Chapter 9 Clinical Data Standards

Question 1

International Classification of Diseases (how began)

Answer 1

-in London by The Worshipful Company of Parish Clerks
-Kept weekly mortality statistics
-London Bills of mortality simply tallies of all the ways people passed away

Question 2

Anatomy of the Human Body

Answer 2

Henry Gray

Question 3

Systematized Nomenclature of Medicine (how began)

Answer 3

-developed by College of American Pathologists
-converted ideas by Henry Gray Anatomy of the Human Body
-includes anatomy, diseases, findings, procedures, microorganisms, and other substances

Question 4

The Diagnostic and Statistical Manual of Mental Disorders

Answer 4

American Psychiatric Association

Question 5

Institute of Electrical and Electronics Engineers (standardization done by)

Answer 5

-resulted in laserdiscs and coaxial cables that became CD-ROM format and Ethernet cables

Question 6

Joint Photographic Experts Group (standardization done by)

Answer 6

-defined the digital formats that allowed images to be digitally stored and visualized on televisions, discs, and network cabling

Question 7

ISO 7 Layer Network Model

Answer 7

-developed by International Organization for Standardization (ISO) and International Telegraph and Telephone Consultative Committee (CCITT)
-Basic Reference Model for Open Systems Interconnection

Question 8

HL7 Working Group (origins)

Answer 8

UCSF protocol, then became standards development organization
-developed Continuity of Care Document (CCD) and Fast Healthcare Interoperability Resources (FHIR) standard

Question 9

Logical Observation Identifiers Names and Codes

Answer 9

Developed by Regenstrief Institute in early 1990s

Question 10

RxNorm

Answer 10

Developed by National Library of Medicine using Unified Medical Language System
-developed in early 1990s

Question 11

BlueButton initiative

Answer 11

-Helped veterans download their health records from VistA (EHR of VA)

Question 12

FHIR

Answer 12

-developed by HL7 group
-adopt standard protocols such as HTTP, REST, OAuth, and OpenID

Question 13

ObjectID Repository

Answer 13

-developed by International Telecommunications Union -Telecommunication standardization sector (ITU-T) and International Organization for Standards (ISO)
-name objects in a permanent and unambiguous way
-nearly any item can be listed, and definitely used for: referencing standards, terminologies, algorithms, templates, rules, protocols, file formats and the like

Question 14

Data standards

Answer 14

-methods, protocols, terminologies and specifications for the collection, exchange, storage and retrieval of information associated with healthcare applications
-has several key elements
=data definition, data interchange formats, terminologies, knowledge representation

Question 15

National Council for Prescription Drug Programs (NCPDP)

Answer 15

-an American National Standards Institute (ANSI) accredited Standards Development Organization (SDO)
-responsible for outpatient pharmacy communications
-has developed standards related to: benefit integration, billing units, formulary and benefit, manufacturer rebates, medicaid subrogation, medical rebates data submission, pharmacy ID cards, prescription file transfer, product identifiers, prior authorization transfer, universal claim forms

Question 16

Accredited Standards Committee X12 (ASC X12)

Answer 16

-an American National Standards Institute (ANSI) accredited Standards Development Organization (SDO)
-produces X12 Electronic data interchange (EDI) standards
-facilitate business transactions (order placement and processing, shipping and receiving information, invoicing, payment and cash application data
-responsible for developing standards related to insurance (medical claims, payroll deducted, benefits enrollment, electronic remittance, eligibility inquiry, claim status inquiry, health services review request)

Question 17

HL7

Answer 17

-an American National Standards Institute (ANSI) accredited Standards Development Organization (SDO)
-HL7 version2
-primary clinical messaging standard in the US, used in over 90% of hospitals
-4 basic types of messages:
=ADT: admit discharge, transfer
=ORM: order management
=ORU: observation result
=DFT: detail financial transaction
-was extended by developers, often differs between implementation and offers limited interoperability
-messages are separated by vertical bars and carets, commonly called pipes and hats
-message is composed of several segments, each segment has a number of fields (also known as composites)

Question 18

Digital Imaging and Communications in Medicine (DICOM)

Answer 18

-an American National Standards Institute (ANSI) accredited Standards Development Organization (SDO)
-responsible for handling, storing, printing, and transmitting medical images
-collection of standards on: file formats, network communications protocols, definitions of grayscale necessary for printing and screen display
-DICOM message is a stream of elements which are composed of an element tag, optional value representation, value length and value
-DICOM files are stored as binary streams, without any human-readable punctuation

Question 19

Terminology

Answer 19

a controlled-limited vocabulary used to express all the terms or concepts in a domain

Question 20

Nomenclature

Answer 20

concepts can be combined according to specific rules to form more complex concepts

Question 21

Thesaurus

Answer 21

network of terms that relate to each other in more or less complex ways

Question 22

ICD-10

Answer 22

-vocabulary created by WHO
-example of terminology?
-arranged in hierarchical format by oran system and etiology
-no multi-hierarchy allowed (a code can only exist in 1 branch of hierarchy)

Question 23

Diagnosis Related Groups (DRG)

