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Standards Evaluation Report

DoD/VA Interagency Program Office (IPO)

April, 2018

DoD/VA IPO Standards Evaluation Report Version 3.0April 2018

Revision History

Release/ Revision

No.Date

A=Add M=Modify D=Delete

Description of Change

1.0 05/25/2017 A Initial Release

2.0 09/15/2017 A, M, D

Added new standards (Cerner Multum, MED-RT, HL7 C-CDA companion guide and HL7 CDA R2 Periodontal); split tables into updated and unchanged; Added acronym table..Removed ISO 639-2 alpha-3 codes for the Representation of Names of Languages.

3.0 01/08/2018 A, M Added a new standard (RFC 5646)

4.0 04/13/2018 A, M Added acronyms. Updated release dates, Key updates and Standard Description.

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ContentsIntroduction...................................................................................................................................................................1

Intended Audience..............................................................................................................................................1Methods 1

Updated Standards since Version 2.0 Release..........................................................................................................2Table 1 - Updated Terminology Standards Summary...................................................................................2

Unchanged Standards since Version 2.0 Release.....................................................................................................6Table 2 - Unchanged Terminology Standards Summary..............................................................................6Table 3 - Unchanged Transport Standards Summary..................................................................................11Table 4 - Unchanged Content and Structure Standards Summary............................................................12

Appendix: Acronyms.................................................................................................................................................20

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IntroductionThe Standards Evaluation Report summarizes the current release status and nature of updates to standards identified in the Healthcare Information Interoperability Technical Package (I2TP) as important to the IPO in support of its mission of facilitating and enhancing interoperability between the Department of Defense (DoD) and the Veterans Affairs (VA).

The standards included in this report are: Vocabulary and Terminology Content and Structure Transport

Intended AudienceThis report is intended for the IPO and Departments’ executives and managers supporting interoperability efforts. The goal is to provide awareness to stakeholders and a high-level overview of changes in each standard release.

MethodsThe Standards Evaluation Report is generated quarterly. Each new version of this report involves the review of a current I2TP version and documents released by the organizations that produce and maintain each of the standards. The update also relies on the latest release notes published by the organizations. A brief summary of the standard is provided in the tables, along with key updates and changes from the previous release. Relevant clincial domains are identified based on the I2TP current documentation.

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Updated Standards since Version 3.0 Release

Table 1 – Updated Terminology Standards Summary

Standard (web page)

Standard DescriptionStandard

Development Organization

I2TP Clinical Domains/IPO Status

Update Frequency

Last Update / Download URL/ Next update

Key Updates/Release Notes

Current Procedural Terminology (CPT)

https://www.ama-assn.org/practice-management/cpt

The CPT code set is used to bill outpatient and office procedures to describe medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.

American Medical Association

https://www.ama-assn.org/

• Encounters (Admissions & Appointments)/ Required• Results -Radiology Reports/ Interim, • Procedures/ Procedure Type/ Required, • Plan of Care Pending orders (Rad Order Item)/ Interim

Quarterly

February 2018

https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/cpt/cpt-corrections-errata-2018.pdf

Next release - May 2018

The following link is the February 2018 CPT Editorial Summary of Panel Actions, and it provides a list of changes from the most recent Panel meeting:

https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/cpt/february-2018-summary-panel-actions.pdf

Healthcare Common Procedure Coding System (HCPCS)

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html

The Healthcare Common Procedure Coding System (HCPCS) is divided into Level I and II principal subsystems. Level I is comprised of CPT numeric coding system maintained by the American Medical Association (AMA). Level II, is a standardized coding system used to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.

Centers for Medicare & Medicaid Services

https://www.cms.gov/

• Encounters (Admissions & Appointments)/ Required• Results -Radiology Reports/ Interim, • Procedures/ Procedure Type/ Required, • Plan of Care Pending orders (Rad Order Item)/ Interim

Level II alphanumeric procedure and modifier codes are updated annually on January 1. Temporary codes are updated quarterly.

