Health Care Informatics Standards Activities of Selected Federal Agencies (continued, 3)

A Compendium

U.S. Department of Transportation (DOT)
National Highway Traffic Safety Administration (NHTSA), Emergency Medical Services (EMS) Division

Contacts

Jeff Michael, Chief
EMS Division
NHTSA
Department of Transportation
Room 5130, Mail Stop (NTS14)
400 7th Street, SW
Washington, DC 20590
Phone: (202) 366-4299
Fax: (202) 366-7721
E-mail: jmichael@nhtsa.dot.gov

Garry B Criddle, R.N.
EMS Division
NHTSA
Department of Transportation
Room 5130, Mail Stop (NTS14)
400 7th Street, SW
Washington, DC 20590
Phone: (202) 366-9794
FAX: (202) 366-7721
E-mail: gcriddle@nhtsa.dot.gov

Data-Related Programs

The agency supports development of 12 National Standard Curricula for emergency medical services and emergency medical technicians. The agency supports the linkage of information from police crash reports, ambulance run sheets, hospital discharge data, and coroners' reports. In cooperation with other agencies and parties, the agency developed the Uniform Pre-Hospital Data Set that in a consensus process defined data elements that should be used on ambulance run reports.

Standards Employed

The EMS Division develops voluntary guidelines for the delivery of prehospital emergency care in cooperation with States and professional organizations. These standards are adopted by states and incorporated into State-required training materials. The guidelines are intended to improve the quality of emergency medical care by incorporating best practices into training materials. The National Standard Curricula provide continuity of training materials for all States and territories.

DOT has a congressional mandate regarding emergency medical services (Public Law 89-564, 1966).

Purpose of Standards

Each State has the responsibility of defining the State requirements for training of emergency medical technicians. The States generally adopt the DOT National Standard Curricula as the required level of training. Although they are guidelines, the National Standard Curricula promote uniformity across the country and limit State-to-State variation in the scope of practice and in educational programs.

Subject Areas Covered

  • National Standard Curricula for training emergency medical technicians.
  • Quality assurance for emergency medical services.
  • Future trends in out-of-hospital emergency medical care.
  • Projected prehospital research agenda.
  • State assessments of emergency medical services.
  • The National EMS Education and Practice Blueprint; and
  • Public education concerning bystander care for the injured.

Standards Activities

Agency personnel participate in standards-setting bodies such as the ASTM F30 Committee on Emergency Medical Services. The EMS Division uses a consensus-building process for development of National Standard Curricula and other system operation guidelines.

Links With Other Agencies

The EMS Division works closely with HRSA's Maternal and Child Health Bureau in administering the Emergency Medical Services for Children's program. The division participates on the Federal Interagency Committee on Emergency Medical Services as well as with other Federal agencies and professional organizations on its various EMS projects.

Data Dictionaries

The Uniform Pre-Hospital Data Set, which proposes guidelines for data collection in ambulance run reports.

Publications and Other Dissemination

  • Twelve National Standard Curricula.
  • The EMS Agenda For the Future.
  • The EMS Agenda for the Future Implementation Guide.
  • The Guidelines for Quality Improvement Programs.
  • The First There...First Care Program.
  • The Make the Right Call Campaign, and other documents specific to emergency medical services activities.

The EMS Division's home page is at http://www.nhtsa.dot.gov/people/injury/ems.

Participation in ANSI-accredited and Other Standards Development Organizations

As invited.

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

Assessments of Effects. The EMS Division is sponsoring research on emergency medical services to assess the effect of emergency medical care on morbidity and mortality.

