Proposed Framework

 

1) Overall "framing" statement of what our end goal is for this effort. Need to make sure we are thinking about how this relates to the EMR, EHR and the PHR, building blocks for each of these.

 

    Interoperable systems are critical in order to assist clinicians in delivering safe, effective, efficient and patient centered care. Clinical data standards are the essential building blocks towards interoperable systems, including Electronic Health Records (EHRs), Electronic Medical Records (EMRs), and Personal Health Records (PHRs). It is important that nurses understand these standards and their impact on care delivery.

 

2) Definitions:

Standard - A definition or format that has been approved by a recognized standards organization or is accepted as a de facto standard by the industry. Standards exist for programming languages, operating systems, data formats, communications protocols, and electrical interfaces.

                                                                                                     HIMSS Dictionary of HIT Terms 2006

 

A standard specifies a well-defined approach that supports a business process and: (1) has been agreed upon by a group of experts; (2) has been publicly vetted; (3) provides rules, guidelines, or characteristics; (4) helps to ensure that materials, products, processes, and services are fit for their intended purpose; (5) is available in an accessible format; and (6) is subject to an ongoing review and revision process.

Standards mean the structure and content of health care data, information, or concepts that are usefully exchanged or provided between and among care providers and public health authorities, and the interchange methods used to facilitate these exchanges.

 Dr. John Halamka, Chair of the Health Information Technology Standards Panel (HITSP), explained to the American Health Information Community that for HITSP work

 

Interoperability - The ability of two or more systems or components to exchange information and to use the information that has been exchanged.

                                                                                                                               IEEE Dictionary

 

Interoperability means the ability of different information systems, software applications and networks to communicate and exchange information in an accurate, effective, useful, and consistent manner.

 

The current landscape of standards does not ensure interoperability due to many factors, such as conflicts and gaps. Further, for true interoperability to be realized, many standards need to be harmonized, including standards that do not traditionally fall into the commonly accepted health care standards arena (e.g., broader technology standards for data interchange).

 

Harmonization means the function of developing, reconciling, setting and maintaining standards required to achieve interoperability.

   Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC)

 

3) Need to define further each type with a good definition, and listing of examples. We should refer to the HIMSS HIT Dictionary of terms that Audrey Dickerson has been working on

 

Once we have determined the categories/types of standards, then within each type we can develop the inventory of relevant standard setting efforts and resources. 

 

Data Exchange/Messaging Standard Type: This table will contain a list of each standard that falls within the Standard Type of "Data Exchange/Messaging" There will be separate tables cataloging the detail for each Standard Type, as they are defined above. - Begin by defining the types of Standards we need to categorize. See table below for examples of the types we came up with

 

Types of Standards

Standard Type	Definition	Examples	Links
Data Exchange/Messaging	These standards allow transactions to flow consistently between systems, as they contain specifications for format, data elements, and structure	HL7 DICOM IHE IEEE	The Link examples will be shown in the detailed Standard Type catalog
Terminology Standards	Standardized terminologies provide specific codes for clinical concepts such as disorders/diseases, problem lists, allergies, procedures, and medications that might have varying textual descriptions in a paper electronic healthcare record. Examples of terminologies include LOINC for lab results, SNOMED CT for computerized healthcare records, ICD-9CM for medical diagnoses and CPT for procedures.	CPT ICD9 -CM ICN LOINC SNOMED CT	The Link examples will be shown in the detailed Standard Type catalog.
Standards Initiatives	What are the key standards initiatives in healthcare information technology today?	HITSP CCHIT
Standards Organizations	What organizations are involved in creating different standards used in healthcare information technology? This section will provide an overview of all of those organizations, and the standards they are responsible for.	HL7 ANSI AMA
Document Standards	These indicate what type of information is included in a document and where it can be found. A common standard in paper medical records is the SOAP format (Subjective, Objective, Assement, Plan) The CCR (Continuity of Care Record) provides a standard format for inter-provider communication,	CCR/CCD Braden Scale Pain Assessment SOAP
Infrastructure Standards	The overall framework or architecture used. This would include an information model. Gap Identified - Usability/UI Standards (There are no standards defined for this area)	caCORE NHIN PHIN

Standard	Acronym	Description	Developer
Health Level 7 Messaging Standards	HL7	Electronic Message formats for clinical, financial and administrative data	Health Level Seven  www.hl7.org
	DICOM
	IHE

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