January 2018

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS-Items/2018-Alpha-Numeric-HCPCS-File-.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

Next release - January 2019

On March 9, 2018, the CMS issued a correction to Federal Register Notice [1683-N] that was published on 2/28/18. This correction was made to the dates of the 2018 HCPCS Public Meetings DMEPOS items.

Follow the link below to learn more about the changes that will be effective April 1, 2018:

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.html

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https://www.cms.gov/










Standard (web page)




Update Frequency



National Drug Codes (NDC)

http://www.fda.gov/Drugs/InformationOnDrugs/ucm142438.htm

The National Drug Code number and directory serve as a universal product identifier for drugs. They are used in the implementation and enforcement of the Drug Listing Act of 1972. This Act requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution.

Food and Drug Administration

https://www.fda.gov/

Immunizations / Emerging Updated daily (weekdays)

3/14/2018

https://www.fda.gov/drugs/informationondrugs/ucm142438.htm

Database file-Excel version:https://www.accessdata.fda.gov/cder/ndcxls.zip

The NDC directory new features:Simplified File Structure: The download files have been condensed into two files: a Products file and a Packages file. These two files can be linked using the PRODUCTNDC data element. Two file formats are offered as well: a spreadsheet version and a traditional tab delimited CSV format.

https://www.fda.gov/drugs/informationondrugs/ucm142438.htm

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

https://www.nlm.nih.gov/healthit/snomedct/us_edition.html

SNOMED CT is the most comprehensive, multilingual clinical healthcare terminology in the world. It enables consistent, processable representation of clinical content in electronic health records. SNOMED CT is mapped to other international standards, and is already used in more than fifty countries. SNOMED CT is a registered trademark of the International Health Terminology Standards Development Organisation (IHTSDO).

National Library of Medicine (NLM)

https://www.nlm.nih.gov/

Note: The clinical terminology is owned and maintained by the SNOMED International

http://www.snomed.org/

• Drug Allergies (Drug Class Allergen, Food and Environmental Allergen) / Required.• Problem Lists / Required• Encounter Data - Appointments (Encounter Diagnosis) / Required• Encounter Data - Admissions (Encounter Diagnosis) / Required• Procedures (Procedure Type) / Required• Social History (Social History Entry, Smoking Status) / Required• Family History (Family History Entry) / Required• Functional Status (Functional Status Entry) / Emerging• Advanced Directives (metadata only) / Required.• Medical Equipment (Medical Eq. Type) /Emerging.

Bi-Annual (March and September)

Note: International version is released January and July.

March 2018https://download.nlm.nih.gov/mlb/utsauth/USExt/SnomedCT_USEditionRF2_PRODUCTION_20180301T120000Z.zip

Note: A UMLS account is needed to access the SNOMED CT data files.

Next release - September 2018

• Addition of 363 new concepts• This new US edition of SNOMED CT contains all content from the January 2018 SNOMED CT International Edition.• Includes the SNOMED CT to ICD-10-CM mapping reference set, with over 122,000 SNOMED CT source concepts mapped to ICD-10-CM targets. (The mapping refset is also released as a standalone download).

Release notes:

https://download.nlm.nih.gov/mlb/utsauth/USExt/doc_SnomedCT-USEdition-ReleaseNotes_Current_en-US_US1000124_20180301.pdf

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Standard (web page)




Update Frequency



Digital Imaging and Communications in Medicine (DICOM)

http://dicom.nema.org/standard.html

DICOM (Digital Imaging and Communications in Medicine) is the registered trademark of the National Electrical Manufacturers Association (NEMA) for its standards publications relating to digital communications of medical information. DICOM enables the transfer of medical images in a multi-vendor environment and facilitates the development and expansion of picture archiving and communication systems.

Medical Imaging & Technology Alliance - a division of NEMA

http://www.medicalimaging.org/

Radiology Images (Image format) / No national standard As needed

February 2018


No scheduled release date.

