National Interoperability Standards and USHIK

Public Health Data Consortium’s 2009 Annual Meeting

J. Michael Fitzmaurice, Ph.D.Agency for Healthcare Research and Quality

November 12, 2009

Does anything exist?Does anything exist?

Cogito, Ergo SumCogito, Ergo Sum

– Rene DescartesRene Descartes

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When I think of all the HITSP productsWhen I think of all the HITSP products

My brain hurts—so many “constructs”My brain hurts—so many “constructs” How do I grasp the power of what HITSP has done?How do I grasp the power of what HITSP has done?

USHIK.ahrq.govUSHIK.ahrq.gov

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USHIK—a National USHIK—a National Metadata RegistryMetadata Registry

AHRQ-USHIK

US Health Information Knowledgebase

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USHIK—a National USHIK—a National Metadata RegistryMetadata Registry

AHRQ-USHIK is an AHRQ-funded and managed AHRQ-USHIK is an AHRQ-funded and managed metadata registry ofmetadata registry of– Data elements endorsed, accepted, and recognized by the Data elements endorsed, accepted, and recognized by the

HHS Secretary for federal agencies’ useHHS Secretary for federal agencies’ use

An organized collection of data elements and their An organized collection of data elements and their characteristics (metadata)—ISO/IEC 11179characteristics (metadata)—ISO/IEC 11179

USHIK contains data elements from National USHIK contains data elements from National Interoperability Standards forInteroperability Standards for– HIPAA transactionsHIPAA transactions– Consolidated Health Informatics DomainsConsolidated Health Informatics Domains– Health Information Technology Standards Panel (HITSP)Health Information Technology Standards Panel (HITSP)

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AHRQ-USHIKAHRQ-USHIK

MissionMission: To represent AHRQ with excellent service: To represent AHRQ with excellent service

Specific GoalSpecific Goal: To be an organized set of repositories that coordinates : To be an organized set of repositories that coordinates the data elements and their metadata from health data standards that the data elements and their metadata from health data standards that the HHS Secretary has endorsed, accepted, and recognized, the HHS Secretary has endorsed, accepted, and recognized, including ARRA data elements, plus AHRQ’s patient safety elements including ARRA data elements, plus AHRQ’s patient safety elements

WhyWhy: To improve the uniformity, accuracy, and computerization of : To improve the uniformity, accuracy, and computerization of health data for researchers and decision makers, including providers, health data for researchers and decision makers, including providers,

patients, plans, and payerspatients, plans, and payers – Improves clinical and administrative data used for researchImproves clinical and administrative data used for research– Speeds applications of research tools developed from these dataSpeeds applications of research tools developed from these data

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Bridge: Normal Deck of 52 CardsBridge: Normal Deck of 52 Cards Data element name(1 of 52): Data element name(1 of 52): 4 of spades4 of spades Attributes (Metadata): Attributes (Metadata):

– DefinitionDefinition playing cardplaying card– NumberNumber 44– SuitSuit spadesspades– Odd/evenOdd/even eveneven– Picture cardPicture card No No – AuthorityAuthority You, or HoyleYou, or Hoyle– Version or date effectiveVersion or date effective 12-14-191712-14-1917– Bridge deck memberBridge deck member YesYes– Pinochle deck memberPinochle deck member NoNo– Euchre deck memberEuchre deck member NoNo– Poker deck memberPoker deck member YesYes

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Card Metadata RegistryCard Metadata Registry

Each game master is the Each game master is the authorityauthority for its game’s cards for its game’s cards The The same card same card can be used in different gamescan be used in different games The The same metadata same metadata about a card can be reused many about a card can be reused many

times, in a metadata registrytimes, in a metadata registry Bridge: all 52 cardsBridge: all 52 cards Euchre: 24 cards, all higher than an 8Euchre: 24 cards, all higher than an 8 Pinochle: 48 cards, all higher than an 8, duplicatedPinochle: 48 cards, all higher than an 8, duplicated Poker:Poker: all 52 cards all 52 cards In total, it would take 176 cards for each of you to display In total, it would take 176 cards for each of you to display

the cards for your games with separate decksthe cards for your games with separate decks

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What cards are needed to play?What cards are needed to play?

Bridge PinochleEuchre Poker

Deck of 52 CARDS Not 176

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AHRQ-USHIK Data ElementAHRQ-USHIK Data Element

Data Element: Data Element: Gender codeGender code Attributes (Metadata): Attributes (Metadata):

– DefinitionDefinition For eligibility, id gender of For eligibility, id gender of the individual memberthe individual member

– ContextContext NCPDP Data DictionaryNCPDP Data Dictionary– Registration. AuthorityRegistration. Authority NCPDPNCPDP– Effective date Effective date 2001-11-272001-11-27– Data typeData type Numeric extendedNumeric extended– Represent. LayoutRepresent. Layout X(1)X(1)– Value DomainValue Domain Gender, coded_VDGender, coded_VD– CodesCodes M (male), F (female), U M (male), F (female), U

(unknown)(unknown)

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Comparison Matrix Aids in Harmonizing Data Elements

www.USHIK.org

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What data elements are needed for What data elements are needed for ARRA meaningful use?ARRA meaningful use?