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U.S. Department of Veterans Affairs
Veterans Health Administration (VHA)

Contacts

Robert M. Kolodner, M.D.
Associate Chief Information Officer for Business Enterprise Solutions and Technologies (191)
Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Phone: (202) 273-8663
Fax: (202) 273-9386/87
E-mail: rob.kolodner@hq.med.va.gov

Gregg R. Seppala
Data Administrator (192)
Department of Veterans Affairs
840 Colesville Road, Suite 200
Silver Spring, MD 20910
Phone: (301) 427-3700
Fax: (301) 427-3711
E-mail: gregg.seppala@med.va.gov

Steven Wagner
Office of the Chief Information Officer
Department of Veterans Affairs
718 Smyth Road
Manchester, NH 03104
Phone: (603) 624-4366, ext. 6780
Fax: (603) 624-6578
E-mail: steve.wagner@med.va.gov

Data-Related Programs

As the second largest of the 14 Cabinet departments, the Department of Veterans Affairs (VA) manages one of the largest automated medical care systems in the nation through its Veterans Health Administration (VHA). VISTA (Veterans Health Administration Information Systems and Technology Architecture) provides the rich automated environment that supports day-to-day operations at VA health care facilities. This system incorporates VHA's previous information system—the Decentralized Hospital Computer Program—into a new, open system, client/server based environment including workstations with graphical user interface, software developed by VA employees, links to commercial-off-the-shelf software, and future incorporation of new technologies including intranet and Internet. All VA facilities are electronically interconnected to centralized data bases for administrative and clinical use. The interconnection allows data exchange throughout the entire VHA network.

Standards Employed

VHA has developed a portfolio of over 120 software applications written in the M (formerly MUMPS) ANSI standard programming language. The applications are based on a single data dictionary, which implements a standard set of data elements and data values.

VHA uses standard medical coding and classification systems, including Physicians' Current Procedural Terminology (CPT); "Diagnostic and Statistical Manual of Mental Disorders," Fourth Edition (DSM-IV); HCPCS; ICD-9; ICD-9-CM; SNOMED; LOINC, and the ANSI ASC X12N Health Care Provider Taxonomy. VHA uses the ASC X12, HL7, the ISO/IEC (International Organization for Standardization/International Electrotechnical Commission) Standard 11179 Specification and Standardization of Data Elements, and DICOM III standards for exchanging health care information between health care facilities and among applications.

VHA has developed a standard clinical lexicon for use in all applications. The clinical lexicon is based on the NLM UMLS. VHA has also undertaken the creation of a Master Patient Index to uniquely identify and enumerate patients. The Master Patient Index maintains unique patient control numbers and a list of current facilities where the patient has been seen. VHA is considering implementing the national provider and payer identification systems that are being developed by HCFA.

Purpose of Standards

The standards are implemented in VHA software applications and specified in applicable contracts for commercial products and services to ensure consistent representation of data and to facilitate the exchange of data between health care facilities.

Subject Areas Covered

The subject areas cover include virtually all aspects of health care and health status, such as electronic medical records; exchange of clinical information; ancillary tests and procedures; instrument interfaces; demographic, financial, and eligibility information; and scheduling information, privacy, data administration, confidentiality, and security.

Standards Activities

VHA representatives participate in numerous informatics standards groups, including the ANSI Healthcare Informatics Standards Board, ASTM Committee E31 on Healthcare Informatics, ASC X12N-Insurance Subcommittee, DICOM III, Institute of Electrical and Electronics Engineers (IEEE), and HL7. They attend meetings, propose improvements to existing standards, identify new standards that are needed, and review and comment on ballots of proposed standards. VHA also develops internal standards when external standards are not available or not applicable.

Data Dictionaries

The ANSI M programming language and the VA FileMan data dictionary provide an internal standard for representing data in VHA applications. VHA is also developing a corporate data registry based on the recommendations in ISO/IEC Standard 11179. VHA uses standard reference data sets, including CPT, DSM-IV, HCPCS, ICD-9-CM, LOINC, and SNOMED codes.

Publications and Other Dissemination

Internal standards are disseminated through policy and other manuals. These manuals are distributed in both printed and electronic form; the latter though a VA Web page (http://www.va.gov), E-mail, and the bulletin board. VHA has made arrangements with the HL7 Committee and ASTM to distribute their standards electronically throughout VHA. Other external standards activities are reported and distributed through electronic mail.

