HIT - Standards

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Government and standards

Much of the activity for Health Information Technology for Economic and Clinical Health (HITECH) and the American Recovery and Reinvestment Act (ARRA) involve standards.

Who is doing the thinking about standards?

The Office of the National Coordinator (ONC), supported by two committees –the Healthcare Information Technology Standards Committee (HITSC) and the Healthcare Information Technology Policy Council (HITPC) are engaged in identifying standards for HIT.

How are standards made?

Government
De Facto standards (Proprietary) created by a vendor
Ad hoc standards create by industry groups
Consensus standards created by open groups of interested stake holders.

Authority for standards

Government –mandate
Single vendor –market share
Ad hoc –vendor agreement
Consensus –balanced voting process among categories of participants. Requires over-whelming agreement. Vote by members or countries.

Who creates standards?

Unfortunately, there are many groups that create standards. The result is competing, conflicting and overlapping standards. The result is inconsistency in what standards are chosen, defeating the purpose of standards.
We refer to a group that creates standards as a Standards Developing Organization (SDO). Some SDOs are international, others are U.S. only.

International SDOs

International Standards Organization (ISO)–ISO TC 215 –Healthcare Informatics
European Committee for Standardization (CEN)
Health Level 7 (HL7) International
Digital Imaging and Communications in Medicine (DICOM)
Institute of Electrical and Electronic Engineers (IEEE)
Clinical Data Interchange Standards Consortium (CDSIC)
GS1
International Healthcare Terminology SDO (IHTSDO)
Joint Initiative Council (JIC)

Related organizations

World Health Organization (WHO)
Object Management Group (OMG)
Integrating the Healthcare Enterprise (IHE)
openEHR
World Wide Web Consortium (W3C)
Organization for the Advancement of Structured Information Standards (OASIS)
Internet Engineering Task Force (IETF)

U.S. HIT SDOs

ASTM
ASC X12N
National Council for Prescription Drug Programs (NCPDP)
MedBiquitous
American Dental Association
International/U.S.–CDISC, DICOM, HL7, IEEE

Related U.S. groups

American National Standards Institute (ANSI)
US Tag to ISO TC 215
National Institute of Standards (NIST)
SDO Charter Organization (SCO)
National Quality Forum (NQF)
Office of the National Coordinator (ONC)–HIT Standards Committee (HITSC)–HIT Policy Council (HITPC)
National Library of Medicine