X12N NCPDPHL7 HITSP

USHIK

AHRQ Patient Safety

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Do the data elements in my EHR fit Do the data elements in my EHR fit HITSP specifications?HITSP specifications?

X12N NCPDPHL7 HITSP

USHIK

Are My EHR data defined the same as HITSP’s?

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How does each authority express How does each authority express gender?gender?

X12N NCPDPHL7 HITSP

USHIK Gender

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ARRA Incentive Payments to ARRA Incentive Payments to ProvidersProviders

American Recovery and Reinvestment Act of 2009 (Feb. 17, American Recovery and Reinvestment Act of 2009 (Feb. 17, 2009) provides2009) provides

Up to $44,000 starting in 2011 through 2015 for Up to $44,000 starting in 2011 through 2015 for Meaningful Meaningful UseUse of of Certified Certified EHRs by eligible ProvidersEHRs by eligible Providers

– Meaningful Use --- so that patients will get valueMeaningful Use --- so that patients will get value– Certified --- to reduce market risk to EHR purchasers about the Certified --- to reduce market risk to EHR purchasers about the

EHR’s capabilities for them to engage in Meaningful Use activitiesEHR’s capabilities for them to engage in Meaningful Use activities

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HIT Policy

ONC

ARRA

CMS/ONC

HIT StandardsHITSP

HHS Secretary

Simple Hypothetical Diagram

Meaningful use definition

Standards Recommendations for Meaningful Use and 8 other areas

Health providers

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HIT Policy

ONC

ARRA

ONC

HIT Standards

HITSP

Other bodies

HHS Secretary

Federal Agencies

CCHIT

Other bodies

Simple Hypothetical Diagram

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HIT Policy

ONC

ARRA

ONC

HIT Standards HITSPOther bodies

HHS Secretary

Federal Agencies

CCHITOther bodies

Simple Hypothetical Diagram

AHRQ USHIK

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HIT Policy

ONC

ARRA

ONC

HIT Standards HITSPOther bodies

HHS Secretary

Federal Agencies

CCHITOther bodies

Simple Hypothetical Diagram

AHRQ USHIK

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Federal AgenciesFederal Agencies

As required by ARRA, when federal agencies As required by ARRA, when federal agencies implement, acquire, or upgrade HI systems for implement, acquire, or upgrade HI systems for exchanging personal health information, they exchanging personal health information, they must use systems that meet standards must use systems that meet standards adopted by the HHS Secretary under ARRAadopted by the HHS Secretary under ARRA. .

Federal agencies are similarly bound by Federal agencies are similarly bound by Executive Order 13410 (Aug. 2006) to use Executive Order 13410 (Aug. 2006) to use standards recognized by the HHS Secretary.standards recognized by the HHS Secretary.

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Federal Agencies must use Federal Agencies must use these Standards per ARRAthese Standards per ARRA

a) SPENDING ON HEALTH INFORMATION TECHNOLOGY SYSTEMS.—As each agency … implements, acquires, or upgrades health information technology systems used for the direct exchange of individually identifiable health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet standards and implementation specifications adopted under [ARRA] ...

(b) FEDERAL INFORMATION COLLECTION ACTIVITIES.—With respect to a standard or implementation specification adopted under [ARRA] … , the President shall take measures to ensure that Federal activities involving the broad collection and submission of health information are consistent with such standard or implementation specification, respectively, within three years after the date of such adoption.

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Vendors of Certified EHR SystemsVendors of Certified EHR Systems

The standards and certification criteria are The standards and certification criteria are forthcoming in the Federal Register by forthcoming in the Federal Register by December 31, 2009, as mandated by ARRA.December 31, 2009, as mandated by ARRA.

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ushik.ahrq.gov promotesushik.ahrq.gov promotes

One-stop shopping for HITSP data elementsOne-stop shopping for HITSP data elements– Reduced resources for implementing HITSP standardsReduced resources for implementing HITSP standards– And for reporting patient safety events in hospitalsAnd for reporting patient safety events in hospitals

Defined authorities for data elements’ meaningsDefined authorities for data elements’ meanings Uniformity of certified EHR contentUniformity of certified EHR content

– Movement toward identical data elementsMovement toward identical data elements– Reconciling inconsistencies within and among HITSP documents and Reconciling inconsistencies within and among HITSP documents and

SDO standardsSDO standards Making available data information from other sources in Making available data information from other sources in

