Data Standards

Existing Standards HHS's Consolidated Health Informatics initiative IOM's Data Standards for Patient Safety Concerns

Existing Standards

Standard		ANSI*		CHI†		Area Addressed		Issues		Further Information
LOINC		N		Y		Laboratory Data		Privately owned and maintained by The Regenstrief Institute (www.regenstrief.org) and subject to Terms of Use		http://www.loinc.org/
IEEE 1073		Y		Y		Medical device communication with computers		??		http://www.ieee.org/
HL-7		Y		Y		Clinical messaging		Private consortium		http://www.hl7.org/
DICOM		N		Y		Medical imaging / Radiology		Developed and owned by the National Electrical Manufacturers Association		http://medical.nema.org/
NCPDP		Y		Y		Pharmacy Services		??		http://www.ncpdp.org/
SNOMED		N		N		Hierarchical systematized structured and coded vocabulary		Privately owned by the College of American Pathologists. Partial rights recently licensed for 5 years by HHS for $32M. The UK National Health Service is implementing SNOMED, which is managed though SNOMED International Authority, in which the NHS has a 20% voting representation.		http://www.snomed.org/
UMLS		N		N		Metathesaurus containing information about biomedical concepts and terms from many controlled vocabularies and classifications used in patient records, administrative health data, bibliographic and full-text databases and expert systems. SNOMED is now being incorporated.		Owned by the US National Library of Medicine.		http://www.nlm.nih.gov/research/umls/
X12N		N		N		Insurance EDI standard		??
NCVHS		-		N		Advisory group to HHS who reviews standard.				http://ncvhs.hhs.gov/
HIPAA		-		-		Secure transmission of data		HIPAA security standard.		http://aspe.hhs.gov/admnsimp/FINAL/FR03-8334.pdf

* Indicates the standard setting group is ANSI accredited. For more information on ANSI see http://www.ansi.org/
† Indicates the standard has been accepted by HHS's CHI initiative.

Other entities interested in standards include:

• http://www.astm.org/COMMIT/COMMITTEE/E31.htm
• eHealth Initiative

Consolidated Health Informatics initiative

see: http://www.whitehouse.gov/omb/egov/gtob/health_informatics.htm

The CHI Initiative seeks to adopt standards in 24 domains:

1. Laboratory Result Names - adopted
2. Messaging Standards: Includes scheduling, medical record/image management, patient administration, observation reporting, financial management, patient care - adopted
3. Messaging Standards: Includes retail pharmacy transactions - adopted
4. Messaging Standards: Connectivity - adopted
5. Messaging Standards: Includes Image Information to Workstations - adopted
6. Medications - recommendations in clearance
7. Interventions/Procedures - recommendations under consideration
8. Demographics - recommendations in clearance
9. Immunizations - recommendations under consideration
10. Lab Result Contents - recommendations in clearance
11. Clinical Encounters - team deployed
12. Diagnosis/Problem Lists - team deployed
13. Test-Based Reports - team deployed
14. History and Physical - team deployed
15. Population Health - team deployed
16. Anatomy/Physiology - recommendations under consideration
17. Multimedia - team deployed
18. Nursing - recommendations under consideration
19. Genes and Proteins - team deployed
20. Supplies (medical devices and other resources including staff) - recommendations under consideration
21. Financial/Payment (Billing) - team deployed
22. Chemical - team deployed
23. Disability - team deployed
24. Units - recommendations in clearance

CHI began by contracting with the Electronic Health Collaborative (EHC) -- lead by HL7 and the IOM. They drafted a series of "essential elements" for the EMR. These were vetted at a series of regional meetings, including one in Chicago attended by a number of Northwestern participants. Their final report is available at online

Institute of Medicine: Data Standards for Patient Safety

See: http://www.iom.edu/project.asp?id=4629

The IOM book, Patient Safety: Achieving a New Standard of Care provides very specific and proscriptive recommendations concerning EMR features and their use. Some of their other publications are relevant.

Concerns

Standards that have been developed have not yet received official endorsement by important industry groups, particularly the US government. This is now being rectified. However, HHS has licensed existing systems and thereby created a de facto standard without securing long-term public domain status for these standards. This puts the industry at risk of profiteering by owners of the standards in future years. David A Stumpf, MD, PhD