Version 3.6.3 of the DICOM ToolKit (DCMTK) software is now available for public release. The link below highlights the main changes:http://dicom.offis.de/download/dcmtk/dcmtk363/ANNOUNCE

Release notes:http://dicom.nema.org/medical/dicom/current/output/pdf/releasenotes_2018a.pdf

RxNorm

https://www.nlm.nih.gov/research/umls/rxnorm

RxNorm is a normalized naming system for generic and branded drugs and is a tool for supporting semantic interoperation between drug terminologies and pharmacy knowledge base systems.



• Medications / Required• Allergies (Drug Allergens) / Required • Plan of Care-Pending Orders (Med Order Item) / Required.

Monthly (full release); Weekly (delta releases) Note: Only the monthly release is tracked in this table.

March 5, 2018

https://download.nlm.nih.gov/umls/kss/rxnorm/RxNorm_full_03052018.zip

Note: Released first Monday of the month; unless a Federal Holiday and then released on first Tuesday.

Next release - April 2018

Release notes: https://www.nlm.nih.gov/research/umls/rxnorm/docs/2018/rxnorm_releasenotes_full_03052018.html

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Standard (web page)




Update Frequency



MED - Reference Terminology (RT)

https://evs.nci.nih.gov/ftp1/NDF-RT/Introduction%20to%20MED-RT.pdf

The new Medication Reference Terminology (MED-RT™) will be the evolutionary successor to the Veterans Health Administration’s National Drug File – Reference Terminology (VHA NDF-RT™). Both are formal ontological representations of medication terminology, pharmacologic classifications, and asserted authoritative relationships between them.

Description – MED-RT is an emerging standard that will be replacing NDF-RT. It will be backwards compatible. MED-RT will include all of the NDF-RT codes with some notes added.

Veterans Health Administration (VHA)

https://www.va.gov/health/

Allergies (Drug Class Allergens) / Emerging

MED-RT is updated monthly.

NOTE: There are no plans to include MED-RT in RxNorm; however, MED-RT will be included in the UMLS Metathesaurus along with RxNorm and its source vocabularies.

March 5, 2018

For information about the MED-RT release, go to:

https://www.cancer.gov/research/resources/terminology/fmt .

https://evs.nci.nih.gov/ftp1/MED-RT/MEDRT%20Release%20Notes.txt

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https://www.cancer.gov/research/resources/terminology/fmt

https://www.cancer.gov/research/resources/terminology/fmt







Standard (web page)




Update Frequency



National Drug File - Reference Terminology (NDF-RT)

https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/NDFRT/

NDF-RT is an extension of the VHA National Drug File (NDF). It organizes the drug list into a formal representation. NDF-RT is used for modeling drug characteristics including ingredients, chemical structure, dose form, physiologic effect, mechanism of action, pharmacokinetics, and related diseases.



Allergies (Drug Class Allergens) / Interim

NDF-RT is updated monthly, with each Metathesaurus release as part of RxNorm.

NOTE: The last release of NDF-RT is in the RxNorm full March release and will remain in the RxNorm full monthly releases for the next several months.Refer to MED-RT in this document.

March 5, 2018


Next release - April 2018

The VHA still plans to cease publication of NDF-RT and begin releasing MED-RT. Delay pending resourcing.

https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/NDFRT/metadata.html

https://www.nlm.nih.gov/research/umls/rxnorm/docs/2018/rxnorm_releasenotes_full_03052018.html

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Unchanged Standards since Version 3.0 Release

Table 2 - Unchanged Terminology Standards Summary

Standard (web page)




Update Frequency



Code on Dental Procedures and Nomenclature (CDT)

http://www.ada.org/en/publications/cdt/

The CDT Code is used to achieve uniformity, consistency and specificity in dental treatment documentation. CDT Code is also used to provide efficient processing of dental claims and to populate an Electronic Health Record. CDT is a HIPAA standards code set.

