HEALTHCARE DATA STANDARDS

Standards are critical component in the development and implementation of an electronic health record
(EHR).

The effectiveness of a healthcare delivery is dependent on the ability of clinicians to access critical
health information when and where it is needed.

The capability of exchanging health information across organizational and system boundaries, whether
between multiple departments within a single institution or among a varied cast of providers, payers,
regulators, and others is essential.

It needs harmonized set of rules and definitions, both at the level of data meaning as well as at the
technical level of data exchange to make this possible.

Need for health data standards

Data standards as applied to healthcare include the “ 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 systems, and administrative processes”.

The ability to communicate in a way that ensures the message is received and the content is understood
is dependent on Standards.

In the domain of information management, standards can be further categorized as

A. those that support the generic infrastructure and are not domain specific,
B. those that support the exchange of information and are domain specific, and
C. those that support activities and practices within a specific domain

The first type of standard would include equipment specification such as processor type or network
transmission protocols such Ethernet or token ring.

A small token ring network 2003 HowStuffWorks

Station A, Station B, Station C and Station D

•The most common local area network alternative to Ethernet is a network technology developed by
IBM, call token ring

• Where Ethernet relies on the random gaps between transmissions to regulate access to the medium,
token ring implements a strict, orderly accessed method A token ring network arranges nodes in a
logical ring The nodes forward frames in one direction around the ring, removing a frame when it has
circled the ring once

1. The ring initializes by creating a token, which is a special type of frame that gives a station
permission to transmit
 2. The token circles the ring like any frame until it encounters a station that wishes to transmit
data
3. This station then “ the token by replacing the token frame with a data carrying frame, which
encircles the network
4. Once the data frame returns to the transmitting station, that station removes data frame,
creates a new token and forwards that token on to the next node in the ring

PROTOCOLS

• In networking, the term protocol refers to a set of rules that govern communications Protocols are to
computers what language is to humans

• Since this article is in English, to understand it, you must be able to read English Similarly, for two
devices on a network to successfully communicate, they must both understand the same protocols.

There are many older and newer technologies that allow you to get connected to the Internet, including
this wireless Internet card.

Cable Modem
A cable modem allows the user to get high speed Internet from their cable provider, though in times of
heavy usage with many connected users, performance might be significantly slower.

DSL Modem
Digital subscriber line ( technology transmit data over phone lines without interfering with voice service

Broadband Modem
Can use DSL cable service to go online Here, the DSL line is connected to the phone jack and the USB line
or Ethernet to the computer.

Broadband Over Powerlines (BPL)

Imagine plugging your computer into any electrical outlet in your home and having high speed internet
access That is BPL, but it has not been implemented on a large scale.

Fiber to the home Broadband (FTTH)

uses fiber optic cables to connect to the Internet. Such optics system can deliver digital information
telephone, video, data, etc. very efficiently.

Mobile Broadband
Most mobile broadband services simply require the use of a wireless internet card (like the one from
T-Mobile photo above), which allows users to access internet through cellular signals.

Wireless Internet Cards

Wi-Fi cards let the user connect to the Internet at home or in a Hotspot if there is a wireless transmitter
or adapter. Some cards come built in to a laptop.
Router
This wireless router emits a signal that a Wi-Fi detector or wireless card can pick up and use to connect
to the Internet A router is needed in setting up a Wi Fi network at home

Municipal WiFi
Municipal WiFi potentially can provide free of cheap Internet access throughout cities Routers, like the
one below, are mounted on light poles.

Wireless Mesh Networks

In a wireless mesh network, the network connection is spread out among dozens or even hundreds of
wireless mesh nodes that “ to each other to share the network connection across a large area.

Portable Internet Devices

Portable internet devices rely on Wi Fi and WiMAX technology to connect to the internet, and include
smart phones and the iPhone.

Healthcare data interchange standards

Data interchange standards address primarily the format of messages that are exchanged between
computer systems document architecture, clinical template uses interface and patient data linkage.

Message format standards

Four broadband classes of message format standards have emerged in the healthcare sector
1. Medical device communications
2. Digital Imaging communications
3. Administrative Data Exchange
4. Clinical Data Exchange

INSTITUTE OF ELECTRICAL and electronic engineers

The IEEE has developed a series of standards known collectively as P 1073 Medical Information Bus
( which support real time, continuous, and comprehensive capture and communication of data from
bedside medical devices such as those found in ICUs ,ORrs, Eds.

These data include physiologic parameter measurement and device settings.

The most widely known standard, 802 11 commonly referred to as WiFi allows anyone with a
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, airports, coffeehouses, convention centers, and even
parks, among other locations.

