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Data Standards, Data Quality, and Interoperability (2013
update)
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Editor's note: This update replaces the 2007 practice brief "Data
Standards, Data Quality, and Interoperability."
Data quality and consistency are critical to ensuring patient safe
ty, communicating delivery of health services, coordinating
care, and healthcare reporting. Assessing the quality and consist
ency of data requires data standards. This practice brief
provides health information management (HIM) professionals w
ith a clear understanding of data standards as a tool to
enable interoperability and promote data quality.
The online version of this practice brief [...] is accompanied by
an appendix that provides HIM professionals with a list of
standards to reference in data dictionary development, electroni
c health records, the exchange of health information, and
general data management processes to ensure information integr
ity and reliability. Evaluation of data validity, reliability,
completeness, and timeliness are accomplished through a combi
nation of human and machine processes in healthcare, and
the list of data standard sources is a helpful reference guide whe
n more detailed information is required.
Data Standards and Regulatory Framework

Data standards are "documented agreements on representations,
formats, and definitions of common data. Data standards
provide a method to codify invalid, meaningful, comprehensive,
and actionable ways, information captured in the course of
doing business."
Rules to describe how the data is recorded to ensure consistenc
y across multiple sources is another way to
think of data standards. Without data standards and data quality,
the future of interoperability is bleak. Data fields and the
content of those fields need to be standardized.
Standards development organizations (SDOs) address a variety
of aspects of health information and informatics. For
example, the American Society for Testing and Materials (AST
M) and Health Level Seven (HL7) target clinical data
standards. Insurance and remittance standards are a focus of the
Accredited Standards Committee (ASC) X12. Standards to
transmit diagnostic images are developed through Digital Imagi
ng and Communications in Medicine (DICOM). The
National Council for Prescription Drug Programs (NCPDP) repr
esents pharmacy messages.
The Institute of Electrical and Electronics Engineers (IEEE), H
L7, ASTM, and others develop data models and
frameworks. See the table on page 65 for a breakdown of regula
tory agencies responsible for working with the American
National Standards Institute (ANSI) to drive data standards to a
chieve interoperability.
The AHIMA Leadership Model states that HIM professionals sh
ould serve as the leaders in healthcare organizations and in
their professional community for ensuring that data content stan
dards are identified, understood, implemented, and managed.
As leaders, HIM professionals will need to collaborate with inte
rnal and external partners to meet interoperability and

health information exchange agreements, influence the develop
ment of standards to meet organizational needs, and
participate in the development of standards to address local and
national industry needs.
Leadership actions for HIM professionals include but are not li
mited to:
Increase knowledge and understanding of data content standards
Assess organizational readiness
Conduct a data content standards requirements analysis
Develop a local data dictionary to support enterprise-wide inter
operability
Advance the development of data content standards
Select integrated electronic systems that support data content re
quirements
Contribute to domain knowledge by participating in relevant pro
fessional association work and mentoring others
Contribute to the development and harmonization of industry an
d professional standards
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http://library.ahima.org/Doc/1/9/0/69827
Interoperability Ensures EHR Compatibility
The Office of the National Coordinator for Health IT (ONC) def
ines interoperability as ensuring that health-related

information flows seamlessly. Information needs to follow the p
atient regardless of geographic, organizational, or vendor
boundaries. Interoperability refers to the architecture or standar
ds that make it possible for diverse EHR systems to work
compatibly. The importance of interoperability goes far beyond
the confines of the EHR. Information must flow into and out
of health information exchanges—
available to the patient at the right time, at the right place, and
containing data that is
accurate and complete.
ONC provides "building blocks" to bring awareness to maintaini
ng and sustaining standard interoperability. These current
initiatives are working to standardize:
Meaning through the use of standardized healthcare vocabularie
s
Structure by leveraging standards in HL7
Transport using secure e-mail protocols
Security through National Institute of Standards and Technolog
y (NIST)-adopted encryption standards
Services through open and accessible application programming i
nterfaces (APIs)
There are many SDOs who are involved in the development and
publishing of healthcare informatics standards at national
and international levels. These standards are crucial to the captu
ring and sharing of clinical information in our electronic
health information systems.
Regulatory Agencies in Standard Development
Multiple regulatory agencies are currently responsible for worki
ng with the ANSI standard development
organization to drive data standards that help achieve interopera
bility, including those listed in the table below.