xxComponent 9 / Unit 3b Networking and Health Information Exchange 1 Version 1.0/Fall 2010 Slide 1 Health IT Workforce CurriculumVersion 1.0 Fall 20101Networking and Health Information ExchangeUnit 3bNational and International Standards Developing OrganizationsComponent 9/Unit #3b ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Objectives•To understand the organizations that develop standards for the international community and for the United States.•To develop an understanding of the kinds of standards being developed and for what purposes.Component 9 / Unit 3b Networking and Health Information Exchange 1 Version 1.0/Fall 2010 Slide 1 Health IT Workforce CurriculumVersion 1.0 Fall 20101Networking and Health Information ExchangeUnit 3bNational and International Standards Developing OrganizationsComponent 9/Unit #3b ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Objectives•To understand the organizations that develop standards for the international community and for the United States.•To develop an understanding of the kinds of standards being developed and for what purposes.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20102 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 ISO TC 215 Healthcare Informatics•Standards have national priority•Members are nations•Established in 1998•Products include Technical Reports, Technical Specifications, and International StandardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20103 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 2 Version 1.0/Fall 2010 Slide 4 Work groups of TC 215•WG1 –Data Structure•WG2 –Data Interchange•WG3 –Semantic Content•WG4 –Security•WG6–Pharmacy and Medicines –Business•WG7 –Medical Devices•WG8 –Business requirements for Electronic Health Records•WG9 –SDO HarmonizationComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20104 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 Significant relationships•Vienna Agreement•HL7 pilot agreement•IEEE partnership agreementComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20105 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Harmonization of international standards•Creation of Joint Initiative Council in 2007.•Founding members –ISO TC 215, CEN TC 251, and HL7. Later members include CDISC, IHTSDO, and GS1.•Operates as a council of equals and was created to create a single standard for a single business use.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 3 Version 1.0/Fall 2010 Slide 7 CEN TC 251•Workgroup within European Union; goal is to achieve compatibility and interoperability between independent systems and to enable modularity in EHR systems.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20107 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 CEN TC 251 work groups•WG I –Information Models•WG II –Terminology and knowledge representation•WG III –Safety and Quality•WG IV –Technology for Interoperability.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20108 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 CEN Standard EN 13606•An important CEN standard is EN 13606 –Health Informatics –Electronic Health Record communication, published in 5 parts–(1) Reference Model–(2) Archetypes interchange specification–(3) Archetypes and term lists–(4) Security–(5) Interface specification•These standards are being used in the European Union and are becoming ISO standardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20109 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 4 Version 1.0/Fall 2010 Slide 10 Health Level 7•Formed in 1987 as a U.S. SDO; invited international affiliates in the early 1990s•Now HL7 International with over 40 international country members•Is an ANSI accredited SDOComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 HL7 steering divisions•Domain Experts•Foundation and Technology•Structure and Semantic Design•Technical and Support ServicesComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 Domain experts•Anatomic Pathology •Anesthesiology •Attachments •Child Health•Clinical Interoperability Council•Community Based Health Services •Emergency Care •Government Projects •Health Care Devices •Imaging Integration •Laboratory •Patient Care •Patient Safety •Public Health Emergency Response (PHER) •Pharmacy •Regulated Clinical Research (RCRIM)Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201012 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 5 Version 1.0/Fall 2010 Slide 13 Foundation and Technology•Conformance & Implementation•Infrastructure & Messaging •Implementable Technology Specifications (ITS) •Java •Modeling & Methodology •Security •Service Oriented Architecture (SOA) •Templates •Vocabulary Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201013 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Structure and Semantic Design•Arden Syntax •Clinical Context Object Workgroup (CCOW) •Clinical Decision Support •Clinical Statement•Electronic Health•Record (EHR) •Financial Management •Genomics •Orders & Observations •Patient Administration •Personnel Management •Scheduling & Logistics •Structured Documents Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Technical and Support Services•Education •Electronic Services •Implementation •Marketing Committee •Process Improvement•Committee (PIC) •Project Services •Tooling Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201015 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 6 Version 1.0/Fall 2010 Slide 16 HL7 products•Messaging Standards–Version 2.x (current is 2.7 published 12/07)–XML Encoding Rules for v2 Messages–Version 3.0 (2008 Normative Edition in publication)•Infrastructure–Master file structure infrastructure–Role-Based Access ControlComponent 9/Unit #3b16Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 HL7 products•Models–Reference Information Model–Data Types–Common Message Element Type–XML Implementation Technology Specification -StructuresComponent 9/Unit #3b17Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 •Application–Electronic Health Record•Functional EHR-S Standard today•Interactions for EHR-S and Functional PHR-S•Profiles–EHR Behavioral Health Functional Model–EHR Child Health Functional Model–Scheduling–Notifiable Condition Report–Personnel Management–Genomics -PedigreeHL7 productsComponent 9/Unit #3b18Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 7 Version 1.0/Fall 2010 Slide 19 HL7 products•Documents–Clinical Document Architecture–Continuity of Care Document•Decision Support–Arden Syntax–Virtual Medical Record–GELLO: Common Expression Language–InfobuttonComponent 9/Unit #3b19Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 HL7 products•Regulated Studies–Structured Product Labeling–Annotated ECG–Individual Case Safety Report–Drug Stability Study–Regulated Product Submission–Common Product Model–Periodic Reporting of Clinical Trials Laboratory ResultsComponent 9/Unit #3b20Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 HL7 products•Clinical Context Object Workgroup –Clinical Context Management–Application Protection Package–Manager Protection Package–User Authenticator PackageComponent 9/Unit #3b21Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 8 Version 1.0/Fall 2010 Slide 22 •HL7 Claims Attachments •Secure HL7 Transactions Using Internet Mail•HL7 Security Service Framework•CDA R2•Common Audit Message•Standard Guide for Implementing HL7 EDI Communication Security•HL7 Version 2.x Message Profiling Specification •Continuity of Care Document (CCD)•And growing…Implementations GuidesComponent 9/Unit #3b22Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 HL7 Standards named in HHS Final Rule•HL7 v2.5.1 Implementation Guide: Electronic Laboratory Results Reporting to Public Health•Clinical Document Architecture (CDA)•Continuity of Care Document (CCD)•Messaging Standard Version 2.5.1•Messaging Standard Version 2.3.1Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201023 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 CDISC standards•Study Data Tabulation Model (SDTM)–Recommended for FDA regulatory submissions•Analysis Data Model (ADaM)–Complements SDTM submission by detailing statistical analysis performed on clinical trials results•Operational Data Model (ODM)•Clinical Data Acquisition Standards Harmonization (CDASH)•Laboratory Data Model (LAB)•CDISC TerminologyComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201024 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 9 Version 1.0/Fall 2010 Slide 25 GS1 key standards•Barcodes•eCom –electronic business messaging standards for automatic transmission of data•GDSN –Global Data Synchronization –allow business partners to have consistent item data in their system at the same time•EPCglobal –use RFID technology to track items in real timeComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201025 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 Summary•Multiple SDOs = competing and overlapping standards•Redundancy in work•Redundancy in people•Limited resoursesComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201026 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________Component 9 / Unit 3b Networking and Health Information Exchange 1 Version 1.0/Fall 2010 Slide 1 Health IT Workforce CurriculumVersion 1.0 Fall 20101Networking and Health Information ExchangeUnit 3bNational and International Standards Developing OrganizationsComponent 9/Unit #3b ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Objectives•To understand the organizations that develop standards for the international community and for the United States.