Health information standars

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Health Care Data Sets and their purpose …

Health Care Data Sets and their purpose
UHDDS, UACDS, MDS, OASIS, DEEDS and EMDS.
Explain the standardization data collection efforts.
Explain the five type of standards that need to be in place to implement the Nationwide Health Information Network (NHIN).
Standard Development Organizations
Evolving and Emerging Health Information Standards

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  • As we know data represent basic facts and measurements, in health care these facts usually describe specific characteristics of individual patients.Data is singularized as datum or data element, and mean single fact as age, gender, insurance company.Information refers to data have been collected, combined, analyzed, interpresed or converted into form that can be used for specific purposes.In HC data is stored in par or electronic formats and then analyzed by (patient, physician, clinicians).Aggregate data is info of group of patients, we can use this information in order to identify a pattern, for example patients who suffered an acute miocardialinfartion.History.1st effort to collect data in the century XVII Captain JhonGraunt, early 1600 the london bills of mortality.Few efforts to undertaken and collect statistical data, about incidence or prevalence of disease appear until mid XX century.1960 use of computers allow use and process of larger amounts of data than could be handled manually (after that healthcare organization realized that one standarization was needed to uniform the data.The first effort focused was generally in Discharge Data, in hospital they used the Hospital Discharge Abstract Systems to comparing and developing data sets or list of recommended data elements.Today hospital and health care organization collect more data and develop more information than even before, the demand of information is increasing, and factor as acreditation encourage this situation.The extensive use of information within and across organizational boundaries demands standards that promote interoperable electronic interchange of data information.

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  • 1. STANDARDSTMU – HCA Pharm. Dr. Alexander BermudezRubashkyn
  • 2. Outline Explain Health Care Data Sets and their purpose UHDDS, UACDS, MDS, OASIS, DEEDS andEMDS. Explain the standardization data collection efforts. Explain the five type of standards that need to be in place to implement the Nationwide Health Information Network (NHIN). Standard Development Organizations Evolving and Emerging Health Information Standards Conclusions
  • 3. Terminology Data (Data element): Representation of a single fact of measurement. Information: Data that have been collected, combined, analyzed, interpreted, and/or converted into a form that can be used for a specific purpose. Aggregate data: De-identified data extracted from health records and combined eg. AMI patient Data Set: A collection of recommended data elements that have uniform definitions.
  • 4. Standards Simplification, Unification, Uniform, Specification. Ensure that there is coupling and integration between different elements. a. An acknowledged measure of comparison for quantitative or qualitative value; criterion, measure, guideline, example, model, guide, pattern, sample, par, norm, gauge, benchmark. b. An object that under specified conditions defines, represents, or records the magnitude of a unit. c. Widely recognized or employed model or pattern.
  • 5. History Health Information Standards XVII – London bills of mortality. 1960 technology and computers Hospital Discharge Data Sets Nowadays, hospitals and Health Care Organizations collect more data and develop more information. The extensive use of information within and across organizational boundaries demands standards that promote interoperable electronic interchange of data information.
  • 6. Standardized Healthcare Data Sets Purposes of data sets  Identify the data elements that should be collected for each patient.  Uniformity in definitions. The Standardization makes possible  Compare data from multiple facilities  Comparison of data for:  External accreditation  Internal performance improvement  Statistical studies  Research activities
  • 7. Standardized Data Sets in HealthCare Uniforms Hospital Discharge Data Set (UHDDS) Uniform Ambulatory Care Data Set (UACDS) Minimum Data Set for Long-term Care and Resident Assessment Protocols (MDS 2.0) Outcomes Assessment Information Set (OASIS) Data Elements for Emergency Department Systems (DEEDS) Essential medical Data Set (EMDS)
  • 8. Uniform Hospital Discharge Data Set(UHDDS)  1969 Conference NCHS, National Center for health services and research and Development and John Hopkins University.  All short-term general hospitals in US must collect minimum set of patient data element UHDDS.  1974 Federal government adopted the UHDDS for Medicare and Medicaid programs.  1983 The UHDDS definitions were incorporated to the new prospective payment DRG.  1986 All federal health programs adopted the UHDDS
  • 9. UHDDS Back
  • 10. Uniform Ambulatory Care Data Set(UACDS) Set information about ambulatory care, or outpatient. Approved by the National Committee on Vital and Health Statistics. Some information is similar to UHDDS. Several information is specific, and focuses in describe living conditions of patients. The goal of UACDS is to be incorporated in federal regulations, UACDS has not been incorporated, that is why is recommended its used but not required.
  • 11. UACDS Back
  • 12. Minimum Data Set for Long-term care (MDS2,0)  Uniform data important in the long-term care setting  Federally mandated.  Standardized assessment form for nursing home resident.  MDS organizes data in 20 main categories, each category includes list of choice and responses.  MDS are used to develop a Resident Assessment Protocol (RAP)  Department of Health and Human Services (HHS) implemented in 2009 the MDS 3,0.
  • 13. Minimum Data Set for Long-term care (MDS2,0)Categories1 .Demographic Information 11. Health conditions2. Identification and background 12. Oral/nutritional statusinformation3. Cognitive Patterns 13. Oral/dental status4. Communication/hearing 14. Skin conditionpatterns5. Vision patterns 15. Activity pursuit patterns6. Mood and behavior patterns 16. Medications7. Psychosocial well-being 17. Special treatments and procedures8. Physical functioning and 18. Discharge potential and overallstructural problems status9. Continence in past 14 days 19. Assessment information10. Disease diagnoses 20. Therapy supplement for Back Medicare PPS
  • 14. Outcomes Assessment Information Set(OASIS)  Sponsored by the Health Care Financing Administration (HCFA).  Used for Medicare beneficiaries in home health industry.  This Data Set Include set of data items collected on all adult home health patients.  Data are used to assess the outcome and measure the quality of the health care services given to the patient.
  • 15. OASIS1. Demographics and Patient History2. Living Arrangements3. Supportive Assistance4. Respiratory5. Neurological6. Psychological7. Integument8. Pain9. Activities of Daily Living /Instrumental Activities of Daily Living10. Medications11. Elimination Status12. General Information13. Emergent Care Back
  • 16. Data Elements for EmergencyDepartment Systems (DEEDS) Developed by the Centers for Disease Control and Prevention (CDC) and National Center for Injury Prevention and Control (NCIPC). Uniform the collection of data in hospital based emergency departments. DEEDS recommends the collection of 156 data elements organized in 8 sections. DEEDS incorporates national standards for electronic data interchange so its implementation in an HER system facilitate communication with other systems.
  • 17. DEEDSPatient identification dataFacility and practitioner identificationdataEmergency department payment dataEmergency department arrival and first-assessment dataEmergency department history andphysical examination dataEmergency department procedure andresult dataEmergency department medication dataEmergency department disposition anddiagnosis data. Back
  • 18. Essential Medical Data Set(EMDS) Developed by the National Information Infrastructure Health Information Network Program NII-HIN Enhance effectiveness of emergency care Complement the DEEDS information, create a health history for an individual patient. Emergency care has a critical impact on patient survival, that is why is important collect standardized and comparable data to assess and improve the efficacy of emergency treatment.
  • 19. Standardized Data CollectionEfforts Health Plan Employer Data and Information Set (HEDIS) Core Measures for (ORYX) National Health Information Network (NHIN)
  • 20. Health Plan Employer Data and Information Set (HEDIS) Sponsored by the National Committee for Quality Assurance (NCQA). Standard performance measures designed to provide purchasers and consumers of healthcare to compare managed healthcare plans. The information collected about specific health – related conditions is used to analyze and assess outcomes of treatment. One of the goals of HEDIS is to encourage the performance improvement for health plans and practices, that is why HEDIS developed the physician profile.  Examples: Diabetes care, Adolescent Immunizations, Smoking cessation programs, breast cancer screeningBack
  • 21. Core Measures for ORYX Sponsored by Joint Commission. Integrate outcomes data and other performance measurements data into accreditation process about the core measures (Selected diagnoses and conditions where the outcomes can be improved by standardizing care. ORYX initiative uses nationally standardized performance measures to improve the safety and quality of healthcare. Back
  • 22. National health Information Network (NHIN)  NCVHS explore the feasibility of a National health Information Infrastructure NHII, that would allow the electronic exchange of HI.  This technology would increase patient safety, reduce medical errors, increase efficiency and effectiveness of healthcare, and contain costs.  Under NHIN initiative efforts are focused on creating standards and defining a universal language of health information, accelerating implementation of EHR.  Besides technologies NHII includes values practices, relationships, laws, standards, systems, and applications that support all facets of individual health, healthcare, and public health.
  • 23. Core data elements and Datacontent Standards Support the development of networked health information systems. Interdependent dimensions NCVHS 2000 – Toward a National Health Information Infrastructure. These three dimensions described, are a useful division for considering health data management requirement in HIM roles and the future environment and practices for health record management.
  • 24. Personal Health Dimension •Patient IDHealthcare Provider Dimension •Patient industry •Personal health record •Patient insurance •Non shared personal info•Patient record elements outlook •Consent forms •Other elements as (Self-care track-of provider. •Medication alert ers, instructions, communications)•Clinical orders •Audit-logs•Practice guidelines •Personal library•Decision-support program•Contextual information •De-identified information •Mandatory reporting •Community directories •Public health services •Vital statistics •Survey data •Inspection reports •Population health •Public education •risks materials •Communicable diseases •Neighborhood •Socioeconomic conditions environmental hazards •Registries Population Health Dimension •Infrastructure data •Planning and policy documents •Surveillance systems •Health disparities data © NCVHS 2000b
  • 25. Healthcare InformationStandards The previous standards were created for use in paper-based health record, that is why can no be longer accommodate for the current healthcare delivery systems. FHA and HIE, have identified the need to develop standards to support the CONECTIVITY and INTEROPERABILITY. Data needs in an Electronic Environment.  Health Organizations must integrate data.  The goals only can be accomplished when every system is using common data standards.
  • 26. Healthcare Information Standards(cont) Def: Describe accepted methods for collecting, maintaining and transferring healthcare data elements between computer systems. These standards provide a common language that facilitates and supports: Exchanging information. Linking data in a secure Sharing environment. Information Comparing Communicating information at a within and across regional, national, disciplines and and international settings level Integrating disparate data systems.
  • 27. Healthcare Information Standards(cont) “The long term vision for Optimal Health Care exchange is to enhance the comparability, quality, integrity and utility of health information management from a wide variety of public sources through uniform data policies and standards” NCVHS 2001 Imagine follow a recipe: no standard measurements, no instructions, nor specific order etc….
