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Health Information Technology Standards

Information Exchange Standards

Organizations that Develop Information Exchange Standards | Tutorials

Information Exchanges Standards define the structure and syntax of the electronic communication and are referred to as the standard ways of sending and receiving information. There are two information exchange standards such as a message-based, i.e., information is sent as a message; and a document-based, i.e., information is sent as a structured document (form).

Information Exchange Standards
Examples of Standards Development Organizations Domains
ASC X12 Financial/Business Transactions, HIPAA Mandated Transactions
ASTM Healthcare
DICOM Images
HL7 Healthcare and Public Health
IEEE Medical Devices
IHE Healthcare, Public Health
ISO Healthcare, Public Health
NCPDP Pharmacy Business Transactions, HIPAA Mandated Transactions
NIEM Health, Human Services

ASC X12 - Accredited Standard Committee X12

ASC X12 develops standards for electronic interchange related to business transactions such as order placement and processing, shipping and receiving information, invoicing, payment and cash application data, and data to and from entities involved in finance, insurance, education, and state and federal governments.

PHDSC representatives participate at the ASC X12 to promote collaboration in the development of health data standards and to provide input to address the needs of public health.

PHDSC representatives also provide support for maintenance and updates to the ASC X12 837 Health Care Services Data Reporting Guide (Guide). The Guide was developed through the work of the PHDSC for use by public health agencies to collect data using national standards. It provides public health and other entities that conduct quality measurement, community assessment, and disease surveillance with a national standard for institutional health care service information. The guide is HIPAA compatible because data elements used for both claims payment and health services reporting are defined identically. The Guide also includes data elements essential for quality measurement and public health assessment purposes.

ASTM Committee E31 American Standards for Testing and Materials Committee E31 on Health Informatics

ASTM International is one of the largest voluntary standards development organizations in the world- for technical standards for materials, products, systems, and services.

ASTM Committee E31 on Healthcare Informatics develops standards related to the architecture, content, storage, security, confidentiality, functionality, and communication of information used within healthcare and healthcare decision making, including patient-specific information and knowledge. The Committee, with a current membership of approximately 300 members, has 3 technical subcommittees that have over 30 approved standards and additional draft standards

DICOM - Digital Imaging and Communications in Medicine

The DICOM Standards Committee develops and maintains international standards for communication of biomedical diagnostic and therapeutic information using digital images and associated data in cardiology, dentistry, endoscopy, mammography, ophthalmology, orthopedics, pathology, pediatrics, radiation therapy, radiology, etc.

HL7 - Health Level Seven

HL7 develops standards for the exchange, management, and integration of data that supports clinical patient care and the management, delivery, and evaluation of health care services.

The HL7 version 2.x messaging standard defines a series of electronic messages to support administrative, logistical, financial and clinical processes. Since 1987 the standard has been updated regularly, resulting in versions all the way up to version 2.6. Collectively these versions are known as version 2.x. The v2.x standards are backwards compatible, i.e., a message based on version 2.3 will be understood by an application that supports version 2.6. HL7 v2.x mostly uses a proprietary (non-XML) encoding syntax based on delimiters.

HL7 v2.x has allowed for the interoperability between electronic Patient Administration Systems (PAS), Electronic Practice Management (EPM) systems, Laboratory Information Systems (LIS), Dietary, Pharmacy and Billing systems as well as Electronic Medical Record (EMR) or Electronic Health Record (EHR) systems. Currently, HL7s v2.x messaging standard is supported by every major medical information systems vendor in the United States.

The HL7 version 3 messaging standard is aimed to support any and all healthcare workflows. Development of version 3 started around 1995, resulting in an initial standard publication in 2005. The v3 standard, as opposed to version 2, is based on a formal methodology and object oriented principles.

The Reference Information Model (RIM) is the cornerstone of the HL7 Version 3 development process and an essential part of the HL7 V3 development methodology. The RIM is a large pictorial representation of the clinical data that identifies the life cycle of events that a message or groups of related messages will carry. It is a shared model between all the domains and as such is the model from which all domains create their messages. The RIM expresses the data content needed in a specific clinical or administrative context and provides an explicit representation of the semantic and lexical connections that exist between the information carried in the fields of HL7 messages. The RIM is essential to increasing precision and reducing implementation costs.

As part of Version 3, the HL7 Vocabulary Technical Committee developed methods that allow HL7 specifications to draw upon codes and vocabularies from a variety of sources. The V3 vocabulary work assures that the systems implementing HL7 specifications have an unambiguous understanding of the code sources and code value domains they are using.