•To develop an understanding of the kinds of standards being developed and for what purposes.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20102 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 ISO TC 215 Healthcare Informatics•Standards have national priority•Members are nations•Established in 1998•Products include Technical Reports, Technical Specifications, and International StandardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20103 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 2 Version 1.0/Fall 2010 Slide 4 Work groups of TC 215•WG1 –Data Structure•WG2 –Data Interchange•WG3 –Semantic Content•WG4 –Security•WG6–Pharmacy and Medicines –Business•WG7 –Medical Devices•WG8 –Business requirements for Electronic Health Records•WG9 –SDO HarmonizationComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20104 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 Significant relationships•Vienna Agreement•HL7 pilot agreement•IEEE partnership agreementComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20105 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Harmonization of international standards•Creation of Joint Initiative Council in 2007.•Founding members –ISO TC 215, CEN TC 251, and HL7. Later members include CDISC, IHTSDO, and GS1.•Operates as a council of equals and was created to create a single standard for a single business use.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 3 Version 1.0/Fall 2010 Slide 7 CEN TC 251•Workgroup within European Union; goal is to achieve compatibility and interoperability between independent systems and to enable modularity in EHR systems.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20107 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 CEN TC 251 work groups•WG I –Information Models•WG II –Terminology and knowledge representation•WG III –Safety and Quality•WG IV –Technology for Interoperability.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20108 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 CEN Standard EN 13606•An important CEN standard is EN 13606 –Health Informatics –Electronic Health Record communication, published in 5 parts–(1) Reference Model–(2) Archetypes interchange specification–(3) Archetypes and term lists–(4) Security–(5) Interface specification•These standards are being used in the European Union and are becoming ISO standardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20109 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 4 Version 1.0/Fall 2010 Slide 10 Health Level 7•Formed in 1987 as a U.S. SDO; invited international affiliates in the early 1990s•Now HL7 International with over 40 international country members•Is an ANSI accredited SDOComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 HL7 steering divisions•Domain Experts•Foundation and Technology•Structure and Semantic Design•Technical and Support ServicesComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 Domain experts•Anatomic Pathology •Anesthesiology •Attachments •Child Health•Clinical Interoperability Council•Community Based Health Services •Emergency Care •Government Projects •Health Care Devices •Imaging Integration •Laboratory •Patient Care •Patient Safety •Public Health Emergency Response (PHER) •Pharmacy •Regulated Clinical Research (RCRIM)Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201012 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 5 Version 1.0/Fall 2010 Slide 13 Foundation and Technology•Conformance & Implementation•Infrastructure & Messaging •Implementable Technology Specifications (ITS) •Java •Modeling & Methodology •Security •Service Oriented Architecture (SOA) •Templates •Vocabulary Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201013 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Structure and Semantic Design•Arden Syntax •Clinical Context Object Workgroup (CCOW) •Clinical Decision Support •Clinical Statement•Electronic Health•Record (EHR) •Financial Management •Genomics •Orders & Observations •Patient Administration •Personnel Management •Scheduling & Logistics •Structured Documents Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Technical and Support Services•Education •Electronic Services •Implementation •Marketing Committee •Process Improvement•Committee (PIC) •Project Services •Tooling Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201015 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 6 Version 1.0/Fall 2010 Slide 16 HL7 products•Messaging Standards–Version 2.x (current is 2.7 published 12/07)–XML Encoding Rules for v2 Messages–Version 3.0 (2008 Normative Edition in publication)•Infrastructure–Master file structure infrastructure–Role-Based Access ControlComponent 9/Unit #3b16Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 HL7 products•Models–Reference Information Model–Data Types–Common Message Element Type–XML Implementation Technology Specification -StructuresComponent 9/Unit #3b17Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 •Application–Electronic Health Record•Functional EHR-S Standard today•Interactions for EHR-S and Functional PHR-S•Profiles–EHR Behavioral Health Functional Model–EHR Child Health Functional Model–Scheduling–Notifiable Condition Report–Personnel Management–Genomics -PedigreeHL7 productsComponent 9/Unit #3b18Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 7 Version 1.0/Fall 2010 Slide 19 HL7 products•Documents–Clinical Document Architecture–Continuity of Care Document•Decision Support–Arden Syntax–Virtual Medical Record–GELLO: Common Expression Language–InfobuttonComponent 9/Unit #3b19Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 HL7 products•Regulated Studies–Structured Product Labeling–Annotated ECG–Individual Case Safety Report–Drug Stability Study–Regulated Product Submission–Common Product Model–Periodic Reporting of Clinical Trials Laboratory ResultsComponent 9/Unit #3b20Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 HL7 products•Clinical Context Object Workgroup –Clinical Context Management–Application Protection Package–Manager Protection Package–User Authenticator PackageComponent 9/Unit #3b21Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 8 Version 1.0/Fall 2010 Slide 22 •HL7 Claims Attachments •Secure HL7 Transactions Using Internet Mail•HL7 Security Service Framework•CDA R2•Common Audit Message•Standard Guide for Implementing HL7 EDI Communication Security•HL7 Version 2.x Message Profiling Specification •Continuity of Care Document (CCD)•And growing…Implementations GuidesComponent 9/Unit #3b22Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 HL7 Standards named in HHS Final Rule•HL7 v2.5.1 Implementation Guide: Electronic Laboratory Results Reporting to Public Health•Clinical Document Architecture (CDA)•Continuity of Care Document (CCD)•Messaging Standard Version 2.5.1•Messaging Standard Version 2.3.1Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201023 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 CDISC standards•Study Data Tabulation Model (SDTM)–Recommended for FDA regulatory submissions•Analysis Data Model (ADaM)–Complements SDTM submission by detailing statistical analysis performed on clinical trials results•Operational Data Model (ODM)•Clinical Data Acquisition Standards Harmonization (CDASH)•Laboratory Data Model (LAB)•CDISC TerminologyComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201024 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 9 Version 1.0/Fall 2010 Slide 25 GS1 key standards•Barcodes•eCom –electronic business messaging standards for automatic transmission of data•GDSN –Global Data Synchronization –allow business partners to have consistent item data in their system at the same time•EPCglobal –use RFID technology to track items in real timeComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201025 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 Summary•Multiple SDOs = competing and overlapping standards•Redundancy in work•Redundancy in people•Limited resourses

