Data Standards and the United States Health Information Knowledgebase 

Slide Presentation from the AHRQ 2011 Annual Conference

Data Standards and the United States Health Information Knowledgebase

Slide Presentation from the AHRQ 2011 Annual Conference

On September 20, 2011, Michael Fitzmaurice, Robin Barnes, and John Donnelly made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (700 KB). Plugin Software Help.

Slide 1

Data Standards and the United States Health Information Knowledgebase

AHRQ Annual Research Conference 2011

September 20, 2011

Slide 2

Agency for Healthcare Research and Quality (AHRQ)

Image: The United States is shown.

Mission

Improve the quality, safety, efficiency and effectiveness of health care for all Americans.

Slide 3

Presentation

• Moderator: J. Michael Fitzmaurice PhD, AHRQ.
• Speakers:
  • John Donnelly, IntePro Solutions.
  • Robin Barnes, Data Consulting Group.

Slide 4

Learning Objectives

• What is the U.S. Health Information Knowledgebase (USHIK)?
  • A metadata registry.
  • Supporting the HHS Secretary's Initiatives.
• Why is USHIK important?
  • To AHRQ.
  • For Quality Measures.
  • For Patient Safety Common Formats.
• What can you do with USHIK.ahrq.gov?
  • Application Projects implemented as USHIK Portals.

Slide 5

Card Games Metadata Registry

• Each game master is the authority for its game's 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.

Slide 6

What Cards Are Needed to Play?

Image: A screen shot of a flow chart. It shows a text box which says "Deck of 52 Cards". Arrows are pointing to it from the following text boxes: Bridge, Euchre, Pinochle, and Poker. To the side of that is a separate box which states: "Not 176".

Slide 7

Which Games Use the 4 of Spades?

Image: A screen shot of a flow chart. It shows a text box which says "Deck of 52 Cards". Arrows are pointing to it from the following text boxes: Bridge, Euchre, Pinochle, and Poker. To the side of that is a separate box which states: "4 of Spades".

Slide 8

Bridge: Normal Deck of 52 Cards

• Data element name(1 of 52): 4 of spades.
• Attributes:
  • 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.

Slide 9

Example: AHRQ-USHIK Data Element

• Data Element Name: Gender code.
• Attributes (Metadata):
  • Definition: For eligibility, id gender of the individual member.
  • Context: National Council for Prescription Drug Programs (NCPDP) Data Dictionary.
  • Registered Authority: NCPDP.
  • Effective date: 2001-11-27.
  • Data type: Alphabetic extended.
  • Representation Layout: X(1).
  • Value Domain: Gender, coded_VD.
  • Codes: M (male), F (female), blank (unknown).

Slide 10

How Does Each Authority Express Gender?

Image: Flowchart showing a text box with the word USHIK in it. Arrows are pointing to it from the following text boxes: X12, Health Level Seven International (HL7), NCPCP, and Healthcare Information Technology Standards Panel (HITSP). To the side of that is a separate box which states: "Gender".

Slide 11

Comparison Matrix Aids in Harmonizing Data Elements

Image: A screen shot of a comparison matrix is shown.

Slide 12

Do the Data Elements in My EHR Fit Meaningful Use Specifications?

Image: Flowchart showing a text box with the word USHIK in it. Arrows are pointing to it from the following text boxes: X12, HL7, NCPCP, and HITSP. There is also a highlighted box with an arrow pointing to the USHIK box with the words "Meaningful Use". To the side of that is a separate box which states: "Are my EHR's data defined the same as for Meaningful Use reqs?".

Slide 13

What Portals Are in USHIK?

• USHIK: HHS Secretary's adopted, endorsed, recognized data elements: Health Insurance Portability and Accountability Act (HIPAA), CHI, HITSP, and all other data elements.
• HITSP: HITSP data elements linked to all 13 HITSP use cases, interoperability specifications, and other documents.
• Patient Safety Common Formats: Specifications for electronically reporting patient safety events in hospitals among Patient Safety Organizations.
• Meaningful Use (pilot): Example: quality measures and the data elements associated with their numerators, denominators, inclusions, and exclusions.
• State All-Payer Claims Data (pilot): Data element specifications from all-payer data bases of 7 states.
• Standards and Interoperability Framework (New) Data element Specs from Transitions of Care, Lab Results Interface, and CDA Harmonization initiatives.

Slide 14

Application Projects Highlighted

• HITSP: Office of the National Coordinator for Health Information Technology (ONC), American Health Information Community (AHIC) Use Case's resolved into Interoperabilty Specs and other constructs.
• S&I Framework: ONC, Use Case's resolved into Requirements, Standards Analysis and Reference Implementation artifacts.
• Meaningful Use: Centers for Medicare & Medicaid Services (CMS), Quality Measure numerators & denominators, exclusions, etc.

Slide 15

HITSP Project Background

• Approach:
  • Use Case's—AHIC.
  • Standards Analysis—HITSP.
  • Pilot Implementations—Nationwide Health Information Networ (NwHIN).
• Artifacts: Interoperability Specs; Transactions/Transaction Packages; Components.
• Data: Transaction Metadata; Clinical Data.

Slide 16

HITSP Project Organization

Image: Diagram of a cube with the Population, Provider and Consumer Perspective Technical Committees (TCs) diagonally across the top, the Domain TCs comprised of Care Management and Health Records, Infrastructure and Security and Privacy, and Administrative and Financial horizontally across the front, and the Foundations Committees comprised of Modeling, Messaging and Data Types, Terminology and Knowledge Representation, Workflow and Process, and Security and Privacy vertically in the depth.

