StandardsStandards – Why have them?Purpose of StandardsA Good StandardSlide 5Standards CommitteesThe 7 layer ISO cakeAccepted StandardsHL7HL7 v. 2.3.XSlide 11HL7 (Health Level 7)HL7 v. 3.0DICOMConformance StatementInteroperability between StandardsTunneling / EncapsulationRe-expression / MappingHarmonizationHIPAAElectronic Transaction StandardAdopt standards forSlide 23Standards to be adopted laterEffective and Compliance DatesHow does Transaction Code Set WorkASCI ASC X12N 837A different segmentChosen StandardsPenaltiesImplicationsSources of InformationCode Set StandardCode SetAdopted Code SetsSlide 36Slide 37Slide 38StandardsThomas Sullivan MD.HSCI 709Standards – Why have them?Successful data exchangeNot vendor, application or platform dependentMove data across enterprisesPurpose of StandardsIntegrates existing standards into new standards making implementation easierMakes life easier for users and vendorsBackward compatibility nice but not always worth itOften unable to fitA Good StandardApplies to all parts of the message construction, transfer and integrationShould be practical and relevantShould be able to be updated and modified to include new technologies and usesDynamicStandardsAgreement on how to implement technologiesProprietary StandardsConsensus StandardsStandards CommitteesAmerican Society for Testing and MaterialsASTMAmerican National Standards InstituteANSINational Institute for Science and TechnologyNISTInternational Standards OrganizationISO - the 7 layer cakeThe 7 layer ISO cake1. Physical (wire from box to wall)2. Data link3. Network4. Transport5. Session6. Presentation7. ApplicationAccepted StandardsHL7ICD9-CMCPT-4HCPCSNDCDICOMHL7Applies toInpatient dataADT (admission, discharge, transfer)OrdersLab measurementsReferralsMany othersHL7 v. 2.3.XCharacter basedLimited to ISO layer 7Lower layers not specified and left to vendors ( ? Good)HL7Messages composed of segmentsSegments composed of predetermined sequence of fieldsCannot insert different data elements than those specifiedMessage construction very limitedHL7 (Health Level 7)Standard for health care records and Medical Data InterchangeSanctioned by ANSIEurope has a different standardCurrent version 2.3.XVersion 3.0 radically differentOnly an application layer standardHL7 v. 3.0Object oriented and model basedHL7 for the multimedia medical recordNot backwards compatible with v. 2.3.XNot yet ratified and acceptedV. 2.2 is about to be de-certifiedIntegrates DICOM at the information model levelDICOMDigital Imaging and Communications in MedicineAn international standardThe standard for the multimedia medical recordObject orientedRadiol, Path, Derm, EKG etc.Conformance StatementA statement by vendors detailing every aspect of functionality and compliance for each device/applicationDICOM and HL7 v.3.0Users can review this statement for different devices/apps and determine compatibilityAbility to exchange a given type of messageInteroperability between StandardsHow do all the standards work together? A B CThree different waysTunneling / EncapsulationA B CData is a payload existing at A and C but moving through B in a way that B understandsRe-expression / MappingA B CMessage created at A using one standardIt is rewritten in another standard as it is transported by BC then rewrites it to its own standardData is the same, only format differsRisk compromising the dataHarmonizationA B CData model of one standard is incorporated into the data model of another standardDICOM 3 is part of HL7 v3.0This represents the best approachHIPAAAn example of using standardsElectronic Transaction StandardCurrently 400 different formats for health care claimsNational standard allow for submitting same transaction to any health plan in USHealth plan could send remittance and referral info back to providersAdopt standards forHealth claims and encounter informationEnrollment/disenrollment in health planEligibility in health planPayment and remittance advicePremium paymentsAdopt standards forHealth claim statusReferral certification and authorizationCoordination of benefitsStandards to be adopted laterFirst report of injuryClaims attachmentsEffective and Compliance DatesFinal rule published August 2000Effective date 60 days later: October 2000Compliance 2 years later: October 20022003 for small health plansHow does Transaction Code Set WorkEach business group of data=Transaction SetEach transaction set contains groups of logically related data in units = segmentsN4 segment has demographic infoTransaction set has multiple segmentSequence of elements within 1 segment is specified by ASCI X12 standardsASCI ASC X12N 837Health care claims: Professional…CLP*12345*1*100*40*40*12….12345=Provider claim ID number1=paid as primary100 = amount billed40 = amount paid40 = patient responsibility12 = PPOA different segment …CAS*PR*1*24**2*16…PR=patient responsibility adjustment reason1 = claims adjustment reason code24 = amount of deductible2 = claims adjustment reason code16 = amount of co-insuranceChosen StandardsANSI ASC X12N version 4010For all but pharmaceutical transactionsNCPDPFor retail pharmacy transactionsPenalties< $100 per violation for any person not in complianceUp to $25,000 per calendar year for violations of any 1 requirementEnforcement procedures still to be publishedImplicationsHealth plans may NOT refuse a standard transaction or delay paymentHealth plans cannot require any other changesHealth plans can require health claims attachments be sent in paper format until standard in effectSources of InformationASC X12 standardhttp://www.wpc-edi.com/hipaaNCPDPhttp://www.ncpdp.orgCode Set StandardHIPAACode SetAny set of codes used for encoding data elementsCode sets for medical data elements required in administrative and financial health care transaction standards under HIPAA for diagnosis, procedures, drugsAdopted Code SetsICD9-CM, Vol 1 & 2Diagnosis - InjuriesImpairments - Other health related prob.Causes of injury, disease, impairmentICD9-CM Vol 3 for hospital inpatientsPrevention - DiagnosisTreatment - ManagementNDCDrugs - BiologicsAdopted Code SetsCode on Dental Procedures and NomenclatureHCPCSMedical Supplies - DMEOrthotic and Prosthetic DevicesCombination HCPCS and CPT4Physician services - Lab testsRadiologic Procedures - OT/PT servicesHearing/vision services - transportationSources of InformationICD9: Government Printing Office202-512-1800CPT4: