National Interoperability Standards and USHIK

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National Interoperability Standards and USHIK

• Public Health Data Consortiums 2009 Annual
  Meeting
• J. Michael Fitzmaurice, Ph.D.
• Agency for Healthcare Research and Quality
• November 12, 2009

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Does anything exist?

• Cogito, Ergo Sum
• Rene Descartes

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When I think of all the HITSP products

• My brain hurtsso many constructs
• How do I grasp the power of what HITSP has done?
• USHIK.ahrq.gov

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USHIKa National Metadata Registry
US Health Information Knowledgebase
AHRQ-USHIK
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USHIKa National Metadata Registry

• AHRQ-USHIK is an AHRQ-funded and managed metadata
  registry of
• Data elements endorsed, accepted, and recognized
  by the HHS Secretary for federal agencies use
• An organized collection of data elements and
  their characteristics (metadata)ISO/IEC 11179
• USHIK contains data elements from National
  Interoperability Standards for
• HIPAA transactions
• Consolidated Health Informatics Domains
• Health Information Technology Standards Panel
  (HITSP)

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AHRQ-USHIK

• Mission To represent AHRQ with excellent service
• Specific Goal To be an organized set of
  repositories that coordinates the data elements
  and their metadata from health data standards
  that the HHS Secretary has endorsed, accepted,
  and recognized, including ARRA data elements,
  plus AHRQs patient safety elements
• Why To improve the uniformity, accuracy, and
  computerization of health data for researchers
  and decision makers, including providers,
  patients, plans, and payers
• Improves clinical and administrative data used
  for research
• Speeds applications of research tools developed
  from these data

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Bridge Normal Deck of 52 Cards

• Data element name(1 of 52) 4 of spades
• Attributes (Metadata)
• Definition playing card
• Number 4
• Suit spades
• Odd/even even
• Picture card No
• Authority You, or Hoyle
• Version or date effective 12-14-1917
• Bridge deck member Yes
• Pinochle deck member No
• Euchre deck member No
• Poker deck member Yes

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Card Metadata Registry

• Each game master is the authority for its games
  cards
• The same card can be used in different games
• The same metadata about a card can be reused many
  times, in a metadata registry
• Bridge all 52 cards
• Euchre 24 cards, all higher than an 8
• Pinochle 48 cards, all higher than an 8,
  duplicated
• Poker all 52 cards
• In total, it would take 176 cards for each of you
  to display the cards for your games with separate
  decks

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What cards are needed to play?
Bridge
Pinochle
Euchre
Poker
Deck of 52 CARDS
Not 176
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AHRQ-USHIK Data Element

• Data Element Gender code
• Attributes (Metadata)
• Definition For eligibility, id gender of
  the individual member
• Context NCPDP Data Dictionary
• Registration. Authority NCPDP
• Effective date 2001-11-27
• Data type Numeric extended
• Represent. Layout X(1)
• Value Domain Gender, coded_VD
• Codes M (male), F (female), U (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 ARRA
meaningful use?
AHRQ Patient Safety
X12N
NCPDP
HL7
HITSP
USHIK
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Do the data elements in my EHR fit HITSP
specifications?
X12N
NCPDP
HL7
HITSP
Are My EHR data defined the same as HITSPs?
USHIK
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How does each authority express gender?
X12N
NCPDP
HL7
HITSP
USHIK
Gender
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ARRA Incentive Payments to Providers

• American Recovery and Reinvestment Act of 2009
  (Feb. 17, 2009) provides
• Up to 44,000 starting in 2011 through 2015 for
  Meaningful Use of Certified EHRs by eligible
  Providers
• Meaningful Use --- so that patients will get
  value
• Certified --- to reduce market risk to EHR
  purchasers about the EHRs capabilities for them
  to engage in Meaningful Use activities