Regulatory Agency Data, Mapping, and Messaging Standards
The Centers for Medicare and
Medicaid Services (CMS)
provides a list of data resources
including standard terms and
abbreviations that promotes
naming and semantic consistency.
The "meaningful use" EHR Incentive Program was developed
to allow care providers to implement EHR technology in three
stages. Stage 1 focuses on data capture and sharing of data,
stage 2 focuses on clinical processes such as information
exchange and patient-controlled data, and stage 3 aims to focus
on improving patient outcomes. The incremental phases allow
care providers to adopt standards into their daily workflow.
The Office of the National
Coordinator for Health
Information Technology (ONC)
promotes flexible implementation
standards that are able to change
incrementally, emphasizing
usability and workflow design to
facilitate data exchange.
Meaningful use stage 2 EHR certification criteria delineates
data standards.
The Agency for Healthcare
Research and Quality (AHRQ)
promotes the development of IT
systems which identify specific
criteria.

The National Strategy for Quality Improvement in Health Care
(National Quality Strategy) is a nationwide effort to align
public and private interests to improve the quality of health and
healthcare for all Americans. Part of the Affordable Care Act,
the National Quality Strategy is guided by three aims that
provide better, more affordable care for an individual and the
community.
The National Quality Strategy (NQS) promotes "national
standards while supporting local, community, and state-level
activities that respond to local circumstances."2 The NQS also
works to align quality efforts among commercial and
government activities, and across federal agencies.
Standards Development
In order to drive interoperability, the adoption of messaging sta
ndards is primarily driven by regulation. There are also
stakeholder groups hard at work on harmonization efforts to ma
nage information in standardized processes to enable data
sharing. A consensus process gathers interested individuals fro
m industry and consumer groups, specialty domains,
agencies, professional organizations, and vendors to develop a c
oncept and express it in a recommended course of action or
standard. Then, a document is drafted to further refine the conce
pt and work through details by an interactive voting process
to assure that the completed standard has been accorded fair rev
iew prior to publishing.

ASTM publishes standard test methods, specifications practices,
guides, terminologies, and classifications. ASTM E1384
and E31.25 (2013) Standard Practice for Content and Structure
of the Electronic Health Record (EHR) describes a logical
data organization and content (common data model) of an EHR.
The model is used by an organization according to the
major informational structures and content of the EHR. A patien
t's health record plays five unique roles:
1. It represents the patient's health history.
2. It provides a method for clinical communication and care pla
nning among the individual healthcare practitioners
serving the patient.
3. It serves as the legal document describing the healthcare serv
ices provided.
4. It is a source of data for clinical, health services, and outcom
es research.
5. It serves as a major resource for healthcare practitioner educa
tion.
HL7 is one organization that is developing international standar
ds for interoperability and messaging including the
Consolidated Clinical Document Architecture (C-CDA) and EH
R functional model. HL7 develops international standards,
which sometimes must be modified to meet the "meaningful use
" EHR Incentive Program or reimbursement systems criteria
unique to the United States. HL7 collaborates with the Internati
onal Organization for Standardization (ISO) for international
balloting.
ISO, the world's largest developer of voluntary standards, has m
any technical committees (TCs) that span a variety of
products and services. ISO/TC 215 Health Informatics primarily
develops voluntary standards in the field of information for
health and health information and communication technology to

promote interoperability. ISO/TC 215 includes standards for
areas such as healthcare delivery, disease prevention and wellne
ss promotion, public health and surveillance, and clinical
research related to health services.
Health informatics standards will play significant roles as electr
onic data management increases. It is important that HIM
professionals learn about informatics in order to serve as a prof
essional resource to healthcare organizations. HIM
professionals can participate in the standards development proce
ss by evaluating proposed standards and recommending
new ones. There has never been a greater need for input from th
e HIM perspective in the domain of data standards.
Areas for standardization in healthcare include health informati
on exchanges (HIE), clinical data harmonization, and
documentation.
Data Standards for Health Information Exchange
Health information exchange organizations are an important par
t of improving efficiency and reducing cost for healthcare
delivery, and global standards will make a difference in the way
healthcare professionals capture and use health information
worldwide.
4
To foster adoption of standardized language to meet the mandat
es of the meaningful use program, HL7 is offering free

access to their standards. HL7's C-CDA is a library of templates
that help facilitate exchange. While multiple record types
fall under the C-CDA, they all provide a common format to assi
st in health information exchange. This library contains the
following nine templates:
Continuity of Care Document (CCD)
Consultation Note
Diagnostic Imaging Report (DIR)
Discharge Summary
History and Physical (H&P)
Operative Note
Procedure Note
Progress Note
Unstructured Document
Each template has defined sections to harmonize the data across
systems. This standard ensures the information integrity
and reliability when sharing data across HIEs or between other
health IT systems.
The Role of Metadata in Standardization
Metadata is identified as a method to manage health information
by indexing and applying attributes to a patient's record at
the "granular" or data-element level. An emerging use of metada
ta is the processing of large amounts of data for data
analytics. Being able to distill large amounts of data for specific
data points will allow the metadata to be used to develop
and improve quality care. Metadata will be critical for leveragin
g the volumes, velocity, and variety of healthcare data now
available due to the increasing use of clinical information syste
ms such as EHRs.
Though metadata will be critical for maintaining and preserving
the healthcare record, there are currently no standards for