National electrical manufacturers association

The National Electrical Manufacturers Association ( in collaborating with the American College
of Radiologists ( and others, formed the DICOM to develop a generic digital format and a transfer
protocol for biomedical images and image related information.

Accredited standards committee x12/insurance

Accredited Standards Committee ( X 12 has developed a broad range of electronic data interchange
( EDI) standards to facilitate electronic business transactions.
National council for prescription drug programs
The NCPDP develops standards for information processing for the pharmacy services sector of the
healthcare industry. This has been very successful example of how standards can enable significant
improvements in the service delivery.

Proprietary standards can often be developed quickly and are supported by available implementations
and tools. If the developer can maintain a dominant market position, the standards can gain widespread
acceptance quickly.

Legislated, government developed standards are able to gain widespread in large, by virtue of their
being required by either regulation or in order to participate in large, government funded programs,
such as Medicare.

Integrating the healthcare enterprise

Standards, while a necessary part of the solution, are not sufficient alone to fulfill the needs for
interoperability. Integrating the healthcare enterprise (IHE)is an initiative that provides standards, filling
the gap between standards, and their implementation.

International organization of standardization (ISO)

• Is an organization that develops and publishes standards internationally.
• ISO standards are developed, in large part, from standards brought forth by member countries, and
through liaison activities with other SDOs.
• Often, these standards are further broadened to reflect the greater diversity of the international
community.

Electronic health record systems

introduction
• In April 2004 the President of the United States issued an Executive Order that called for the action to
HER S in place for most Americans in 10 years (White House, 2004).
• This order gave new momentum to effort across the healthcare community to use HIT to improve
healthcare.

• The term HER S is often used interchangeably with computerized patient record, clinical information
system, electronic medical record, and many others
• This reflects the broader focus on health of the consumer or patient and indicates that the HER S may
be used by all participants in the process of achieving health, including all disciplines of clinicians, family,
caregivers and the patient
• This is recognized internationally

Computer-based patient record system

• The set of components that form the mechanism by which the patient records are created, used and
stored, and retrieved
• It is usually located within a health care provider setting
• It includes people, data, rules and procedures, processing and storage devices, communications and
support facilities.
An her-s includes the following
1. Longitudinal collection of electronic health information for and about a person, where health
information pertaining to the health of an individual.
2. Immediate electronic access to person and population level information by authorized, and only
authorized users.
3. Provision of knowledge and decision support that enhances the quality, safety, efficiency of patient
care and;
4. Support of efficient process for health care delivery

Government as provider and early adopter

• The Department of Veteran Affairs Veterans Health Information Systems and Technology Architecture
(VistA) supports day to day clinical and administrative operations at local VA healthcare facilities
• Department of Defense Within DOD, providers have has a computerized physician order entry
capability that enables them to order lab tests and radiology examinations electronically for over 10
years.

Government as leaders
• Federal agencies that do not provide direct care are taking people multiple approaches to promote use
of HER S These include decreasing the cost and risk of acquisition and providing incentives for their use.
1. Office of the National Coordinator for Health Information Technology
2. The National Committee on Vital and Health Statistics
3. Agency for Healthcare Research and Quality

• Under this pay for performance program, physicians are using IT (such as e mail and clinical alerts
and reminders) and evidence based medicine to meet the needs of beneficiaries.

Connecting for health

• Is addressing the barriers to development of an interconnected health information infrastructure
• I brings together several dozen of the leading healthcare provider and prayer organizations, HIT
Vendors, and representatives of federal and state agencies.

eHealth Initiative
• Is an independent non-profit affiliated organization established to .foster improvement in the quality,
safety and efficiency of healthcare through information and IT
• Its membership brings together hospitals and other providers, practicing clinicians, community
organizations prayers, employers, community-based organizations HIT suppliers, manufacturers, and
academic organizations.

INSTITUTE OF MEDICINE
• Has championed the advantages of IT to improve health acre since 1991
• The computer based patient record, which was revised and published in 1997
• The IOM continues to illuminate the importance for the use of IT in healthcare
Centers for medicare and Medicaid services
• Several large pilot programs were authorized in 2003 Medicare Modernization Act (MMA).
• The 3 year Care Management Performance Demonstration Program intended to:
A. Promote continuity of care
B. Help stabilize medical conditions
C. Prevent or minimize acute exacerbations of chronic conditions, and
D. Reduce adverse health outcomes, such as adverse drug interactions

Health level seven

• An international, non-profit, volunteer standards organizations Health Level Seven (HL 7 2004 is known
for the transfer of healthcare data.
• This transport mechanism, known as messaging, is a widely used domestically and internationally As
an organization, HL 7 continues to have technical specifications for messages as the primary body of its
work product but is changing to address additional technical solutions for the transport of healthcare
data.