Health Care Informatics Standards Activities of Selected Federal Agencies (continued, 2)

A Compendium

U.S. Department of Health and Human Services
National Institutes of Health, National Library of Medicine

Contact

Betsy L. Humphreys, M.L.S.
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Phone: (301) 496-6921
Fax: (301) 496-6923
E-mail: blh@nlm.nih.gov

Data-Related Programs

Although its basic services are focused on acquisition, organization, preservation, and access to the published literature, NLM also has several programs related to biomedical and health data:

  • NLM's National Center for Biotechnology Information builds and maintains GenBank, a huge data base of molecular sequence data, and develops information systems that allow researchers to contribute to the data base, to use it to aid their research, and to link it to related biological information sources.
  • NLM collaborates with other Federal agencies to build and make available data banks on the toxicological and environmental effects of chemicals and on AIDS clinical trials and experimental drugs. NLM was recently assigned lead responsibility by the director of the National Institutes of Health (NIH) to build a comprehensive clinical trials data base.
  • The Visible Human Project has created high-resolution volumetric data sets for entire human male and female cadavers.
  • The Unified Medical Language System (UMLS) project has developed a Metathesaurus that integrates concepts and terms from about 50 different health-related vocabularies and classifications in a single data base format. Developers of health data systems can use the Metathesaurus as a convenient and uniform source of controlled vocabulary for data creation applications.
  • NLM's Extramural Grants program has a 25-year history of funding research related to the development of clinical information systems and automated patient data. More recently, as a participant in the multi-agency High Performance Computing and Communications (HPCC) program, NLM has funded research and development regarding health-related applications of NII, including patient record systems, the transfer of data between the health care and public health systems, and ensuring the confidentiality of electronic health data.

Standards Employed

NLM uses a wide range of national and international standards for bibliographic and publication data, including SGML (Standard Generalized Mark-up Language), standards for bibliographic references, cataloging records, holdings data, and abbreviations of titles of journal articles.

NLM also uses the Abstract Syntax Notation 1 (ASN-1) in the distribution of molecular biology data and has begun experiments with the use of eXtensible Markup Language (XML) for the distribution of UMLS knowledge sources.

Purpose of Standards

NLM employs standards to facilitate the integration of its bibliographic, molecular biology, and vocabulary data into information systems throughout the world and the incorporation of information generated elsewhere into its systems and services.

Subject Areas Covered

Standards apply to published literature; molecular biology data; chemical, toxicological, and environmental health data; and biomedical and health-related nomenclature.

Standards Activities

NLM is a voting member of the National Information Standards Organization and from time to time chairs or participates in committees developing specific library and information science-related standards.

NLM currently chairs the HHS Data Council Working Group on International Health Data Collaboration: G7 Nations, and represents NIH on the HHS Data Council's Committee on Health Data Standards and Interdepartmental Health Privacy Working Group.

From 1995 to 1997, NLM provided support for the development and extension of the DICOM standard and related work on aligning HL7 and Digital Imaging and Communications in Medicine (DICOM).

NLM participated in the ANSI HISPP (Health Informatics Standards Planning Panel) Vocabularies and Codes Working Group.

In 1996 to 1997, NLM and AHCPR sponsored an Internet-based Large-scale Vocabulary Test to determine the extent to which a set of controlled vocabularies cover the concepts and terms needed in health care and public health applications. The results of the test were published in the November 1997 issue of The Journal of the American Medical Informatics Association. The results indicate that the set of existing vocabularies contain a substantial majority of the concepts required to describe patient conditions in computer-based patient records. A combination of vocabularies provides substantially better coverage of these concepts than any single vocabulary does.

NLM has initiated a collaborative effort involving the American Medical Association, the College of American Pathologists, and NCHS to develop standard formats for mapping detailed clinical vocabularies to statistical and billing codes.

Data Dictionaries

NLM maintains data dictionaries for its bibliographic, thesaurus, molecular biology, and chemistry and toxicology data.

The UMLS Metathesaurus will be the vehicle for public distribution of HL7's decisions about which vocabulary terms are valid values for specific parts of HL7 messages.

Publications and Other Dissemination

NLM maintains data dictionaries for its bibliographic, thesaurus, molecular biology, and chemistry and toxicology data.