the metadata schema. The proposed HL7 EHR-S RM-ES Functio
nal profile will require the capture and retention of
authors, data creation time stamps, modification, view, and dele
tion. HL7 standards are also not mandated at this time, but
using the conformance criteria will benefit health information m
anagement professionals who are involved with the RFP
process or are assessing an EHR system.
The schema varies by organization and within jurisdictions acco
rding to business needs. HIM professionals need to direct
their organizations to consider specific business needs and the r
egulatory environment when making decisions about the
maintenance and management of metadata. Understanding and
managing metadata is not the sole responsibility of
information technology (IT) professionals. HIM professionals s
hould collaborate with IT to develop processes and
procedures to ensure that metadata is managed effectively withi
n their organizations.
Metadata captures information such as the date and time that an
entry was made in the health record, who accessed the
record and when, what changes have been made to the record an
d by whom, and the identity of staff who document sections
of the record when this information is not collected by an authe
ntication or signature, such as portions of a template that are
completed by nursing or other allied healthcare staff. Metadata i
s an important tool that can be used to follow up on
documentation or compliance issues, facilitate response to reque
sts for an accounting of accesses of the medical record, or
to meet internal or external reporting or analytics requirements.
Clinical Data Standards Harmonization
Semantic interoperability is the ability of computer systems to i
nterchange data and to interpret and use the data according
to its meaning, rather than just its surface form. Problems arise

when one term has multiple meanings or when two or more
terms refer to the same concept but are not easily recognized as
synonyms. Many multi-stakeholder workgroups are in
existence today to address semantic interoperability. Examples i
nclude HL7, ISO, and the International Health Terminology
Standards Development Organisation (IHTSDO)—
the organization that maintains SNOMED CT.
Harmonizing disparate information systems requires data transla
tion and mapping, as well as document and messaging
standards with a regulatory framework that promotes their use.
HIM professionals understand where data is created and
distributed; this knowledge can be utilized to ensure harmonizat
ion between systems. There are multiple data models as
they relate to health information exchange such as centralized, d
ecentralized, and federated models. The type of model
selected will determine how and where information will be colle
cted and stored.
A centralized model collects data from local sources and stores
the data in a central repository. A decentralized data model,
also called a federated model, gives an organization control of t
he healthcare record, providing a quick and easy way to
distribute data-sharing across regions. The hybrid model is a co
mbination of the previous two models.
Along with developing standards for meaningful use interoperab
ility, it is important to exchange information with standalone
registry systems. When developing these standards, these syste

ms should be considered in the forefront to eliminate manual
data collection into disparate systems. Without standards there
will be unstable and inconsistent data collection resulting in
the inability to compare and improve outcomes.
When developing standards one also needs to consider the abilit
y to connect clinical outcomes with billing data to help
determine the value of healthcare provided. The value of health
care is the quality over the cost. Every system has its own
way of representing data. For example, relational databases hav
e their own schema for defining tables and fields.
Ontologies are one method of managing data and providing a me
chanism for disparate systems to communicate. Although
this is not a new term, it will be one that HIM professionals will
hear in discussions related to interoperability and data
standards. An ontology viewed with a data standards lens is a m
odel of knowledge that serves as a semantic translator that
is able to reconcile metadata standards, XML dialects, and datab
ase access methods.
Data Standards and Documentation of Health Services
Employing data standards in health services documentation furt
her entails consistent, accurate, and reproducible capture of
clinical concepts using standardized terminology to describe dis
eases and procedures. This supports an environment
conducive to the assessment of patient management, outcomes
measures for quality and performance improvement, and
clinical research. Current initiatives to measure quality and perf
ormance through data include the Joint Commission Core
Measures, CMS' Present on Admission Indicator Reporting, CM
S' Clinical Quality Measures, and the National Committee
for Quality Assurance Healthcare Effectiveness Data and Inform
ation Set (HEDIS).
Documentation describes the methods and activities of collectin

g, coding, ordering, storing, and retrieving information to
fulfill future tasks. …
BUSI 604 100 Integrated Discussion Boards 1-4 Rubric
Criteria
Levels of Achievement
Content 70%
Advanced 92-100%
Proficient 84-91%
Developing 1-83%
Not present
Part 1-- Key Term/Concept Reservation
Part 2 -- Main Thread
37 to 40 points
Major Points are supported by all of the following:
Your thread must be placed in the Discussion Board Forum text
box and adhere precisely to the following headings:
· KEY TERM and WHY YOU ARE INTERESTED IN IT
· EXPLANATION OF THE KEY TERM
· MAJOR ARTICLE SUMMARY
· DISCUSSION
· REFERENCES
34 to 36 points
Major Points are supported by most of the following:
box and adhere precisely to the following headings and format:

