09 - Networking and Health Information Exchange - Unit 3 - National and International Standards Developing Organizations - Lecture C

Networking and Health
Information Exchange
National and International Standards
Developing Organizations
Lecture c
This 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.
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 developed
b. Who develops them
c. How standards are accredited
d. 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
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)

3
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

4
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

5
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

6
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

7
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

8
Lecture c
IHE Products
Integration profiles
Integration statements
Technical frameworks
Connectathon
Showcases


9
Lecture c
IHE Domains
Anatomic Pathology
Cardiology
Dental
Endoscopy
Eye Care
IT Infrastructure
Laboratory


Patient Care
Coordination
Patient Care Device
Pharmacy
Quality, Research
and Public Health
Radiation Oncology
Radiology
10
Lecture c
ASTM E31
Healthcare Informatics
Develops standards related to:
Architecture
Content
Storage
Security
Confidentiality
Functionality
Communication of information used within
healthcare

11
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

12
Lecture c
ASTM E31 Key Standards
Confidentiality, privacy and security;
authentication and authorization
Guideline Elements Model (GEM)
Quality Indicators
Voluntary Universal Healthcare
Identification System

13
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.

14
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

15
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).

16
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

17
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)

18
Lecture c
SDO Charter Organizations
Objectives
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

19
Lecture c
Standards Categories, Examples,
and SDOs (1/2)
3.1 Table Standards Categories, Examples, and SDOs 1/2
20
Lecture c
Category Examples SDOs
Generic, broad use XML, TCP/IP, Web services, OCL,
OWL, CCOW, GIS
W3C, 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

21
Lecture c
Summary View of Standards

22
Lecture c
Planning
Phase
Data
Data
Exchange
Data
Store
Reposi-
tories
Collec-
tion
Decision
Support
EHR
Applica-
tions
Presen-
tation
ISO, CEN, HL7, CDISC,
DICOM, IEEE, IHTSDO,LOINC,
GS1, IHE, NCPDP, X12,
openEHR, WHO/ICD,
Reports
Audits
Story boards
Use cases
Data models
RIM
MDF
DAM
BRIDG
SOA
Data
Elements
Data types
Terminology
Units
CMETS
Templates
Archetypes
Templates
Clinical
Statements
CDA
CCD
CTS
CDASH
XFORM
Templates
CDA
HL7 v2
HL7 v3
CEN
13606
IEEE
DICOM ISO
EHR FM
PHR FM
CCOW
Geno-
mics
ISO
Arden
Syntax
GELLO
GLIF
Info
buttons
Privacy and Security Standards
Identifiers
Profiles
Queries
Filters
Medical
Devices
PHD
New
Needs
Supply Chain
Dem
Lab
Meds
Probs
AE
CDW
Getting access to standards
Standards Knowledge Management Tool
JIC/ISO project sponsored by Universit de
Sherbrooke
www.skmtglossary.org
Most major standards listed
Duke Center for Best Practices
www.ctnbestpractices.org/standards-inventory/

23
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.

24
Lecture c
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.
25
Lecture c
References Lecture c
References
Main Page - IHEWiki.wustl.edu: Support of IHE Connectathons. (n.d.). Retrieved January 10, 2012, from
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/

Images
Slide 22: courtesy of Dr. Ed Hammond

Tables
3.1 Table: created by Dr. Ed Hammond
3.2 Table: created by Dr. Ed Hammond
26
Lecture c

09 - Networking and Health Information Exchange - Unit 3 - National and International Standards Developing Organizations - Lecture C

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