The UMLS Metathesaurus will be the vehicle for public distribution of HL7's decisions about which vocabulary terms are valid values for specific parts of HL7 messages.

Participation in ANSI-accredited and Other Standards Development Organizations

As stated above:

  • NLM is a voting member of the National Information Standards Organization, an ANSI-accredited SDO.
  • The UMLS Metathesaurus will be the vehicle for public distribution of HL7 decisions about which vocabulary terms are valid values for specific parts of HL7 messages. HL7 is an ANSI-accredited SDO.

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation: Betsy L. Humphreys is co-chair of the Codes and Classifications Implementation Team for HIPAA Administrative Simplification.
  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts: N/A.
  • Plans or Planning Groups Established to Implement HIPAA Changes: N/A.

Comments

N/A

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U.S. Department of Defense

Contact

Marco Johnson and Glenn Sperle
Office of the Assistant Secretary of Defense (Health Affairs)
TRICARE Management Activity
Information Management, Technology and Re-engineering
Function Integration and Data Administration
Data Administration
Five Skyline Place, Suite 810
5111 Leesburg Pike
Falls Church, VA 22041-3206
Phone: (703) 681-5611
Fax: (703) 681-8845
E-mail: marco.johnson@tma.osd.mil, glenn.sperle@tma.osd.mil

Data-Related Programs

This office participates in the Department of Defense's (DOD) data standardization program by developing standards needed to support the changing business of the Military Health System (MHS). This includes data to support such activities as medical readiness, force health protection, managed care, immunization, credentials, and patient-based records keeping. The MHS is also a tri-service activity including the Army, Navy, and Air Force health/medical communities. The Office of the Assistant Secretary of Defense (Health Affairs) is partnering with the Department of Veterans Affairs, HHS, and others to develop a Government computer-based patient record. This office publishes as a directive the MHS Glossary, which is based on health and medical terms and definitions used throughout DOD. Glossary and data standards activities are tied to the formal forms and reports management programs. An enterprise approach to data standards development and use is taken from the policy and management level to modeling functional requirements for computer applications.

Standards Employed

Health industry standards are incorporated and used by MHS as appropriate. Health industry standards are reviewed and applied to influence MHS standards models and DOD standards. For example, ASC X12 series, HL7, HIPAA, and other health industry standards are used.

Purpose of Standards

The standards are used in MHS policy, forms, and reports management programs and computer applications to achieve better sharing of data and interoperability of systems, both within MHS and among the other DOD and civilian systems, and in the selection process to acquire commercial off-the-shelf products. The one set of standards are organized into a formal directive and published as an MHS Glossary.

Subject Areas Covered

The subject areas covered by the data administration group include all aspects of military health force protection, readiness, and managed care. This includes data needed to provide and manage clinical services, resources, to provide medical logistics support, and to make executive decisions.

Standards Activities

Standards activities include developing new standards and coordinating them across the three services, with other DOD functional areas, the Department of Veterans Affairs, HHS, the Department of Commerce, and with industry. Standards activities begin at the management level, where policy, directives, manuals, and other communications use standard terms and definitions that are the basis of formal data standards. Standards activities are embedded in the formal forms and reports management programs. These standards are used in business processes and also include assisting developers to implement the standards in the computer systems. This office also works with the Federal Chief Information Officer standards committee. The Military Health System Data Program is building a Data Registry. This project includes components of HIPAA 1996, MHS standards, DOD standards, and others. HHS and EPA are partners with the Military Health System Data Program Office in this data registry project.

Participation in ANSI-accredited and Other Standards Development Organizations

DOD and MHS work extensively in ANSI-accredited and other standards development organizations. Work is conducted by providing guidance and by voting in ASC X12 insurance data modeling for electronic data interchange transactions and other groups. Work is also conducted on the model-based strategic planning for ASC X12 future direction. The office is completing a comparative analysis with the DOD, MHS functional area models and the HL7 model for exchanging data among clinical systems. The office also provides data models to various standards development organizations via public access to its Internet site.