· DISCUSSION
· REFERENCES
1-33 points
Major Points are supported by some of the following:
box and adhere precisely to the following headings and format:
· DISCUSSION
· REFERENCES
0 points
No work submitted.
Or
Duplicate concept reservations will not earn credit under any
circumstance—this includes work submitted in a previous
course
Part 3 – Replies
28 to 30 points
A minimum of 3 substantive and comprehensive replies to other
student postings are submitted, in at least one of the following
ways:
· compare/contrast the findings of others with your research;
· compare how the findings of others relates/adds to the
concepts learned in the required readings; and/or
· share additional empirical knowledge regarding global
business -- or international experiences you may have had --
relative to the postings of others.
25 to 27 points
A minimum of 2 substantive and comprehensive replies to other

ways:
1-24 points
A minimum of 1 substantive and comprehensive reply to other
ways:
0 points
No work submitted.
Or
course
Structure 30%
Advanced 92-100%
Proficient 84-91%
Developing 1-83%
Not present
Posted in Text Box
5 points
All 3 parts of the Forum are posted in the text box.
4 points
2 parts of the Forum are posted in the text box.

1 to 3 points
1 part of the Forum is posted in the text box.
0 points
No parts of the Forum are posted in the text box.
Or
course
Grammar/Spelling
5 points
Proper spelling and grammar are used.
4 points
Between 1–2 spelling and grammar errors are present.
1 to 3 points
Between 3–4 spelling and grammar errors are present.
0 points
More than 4 spelling and grammar errors are present.
Word Count
9 to 10 points
At least 800 words are submitted for Part 2; 450 words are
submitted for Part 3.
8 points
799 to 750 words are submitted for Part 2; 449 to 400 words are
submitted for Part 3.
1 to 7 points
749 to 100 words are submitted for Part 2; 399 to 100 words
are submitted for Part 3.
0 points
Less than 100 words are submitted for Part 2; less than 100
words are submitted for Part 3.
Part 2 References are in APA format
9 to 10 points
All references are in APA format.
8 points
Most references are in APA format.
1 to 7 points

Some references are in APA format.
0 points
No references are in APA format.
Important Notes:
All parts of the DB are posted in the text box -- not as an
attachment -- before or on the due date. In the event formatting
is lost in the text box, you may also attach your Word file to the
text box as evidence of proper formatting.
BUSI 604 Discussion Board Forum 1–4 Instructions
Important Assignment Deadlines:
· Part 1 due by 11:59 p.m. (ET) on Thursday of the first of the
assigned modules/weeks.
· Part 2 due by 11:59 p.m. (ET) on Monday of the second of the
· Part 3 due by 11:59 p.m. (ET) on Sunday of the second of the
· Note: For Module Week 8, Part 3 is due by Friday, 11:59pm
EST, since that is the last day of class. No work is accepted
after the course ends.
Part 1 (no word count)
As you read the chapters assigned to each module/week, you
will find some concepts more interesting and applicable to your
personal or work situation than others. Review the key terms
listed in the assigned chapters; then, submit a preliminary
thread indicating the key term that you wish to reserve for your
thread for that module/week.
Check the discussion board area prior to submitting your
reservation to ensure no one else has chosen that key term. In
the event the key term you wish to explore is already reserved
by someone else, simply move on to another key term in your
readings. Duplicate key terms will not earn credit under any