<br/> Slide 3 ISO TC 215 Healthcare Informatics•Standards have national priority•Members are nations•Established in 1998•Products include Technical Reports, Technical Specifications, and International StandardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20103 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 2 Version 1.0/Fall 2010 Slide 4 Work groups of TC 215•WG1 –Data Structure•WG2 –Data Interchange•WG3 –Semantic Content•WG4 –Security•WG6–Pharmacy and Medicines –Business•WG7 –Medical Devices•WG8 –Business requirements for Electronic Health Records•WG9 –SDO HarmonizationComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20104 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 Significant relationships•Vienna Agreement•HL7 pilot agreement•IEEE partnership agreementComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20105 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 Harmonization of international standards•Creation of Joint Initiative Council in 2007.•Founding members –ISO TC 215, CEN TC 251, and HL7. Later members include CDISC, IHTSDO, and GS1.•Operates as a council of equals and was created to create a single standard for a single business use.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 3 Version 1.0/Fall 2010 Slide 7 CEN TC 251•Workgroup within European Union; goal is to achieve compatibility and interoperability between independent systems and to enable modularity in EHR systems.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20107 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 CEN TC 251 work groups•WG I –Information Models•WG II –Terminology and knowledge representation•WG III –Safety and Quality•WG IV –Technology for Interoperability.Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20108 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 CEN Standard EN 13606•An important CEN standard is EN 13606 –Health Informatics –Electronic Health Record communication, published in 5 parts–(1) Reference Model–(2) Archetypes interchange specification–(3) Archetypes and term lists–(4) Security–(5) Interface specification•These standards are being used in the European Union and are becoming ISO standardsComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 20109 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 4 Version 1.0/Fall 2010 Slide 10 Health Level 7•Formed in 1987 as a U.S. SDO; invited international affiliates in the early 1990s•Now HL7 International with over 40 international country members•Is an ANSI accredited SDOComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 HL7 steering divisions•Domain Experts•Foundation and Technology•Structure and Semantic Design•Technical and Support ServicesComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 Domain experts•Anatomic Pathology •Anesthesiology •Attachments •Child Health•Clinical Interoperability Council•Community Based Health Services •Emergency Care •Government Projects •Health Care Devices •Imaging Integration •Laboratory •Patient Care •Patient Safety •Public Health Emergency Response (PHER) •Pharmacy •Regulated Clinical Research (RCRIM)Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201012 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 5 Version 1.0/Fall 2010 Slide 13 Foundation and Technology•Conformance & Implementation•Infrastructure & Messaging •Implementable Technology Specifications (ITS) •Java •Modeling & Methodology •Security •Service Oriented Architecture (SOA) •Templates •Vocabulary Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201013 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 Structure and Semantic Design•Arden Syntax •Clinical Context Object Workgroup (CCOW) •Clinical Decision Support •Clinical Statement•Electronic Health•Record (EHR) •Financial Management •Genomics •Orders & Observations •Patient Administration •Personnel Management •Scheduling & Logistics •Structured Documents Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 Technical and Support Services•Education •Electronic Services •Implementation •Marketing Committee •Process Improvement•Committee (PIC) •Project Services •Tooling Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201015 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 6 Version 1.0/Fall 2010 Slide 16 HL7 products•Messaging Standards–Version 2.x (current is 2.7 published 12/07)–XML Encoding Rules for v2 Messages–Version 3.0 (2008 Normative Edition in publication)•Infrastructure–Master file structure infrastructure–Role-Based Access ControlComponent 9/Unit #3b16Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 HL7 products•Models–Reference Information Model–Data Types–Common Message Element Type–XML Implementation Technology Specification -StructuresComponent 9/Unit #3b17Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 •Application–Electronic Health Record•Functional EHR-S Standard today•Interactions for EHR-S and Functional PHR-S•Profiles–EHR Behavioral Health Functional Model–EHR Child Health Functional Model–Scheduling–Notifiable Condition Report–Personnel Management–Genomics -PedigreeHL7 productsComponent 9/Unit #3b18Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 7 Version 1.0/Fall 2010 Slide 19 HL7 products•Documents–Clinical Document Architecture–Continuity of Care Document•Decision Support–Arden Syntax–Virtual Medical Record–GELLO: Common Expression Language–InfobuttonComponent 9/Unit #3b19Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 HL7 products•Regulated Studies–Structured Product Labeling–Annotated ECG–Individual Case Safety Report–Drug Stability Study–Regulated Product Submission–Common Product Model–Periodic Reporting of Clinical Trials Laboratory ResultsComponent 9/Unit #3b20Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 21 HL7 products•Clinical Context Object Workgroup –Clinical Context Management–Application Protection Package–Manager Protection Package–User Authenticator PackageComponent 9/Unit #3b21Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 8 Version 1.0/Fall 2010 Slide 22 •HL7 Claims Attachments •Secure HL7 Transactions Using Internet Mail•HL7 Security Service Framework•CDA R2•Common Audit Message•Standard Guide for Implementing HL7 EDI Communication Security•HL7 Version 2.x Message Profiling Specification •Continuity of Care Document (CCD)•And growing…Implementations GuidesComponent 9/Unit #3b22Health IT Workforce Curriculum Version 1.0 Fall 2010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 23 HL7 Standards named in HHS Final Rule•HL7 v2.5.1 Implementation Guide: Electronic Laboratory Results Reporting to Public Health•Clinical Document Architecture (CDA)•Continuity of Care Document (CCD)•Messaging Standard Version 2.5.1•Messaging Standard Version 2.3.1Component 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201023 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 24 CDISC standards•Study Data Tabulation Model (SDTM)–Recommended for FDA regulatory submissions•Analysis Data Model (ADaM)–Complements SDTM submission by detailing statistical analysis performed on clinical trials results•Operational Data Model (ODM)•Clinical Data Acquisition Standards Harmonization (CDASH)•Laboratory Data Model (LAB)•CDISC TerminologyComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201024 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3b Networking and Health Information Exchange 9 Version 1.0/Fall 2010 Slide 25 GS1 key standards•Barcodes•eCom –electronic business messaging standards for automatic transmission of data•GDSN –Global Data Synchronization –allow business partners to have consistent item data in their system at the same time•EPCglobal –use RFID technology to track items in real timeComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201025 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 26 Summary•Multiple SDOs = competing and overlapping standards•Redundancy in work•Redundancy in people•Limited resoursesComponent 9/Unit #3bHealth IT Workforce Curriculum Version 1.0 Fall 201026 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