Data Dictionaries

The data dictionary project is part of the overall methods and technology framework employed to support the full data life cycle. This is part of a data architecture that includes a top-down approach from management glossaries to computer system data dictionaries. Migration system data dictionaries are registered in the Defense Data Dictionary system along with DOD-approved standard data elements. Both approved and developmental data elements are recorded in the MHS Functional Area Model—Data (FAM-D). All new data dictionaries are supposed to be model-based and derive from logical models to physical models to build reusable components in a variety of implementations. Some data dictionary projects are now part of the enterprise data warehouse project, in which data standards are being implemented from a different view.

Publications and Other Dissemination

The main source of publications is the health information resources service. Version control of some publications is managed to incorporate new business practices and data standards. The primary products are the Military Health System Functional Area Model-Data and Military System Functional Area Model-Activity. The functional area models are the foundation of overall data quality activities.

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation:

    Marco Johnson is the DOD MHS voting representative to the Federal Inter-agency Health Data Standards Committee hosted by the HHS. Glenn Sperle and Lloyd Anderson are senior operations researchers working on HHS teams and serve as coordinators of the DOD members to HIPAA Implementation Teams.

  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts:

    The DOD, MHS conducts model-based reviews of the HIPAA transaction standards and conducts mapping and gapping analysis of the HIPAA transactions to the current DOD, MHS data standards and measures the impact of the transactions to the operational automated information systems to determine the degree of change needed.

  • Plans or Planning Groups Established to Implement HIPAA Changes:

    DOD HIPAA assessment and planning sessions take place as part of the chartered MHS Data Program Work Group. Specific staff is identified from all parts of the MHS organization and all partners (managed care contractors). Issues are identified and being worked. The data staff has alerted the full organization about HIPAA, and work sessions are under way.

Comments

This office recommends that a Federal agency be designated as custodian of a Federal Health Services model. This model should tie together the Federal health business across all departments. The States can use this model. This office recommends that the Military Health System Model be used as a starting point. This model was first developed in 1990 and as of January 1999 continues to be validated by the health community. This model is being used to jump-start the Government Computer-based Patient Record (GCPR) project. The GCPR project includes the DOD, Department of Veterans Affairs, HHS, and others.

This recommendation would save the rest of the health standards community thousands, perhaps millions of hours of work and also streamline the standards process. This publication is already being used as Government-furnished information for acquisition purposes by the DOD, Assistant Secretary of Defense for Health Affairs. The data quality in the Government will increase if the entire process of developing and publishing data standards, terms, and definitions, and so on were model based.

This office believes it is imperative that an agency such as AHCPR be the source for model-based research and development. Tools and techniques are in place and products are available for validation by the Federal health community. Now is the time to respond to this health business need. This will allow structured research to support policy options.

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U.S. Department of Energy (DOE)

Contact

Janet Macon
Office of Occupational Safety and Health Policy (EH-51)
19901 Germantown Road
Germantown, MD 20874
Phone: (301) 903-6096
Fax: (301) 903-8497
E-mail: janet.macon@eb.doe.gov

Data-Related Programs

The Office of Environment, Safety and Health accident recordkeeping and reporting program includes collection and analysis of DOE and DOE contractor reports of injuries, illnesses, and other accidents that occur during DOE operations. It also includes exposure information such as hours worked, miles driven, and property valuation that can be used to calculate accident rates. This information is measured and tracked in the Computerized Accident/Incident Reporting System (CAIRS). Incidence rates and the number of cases available from this system are analyzed to identify trends and potential hazards and prioritize means for improvement of safety and health performance.

Standards Employed

The recordkeeping criteria for occupational injuries and illnesses are based on Occupational Safety and Health Administration (OSHA) guidelines for recording occupational injuries and illnesses. Property and vehicle damage reporting is value based. The current thresholds for property and vehicle damage reporting are $5,000 and $1,000, respectively. Occupational injury and illnesses data are coded by occupation, nature of the injury, part of body affected, source of the injury/illness, and type of injury/illness.

Purpose of Standards

The standards are used to facilitate comparisons with data collected from DOE and external data sources.

Subject Areas Covered

The subject areas covered include all recordable accidents (injury/illness, property, and vehicle) that occur during DOE operations.

Standards Activities

Development of standard codes for environment, safety, and health data bases.

Data Dictionaries

A users' manual and coding manual are available for CAIRS. These documents identify data fields and codes.

