APHL/CDC Presentation to Vietnamese Health Officials and Stakeholders

1. Analysis. Answers. Action. www.aphl.org
Standards for Data Exchange
March 2016

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Introduction
• Personal background
• Professional background
• Project examples

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What are standards?
• The word “standard” as used in information technology
has multiple meanings.
• “Standard” refers to a generally accepted specification
created by an organization that includes more than one
corporation or company.
• Ideally, a standards development organization or
industry consortium uses a consensus-driven process to
create the standard. These organizations may be
international, regional, or national governmental, quasi-
governmental, or non-governmental entities.

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Are there different types of
standards?
Yes! Standards are typically broken down into three categories:
• Formal Standardsrefer to a specification that has been approved
and published by a standards setting organization, such as ISO or
HL7.
• De Jure Standardsrefer to standards mandated by government
legislation or regulation, or may refer generally to any formal
standard.
• De Facto Standardsrefer to a specification, protocol or technology
that has achieved widespread use and acceptance - often without
being approved by any standards organization orby receiving such
approval only after it has already achieved widespread use.

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Why do we need standards?
• Standards can be found in almost every area of our daily
lives, but why do we need them in healthcare information
technology?

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Why do we need standards?
• The healthcare delivery system today employs many
different information systems from different vendors,
both within a single organization and across multiple
organizations.
• Example: a hospital may have a laboratory system from
one vendor, a pharmacy system from another vendor,
and a patient care documentation system from a third
vendor. Physicians affiliated with the hospital also have
different systems in their offices, yet need access to data
from the hospital on their patients.

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Why do we need standards?
• In healthcare, standards provide a common language
and set of expectations that enable interoperability
between systems and/or devices.
• Ideally, data exchange schema and standards should
permit data to be shared between clinician, lab, hospital,
pharmacy, and patient regardless of application or
application vendor in order to improve healthcare
delivery.

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How do standards relate to
interoperability?
• Standards are created in order to enable interoperability
between two systems.
• HIMSS' definition of interoperability incorporates the
definition given by the Institute of Electronics and
Electrical Engineers Standards Association (IEEE-
SA), which is the most often quoted and/or
paraphrased: "The ability of two or more systems or
components to exchange information and to use the
information that has been exchanged." (source)

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How do standards relate to
interoperability?
• A more recent IEEE definition states that a standard
is the "ability of a system or a product to work with other
systems or products without special effort on the part of
the customer. Interoperability is made possible by the
implementation of standards."
• Standards provide a common framework for
communicating across a variety of use cases, which thus
enables system interoperability.

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Examples of Standards
• Data exchange and system standards (Link)
• Pharmacy and terminology standards (Link)
• Medical device standards (Link)
• Public health reporting standards (Link)

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Vocabulary and Terminology
Standards
Define the specific set of values that apply to a specific data type
• SNOMED CT (Systemized Nomenclature of Medicine Clinical
Terms)
• ICD-10 (International Statistical Classification of Diseases and
Related Health Problems, 10th revision)
– Note: The US currently uses ICD-9, and will be moving to ICD-
10 in 2015.
• LOINC (Logical Observation Identifiers Names and Codes)
• DICOM (Digital Imaging Communications in Medicine)
• RxNorm - Normalized names for clinical drugs

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Transport Messaging Standards
Describe how messages get transported/exchanged between systems
• SOAP (Service Object Access Protocol)
• TCP/IP (Transmission Control Protocol / Internet Protocol)
• Secure VPN (Virtual Private Network) over SSL (Secure Socket
Layer)
• DIRECT - like email, using SMTP (Simple Message Transport
Protocol) or XDR (External Data Representation) protocols
• EDI (Electronic Data Interchange)
• IEEE (Institute of Electronics and Electrical Engineers) - used for
medical device data

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Content Standards
Describe what data elements are included, where they are included in
the message, field length, data type, etc. Common examples of content
and document standards include:
• CDA (Clinical Document Architecture)
• HL7 (Health Level Seven) V2.3x, V2.5x and V3
• ASC X12 (Accredited Standards Committee) - examples include
277/278 eligibility

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Additional Standards
• Reference Standards - have an assigned value by direct
comparison with a reference base or model
• Specification Standards - explicit set of requirements for item,
material, component, system or device
• Services Standards - assist in the translation, movement or
securing of data
• Certificates - certificate services assure that messages are secure
• Technical Standards - usually a formal document that established
uniform engineering or technical criteria, methods, processes and
practices

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Are Implementation Guides
standards?
• Standards are helpful because they describe
and constrain the "what" of the data
movement. Implementation Guides (IG)describe
the "how" for a specific use case.
– Although an IG is referred to as a standard by HL7,
the common understanding in the healthcare domain
is that an IG is a companionto a standard that
describes how the standard should be used to
satisfy a specific healthcare use case. The IG is
often balloted along with the standard.

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Standards and LIS Initiative
• Sustainability and effectiveness
• Data Quality
• Reporting
• Data Exchange
• Interoperability

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Summary
Standards…
• “Get you going”.
• Reduce or eliminate competing and often unnecessarily duplicative
efforts.
• Foster collaboration.
• Need to be adjusted for your organization.
• Enable faster development and more rapid time to market/interface.
• Allows for a more scalable interface – lower cost structures.
• Can be complex and require analysis and training.
• Can make a significant impact if there are supporting policies.
• Can reduce complexity of supporting interfaces.
• Are not the end all.

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Contact Information
Eduardo Gonzalez Loumiet,
MBA, PMP, CPHIMS
eddie@uberops.com
www.UberOps.com
www.Eduardo.tech