Participation in ANSI-accredited and Other Standards Development Organizations

VHA representatives serve on international, national, and interagency standards organizations and committees, including: Global Information Infrastructure—G7 Global Healthcare Applications—International Harmonisation of Use of Data Cards in Healthcare Sub-project; HHS Data Council—Joint Working Group on Telemedicine, Interagency Health Privacy Working Group, and the Committee on Health Data Standards; ASTM Committee E31 on Healthcare Informatics; ANSI Healthcare Informatics Standards Board; ISO TC215 on Health Informatics; ASC X12N—Insurance Subcommittee; DICOM III; IEEE; and HL7. VHA representatives attend standards meetings, propose improvements to existing standards, identify new standards that are need, and review and comment on ballots of proposed standards. VHA also provides funds to support an HL7 Government Projects Special Interest Group to expedite processing of proposals that benefit the Government Projects Special Interest Group (GCPR) initiative.

HIPAA 1996-Related Activities

VHA is a member of the HHS Data Council—Committee on Health Data Standards and has representatives participating in various work groups that are addressing the Administrative Simplification provisions of HIPAA 1996.

  • Key Personnel Assigned to HIPAA Implementation:
  • Robert M. Kolodner, M.D.
    Associate Chief Information Officer (191)
    Department of Veterans Affairs
    810 Vermont Avenue, NW
    Washington, DC 20420
    Phone: (202) 273-8663
    Fax: (202) 273-9386/87
  • Reviews of HIPAA-Related Transaction Standards Needs and Efforts:
  • VHA is developing a process to standardize its health insurance claims and remittance processing activities through electronic data interchange using ANSI X12 standards. VA will use value-added network(s) to translate transactions to proprietary carrier formats, including paper UB-92's and HCFA-1500's where necessary, to accomplish a claim. All data transmitted between the VA and its value-added network(s) will be formatted according to ANSI X12 standards. VHA will begin using TS 837, Health Care Claim, and TS 997, Functional Acknowledgment. Transaction segments planned for future implementation are T.S. 277, Health Care Status; T.S. 835, Health Care Payment/Remittance Advice; TX 270, Health Care Eligibility/Benefit Information; and T.S. 276, Request for Status of Health Care Claim.
  • Plans or Planning Groups Established to Implement HIPAA Changes:
  • VHA plans to implement the recommendations of NCVHS relating to the Administrative Simplification provisions of HIPAA 1996.

Comments

There is a need for a standard clinical terminology, especially in areas such as mental health.

Proposed legislation concerning privacy, confidentiality, and security will, if enacted, significantly affect VHA.

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Consumer Product Safety Commission (CPSC)

Contact

Arthur K. McDonald, Director
Division of Hazard and Injury Data Systems
U.S. Consumer Product Safety Commission
4330 East West Highway
Bethesda, MD 20814-4408
Phone: (301) 504-0539, ext. 1249
Fax: (301) 504-0038

Data-Related Programs

CPSC is an independent Federal regulatory agency, charged with responsibility for reducing the risk of injury and death due to consumer products. In order to measure and track injuries and deaths related to consumer products, CPSC operates a number of data systems, among which are the following:

  • The National Injury Surveillance System (NEISS). A hospital emergency department surveillance system designed to collect consumer product related injuries on an ongoing daily basis in a timely manner, is CPSC's primary data system. In 1997, 101 hospital emergency departments in the United States and its territories comprise a probability sample of all such hospital emergency departments. CPSC contracts with each participating hospital to provide surveillance data derived from emergency department records. Generally, these data are coded and entered into personal computers by hospital employees. A personal computer at CPSC headquarters collects the data nightly via another unattended personal computer. In addition to providing valuable surveillance data, the cases collected serve as a sampling frame for follow-back investigations of specific hazard types.
  • The CPSC Death Certificate Project. Designed to provide product data for a limited number of ICDA E Code categories purchased from the 50 States, the District of Columbia, and New York City. Contracts are negotiated with each State to provide the in-scope death certificates in as timely a manner as is feasible. Those death certificates whose narrative provides sufficient detail are coded with CPSC's numeric product code and entered into a computer data base. The number of death certificate categories purchased each year is subject to the available funds and has varied over time.
  • The Injury and Potential Injury Incident (IPII). The file includes anecdotal data from many different sources: consumer complaints, newspaper clippings, medical examiner/coroner reports, fire departments, etc. These reports often serve to alert CPSC staff regarding hazardous or potentially hazardous consumer products.