HL7 V3 Clinical Document Architecture (CDA) allows for a common format for exchanging a patient's medical record between different hospital systems or even different hospitals. This HL7 standard has come to serve as a foundation for the universal electronic medical record. It is an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange.

CDA is based on the HL7 Reference Information Model (RIM) and the HL7 Version 3 Data Types, although it can be used independently of any HL7 Version 3 messaging (i.e., CDA documents can be exchanged using other mechanisms, such as HL7 Version 2, DICOM, MIME attachments to email, http or ftp, etc.).

The CDA tries to ensure that the content will be human-readable and is therefore required to contain narrative text, yet still contain structure, and most importantly, allow for the use of codes (such as from SNOMED and LOINC) to represent concepts.

PHDSC members are active participants of the HL7 Public Health and Emergency Response Work Group (PHER WG), HL7 Attachments Work Group, HL7 Security Work Group HL7 Electronic Health Record technical Committee, HL7 Education Committee and other HL7 committees and work groups Most HL7 standards have been developed to serve the needs of clinical care of individual patients. PHDSC members work with HL7 to assure that the interests of public health are represented in the standards development process. This includes the development of standards for immunization information systems, vital statistics, environmental monitoring, public health surveillance & case investigation, outbreak detection & coordinated response, and food safety.

As participants of the HL7 PHER WG, PHDSC members have been involved in the development and are maintaining a growing number of domain analysis models, e.g. vital registration, and HL7 version 2 and version 3 messages to assure that HL7 standards address the public health requirements of governmental agencies and public and private organizations. The message standards developed by PHER may also be used to communicate local, state and national health summary information to international monitoring bodies such as the World Health Organization (WHO) and the World Organization for Animal Health (OIE).

IEEE - Institute of Electrical and Electronics Engineers, Inc

IEEE is a leading developer of standards in telecommunications, information technology and power generation. In healthcare domain, IEEE has been developing information exchange standards for medical devices.

IHE - Integrating the Healthcare Enterprise

IHE is a multi-year initiative under the leadership of Healthcare Information Management & Systems Society (HIMSS) and the Radiological Society of North America (RSNA). IHE began in November 1998 as a collaborative effort to improve the way computer systems in healthcare share critical information. IHE includes medical and public health experts, administrators, standards organizations, IT professionals, and vendors. IHE Technical Committees develop integration profiles to assure that health information seamlessly is passing from application to application, system to system, and setting to setting across the entire healthcare enterprise. IHE Information Infrastructure Technical Committee develops structured document exchange integration profiles.

PHDSC was invited by IHE to start a Public Health Domain at IHE. PHDSC and IHE are collaborating to enable interoperability across clinical and public health enterprises. This includes the development of interoperability standards for immunization information systems, cancer registries, chronic disease registries (diabetes) and maternal and child health (newborn screening). This also includes work on information infrastructure issues such as service-oriented architecture (SOA) for public health. PHDSC member organizations, American Immunization Registry Association (AIRA), North-American Association of Central Cancer Registries (NAACCR), Software Partners and OZ Systems, have been working on various public health projects at IHE.

ISO - International Organization for Standardization

ISO is a network of national standards institutes from 140 countries working in partnership with international organizations, governments, industry, business, and consumer representatives.

ISO 215 Technical Committee on Health Informatics (ISO/TC 215) works on the standardization of health information and communications technology to allow for compatibility and interoperability between independent systems through the following Working Groups:

  • WG 1: Data Structure
  • WG 2: Messaging and Communications
  • WG 3: Health Concept Representation
  • WG 4: Security
  • WG 5: Health Cards
  • WG 6: Pharmacy and Medication
  • WG 7: Devices
  • WG 8: Business Requirements for Electronic Health Records

The ISO/TC 215 developed messaging standards for information exchange between healthcare systems.

ISO/TC 215 Standards List

NCPDP - National Council for Prescription Drug Programs

NCPDP is a Standards Development Organization whose mission is to create and promote data interchange standards for the pharmacy services sector of the health care industry.

NIEM National Information Exchange Model

NIEM, a national program supported by the federal government, connects communities of people who share a common need to exchange information in order to advance their missions. The goal is to establish standards and best practices for intergovernmental information exchange so that practitioners at all levels of government can share accurate, complete, timely and appropriately secured information to enable informed decision making. NIEM establishes common vocabulary to ensure consistency and understanding among domains that may not have collaborated in the past. NIEM operates collaboratively through domain-specific communities of interest, who work to specify and define specific data exchanges.

The Office of the National Coordinator for Health Information Technology (ONC) is the steward of the NIEM Health Domain. ONC is working with U.S. Department of Health and Human Services Chief Information Officer (HHS CIO) to establish the governance processes for the NIEM Health Domain.