course. Do not ask the instructor to accept a duplicate key term,
as this is not fair to those who followed these explicit
directions.
Include the exact key term you selected in your thread’s subject
line.
Submit Part 1 to the Discussion Board Forum by 11:59 p.m.
(ET) on Thursday of the first of the assigned modules/weeks.
Part 2 (800 words minimum)
After you have successfully reserved the key term that interests
you the most, research a minimum of 5 recent scholarly articles
that relate to the concept on which you wish to focus your
research. Articles must be found in reputable professional
and/or scholarly journals and/or informational venues that deal
with the content of the course (i.e., not blogs, Wikipedia,
newspapers, etc.). After reading the articles, select the 1 article
that you wish to discuss.
It is highly recommended that you use Liberty University’s
Jerry Falwell Library online resources. A librarian is available
to assist you in all matters pertaining to conducting your
research, including what constitutes a scholarly article. For
more details on what constitutes a scholarly journal (and what
does not), visit Jerry Falwell Library’s "Scholarly Journals –
What Are They?" page.
Your thread must be placed in the Discussion Board Forum
textbox (not as an attachment) and adhere precisely to the
following headings and format:
1. Key Termand Why You Are Interested in It (100 words
minimum)
After reading the textbook, specifically state why you are
interested in conducting further research on this key term (e.g.,

academic curiosity, application to a current issue related to
employment, or any other professional rationale). Include a
substantive reason, not simply a phrase.
2. Explanation of the Key Term(100 words minimum)
Provide a clear and concise overview of the essentials relevant
to understanding this key term.
3. Major Article Summary(300 words minimum)
Using your own words, provide a clear and concise summary of
the article, including the major points and conclusions.
4. Discussion
In your own words, discuss each of the following points:
a. How the cited work relates to your above explanation AND
how it relates specifically to the content of the assigned
module/week. This part of your thread provides evidence that
you have extended your understanding of this key term beyond
the textbook readings. (150 words minimum)
b. How the cited work relates to the other 4 works you
researched. This part of your thread provides evidence that you
have refined your research key term to a coherent and
specialized aspect of the key term, rather than a random
selection of works on the key term. The idea here is to prove
that you have focused your research and that all works cited are
related in some manner to each other rather than simply a
collection of the first 5 results from your Internet search. (150
words minimum)
5. References
A minimum of 5 recent scholarly articles (not textbooks,
Wikipedia, or other popular reading magazines), in current APA
format, must be included and must contain persistent links so
others may have instant access. In the event that formatting is
lost or corrupted when submitting the thread, attach the

Microsoft Word document to your thread as evidence that your
work was completed in the proper format. Access the following
URL from the Jerry Falwell Library for instructions on creating
persistent links: How to Create a Persistent Link.
(ET) on Monday of the second of the assigned modules/weeks.
Part 3 (150 words minimum, per reply)
Additionally, you will reply to a minimum of 3 other
classmates’ threads. Thus, you will have submit substantive
written responses to a minimum of 3 other classmates’ threads.
(ET) on Sunday of the second of the assigned modules/weeks.
· Note: For Module Week 8, Part 3 is due by Friday, 11:59pm
EST, since that is the last day of class. No work is accepted
after the course ends.
Performance Task: Write a Narrative
Now that you've read both points of view on nature—that of the
Transcendentalists, and that of Oates — which perspective do
you agree with?
· Create a narrative using one of the perspectives you read
about: supporting nature or going against it.
· Tell a story about an experience you had in nature that either
affected you positively or negatively.
· Compose a narrative of 500–1,000 words that discusses your
experience in nature.
· Be clear on the stance you are choosing, and what you have
learned from this experience.
· Has reading the poems and stories of the Transcendentalists
changed your perspective on nature for the better or worse?

Performance Task: Argument with Research
One of the goals of this unit is to conduct research. Now that
you have finished reading The Adventures of Huckleberry
Finn, you will be conducting and writing your own research
paper of 1,000–1,500 words on one of the topics listed below.
In addition to specific quotes and evidence from the text, you
will use outside research to support your claims. You may use
articles and information found online, in books, or
magazines, but do not use Wikipedia. All research must be
properly cited in MLA format on a final "Works Cited" page
listing all sources used. (Refer to the MLA Formatting and Style
Guide for support.)
· Examine the novel's portrayal of racism. Is the novel racist or
is it merely holding a mirror to a racist society?
Essay could examine: Huck's relationship with Jim, Pap's views
of African Americans, Twain's portrayal of Jim, Use of the "n"
word. Is Twain taking a stance against, and shining a light on,
society, showing them the absurdity of their ways? Or, is this
providing the author's own perspective on the time? Choose one
side and defend.
· Is Huck a transcendentalist, reflecting the new philosophy of
the time? Use quotes from the book, as well as research on the
transcendental philosophy, to argue for or against this claim.
· The Adventures of Huckleberry Finn was censored
immediately upon its release, and is still censored in many
schools today. Argue or support that this book deserves to be
censored, comparing it with modern censorship of books or
media. Research the reasons behind the book's censorship both
then and now, as well as other media that has been censored in
modern times, and the reasons for that censorship. Is it
justified, or does it infringe upon the First Amendment?

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