Overview

Introduction

Standards are an agreed-upon, common and consistent way to record and communicate health information. eHealth Initiative (eHI) defines a standard as a well defined approach that supports a business process, has been agreed upon by a group of experts and has been publicly vetted. According to this definition, standards provide rules, guidelines or characteristics and help ensure that products, processes and services are fit for their intended purpose. Standards need to be available in an accessible format and subject to ongoing review and revision process.

Standards establish a common terminology, facilitate interoperability and integration, create structured information models for data structure and interchange and enhance privacy & security (HIMSS definition)*. The Health Information Technology Standards Panel (HITSP) views standards as including: Specifications, Implementation Guides, Code Sets, Terminologies and Integration Profiles.

Interoperability is the ability to transfer data cross multitude of health information systems without the need for elaborate mapping, translation to new formats and additional efforts on the part of a consumer. Interoperability can be defined as the ability of two or more systems or components to exchange information (functional interoperability) and to use the information (semantic interoperability) that has been exchanged. Standards are vital ingredients to promote interoperability.

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Need for e-Health Standards

e-Health standards are designed to address the demand for a more efficient health system that uses data as a resource to improve health care quality, increase patient safety, reduce health care costs and improve public health. e-Health standards allow data to be exchanged among different information systems, and for that data to have consistent meaning among the various clinical divisions, in numerous health information systems and across a multitude of organizations.
e-Health standards are one of the critical ingredients for the success of health information technology. Standards are solutions to the pursuit of creating patient-centric electronic health records that are capable of aggregating information from a multitude of sources. Standards are essentially the key to the building of regional and national health information networks. Standards facilitate the electronic movement of data across sites taking care of patients / populations.
In order to share and utilize data across numerous health institutions, data must be hold similar information (data elements), utilize similar words (terminology) and use an agreed upon way to communicate (messaging). With health data, standards make it possible, for example, to collect individual names in the same way (one field for first name, a second for middle initial, another for last name and a final field for suffixes). When information systems collect and store individual names in the same way, it is much more efficient and accurate for one system to send that data to another, or to compare and match names from two different systems so the data can be exchanged or merged accurately and efficiently.
The movement of healthcare information electronically across organizations within a region or community is referred to as Health Information Exchange (HIE). One of the strategies for their success lies in the adoption and utilization of standards for data representation and data exchange.

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Types of e-Health Standards

Category
Description
Example Standards
Terminology
Enables the consistent definition of entities and attributes, usually with a specific domain, and therefore facilitates standardization of data representation.  
Code sets: A list of codes, each code being associated with a particular result, product or term. LOINC (Logical Observations, Identifiers, Names, and Codes): Widely used by public health and clinical laboratories for electronic reporting of lab results.
CVX: Code set developed by CDC to uniquely identify each vaccine product.
Classification systems: A method for classifying data into terms that can be easily and consistently reported, understood, retrieved and analyzed. ICD-10 (International Statistical Classification of Diseases and Related Health Problems): Widely used for both billing and statistical analyses and used to code and classify mortality data from death certificates.
Nomenclature: Specialized terms that are given standardized, precise and unambiguous definitions, which makes meaningful exchange of data between providers possible. SNOMED: The Systemized Nomenclature of Medicine is a robust classification system used in human and veterinary medicine.

Omaha System: A system for standardizing terminology used in nursing. Used in PH-Doc, CHAMPS and other integrated public health information systems.
Category
Description
Example Standards
Information Interchange / Messaging
Define and facilitate communication between systems usually within well-defined domains. These standards regulate the messages and documents, including their format and interaction, sent between systems.

HL7 (Health Level 7) is a way to package data so that the receiving computer knows precisely what data is coming in, and where each data element occurs in the electronic file. An HL7 message shown below:

PID||0493575^^^2^ID1||DOE^JOHN
^M^^|DOE^JOHN^M^^|19480203|M
||B|254E38ST^^DULUTH^MN^55802
^USA||(218)625-4359|||

Used for a very wide range of clinical and demographic data, any of which may need to be exchanged between health care organizations. HL7 enables data interchange amongst organizations using different health information systems.

ebXML
X12N – 270/271
IHE XDS
Data Content Standards
Cover a wide range of data standards, mostly around establishing a consistent, uniform way to capture, record and exchange data. They relate to data elements that are the smallest units of data that convey meaningful information. Census standard for collection of race and ethnicity data.
Core Data Set by CDC for immunization registries used as the standard for buying / building applications, and also for establishing data needs for provider reporting.
Category
Description
Example Standards
Security
Standards that ensure healthcare information is used only by those authorized to do so. Supported by the 4A principles of authorization, authentication, access control and audits. HTTPS
Privacy
Standards that facilitate uniform protection of electronically maintained and transmitted healthcare information. HIPAA (Health Insurance Portability and Accountability Act), Public Law 104-191, included "Administrative Simplification" provisions that required adoption of national standards for electronic health care transactions. Minnesota statutes (sections 144.291 to 144.298) referred to as Minnesota Health Records Act http://www.health.state.mn.us/e-health/mpsp/healthrecordsact2007.pdf
Transactions / Claims Standards
Standards that facilitates the electronic submission of health care claims and increases administrative efficiency. ASC X12N 837
Identifier (Individual & Organizational)
Standards that enable the unique identification of individuals, providers and healthcare centers, etc. FEIN (Federal Employer Identification Number)
HIPAA National Provider Identifier
ISO/IEC 24760
Functionality, Process & Workflow
Standards that define how orders and results are processed. Clinical Guidelines
Information Model
Standards that regulate context by defining the relationship between data elements, and also enable standardized representation of data. HL7 v3 Patient demographics
NCPDP Script
ASTM E 1239-04
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Updated Tuesday, 27-May-2014 11:24:24 CDT