Publications and Other Dissemination

Occupational Injury and Property Damage summary reports are made available online following the end of each quarterly collection period. The annual summary report includes summary tables and analysis. Access to CAIRS is available to staff of DOE and DOE contractor organizations. Access to sensitive data requires special authorization. Through the database users can access CAIRS standard reports, basic reports, logs, and search and distribution. The standard reports provide easy access to preformatted reports. The logs allow users to easily prepare listings of accident cases by organization, date, and type of case. The basic reports allow users some flexibility in determining the data elements to be included in each report. The search and distribution option provides the capability of performing detailed searches of the CAIRS data and displaying the results in user-defined reports.

Participation in ANSI-accredited and Other Standards Development Organizations

None reported.

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation: None reported.
  • Reviews of HIPAA Related Transaction Standards Needs and Efforts: None reported.
  • Plans or Planning Groups Established to Implement HIPAA Changes: None reported.

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U.S. Department of Justice (DOJ)
Office of Justice Programs, Bureau of Justice Statistics

Contact

Michael Rand, Chief
Victimization Statistics Branch
810 7th Street, NW
Washington, DC 20531
Phone: (202) 616-3494
Fax: (202) 307-1463
E-mail: randm@ojp.usdoj.gov

Data-Related Programs

National Crime Victimization Survey (NCVS). DOJ is also implementing a State prison health care information survey. The contact point for that survey is Paula Ditton. Her telephone number is (202) 305-9014; her E-mail address is dittonp@ojp.usdoj.gov.

Standards Employed

N/A

Purpose of Standards

N/A

Subject Areas Covered

Data covered in NCVS cover injuries inflicted during crimes of violence, including nature of the injuries, medical treatment received, medical insurance coverage, and days lost from work. The survey of State and local prisons provides data on the health problems of inmates as well as types of treatment they receive.

Standards Activities

N/A

Data Dictionaries

Data from NCVS are available through the National Archive of Criminal Justice Data, (800) 999-0960.

Publications and Other Dissemination

Publications are available online from the Bureau of Justice Statistics Web site at http://www.ojp.usdoj.gov/bjs, or from the National Criminal Justice Reference Service, (800) 732-3277. A report summarizing the mental health data obtained from the State prison survey was released in summer 1999.

Participation in ANSI-accredited and Other Standards Development Organizations

N/A

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation: N/A.
  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts: N/A.
  • Plans or Planning Groups Established to Implement HIPAA Changes: N/A.

Comments

N/A

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U.S. Department of Labor
Bureau of Labor Statistics

Contact

William L. Weber
Office of Safety, Health, and Working Conditions
2 Massachusetts Avenue, NE
Room 3180
Washington, DC 20212
Phone: (202) 606-6304
Fax: (202) 606-6310

Data-Related Programs

The Bureau of Labor Statistics (BLS) occupational safety and health statistics program includes the annual Survey of Occupational Injuries and Illnesses that reports information on nonfatal work-related accidents and the Census of Fatal Occupational Injuries. The program provides information on the number and incidence of job-related injuries, illnesses, and fatalities by Standard Industrial Classification (SIC). For nonfatal injuries and illnesses that involve recuperation away from work, demographic data about the injured and ill workers are reported, along with details about the circumstances of the injuries and illnesses. Information about workplace fatalities is available by occupation and other worker characteristics, equipment being used, and circumstances of the event.

Standards Employed

The BLS occupational injury and illness data are classified by industry using the SIC system. The occupations of the injured and ill workers are coded using the Bureau of the Census occupational classification system. The injury and illness characteristics (nature of injury/illness, part of body affected, source of injury/illness, and event or exposure leading to the injury/illness) are classified according to the BLS Occupational Injury and Illness Classification system.

Purpose of Standards

The standards allow descriptive information about work-related injuries and illnesses to be classified in formats that can be tabulated, compared, and published.

Subject Areas Covered

The Survey of Occupational Injuries and Illnesses gathers data on nonfatal occupational injuries and illnesses that occur during the reference year to workers in private industry, except on farms with fewer than 11 employees. The Census of Fatal Occupational Injuries covers fatal traumatic injuries during the reference year to workers in both private industry and the public sector, including the self-employed.