Component 9 / Unit 3c Networking and Health Information Exchange 1 Version 1.0/Fall 2010 Slide 1 Health IT Workforce CurriculumVersion 1.0 Fall 20101Networking and Health Information ExchangeUnit 3cNational and International Standards Developing OrganizationsComponent 9/Unit #3c ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 2 Health IT Workforce Curriculum Version 1.0 Fall 20102Unit 3 Objectives•To learn about standards developing organizations and the standards they create –a continuation of the focusing on U.S. standards bodies.Component 9/Unit #3c ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 3 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.Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20103 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 2 Version 1.0/Fall 2010 Slide 4 Digital Imaging and Communications in Medicine •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.Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20104 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 5 DICOM•DICOM addresses images in cardiology, dentistry, endoscopy, mammography, ophthalmology, orthopedics, pathology, pediatrics, radiation therapy, surgery, and others.Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20105 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 6 DICOM functionality•Transmission and persistence of objects (images, waveforms, and documents)•Query and retrieval of such objects•Performance of specific functions (such as printing images on film)•Workflow management (support of worklists and status information)•Quality and consistency of image appearance for display and printComponent 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20106 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 3 Version 1.0/Fall 2010 Slide 7 ASTM E31 Healthcare Informatics•Develops standards related to the architecture, content, storage, security, confidentiality, functionality, and communication of information used within healthcare. Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20107 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 8 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 EHRComponent 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20108 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 9 ASTM E31 key standards•Confidentiality, privacy and security; authentication and authorization•Guideline Elements Model (GEM)•Quality Indicators•Voluntary Universal Healthcare Identification SystemComponent 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 20109 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 4 Version 1.0/Fall 2010 Slide 10 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 X122N standards.Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201010 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 11 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 HL7Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201011 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 12 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 in Medicare Prescription Drug, Improvement, and Modernization Act (Medicare, Part D).Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201012 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 5 Version 1.0/Fall 2010 Slide 13 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 standardsComponent 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201013 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 14 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)Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201014 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 15 SDO Charter Organizationsobjectives•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 expertsComponent 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201015 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 6 Version 1.0/Fall 2010 Slide 16 Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201016CategoryExamplesSDOsGeneric, broad useXML, TCP/IP, Web services, OCL, OWL, CCOW, GISW3C, IETF, OMG, HL7. Data definitionRIM, data elements, data types, terminology, templates, archetypes, clinical statementsHL7, CEN, ISO, NCPDP, X12N, IEEE, SNOMED, LOINC, RxNorm, SPL, openEHRData exchangeStructured and free form documents, images, CDA, CCRHL7, DICOM, ASTM, NCPDP, IEEE, X12N. ISOKnowledge representationGuidelines and protocols, Arden Syntax, GLIF, GEM, PRODIOGY, PROTIGE, vMR, GELLO, disease managementHL7, ASTM, CEN, openEHR, ISO ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 17 Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201017CategoryExamplesSDOsElectronic Health RecordFunctional requirements, content data sets, minimum data sets, EHR models, architectureHL7, ASTM, CEN, openEHR, ISOSecurity and PrivacyEncoding, encryption, authentication, authorization, integrity, digital signatureIETF, OMG, ASTM, HL7, ISOApplicationIdentifiers, resource registries, tool sets, conformance requirements, certification, SOA., simulation, implementation manualsHL7, ASTM, ISO, CEN ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 18 Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201018PlanningPhaseDataDataExchangeDataStoreReposi-toriesCollec-tionDecisionSupportEHR Applica-tionsPresen-tationISO, CEN, HL7, CDISC, DICOM, IEEE, IHTSDO,LOINC, GS1, IHE, NCPDP, X12, openEHR, WHO/ICD, …ReportsAuditsStory boardsUse casesData modelsRIMMDFDAMBRIDGSOAData ElementsData typesTerminologyUnitsCMETSTemplatesArchetypesTemplatesClinical StatementsCDACCDCTSCDASHXFORMTemplatesCDAHL7 v2HL7 v3CEN 13606IEEEDICOMISOEHR FMPHR FMCCOWGeno-micsISOArden SyntaxGELLOGLIFInfo buttonsPrivacy and Security StandardsIdentifiersProfilesQueriesFiltersMedical DevicesPHDNew NeedsSupply ChainDemLabMedsProbsAECDW ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Component 9 / Unit 3c Networking and Health Information Exchange 7 Version 1.0/Fall 2010 Slide 19 Getting access to standards•Standards Knowledge Management Tool–JIC/ISO project sponsored by Universite de Sherbrooke–www.skmtglossary.org–Most major standards listed•Duke Center for Best Practices –www.ctnbestpractices.org/standards-inventory/Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201019 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Slide 20 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.•SDO provide tutorials and educational opportunities to learn about the standards.Component 9/Unit #3cHealth IT Workforce Curriculum Version 1.0 Fall 201020 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