Answer 23

-developed by Yale in 1970s
-example of terminology?
-List of 745 principal diagnoses are meant to describe hospital inpatient episodes of care, in terms of amount of resources required and intensity of services provided
-used by CMS to determine reimbursement under the inpatient prospective payment system (IPPS)
Computer programs called groupers are used to classify discharges into one of the ERG codes
-DRGs are grouped into 25 body systems, known as Major Diagnostic Categories
-Severity of diagnosis is specified as having Major Comorbid Conditions (MCC) or Comorbid Conditions (CC) or without comorbid conditions

Question 24

Current Procedural Terminology (CPT)

Answer 24

-example of terminology?
-maintained by American Medical Association (AMA)
-each code is assigned Relative Value Unit (RVU) weight, correlates to degree of skill, risk, and/or time required for the procedure
-some codes are bundled

Question 25

Universal Medical Device Nomenclature System (UMDNS)

Answer 25

-hierarchical terminology for medical devices including both device type, and specific make/model records

Question 26

National Drug Code (NDC)

Answer 26

-example of terminology?
-approved by FDA
-10 digit number broken into 3 segments
=first 4: labeler (manufacturer, packager, or distributor)
=next 4: strength, formulation, dosage form
=last 2: size and contents of package

Question 27

Health Care Financing Administration Common Procedure Coding System (HCPCS)

Answer 27

-example of terminology?
-provides codes for products and services not mentioned in CPT

Question 28

Classification

Answer 28

arrangement of concepts into groups according to established criteria, such as ICD

Question 29

Taxonomy

Answer 29

rigidly hierarchical structure where each child concept inherits characteristics from a parent concept
-only simple parent-child relationships (like family tree)

Question 30

Ontology

Answer 30

extension of taxonomy where concepts can be related in multiple different ways in addition to simple parent-child relationships

Question 31

Characteristics of ideal ontology

Answer 31

1) concept orientation: elements of terminology are coded concepts with hierarchical relationships to other coded concepts (redundant, ambiguous and vague concepts are excluded)
2) concept permanence: coded concepts remain in dictionary forever, codes are never deleted or reused
3) non ambiguity: coded concepts have only one meaning
4) explicit versioning: each version of the dictionary is given a version number
5) meaningless identifiers: codes themselves are unrelated to the hierarchy or relationship among concepts (i.e. codes themselves are non-semantic)
6) multi hierarchy: concepts may be reached through multiple different paths
7) formal definitions: concepts are defined in a formal way so as to make detection of duplicates easier
8) multiple granularities: concepts have varying degrees of specificity for different users
9) no residual categories: concepts are defined with as much specificity as possible, so containers such as not otherwise specified are not needed
10) non redundancy: coded concepts must be unique so that even if multiple terms refer to the same entity, only 1 code is found in the dictionary. When redundant codes do exist, they are easily recognized as aliases or synonyms

Question 32

RxNorm

Answer 32

-project of National Library of Medicine
-example of an ontology
-drug components are placed into a semantic normal form which expresses the active ingredients(s), strength, dosage and unit of measurement
-each component is assigned a Concept Unique Identifier (CUI)
-concepts are linked to each other using several bidirectional relationships

Question 33

Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)

Answer 33

-comprehensive, hierarchical medical vocabulary (ontology?)
-initially developed by the College of American Pathologists and England’s National Health Service
-Since 2007, has been distributed by the International health Terminology Standards Development Organization (IHTSDO)
-SNOMED includes concepts and relationships between concepts
-19 top-level hierarchies (body part, clinical finding, procedure, substance, event, and others)
-common concepts are assigned by pre-coordination, but there is some post-coordination
-most common relationship is parent-child relationship, but there is also non-hierarchical terms (causative agent, finding sites, etc.)

Question 34

Logical Observation Identifiers, Names and Codes (LOINC)

Answer 34

-includes 80K defined entries for laboratory and clinical observations
-maintained and distributed by the Regenstrief Institute and is free for all users
-codes are 6 digits long with hyphen between 5th and 6th digit

Question 35

HL7 version 3

Answer 35

-bears little resemblance to HL7 V2
-V3 is encoded as extensible Markup Language (XML) and not backward-compatible to V2
-major thrust was to create semantic interoperability, accomplished through Reference Information Model (RIM)
-Not widely adopted as messaging standard, other than Clinical Document Architecture (CDA), a hierarchical text-based format for medical record exchange
-Example of CDA is Continuity of Care Document (CCD) which was a part of Meaningful use

Question 36

Semantic interoperability

Answer 36

-ability to exchange data with unambiguous shared meaning

Question 37

Reference Information Model (RIM)

Answer 37

-Part of HL7 V3
-composed of 4 base classes
=entities (people, places, things)
=roles
=participations
=acts

Question 38

FHIR

Answer 38

-newer standard for transfer of medical information
-relies on well-established web technologies, for example:
=Hypertext Transport Protocol (HTTP) with representational state transfer (REST) endpoints for transport
=Hypertext Markup Language (HTML) and Cascading Style Sheets (CSS) for presentation
=Javascript Object Notation (JSON) and extensible markup language (XML) for data representation
=Atom for publication and syndication
-Supports transmission of documents, messages, and services using RESTful endpoints
-fundamental building block of FHIR is a resource