CT to work with HL7 and to drive the harmonization between SNOMED CT and the HL7 Reference Information Model.Health Data Standards Assignment Paper
Recognizing the importance of standards harmonization in enabling widespread interoperability among healthcare IT, the Department of Health and Human Services awarded a contract to the American National Standards Institute (ANSI) in fall 2005. ANSI convened the Healthcare Information Technology Standards Panel to demonstrate a consensus-based process for setting standards in the healthcare industry. For more on this effort, see “HITSP Goes to Work” below.
We recently conducted an in-depth study at Lu mere to gain insight into physicians’ perceptions of clinical variation and the factors influencing their choices of drugs and devices. Based on a survey of 276 physicians, our study results show that it’s necessary to consistently and frequently share cost data and clinical evidence with physicians, regardless of whether they’re affiliated with or directly employed by a hospital. This empowers physicians to support the quality and cost goals inherent in a health system’s value-based care model. Below, we offer three recommendations for health systems looking to do this.
Assess how data is shared with physicians. The reality is that in most health systems, data sharing occurs in irregular intervals and inconsistent formats. Ninety-one percent of respondents to our survey reported that increasing physician access to cost data would have a positive impact on care quality. However, only 40% said that their health systems are working to increase physician access to such data.Health Data Standards Assignment Paper
While working directly with health systems to reduce clinical variation, Lu mere has discovered firsthand that the manner and type of cost and evidence-based data shared with physicians varies dramatically. While some organizations have made great strides in developing robust mechanisms for sharing data, many do little beyond circulating the most basic data from the Centers for Medicare and Medicaid Services’ patient-satisfaction survey (the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS).
There are multiple explanations as to why health system administrators have been slow to share data with physicians. The two most common challenges are difficulty obtaining accurate, clinically meaningful data and lack of knowledge among administrators about communicating data.
When it comes to obtaining accurate, meaningful data, the reality is that many health systems do not know where to start. Between disparate data-collection systems, varied physician needs, and an overwhelming array of available clinical evidence, it can be daunting to try to develop a robust, yet streamlined, approach.Health Data Standards Assignment Paper
As for the second problem, many administrators have simply not been trained to effectively communicate data. Health system leaders tend to be more comfortable talking about costs, but physicians generally focus on clinical outcomes. As a result, physicians frequently have follow-up questions that administrators interpret as push-back. It is important to understand what physicians need.
Determine the appropriate amount and type of data to share. Using evidence and data can foster respectful debate, provide honest education, and ultimately align teams.
Physicians are driven by their desire to improve patient outcomes and therefore want the total picture. This includes access to published evidence to help choose cost-effective drug and device alternatives without hurting outcomes. Health system administrators need to provide clinicians with access to a wide range of data (not only data about costs). Ensuring that physicians have a strong voice in determining which data to share will help create alignment and trust. A more nuanced value-based approach that accounts for important clinical and patient-centered outcomes (e.g., length of stay, post-operative recovery profile) combined with cost data may be the most effective solution.Health Data Standards Assignment Paper
While physicians generally report wanting more cost data, not all physicians have the experience and training to appropriately incorporate it into their decision making. Surveyed physicians who have had exposure to a range of cost data, data highlighting clinical variation, and practice guidelines generally found cost data more influential in their selection of drugs and devices, regardless of whether they shared in savings under value-based care models. This was particularly true for more veteran physicians and those with private-practice experience who have had greater exposure to managing cost information.
Health systems can play a key role in helping physicians use cost and quality data to make cost-effective decisions. We recommend that health systems identify a centralized data/analytics department that includes representatives of both quality-improvement teams and technology/informatics to own the process of streamlining, analyzing, and disseminating data.Health Data Standards Assignment Paper
Compare data based on contemporary evidence-based guidelines. Physicians would like to incorporate reliable data into their decision-making when selecting drugs and devices. In our survey, 54% of respondents reported that it was either “extremely important” or “very important” that hospitals use peer-reviewed literature and clinical evidence to support the selection of medical devices. Further, 56% of respondents said it was “extremely important” or “very important” that physicians be involved in using data to develop clinical protocols, guidelines, and best practices.