Standards Employed

N/A

Purpose of Standards

N/A

Subject Areas Covered

CPSC has jurisdiction over products customarily produced for sale to or use by consumers. Among the excluded categories are motor vehicles, aircraft, firearms, pesticides, and medical devices.

Standards Activities

CPSC has the authority to mandate product standards, although standards may be developed voluntarily by industry groups.

Data Dictionaries

CPSC has developed its own data dictionaries and coding manuals specific to each data base.

Publications and Other Dissemination

The National Injury Information Clearinghouse serves as CPSC's information link to the public. Freedom of Information requests are handled by the Office of the Secretary. One available document is the "Consumer Product Safety Review," published quarterly and available through the Superintendent of Documents.

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

Office of Personnel Management

Contact

Frank D. Titus
Office of Insurance Programs
Office of Personnel Management
1900 E Street, NW, Room 3400
Washington, DC 20415
Phone: (202) 606-0770
Fax: (202) 606-2922
E-mail: fdtitus@opm.gov

Ellen E. Tunstall
Office of Insurance Programs
Office of Personnel Management
1900 E Street, NW, Room 3415
Washington, DC 20415
Phone: (202) 606-0745
Fax: (202) 606-0767
E-mail: eetunsta@opm.gov

Nancy H. Kichak
Office of Actuaries
Office of Personnel Management
1900 E Street, NW, Room 4307
Washington, DC 20415
Phone: (202) 606-0722
Fax: (202) 606-2922
E-mail: nhkichak@opm.gov

Data-Related Programs

The Office of Personnel Management (OPM) is responsible for administering the Federal Employees Health Benefits Program (FEHBP), which covers approximately 9 million Federal employees, retirees, and family members. OPM has more than 350 carriers under contract servicing the FEHBP. The demand for current and accurate health care data is constant. In addition to contract administrative data, OPM is frequently requested to participate in major employer survey initiatives such as the annual MEPS and numerous other nationwide employer/health insurance studies.

Standards Employed

None mentioned.

Purpose of Standards

N/A

Subject Areas Covered

N/A

Standards Activities

None mentioned.

Data Dictionaries

N/A

Publications and Other Dissemination

None mentioned.

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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Social Security Administration

Contact

Derek Wang
Executive Assistant
Social Security Administration
6401 Security Blvd., Alt 250
Baltimore, MD 21235
Phone: ( 410) 965-2662
Fax: (410) 965-4525
E-mail: derek.wang@ssa.gov

Data-Related Programs

Within the Social Security Administration (SSA), office A01.6 has responsibility for coordinating and demonstrating direct access to medical records for SSA personnel who make medical determination for disability programs. The major initiative in this area is a partnership SSA is developing with VA. Efforts are under way to establish a policy and operational framework that would permit State disability examiners online access to the automated patient records maintained by VA medical examiners. It is expected that this process will expedite the processing of veterans' claims for SSA disability benefits. The disability examiners work in State determination services offices, which make the medical and vocational determinations for SSA according to Federal regulations.

The main goals of the partnership between SSA and VA are to demonstrate that the direct access method is both legally and technically feasible and will improve customer service by reducing claims processing time. In addition, it is expected that the new system will reduce administrative costs for both SSA and VA.

SSA's general counsel has found legal support for SSA to obtain the medical records from the VA medical centers via the direct access approach. The general counsels of both organizations will begin to discuss the details of the policy and operational procedures needed to ensure compliance with the Privacy Act and other related requirements. Then, after resolution of other technical issues, pilot operations will proceed.

Upon successful completion of the pilot demonstrations, SSA will use this example as a model to encourage other medical institutions to allow SSA the direct automated access needed for more timely and efficient collection of medical evidence using electronic technology.

Standards Employed

None specified.

Purpose of Standards

N/A.

Subject Areas Covered

N/A.

Standards Activities

None specified.

Data Dictionaries

None specified.

Publications and Other Dissemination

None specified.

Participation in ANSI-accredited and Other Standards Development Organizations

None specified.

HIPAA 1996-Related Activities

None specified.

  • 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

Page last reviewed December 1999
Internet Citation: Health Care Informatics Standards Activities of Selected Federal Agencies (continued, 3): A Compendium. December 1999. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/1999-compendium/infostd4.html