  • 28. Healthcare InformationStandards Information Standards Clinical Data Representation Standards Technical Standards Medication Standards Data Privacy and Security Standards
  • 29. Information Standards Content and Structure of HER.  Structure and Content Standards establish and provide, uniform definitions of data elements.  Specify type of data to be collected in each data field, width of each data field, content of each data field. I. HL7 II. ASTM E31 Committee III. Identifier Standards
  • 30. Health Leven Seven (HL7) HL7 is a non profit Organization. 1987 Provides comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic, information. Consist of rules for transmitting demographic data, orders, patient observations, laboratory results, history and physical observations and findings, also include message rules for appointment scheduling, referrals, etc. CDA. Clinical Document Architecture (history, physical reports, discharge summaries, progress notes). SPL, HL7 v2 and v3, GELLO, Arden Sintax, CCOW
  • 31. Health Leven Seven (HL7)
  • 32. American Society for TestingMaterial (ASTM) E31 Committee. Established in 1970 ASTM develops standards related to EHR ASTM Standard E1384-02a  The scope cover all types of health care services  Purposes are outlined for ASTM practitioners for content and structure of the EHR.  Logical data consistently attached to patient record content as (Physical test, Lab test, Diagnosis, Orders, Treatments, Documentation, Patient info, orders, legal permissions)  Explain relationship of the data coming from different sources  Provide a common vocabulary  Create a unique setting view  Map the content to select relevant biomedical and HIS
  • 33. Identifier Standards Recommend methods for assigning “Unique identification numbers” to individual, including patients, healthcare providers, corporate providers. Combination of numeric or alphanumeric characters. Used within one facility or a single healthcare system. There is not consensus on method. Identification number Social Security Number (Identifier) instead DNI (not designed for being universal identifier. Back Other sources for identify confirmation in health
  • 34. Clinical RepresentationStandards Includes clinical terminology / classification and vocabulary system, lab and clinical data, observation codes, drug codes, metadata. This tool encourage consistent descriptions of an individual condition.  Medical terminology extremely complex, Is not easy standardize.  Use of ICD and CPT uniform the terminology for data capture.  Code Sets are often featured as HL7 There is not master set of data elements that would facilitate HIE. Back
  • 35. Technical Standards Electronic Data Interchange/ e-commerce• Structured transmission of data between organizations by electronic means.• Exchange medical, billing information• Fast and cost effective transactions. ASCX12N or X12N• Develop uniform standards for electronic interchange of business transactions: claims/encounters, attachments, enrollment, disenrollment, eligibility.• Payment/remittance advice, premium payments, first report injury, claim status, referral, authorization certification.
  • 36. Technical Standards (cont) LOINC Used to provide standard set of universal names and codes for identifying individual laboratory and clinical results. Electronic exchange of laboratory results. IEEE 1073• Provide for open systems communications in healthcare applications.• Interoperability standard for electronic health data exchange from medical devices and patients, optimized for the acute care setting. DICOM• Standard which permits interchange of biomedical images. Back
  • 37. Medication Standards FDA National Drug Code (NDC) Drug codes and (SPL) Labeling. FDA Center for Drug Evaluation and Research Data Standards (CDER) manual. • Several codes COMIS, DFS, CPRF, DRLS, DADS, SPOTS. • Strictly voluntary National Council for Prescription Drug Programs, • NCPDP Transmitting prescription information between prescribers, providers, and other organizations or agents. Addresses electronic transmission of new prescriptions, changes, refills, notifications, cancellations.
  • 38. Medication Standards (cont) Semantic Clinical Drug (SDC) of RxForm• Provides standardized names for clinical drugs (active ingredients) doses, forms, brand names, RxForm is produced through HL7.• Is a subset of RxForm, provide interoperability for clinical drug nomenclature. LOINC Clinical Special Product Labeling (SPL)• Structured product labeling, specification purpose is to facilitate the submission, review, storage, dissemination, and access to product labeling information.
  • 39. Medication Standards (cont) Electronic Prescribing Back
  • 40. Privacy and Security Standards Mandated by HIPAA Ensure confidentiality and protection from unauthorized disclosure alteration or destruction effective security standards are especially important in computer-based environments because patient information is accessible to many users in many locations ASTM and HL7 have developed security standards.
  • 41. Standards Development Standards development Organizations SDO. (ISO, WHO, ASTM, ANSI, HL7) Process : Identifying, negotiating, drafting. Organizations that coordinate standards development: ANSI ISO, International Standards Private and government organizations influence development of standards.
  • 42. Healthcare StandardsLandscape © Hammond, William Edward; Jaffe, Charles; Kush Rebecca Daniels. "Healthcare Standards Development: The Value of Nurturing Collaboration " Journal of AHIMA 80, no.7 (July 2009): 44-50.
  • 43. Evolving and Emerging Health InformationStandards • HIS are far from complete. • Extensible Markup Language (XML): HTML • XML allows data to be communicated from one computerized system to another. • No loss of integrity of data • XML combined with existing classification systems • XML allows data in health record to be organized. • Can serve as a standard for exchange of HI over the web.
  • 44. Conclusions 我听 不懂。 !