Health systems should ensure that data is organized and presented in a way that is clinically meaningful and emphasizes high-quality patient care. Beginning the dialogue with physicians by asking them to reduce costs does not always inspire collaboration. To get physicians more involved, analyze cost drivers within the clinical context.
Finally, health systems should keep data and communication simple by developing, communicating, and mobilizing a small number of critical key performance indicators (KPIs). These indicators should reflect the voices of health care customers, including patients, care providers, and payers. In some instances, these will overlap — for example, length of stay, infection rates, readmission’s, and likelihood to recommend the provider in the future. Consistent, relevant benchmarks will keep physicians focused on organizational goals.Health Data Standards Assignment Paper
Our survey results have a clear message: Health systems must openly and transparently engage with both employed and affiliated physicians and foster a culture that appreciates data and analytics. Only then will we see improved clinical, operational, and financial outcomes.
Data standardization plays a significant role, especially in the healthcare industry, in creating a common format of data to allow different institutions to collaborate in an efficient way while using various information processing tools. This helps clinics, hospitals, and other medical organizations perform large-scale analytics, mutual research, and share effective methodologies.
The primary large-scale set of healthcare IT data standards is the Health Insurance Portability and Accountability Act (HIPAA) published in 1996. This act contains the rules of security measures regarding personal health information (PHI) storage and privacy policies aimed at protecting patients from PHI data thefts. The HIPAA was created to solve the problem of uncontrolled and unsecured PHI exchanges, and to avoid data breaches in the healthcare industry; however, the act does not ensure that different healthcare organizations will easily and efficiently process the received information. This is why standardization has been implemented in the medical industry.Health Data Standards Assignment Paper
What Are The Data Standards in Healthcare?
Healthcare data standards are the commonly adopted rules regarding definitions and formats of health information, and the methods of recording, storing, and sharing data within medical organizations. At a basic level, data standardization is aimed at defining what information can and should be collected, determining a way for this information to be represented, and deciding how to encode it for further transmission.
The standards involve the following types of data:
Radio logical images;
Medical monitoring systems;
Payment information; and
Healthcare data standards apply to both computer-based and paper-based healthcare data systems. They involve the following components:
Let’s cover each component in more detail.
A data element is a basic unit of information that can be collected, stored, and used in data systems in any clinic, hospital, or other healthcare organization.Health Data Standards Assignment Paper
Data element examples include:
Healthcare Data Exchange Standards
Data interchange standards cover the rules and recommendations that include common encoding specifications, medical templates for structuring information, document architectures, and information models for determining relationships between different data elements to ensure standardized message formats. In 2003, the Consolidated Health Informatics organization announced its requirement that any federal health care provider has to adopt common messaging formats for data exchanges.
One of the messaging format standardization sets is Health Level 7 International (HL7), created in 1987. This is a healthcare protocol standardized by the American National Standards Institute, commonly known as ANSI. Healthcare data standard HL7 covers the rules of the integration, management, and exchange of electronic healthcare information. It also sets a standard structure and types of messages that may be sent between healthcare institutions.
The functions covered by HL7 include:
Data exchange structuring; and
Data exchange mechanism.
In the U.S., federal healthcare providers have been using HL7 version 2.5 as a messaging standard for data exchange since 2004. One of the components of HL7 is the Clinical Document Architecture that sets an exchange model for various types of clinical information, including multimedia by utilizing an XML format (the extensible markup language). Adopting the HL7 2.5 is crucial for ensuring comprehensive and standardized sharing of machine-generated, processable health data.Health Data Standards Assignment Paper
Unified terminologies are crucial for facilitating electronic data collection. That is why ANSI created a detailed framework of information criteria for the development of terminologies in 1998. Later in 2003, the National Committee of Vital and Health Statistics developed a set of basic non redundant and well-integrated national standards of medical terminologies.