Standards Activities

N/A

Data Dictionaries

N/A

Publications and Other Dissemination

News releases for the Survey of Occupational Injuries and Illnesses are available in two releases:

  1. Case counts and incidence (frequency) rates by industry in December following the reference year.
  2. Case characteristics and worker demographic profiles the following April.

The news release for the Census of Fatal Occupational Injuries is available in August following the reference year. A bulletin, "Occupation Injuries and Illnesses: Counts, Rates, and Characteristics," which reports comprehensive data from the survey, is published for each reference year. An annual report, "Fatal Workplace Injuries: A Collection of Data and Analysis," reports detailed fatality information and includes research articles about high-risk jobs. Extensive tables reporting information on both fatal and nonfatal job-related injuries and illnesses is available at http://www.bls.gov/news.release/cfoi.toc.html.

Participation in ANSI-accredited and Other Standards Development Organizations

Member, ANSI Z16 committee.

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation: N/A.
  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts: N/A.
  • Plans or Planning Groups Established to Implement HIPAA Changes: N/A.

Comments

N/A

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U.S. Department of State

Contact

Jennifer L. Grise, CFNP
Division of Medical Informatics
Office of Medical Services
SA-1, Room L213
Columbia Plaza
U.S. Department of State
Washington, DC 20522
Phone: (202) 663-1690
E-mail: grisejl@ms2906wpoa.us-state.gov

Data-Related Programs

The Office of Medical Services is the health care organization with the responsibility mandated by the Office of the Director General of the U.S. Foreign Service to maintain and promote the health of Foreign Service employees and their families serving in over 250 locations worldwide. This mandate includes health maintenance activities, acute health care services, and facilitating access to health care.

The Department of State is engaged in developing two data base management systems to support this health care program. The first system, in testing now, is the Worldwide Health Resources, Risks and Recommendations System, designed to integrate legacy data together with disparate information from over 150 overseas medical program sites. In early development is the Department of State Electronic Medical Record system, integrating an Oracle data base management system and a commercial off-the-shelf interface with imaged medical records and customized laboratory and radiology data base management system.

Standards Employed

The Department of State is committed to use of health industry standards in managing data. The NLM's UMLS will be applied, as well as HL7 transfer protocols. Other HHS and Joint Commission on the Accreditation of Healthcare Organizations information management standards and guidelines are sought for application as relevant. ICD-9-CM standards are used in disease, condition, and procedure reporting.

Purpose of Standards

Compliance with data standards will be essential in data analysis within the Department of State's health care organization, as well as allowing comparability to other appropriate U.S. patient population data residing with other organizations such as CDC.

Subject Areas Covered

Capability of foreign health care systems worldwide, located in areas where Foreign Service personnel live and work, to support adequate care. Capability of Department of State Medical Program staff in 56 locations worldwide, to support adequate care, including referrals, hospitalizations, and medevacs. Health risks and recommendations unique to foreign work environments. Documentation of all Medical Program patient encounters.

Standards Activities

Development of medical informatics data standards for the Department of State Office of Medical Services programs, across all existing and in-development database management systems.

Participates in the interagency Data Working Group. Participates in UMLS. No involvement in standard setting bodies at this time. Standards activities are monitored by Division of Medical Informatics staff.

Data Dictionaries

Will use UMLS data dictionary, once design of Department of State Electronic Medical Record (EMR) System is detailed and fixed. Will assess whether a unique Department of State Data Dictionary System should be defined before complete development of EMR.

Publications and Other Dissemination

Will be published in Department of State policy and procedure documentation. Will be available when future Web site is up.

Participation in ANSI-accredited and Other Standards Development Organizations

N/A

HIPAA 1996-Related Activities

  • Key Personnel Assigned to HIPAA Implementation:

    Jennifer Grise, as above, until staff is expanded.

  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts:

    Medical record imaging standards for the organization are currently under review. Recommendations for organization in draft. Transaction standards for commercial off-the-shelf products for EMR set in 1997 for selection of vendor. Work on specific compliance begun in 1998.

  • Plans or Planning Groups Established to Implement HIPAA Changes:

    To be addressed in Information Strategic Plan.

Comments

N/A

Current as of December 1999
Internet Citation: Health Care Informatics Standards Activities of Selected Federal Agencies (continued, 2): A Compendium. December 1999. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/1999-compendium/infostd3.html