USHIK for HITSP comparisons and choicesUSHIK for HITSP comparisons and choices Federal agency and private sector comparisons of their Federal agency and private sector comparisons of their

program and product data needs with HITSP data elementsprogram and product data needs with HITSP data elements

What’s New in USHIKWhat’s New in USHIK

As of July 15, 2009, As of July 15, 2009, every HITSP-specified data elementevery HITSP-specified data element is in USHIK and linked to every HITSP construct is in USHIK and linked to every HITSP construct (document) in which it appears(document) in which it appears

Developing new, faster Developing new, faster data loaderdata loader Updating Updating SDO informationSDO information: X12, NCPDP, HL7: X12, NCPDP, HL7

– X12 data elements are being updated in USHIKX12 data elements are being updated in USHIK 4010 in the USHIK staging server now4010 in the USHIK staging server now 4050 and 5010 generic elements developed next week for loading the 4050 and 5010 generic elements developed next week for loading the

following week [Thank you, Steve Bass]following week [Thank you, Steve Bass]

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What’s New in USHIKWhat’s New in USHIK

X12 is taking responsibility for properly loading its data X12 is taking responsibility for properly loading its data elements into USHIK; HITSP should reference them thereelements into USHIK; HITSP should reference them there

NCPDP and HL7 are proposed to followNCPDP and HL7 are proposed to follow

****USHIK has a preliminary USHIK has a preliminary view of HITSP’s view of HITSP’s Capabilities and Services CollaborationsCapabilities and Services Collaborations****– Within IS 07 – EHR Centric Context with links to Within IS 07 – EHR Centric Context with links to

capabilities, service collaborations, all constructs, capabilities, service collaborations, all constructs, data elements, value setsdata elements, value sets

– Not officialNot official, but presented for improving , but presented for improving understanding and understanding and obtaining user commentsobtaining user comments

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What’s New in USHIKWhat’s New in USHIK

AHRQ has recently funded USHIK to:AHRQ has recently funded USHIK to:– Develop a State All-Payer Data (SAPD) Metadata PortalDevelop a State All-Payer Data (SAPD) Metadata Portal– Develop a Meaningful Use Metadata Measure (MUMM) Develop a Meaningful Use Metadata Measure (MUMM)

Metadata Analysis Metadata Analysis andand Portal (with Abt Associates, Inc.) Portal (with Abt Associates, Inc.)– Continue developing AHRQ’s Patient Safety Common Continue developing AHRQ’s Patient Safety Common

Formats PortalFormats Portal– Put HITSP T66 compliant web services in place for external Put HITSP T66 compliant web services in place for external

queries of/by USHIKqueries of/by USHIK AHRQ and VA will continue their USHIK partnership—AHRQ and VA will continue their USHIK partnership—

HITSP data elements HITSP data elements Quality Measure domain Quality Measure domain26

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Where is Value?Where is Value?

Publishing in one place the data elements from the Publishing in one place the data elements from the standards’ processes ONC has developed standards’ processes ONC has developed

Being a source for what is required by the Being a source for what is required by the President’s and HHS Secretary’s Interoperability President’s and HHS Secretary’s Interoperability Standards—Federal Agencies, Federal ContractsStandards—Federal Agencies, Federal Contracts

Supporting federal and private sector efforts to Supporting federal and private sector efforts to match their programs and products’ data elements match their programs and products’ data elements with those of Federal Interoperability Standardswith those of Federal Interoperability Standards

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FinaleFinale

See the HITSP Portal Information Models at See the HITSP Portal Information Models at

Ushik.ahrq.govUshik.ahrq.gov

See also CDC’s PHIN VADS for public health data See also CDC’s PHIN VADS for public health data value set information at value set information at

Phinvads.cdc.govPhinvads.cdc.gov

National Interoperability Standards and USHIK

Public Health Data Consortium’s 2009 Annual Meeting

J. Michael Fitzmaurice, Ph.D.Agency for Healthcare Research and Quality

November 12, 2009

30

USHIK Metadata Registry Contents, USHIK Metadata Registry Contents, data elements fromdata elements from

X12X12 ASTMASTM NCPDP SCRIPT, Batch, Data NCPDP SCRIPT, Batch, Data

DictionaryDictionary American Dental AssociationAmerican Dental Association HIPAAHIPAA HL7HL7 MHS Functional Area Model MHS Functional Area Model Public Health Care Data Public Health Care Data

Standards Standards   

LOINCLOINC

IEEE: Medical Device IEEE: Medical Device Communications Industry Communications Industry Group (IEEE/ISO 11073)Group (IEEE/ISO 11073)

DoD Military Health SystemDoD Military Health System NCVHSNCVHS Clinical Care Classification Clinical Care Classification

(Nursing Taxonomy(Nursing Taxonomy))

HITSPHITSP AHRQ Patient Safety AHRQ Patient Safety

EventsEvents Other sourcesOther sources