They include basic concepts of terminology development and principles of term representation based on the following technical criteria: the absence of meaningless identifiers, comprehensive multi-hierarchies, non redundancy, formal definition concepts, and proper links to related terminologies.
Healthcare Data Collection Standards
Knowledge representation and data collection standards cover the methods, formats, and rules of a proper and unified system for computer-based information and how it is collected and represented in medical organizations to help them make evidence-based decisions. These standards are aimed at the implementation of healthcare knowledge into medical automated systems, to improve the quality and efficiency of clinical care.
Knowledge representation standards include the following:
Alerts and reminders;
Medical literature referencing;
Protocols and guidelines development; and
Implementation of clinical decision support systems.
Clinical practice guidelines have to be modeled and executed in the Guideline Interchange Format commonly known as GLIF. GLIF is a computer-interpret able language created by the Inter Med Col laboratory, its focus being to create building-block components which will be easily accommodated by guideline models.Health Data Standards Assignment Paper
Examples of building-block components are:
Data references; and
Healthcare representation standards set the rules of using common drug knowledge databases such as Tumult, Mei-Span, and First Data bank. These databases provide information on toxicology, contraindications, allergies, drug-laboratory inferences, and drug-drug interactions.
Information Security, Confidentiality, and Privacy
Ensuring full data security is crucial for the healthcare industry. Without it, health information could be accessed, stolen, or even modified by unauthorized users. Therefore, implementing various IT security measures is required for any healthcare organization. The main way to ensure information protection is to define the users who can access particular data, which is why organizations that deal with personal health information stored in an electronic manner (e Phi) have to implement data security standards and methods.Health Data Standards Assignment Paper
Data security methods include:
Digital Signatures; and
Imagine a world without standards. An electrical cord for a new television set would not fit into the wall outlet, a spark plug for an automobile would be incompatible with motors of different cars, and money from one location would not buy products in another. A standard is a definition or a format that has been approved by a recognized standards organization or is accepted as a de facto standard by an industry.
McDonald and Hammond1 wrote,
Technical progress depends on standards. Standards for gauge and size make it possible to thread nuts onto bolts. Standards for voltage and frequency permit the use of an electrical appliance anywhere in the United States. Standards for laboratory reagents assure use that test results are consistent over time.
In general, standards let us mix and match components, create large assemblies from many parts, and communicate efficiently. Conversely, the absence of standards hinders progress and communication.Health Data Standards Assignment Paper
Until recently, a lack of standards in health care has interfered with the accessing, merging, and analyzing of clinical data. To understand this Tower of Babel, one need only consider how many ways something as seemingly simple as a date could be represented in an information system: January 1, 2001; Jan 1, 2001; 1/1/01; 2001 Jan 1; 01 01 01; and so on. Without some means of standardizing the coding and sharing of data, merging and analyzing health care information would be a difficult, if not impossible, undertaking.
Numerous industries, including banking, electronics manufacturing, and airline reservations, have thrived as a result of adopting standards. Although some standards for information coding and exchange have been widely implemented in health care, others are just emerging. In this article, we will discuss the organization and storage of data, barriers to health care information exchange, and the state of affairs regarding health care information standards. The major goal of medical informatics should be to reduce the entropy of the many sources of health information by developing standards for messages, codes, and user and component interfaces. This will allow the more efficient capture of clinical data to improve the delivery of care to patients with myocardial ischemia-infarction, to other emergency patients, and to health care recipients in general.
Health care databases
Health care providers, health insurance companies, researchers, and pharmaceutical manufacturers have pressing needs for large amounts of clinical health data. The pressure to improve health care and provide better care at a lower cost has generated the need for efficient capture of clinical data. For all parties, it would be easiest if these clinical data could be obtained electronically. A rich lode of electronic clinical data exists in laboratories, pharmacies, hospitals, and other clinical care settings. As time goes on, more sources of electronic data are becoming available: ECG carts, Health Data Standards Assignment Paper electrocardiography, cardiac cauterization, Holter monitoring, endoscopy reporting, isometry, and ophthalmology systems to name just a few.
