Information Standards in Health Care Information Systems

As the Health Information Manager, the ability to understand and implement major methods of standards for ad hoc, de facto, government, and consensus, must be developed, and the ability to identify which standard and organization that has developed or approved of the methods used: Classification standards, Vocabulary and terminology standards, Standards for electronic data interchange, and Health record content and functional standards, through discussion of the role of the organization and the impact of adopting information standards into our current health care information systems in the United States (Wager, Lee, & Glaser, 2013).

Understanding why there are so many different IT and health care information standards development process that exist, we need to address the basic standards process that has been developed in the United States and Internationally, whey so many changes have occurred in the past decade are being used to establish health care IT standards, have been divided into four categories, in which we will explore three, and discuss their relevancy, changes, and issues surrounding these standards (Wager et al., 2013). We will discuss the Ad hoc: which has been established by the ad hoc method, De facto: is a standard used when a vendor or other commercial enterprise desires to control a large segment of the IT market, Government mandate: mandates that are established by the government that the health care industry must adopt, and Consensus: brings together various interested groups who have come a formal agreement on specifications (Wager et al., 2013).

The United States creation of an aggregated, patient-centric electronic health record to form a regional health information network, with the ability to interchange data with independent sites, population database of health surveillance and bioterrorism defense, will require the development of health data standards, however, there are problems and issues affecting this progress and the acceptance of these standards that are necessary to implement and improve on the quality of healthcare in the U.S. and Internationally (Hammond, 2005). Although these standards exist, there is no nationwide coordination of how to process and ensure that these standard are a part every organization daily transaction.

In order to create a better-functioning health care system requires a complete, comprehensive electronic health record (EHR) at the time of care, to create an aggregate and data sharing system to sites where a patient may receive care and patient care that is from multiple institutions, building on common words (data elements and terminology), structures, and organizations, that will be implemented into IT will require interoperability (Hammond, 2005). Starting with the smallest component for data interchange, we must develop the use of interoperability, where a unit of data codes, name, definitions, and permissible valuables will need to be specified by a set of attributes to include data type, unit, and category (lab test, medication, and so on), which all health care data elements should represent (Hammond, 2005). This is the reason so many standards are required to support interoperability for a Health Information Manager (HIM), is based on the early days of health IT development systems that were stand-alone applications used for a specific purpose, and was on affordable by inpatient setting, with the hardware as the largest cost, until cost began to go down when the minicomputer was designed, along with departmental systems and ambulatory IT systems; although some departmental systems were considered stand-alone application, such as laboratory systems which served only the lab; lab test were printed out and distributed to the appropriate clinical unit. This created major problems for merging the data from the lab to an EHR system, because of human resources, and high error rates, that were transferred in paper form.

It became necessary for IT vendors to develop a more complete system, for the best solution of implementing a single integrated product to eliminate the need for any standards, however, the use of different systems are used, the expenses of building a custom-made interface would be necessary, and the cost would occur with every interface; with changes to the each interface, this cost will continue to recur, that is why many users of IT systems came together to introduce a set of standards into health care (Hammond, 2005). As this awareness began to take notice, the removing of trade barriers and expansion of some markets became a common procedure or protocol that would benefit a community in a specific area, thereby creating a technical expertise group to introduce these standards, for vendors, as an open process to allow widespread buy-in, and the ability to market the standards to be adopted and implemented into the health care industry by the vendor products and certification of the application that is using the standard, manuals should be provided to explain in an easy and essential way to implement these standards.

A roadmap does not exist for health data standards, and no future plan of developing or creating such a map, there is no given standard to support inter-operability implementation of a national information network (NHIN), leaving gaps in the system, but the needs that are identified, continues to progress toward realizing our need for a NHIN (Hammond, 2005). With all the competition of the Standard Developing Organizations (SDOs), complications are arising from other groups, such as Healthcare Information and Management System Society (HIMSS), the National Alliance for Health Information Technology (NAHIT), the Office of the National Coordinator for Health Information Technology (ONCHIT), the Working Group for Electronic Data Interchange (WEDI), and many other organizations that are getting involved in standard-development process, we are seeing the competition of these SDOs has become unintentional but resulting in the evolution and expansion of the process (Hammond, 2005).