ii yyyy

Some Standards Originators

ISO TC 215 www.iso.org/iso/iso_technical_committee?commid=54960

Health Level 7 www.hl7.org

CDISC ww.cen.eu/cen/Sectors/Sectors/ISSS/Committees

GS1 www.gs1.orgw.gs1.org

NCPDP www.ncpdp.org

ASC X12N www.x12n.org

ASTM E31 www.astm.org/COMMIT/COMMITTEE/E31

IHE www.himss.org/ASP/topics_ihe

DICOM http://medical.nema.org/

IHTSDO www.ihtsdo.org

ONC http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2

Some Standards of Vocabulary

International Classification of Disease –(ICD) [WHO]
Common Procedural Terminology (CPT) [American Medical Association]
DSM-IV
Diagnosis-related Group (DRG)
National Drug Codes (FDA)
RxNorm (FDA)
VA National Drug Formulary
Structured Product Labeling
Logical Observation Identifiers, Names and Codes (LOINC) [Regenstrief]
MEDCIN
SNOMED –CT
International Classification of Primary Care (ICPC) [WONCA]
Medical Dictionary for Regulatory Activities (MedDRA) [ICH]
Nursing Terminologies
Mesh (NLM)
Gene Ontology
Unified Medical Language SystemHealth IT Workforce Curriculum Version 1.0 Fall 2010

UNIT 5

*Unit Five

Learning Objectives

By the end of this unit the student will be able to:

1. Understand linking and aggregating data at all levels
2. Understand how data may be interchanged among heterogeneous settings without loss of information
3. Understand HL7 v2.x messaging communication standard
4. Understand HL7 v3.0 messaging standards
5. Understand other data interchange standards including DICOM, IEEE, and IHE
6. Explain how model-based standards are created
7. Define the methodology development framework
8. Describe HL7 v3.0 messaging standards
9. Discuss other data interchange standards including DICOM
10. Understand imaging standards
11. Understand standards for pharmacy services
12. Understand interface standards for medical devices
13. Understanding claims and reimbursement standards
14. Understand concept of profiling
15. Understand the use and value of implementation guides

Additional Resources

Heath Level Seven International

Read more about HL7 including standards and how to implement.