To better use health care information, clinicians, health care managers, and policy makers need a conceptual framework for the organization of data. A database is a collection of data that is organized for rapid search and retrieval, usually by a computer. Databases are structured to facilitate the storage, retrieval, modification, and deletion of data for various data processing operations.2 A database consists of a file or set of files. A file is comprised of a number of records. Each record normally has a common set of characteristics. A record is comprised of fields. A field is the basic unit of data storage, and each field typically contains information pertaining to one aspect or attribute of the entity described by the database. For example, an emergency department might maintain a database consisting of several files: a patient demographics file, an outcomes data file, and an accounts receivable and payable file. The patient demographic file would contain a record of all the patients treated at that ED. Each record could contain fields for patient name, date of birth, and time of arrival. In summary, a database consists of files, files are broken down into records, and each record consists of one or more fields.Health Data Standards Assignment Paper
Database records and files must be organized to allow retrieval of the information. Early systems were arranged sequentially (ie, alphabetically, numerically, or chronologically). The development of direct-access storage devices made possible random access to data through indexes. Queries are the main way users retrieve database information. Typically, the user provides a string of characters, and the computer searches the database for a corresponding sequence and provides the source materials in which those characters appear. A user can request, for example, all records in which the contents of the field for a person’s last name are the word “Smith.”
The many users of a large database must be able to manipulate the information within it quickly at any given time. Moreover, large businesses and organizations, particularly those in the field of health care, tend to build up many independent files containing related and even overlapping data, and their data-processing activities often require the linking of data from several files. Several different types of database management systems have been developed to support these requirements: flat, hierarchical, network, relational, and object oriented. Although the distinctions between these types of databases are beyond the scope of this discussion, they are important in understanding the barriers to accessing, merging, and analyzing health care data.Health Data Standards Assignment Paper
Industry Standards for the Healthcare Industry
Industry standards are the foundation for process interoperability between SAP and non-SAP applications and platforms. Industry standards define a common language, which is required to cost-effectively enable process integration between systems, both inside an organization and across the value chain. Standards enable process flexibility by providing concrete rules for integration that have been developed by representatives of the healthcare community. SAP has worked with numerous industry standards organizations to enable more efficient and effective business processes.
The following organizations produce standards that SAP customers in the healthcare industry have found to be most useful in enabling processes between applications as well as their trading partners. The standards produced by these organizations are frequently leveraged in SAP solutions packages.
Industry Standards for Healthcare are separate from, yet closely related to, Industry Standards for the Life Sciences Industry. The Industry Standards for the Life Sciences Industry section of the Life Sciences Industry BPX has more information on specification related to both healthcare and life sciences.Health Data Standards Assignment Paper
Industry Standards for Health Care
Health Layer Seven (HL7) is an ANSI accredited standards organization that focuses on the interface requirements of the entire health care organization, including clinical and administrative data. It is an international community of experts that creates and promotes the use standards for the exchange, management and integration of electronic healthcare information. HL7 focuses on object models and message structures for healthcare information that needs to be exchanged between systems. The extensible nature and optional elements in these structures are one of the reasons for the adoption of these specifications.
Integrating the Healthcare Enterprise (IHE) is an initiative by to improve the sharing of electronic healthcare data, not by inventing its own set of standards, but rather by profiling specifications that already exist, like HL7, to address specific clinical needs in support of optimal patient care. By reducing the number of optional elements, systems that conform to IHE profiles should be able to communicate with one another more easily.