ICD has become the most recognized and coding system, along with Current Procedural Terminology (CPT). And diagnosis related groups (DRGs), these systems are designed to classify diagnoses and procedures for the retrieval of information from a health care information system; many being designed to facilitate disease and procedure information retrieval, are now being implemented and adopted to code for billing of services, which have been incorporated into a standard vocabulary such as SNOIMED-CT and UMLS; HIPAA has defined these codes for diagnoses and procedures used in any transaction by a covered entity (Wager et al., 2013). These set of codes that are required by HIPAA are: HCPCS (ancillary services or procedures, CPT-4 (physician procedures), ICD-9 (for diagnoses and hospital patient procedures), and NDC (national drug codes), along with the code on Dental Procedures and Nomenclature established by the American Dental Association (ADA); these codes are designed to support accurate recording and reporting of dental treatments, are kept up-to-date by the ADA. The National Drug Codes are universal as a product identifier for all human drugs, which in 1972, was required as the Drug Listing Act of 1972, that all drug companies provide the Food and Drug Administration (FDA) with a current list of all drugs being manufactured (Wager et al., 2013).

However, the most difficult problem we find with exchanging health care information and building a longitudinal electronic health record system (EHR), takes the coordination of a large amount of health information generated into a diverse location for patient and population, a vocabulary and terminology standard must be established to allow for different information systems and vendor products to be able to communicate unambiguously with each other, a simple “myocardial infarction,” a medical term used to map out the term “heart attack,” should share the same attribute (Wager et al., 2013). Having and effective standard vocabulary that is a standardized complex hierarchy and syntax language that can be used in the health industry, has become more complex as we continue to embark on implementing a vocabulary and terminology standard.

The National Committee on Vital and Health Statistic (NCVHS) that falls under HIPAA mandates is responsible for making recommendations for a uniform data standard as the core of PMRI terminology standards (Wager et al., 2013). Along with the Logical Observation Identifies Names and Codes system to transmit laboratory results to hospitals, physicians, and third-party payers, the Regenstrief Institute at Indians University (LOINC) in 1994, established and provided a universal name and code identifier for individual clinical results, and with the Center for Disease Control and Prevention (CDC), National Center of Immunization and Respiratory Disease (NCIRD), allowed for the development of the Clinical Vaccines Administration (CVX) using the HL7 standard of transmitting and retrieving data. As our RxNorm (National Library of Medicine (NLM), serves two purposes, for naming a system of generic and brand name drugs, this standard supports semantic interoperation between drug terminology and pharmacy knowledge systems (Wager et al., 2013), with at least twelve RxNorm data files being released on a monthly basis to show: Drug name and unique identifier, Relationships, Attributes, Semantic types, Data history, obsolete data, Metadata, the National Library of Medicine (NLM), a part of the National Institute of Health, introduced and implemented the Unified Medical Language System (UMLS) to assist with the development of computer systems to understand biomedicine and health language (Wager et al., 2013).

Having the ability to exchange and integrate data with various health care applications is becoming a critical aspect of the success of health care information system, with the overlapping of standards based on the vocabulary of these standards, the major purpose of standardizing an actual “messaging” between health care information systems for exchanging and integration of this data, the need for a identifier standards are necessary to provide standards to address the various types of applications with only one type of application (Wager et al., 2013). The Health Level Seven Standard is uses as an ANSI-accredited standard that developers found as an ad hoc, Digital Imaging and Communication Medicine (CT Scans and MRIs), the National Council for Prescription Drug Programs (NCPDP), is responsible for business solutions, and guidance for information exchange, and ANSI ASX X12N was developed by the ANSI as X13 and XML formats for the electronic exchange of business information (Wager et al., 2013).

There has been a federal initiative affecting health care IT standards, which are related to HIPAA final rule outlining these standards to be adopted by health care organizations using EHR systems, and is the designated standard maintenance organizations (DSMOs), for which HIPAA has adopted as the transaction standard for all covered entities electronic data interchange (EDI) claims, eligibility, enrollment, dis-payment and remittance advice, referrals and authorizations, coordination of benefits and premium payments (Wager et al., 2013). HIPAA transact standards are using ASC X12N version of 5010 to accommodate ICD-10 and NDPDP D.0 for certain pharmacy transactions.

In conclusion, health care information standards will continue to evolve of the years to come, in order to be more efficient and effective, a system must be developed to accommodate these changes.

References

Hammond, W. E. (2005). The Making and Adoption of Health Data Standards. Retrieved May 12, 2015, from http://content.healthaffairs.org/content/24/5/1205.full

Wager, K. A., Lee, F. W., & Glaser, J. P. (2013). Health Care Information Systems (3rd Ed.). San Francisco, CA: Jossey-Bass.