Slide 17

HITSP Deliverables

• Use Case Artifacts:
  • 15+ Interoperability Specs.
  • 30+ Transaction Packages / Transactions.
  • 40+ Components.
• Technical Notes (7).
• Acronym and Data Element Glossaries.
• http://hitsp.org

Slide 18

USHIK Focus and Deliverables

• HITSP Data Component Artifacts:
  • Constrain existing data standards from SDO's.
  • HL7 CDA, HL7 2.x, ASTM CCR, ANSI X12, etc.
  • Re-purposing structure for CDA data elements:
    • C154 → C83 → C32, C37, C48, C78.
• Clinical Data Portal:
  • Clinical Data "Concepts".
  • "Model" Primarily Use Case specific.
  • Leverage HITSP Glossaries.

Slide 19

USHIK Demonstration

HITSP Portal

Slide 20

S&I Framework Project Background

• Approach:
  • Use Case's, Standards Analysis, Reference and Pilot Implementations → Single Contiguous Program.
  • Cross-Use Case Harmonization; Use Case Simplification WG for re-purposing.
• Artifacts: Use Case Requirements, Clinical Information Model (CIM). Standards Analysis Worksheet, Reference Impl Guide, Pilots Results.

Slide 21

S&I Framework Project Organization

Image: Diagram of a sequence of interconnected boxes reflecting the contiguous project flow beginning with Use Case Development, thru Standards Development and Harmonization of Core Concepts (with interaction with SDO's, SSO's, and VMO's), the creation of Implementation Specs and a Reference Implementation Guide, followed by documented results from Pilot Demonstrations. The final box is the incorporation of this development process into the ONC's Certification and Testing program.

Slide 22

S&I Framework Deliverables

• Use Case and Implementation Artifacts:
  • 2 Clinical Operations Initiatives:
    • Transitions of Care (ToC), Lab Results Interface (LRI).
  • 2 IT Infrastructure Initiatives:
    • Provider Directories, Certificate Interoperability.
  • 1 Population Health Initiative (new):
    • Query Health.
• Cross-Initiative Workgroups and Functions.
• http://wiki.siframework.org

Slide 23

USHIK Focus and Deliverables

• S&I Cross-Initiative Artifacts:
  • Use Case Simplification Matrix:
    • Actors, Actions, Data Element Sets (DES).
• Clinical Information Model (CIM):
  • Transitions of Care (ToC), Lab Results Interface (LRI).
• Standards Analysis Results:
  • CDA Consolidation Ballot templates.
  • DES correlation to SDO standards:
    • Currently CDA, HL7 v2.x.

Slide 24

USHIK Demonstration

S&I Framework Portal

Slide 25

Meaningful Use Project Background

• Approach:
  • Product Certification as per HITSP interoperability requirements (ONC/NIST).
  • Administrative/Operational process changes.
  • Quality Measures in harmonization with existing AHRQ authored measures (CMS/AHRQ/NQF).
• Artifacts: Quality measures expressed as "eMeasures" leveraging HITSP and S&I Framework recognized data definitions and vocabularies.

Slide 26

Meaningful Use Measures

• Meaningful Use Guidance:
  • Administrative/Operative and Clinical measures.
  • eMeasure Numerators, Denominators, Exclusions, Inclusions.
• Targeting EP and EH provider types:
  • Physician Quality Reporting Initiative (PQRI), Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU), National Quality Forum (NQF) .
• Time Period Based Registration & Attestation Requirements to Qualify.
• http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3584.

Slide 27

USHIK Focus and Deliverables

• Quality Measure Definition:
  • Description, objective, numerical components.
• Help with knowing "what measures are for what purpose":
  • MU, PQI, other quality improvement/payment programs.
• Help with knowing more about the data elements used in the measure:
  • Base Standards used (e.g SNOMED, LOINC).
  • Where else these data elements are used.

Slide 28

USHIK Demonstration

MUMM Portal

Slide 29

We value Your Input!!

Image: A screen shot of the USHIK Web site is shown.

Image: At the bottom left of each page, please find a notepad/pencil icon stating "Give your feedback".

Slide 30

Lessons Learned

• Use information models.
• Trade off value of what USHIK supplies against the cost of supplying it.
• Intellectual property has value—protect its value.
• Work with users:
  • Anticipate their needs. Save them time.
  • Give them accuracy. Save them money.
  • Seek their feedback.

Slide 31

Finale

• Data Dictionaries promote understanding.
• Metadata registries promote interoperability, reuse, and one-stop shopping for information.
• Research needs health data that are more uniform, accurate, and computerized.
  Don't we all!
• See the HITSP, S&I Framework, MU, USHIK Common Format and APCD Portals at http://ushik.ahrq.gov.

Slide 32

Data Standards and the United States Health Information Knowledgebase

AHRQ Annual Research Conference 2011

J. Michael Fitzmaurice, Ph.D. [AHRQ]
John Donnelly [Intepro Solutions]
Robin Barnes (Data Consulting Group)

Thank You.

Current as of December 2011

Internet Citation:

Data Standards and the United States Health Information Knowledgebase. Slide Presentation from the AHRQ 2011 Annual Conference (Text Version). December 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualconf11/fitzmauricebarnesdonnelly/fitzmauricebarnesdonnelly.htm