In April 2011 SAP successfully participated at the European Connectathon in Pisa (SAP for Healthcare gets Stamp from Global Authority on Standards for Interoperability). The obtained Integration Statement can be found here.Health Data Standards Assignment Paper
The United States Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. Title II of the Act focuses on simplifying administration procedures, and requires the establishment of national standards for electronic health care transactions, national identifiers for providers, health insurance providers, and employers. Additionally title II addresses the sensitive nature of this data by requiring security and privacy provisions. The result is standards designed to facilitate more efficient processes in the healthcare industry, and these are manifested in the HIPAA/EDI set of standards. The Centers for Medicare and Medicaid Services (CMS), a federal agency that administers the Medicare and works with states to administer Medicaid, required that all providers file their claims electronically using these EDI standards after July 1st, 2005 or they would not be reimbursed.
The Systematized Nomenclature of Medicine (SNOMED) pursues advancements in patient care through their terminology and implementation support products and services. The clinical terminology covers diseases, technical findings and procedures, allowing for a consistent way of describing, indexing, storing, retrieving, and aggregating clinical data. Health Data Standards Assignment Paper
More on Standards and Interoperability
Standards and Service-Oriented Architecture (SOA)
SOA is a business-driven software architecture that increases adaptability, flexibility, openness, and cost-efficiency. With SOA, organizations can compose applications and enable business processes rapidly using enterprise services. With SOA, organizations can improve their reuse of software and become more agile in responding to change. Standards are critical to SOA as they enable SAP and non-SAP applications and services to interoperate, so that they work together as seamlessly as possible, without adding unnecessary cost and risk to the business.Health Data Standards Assignment Paper
The lesson evaluates four types of data interchange standards that exist in healthcare: all communication between medical devices and electronic medical records, digital imaging communications, administrative data exchange, and clinical data exchange.
Data Interchange Standards in Healthcare
Have you ever been in a hospital? If you haven’t, congratulations! That’s quite a feat. If you have, then chances are when you were in there you noticed a few things. When you were staying in the hospital, I bet there were a lot of machines and devices beeping and displaying numbers proudly. I also bet that a number of nurses wheeled computers around wherever they would go so that they could complete all kinds of tasks, from big to small, including medication administration.Health Data Standards Assignment Paper
I also bet that if you had any x-rays, CT scans, or MRIs done, you can request those images as well as your medical chart and they will present you with a digital copy to take to your primary care physician. Finally, did they stop by your room or ask you to stop by before you left so they could go over some billing information? Did the person conduct all of his or her work from a computer? These are all examples of the various types of data interchange standards that exist in healthcare today.
Throughout the history of healthcare, medicine has evolved, and the introduction of computers and technology has helped aid in patient outcomes and disease management. It has also worked to ease the job of the physicians, nurses, ancillary staff, and hospital administrators so that better quality outcomes can be achieved and in a quick manner. In addition, these data interchange standards play a vital role in providing safe patient care. This also contributes to the culture of safety.Health Data Standards Assignment Paper
Medical Devices & EMR Communication
To be specific, four types of data interchange standards exist within the field of healthcare today. The first standard refers to the communication that takes place between medical devices and between devices and electronic medical records (EMRs). This communication is exactly as it sounds: information is processed by an electronic device such as an ECG monitor, ventilator, or even an IV infusion pump and dropped directly into the electronic medical record of that patient. This type of technology eases the workload of the nurse, makes results more readily available for the physician so quicker and more accurate care can be provided, and reduces the potential for errors to occur by eliminating a third party to have to input the information.
Digital Imaging Communication
The second type of data interchange standard is digital imaging communication, addressing the communication that takes place between radio logical images and the practitioners who read/interpret them to the practitioners who will then base their treatment plan off of that interpretation. When a radio logical image is taken, it is converted into a digital file that a radiologist can then view via a computer or tablet. The radiologist then dictates his or her findings and then the report and image can be delivered to the physician who ordered the test. Based on this communication, the physician will then make or modify the plan of care to suit the patient’s needs.Health Data Standards Assignment Paper
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