http://www.hl7.org/index.cfm

Ascend HL7 Interface Specification

Describes HL7 message standards for Hann's On Software (HOS).

http://www.hosinc.com/Products/Interfaces/interface_documentation.htm

HL7 ADT Message Overview
This article provides a simple overview of HL& ADT messages.
http://knol.google.com/k/hl7-adt-message-overview#

DICOM

Digital Imaging and Communications in Medicine homepage.

http://medical.nema.org/

IHE

Integrating the Healthcare Enterprise homepage.

http://www.ihe.net/

Standardization of Terminology

This article talks about the importance of creating a standard for terminology so that different healthcare organizations can share information.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526413/?tool=pubmed

Unit 5a

Unit 5b

Unit 5c

Discussion Board
Click on the link above to join the discussion board.

UNIT 6

*Unit Six

Learning Objectives

By the end of this unit the student will be able to:

1. Analyze fundamental structure and components of data (e.g., standards-based data elements, terminology, templates, and archetypes)
2. Explain the relevance of health data interchange standards (specifically HL7 v2.x and HL7 v3.0) for data mobility for health records.
3. Explain the relevance of document and imaging standards (specifically CDA, CCD, CCR, and DICOM) for data mobility for health records
4. Explain the relevance of medical device standards (specifically IEEE 110-73 series) for data mobility for health records
5. Explain the concept of profiling and the role of IHE in defining profiles.

Additional Resources

http://www.hl7.org/index.cfm

Read more about HL7 including standards and how to implement.

http://www.himss.org/ASP/topics_ehr.asp

Info and news concerning EHR.

http://www.ahraonline.org/Downloads/onlineinstitute/quickcredit/oiqc_elechealthrecord.pdf

An article about choosing an EHR.

http://www.cchit.org/

Information about EHR certification.

http://www.healthdatamanagement.com/

A resource for information regarding all aspects of health data management including HER, EDI, HIE and data security.

http://www.openehr.org/home.html

Information about open EHR

Unit 6a

Unit 6b

Unit 6c

Discussion Board
Click on the link above to join the discussion board.

UNIT 7

*Unit Seven

Learning Objectives

By the end of this unit the student will be able to:

1. Identify and discuss a family of clinical decision support standards, including Arden Syntax, Clinical Guideline standards, and the Infobutton
2. Discuss single sign-on standards and the HL7 Clinical Context Object Workgroup (CCOW) standard
3. Define and discuss regulatory standards, standards enhancing patient safety, including reporting requirements
4. Bar code standards
5. Master patient index, patient registries, and record locating standards

Additional Resources

Using Features of Arden Syntax with Object-Oriented Medical Data Models for Guideline Modeling
This article contains information about many of the clinical decision support standards.

http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.24.5737

Arden Syntax

A table showing information about Arden syntax.

http://www.openclinical.org/gmm_ardensyntax.html

GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support

This is a paper that discusses the format of GELLO and its use.

http://www.openclinical.org/docs/int/docs/gello.pdf

HL7 Infobutton Product Information
This link provides HL7's product brief about Infobuttons.
http://wiki.hl7.org/index.php?title=Product_Infobutton

Infobuttons at Intermountain Healthcare: Utilization and Infrastructure
This article “describes the infobuttons infrastructure at Intermountain Healthcare and assesses their use after 4 years of their initial release.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839474/

Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information Prescriptions
This article explains the usefulness of Infobuttons and a particular company's implementation.
http://hwinfo.healthwise.org/docs/DOCUMENT/8325.pdf

HL7 CCOW standard
This page is HL7's CCOW standard page providing information about CCOW.
http://www.hl7.org.au/CCOW.htm

CCOW Information for the Healthcare Industry
This site provides information about CCOW including what it is, how it works and its benefits.
http://www.cryptlib.orion.co.nz/

Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations
This article discusses the effects of clinical guidelines of medical practices. Registration is required to read the article but is free.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-49KC744-
F0&_user=5961205&_coverDate=11%2F27%2F1993&_rdoc=1&_fmt=high&_orig=sear
ch&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000068954&_version=1&_
urlVersion=0&_userid=5961205&md5=f6a8456e396d21342396879a39f4cfbd&searchty
pe=a

National Guideline Clearinghouse
NGC is a public resource for evidence-based clinical practice guidelines.
http://www.guideline.gov/

Single Sign-On
Wikipedia article about single sign-on.
http://en.wikipedia.org/wiki/Single_sign-on

Unit 7a

Unit 7b

Unit 7c

Unit 7d

Discussion Board
Click on the link above to join the discussion board.