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Simple Hypothetical Diagram
Standards Recommendations for Meaningful Use and
8 other areas
ARRA
Health providers
HHS Secretary
CMS/ONC
ONC
Meaningful use definition
HITSP
HIT Policy
HIT Standards
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Simple Hypothetical Diagram
ARRA
Federal Agencies
HHS Secretary
ONC
ONC
HITSP Other bodies
CCHIT Other bodies
HIT Policy
HIT Standards
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Simple Hypothetical Diagram
AHRQ USHIK
ARRA
Federal Agencies
HHS Secretary
ONC
ONC
CCHIT Other bodies
HITSP Other bodies
HIT Policy
HIT Standards
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Simple Hypothetical Diagram
AHRQ USHIK
ARRA
Federal Agencies
HHS Secretary
ONC
ONC
CCHIT Other bodies
HITSP Other bodies
HIT Policy
HIT Standards
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Federal Agencies

• As required by ARRA, when federal agencies
  implement, acquire, or upgrade HI systems for
  exchanging personal health information, they must
  use systems that meet standards adopted by the
  HHS Secretary under ARRA.
• Federal agencies are similarly bound by Executive
  Order 13410 (Aug. 2006) to use standards
  recognized by the HHS Secretary.

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Federal Agencies must use these 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 Systems

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

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ushik.ahrq.gov promotes

• One-stop shopping for HITSP data elements
• Reduced resources for implementing HITSP
  standards
• And for reporting patient safety events in
  hospitals
• Defined authorities for data elements meanings
• Uniformity of certified EHR content
• Movement toward identical data elements
• Reconciling inconsistencies within and among
  HITSP documents and SDO standards
• Making available data information from other
  sources in USHIK for HITSP comparisons and
  choices
• Federal agency and private sector comparisons of
  their program and product data needs with HITSP
  data elements

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Whats New in USHIK

• As of July 15, 2009, every HITSP-specified data
  element is in USHIK and linked to every HITSP
  construct (document) in which it appears
• Developing new, faster data loader
• Updating SDO information X12, NCPDP, HL7
• X12 data elements are being updated in USHIK
• 4010 in the USHIK staging server now
• 4050 and 5010 generic elements developed next
  week for loading the following week Thank you,
  Steve Bass

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Whats New in USHIK

• X12 is taking responsibility for properly
  loading its data elements into USHIK HITSP
  should reference them there
• NCPDP and HL7 are proposed to follow
• USHIK has a preliminary view of HITSPs
  Capabilities and Services Collaborations
• Within IS 07 EHR Centric Context with links to
  capabilities, service collaborations, all
  constructs, data elements, value sets
• Not official, but presented for improving
  understanding and obtaining user comments

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Whats New in USHIK

• AHRQ has recently funded USHIK to
• Develop a State All-Payer Data (SAPD) Metadata
  Portal
• Develop a Meaningful Use Metadata Measure (MUMM)
  Metadata Analysis and Portal (with Abt
  Associates, Inc.)
• Continue developing AHRQs Patient Safety Common
  Formats Portal
• Put HITSP T66 compliant web services in place for
  external queries of/by USHIK
• AHRQ and VA will continue their USHIK
  partnershipHITSP data elements ? Quality Measure
  domain

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Where is Value?

• Publishing in one place the data elements from
  the standards processes ONC has developed
• Being a source for what is required by the
  Presidents and HHS Secretarys Interoperability
  StandardsFederal Agencies, Federal Contracts
• Supporting federal and private sector efforts to
  match their programs and products data elements
  with those of Federal Interoperability Standards

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Finale

• See the HITSP Portal Information Models at
• Ushik.ahrq.gov
• See also CDCs PHIN VADS for public health data
  value set information at
• Phinvads.cdc.gov

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National Interoperability Standards and USHIK

• Public Health Data Consortiums 2009 Annual
  Meeting
• J. Michael Fitzmaurice, Ph.D.
• Agency for Healthcare Research and Quality
• November 12, 2009

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USHIK Metadata Registry Contents, data elements
from

• IEEE Medical Device Communications Industry
  Group (IEEE/ISO 11073)
• DoD Military Health System
• NCVHS
• Clinical Care Classification (Nursing Taxonomy)
• HITSP
• AHRQ Patient Safety Events
• Other sources

• X12
• ASTM
• NCPDP SCRIPT, Batch, Data Dictionary
• American Dental Association
• HIPAA
• HL7
• MHS Functional Area Model
• Public Health Care Data Standards  
• LOINC