UNIT8

*Unit Eight

Learning Objectives

By the end of this unit the student will be able to:

1. Explain the significance of Service Oriented Architecture in networking and health information exchange networks
2. Explain the value of an Enterprise Architecture in networking and health information exchange networks
3. Describe key elements of various service oriented architecture platforms and infrastructure options
4. Explain regional healthcare networks – policy and implementation strategies
5. Explain the concept of a Nationwide Healthcare Information network

Additional Resources

OMG Healthcare Domain Task Force
This site contains information about the Healthcare Service Specification Project.
http://healthcare.omg.org

Health Information Sharing Environment
Information about creating a framework for sharing personal medical information.
http://www.cisco.com/web/about/ac79/docs/pov/Health_Information_Sharing_Environment_0526FINAL.pdf

NIHN Enterprise Architecture Overview
This document from ONC provides an overview of EA.
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910398_0_0_18/NHINEnterpriseArchitectureOverview.doc

SOA Solutions
This article from IBM describes how to develop SOA solutions for healthcare organizations using business-driven development.
http://www.ibm.com/developerworks/webservices/library/ws-soa-bddhealth/

Network for Regional Healthcare Improvement
This site is home to The Network for Regional Healthcare Improvement (NRHI), a
National coalition of Regional Health Improvement Collaboratives.
http://www.nrhi.org/

Nationwide Health Information Network
This site developed by ONC covers information about HIN.
http://healthit.hhs.gov/portal/server.pt?open=512&objID=1142&parentname=CommunityPage&parentid=4&mode=2

A Service Oriented Architecture based Medical Grid Application
This article presents a case of using SOA for different medical entities to share mammogram images.
http://arxiv4.library.cornell.edu/ftp/cs/papers/0405/0405074.pdf

Unit 8

Discussion Board
Click on the link above to join the discussion board.

UNIT 9

*Unit Nine

Learning Objectives

By the end of this unit the student will be able to:

1. Explain the concepts of privacy and confidentiality requirements and policies and learn how to implement the requirements
2. Define access control methods
3. Describe how to secure data storage and transmission using data encryption, signatures, validation, non-repudiation, and integrity (PKI, certificates, and security protocols)
4. Analyze access restrictions to data storage and retrieval (physical and software)

Additional Resources

Microsoft – The Latest in Computer Security
This site contains information about security products, updates, tools and news.
http://www.microsoft.com/security/default.aspx

Orange Book Certification
This site contains the criteria for obtaining Orange Book certification. They also explain
the different levels of Orange Book certification.
http://en.wikipedia.org/wiki/Trusted_Computer_System_Evaluation_Criteria

Hashes
This article contains information about hashes.
http://en.wikipedia.org/wiki/Cryptographic_hash_function

Encryption
This article contains information about encryption, symmetric and asymmetric.
http://www.encryptionanddecryption.com/encryption/

Tutorial: An introduction to Public Key Infrastructure (PKI)
This video is a tutorial about PKI. It explains the different pieces of the infrastructure
including certificates and keys. 9 minutes and 34 seconds long.
http://www.youtube.com/watch?v=EizeExsarH8

How to Choose a Good Password (And Why You Should)
This article contains information about what you should do and what you shouldn’t do
with passwords. It also includes information about why you should do these things.
http://www.mit.edu/afs/sipb/project/doc/passwords/passwords.html

Guidelines for Strong Passwords
This article discusses how to create strong passwords along with examples of weak
passwords.
http://en.wikipedia.org/wiki/Password_strength#Guidelines_for_strong_passwords

Security Policies
These sites discuss the use of security policies in an organization. The SANS site
includes policy templates.
http://www.sans.org/security-resources/policies/
http://www.symantec.com/connect/articles/introduction-security-policies-part-oneoverview-
policies

HIPPA
Information about HIPPA including who must follow the law, what information is
protected, what rights does the law provide to consumers and who can look at your
health information.
http://www.hhs.gov/ocr/privacy/

Assuring the Privacy and Security of Transmitting Sensitive Electronic Health
Information
This article discusses concerns about the security of transferring health information.
Includes case studies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815468/?tool=pubmed

Social Networking and the Medical Practice: Guidelines for Physicians, Office Staff and
Patients
These guidelines were produced by the Ohio State Medical Association.
http://www.osma.org/files/documents/tools-and-resources/running-a-practice/socialmedia-
policy.pdf

2009 Global Life Sciences & Health Care Security Study
Findings from a 2009 study on cyber security, privacy and data protection.
http://it.ouhsc.edu/services/infosecurity/documents/WP_ERS_SP_GSS_LSHC_final_lo
w.pdf

Proposed HIPPA Rule Change
On July 8, 2010 HISS announced a proposed change to HIPPA that would affect the
privacy, security and enforcement rules. This pdf is the proposed change.
http://www.himss.org/handouts/20100714_ProposedRegsHHS.pdf

Unit 9a

Unit 9b

Back

HIT - Standards

This page is currently "under construction".

*Unit Five

HL7 ADT Message Overview This article provides a simple overview of HL& ADT messages. http://knol.google.com/k/hl7-adt-message-overview#

*Unit Six

*Unit Seven

*Unit Eight

*Unit Nine

HL7 ADT Message Overview
This article provides a simple overview of HL& ADT messages.
http://knol.google.com/k/hl7-adt-message-overview#