American Dental Association

http://www.ada.org/en

• Procedures (dental procedures)/ - Required Annual; May

5/16/2017

http://ebusiness.ada.org/productcatalog/20354/Coding/K217i?source=ADAorg&content=CDT&medium=DisplayAd

Next release - May 2018

Accepted requests for 18 additions, 16 revisions, and 3 deletions.

http://www.ada.org/~/media/ADA/Publications/Files/CDT_CMC_2017MarchMeeting_SubstantiveActionReport_%2017Mar28.pdf?la=en

All these changes are part of CDT 2018, which became effective Jan. 1, 2018.

CDC Race and Ethnicity Code Set

https://phinvads.cdc.gov/vads/SearchVocab.action

The U.S. Centers for Disease Control and Prevention (CDC) has prepared a code set for use in coding race and ethnicity data. This code set is based on current federal standards for classifying data on race and ethnicity, specifically the minimum race and ethnicity categories defined by the U.S. Office of Management and Budget (OMB) and a more detailed set of race and ethnicity categories maintained by the U.S. Bureau of the Census (BC). The main purpose of the code set is to facilitate use of federal standards for classifying data on race and ethnicity when these data are exchanged, stored, retrieved, or analyzed in electronic form.

Centers for Disease Control and Prevention

https://www.cdc.gov/

• Demographics (Ethnicity and Race) / Required.

Updates is based on the U.S. Bureau of the Census (BC) decennial census.

The current version is the intitial version.• Race Category Value Sethttp://phinvads.cdc.gov/vads/ViewValueSet.action?id=67D34BBC-617F-DD11-B38D-00188B398520

• Ethnicity Group Value Set http://phinvads.cdc.gov/vads/ViewValueSet.action?id=35D34BBC-617F-DD11-B38D-00188B398520


None available

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http://www.ada.org/en





Standard (web page)




Update Frequency



Administrative Gender Concept Code

https://www.hl7.org/fhir/valueset-administrative-gender.html

The gender of a person used for administrative purposes. This is a value set defined by the FHIR project.

Health Level Seven International Patient Care & Patient Administration Workgroups

http://www.hl7.org/Special/committees/patientcare/index.cfm

http://www.hl7.org/Special/committees/pafm/index.cfm

• Demographics (Gender) / Required

• Demographics (Birth sex) / Emerging.

Administrative Gender code system updated as needed.

April 2017

https://www.hl7.org/fhir/valueset-administrative-gender.html#4.3.1.1

None available

Unique Device Identification

https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/UniqueDeviceIdentification/default.htm

In 2013, the Food and Drug Administration (FDA) released a final rule establishing a unique device identification system designed to adequately identify devices through distribution and use. The final rule requires device labelers to include a unique device identifier (UDI) on device labels and packages, except where the rule provides for an exception or alternative. Each UDI must be provided in a plain-text version and in a form that uses automatic identification and data capture (AIDC) technology. The UDI will also be required to be directly marked on a device that is intended for more than one use, and intended to be reprocessed before each use. Dates on device labels and packages are to be presented in a standard format that is consistent with international standards and international practice.

Federal Drug Administration


Medical Equipment (Identification)/ Required

There are three FDA-Accredited UDI Issuing Agencies, Global Standards One (GS1), Health Industry Business Communications Council (HIBCC), and International Council for Commonality in Blood Banking Automation (ICCBBA).UDI format changes are based on these agencies modifying their respective UDI formats.

11/6/2017

https://www.nlm.nih.gov/research/umls/licensedcontent/downloads.html

• Addition of a new source name: NCI HUGO Gene Nomenclature, 1703D.• 90 source names were updated.

https://www.nlm.nih.gov/research/umls/licensedcontent/umlsknowledgesources.html

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Standard (web page)




Update Frequency



Religious Affiliation Codes

https://www.hl7.org/fhir/v3/ReligiousAffiliation/index.html

Assigment of spiritual faith affiliation

Health Level Seven InternationalVocabulary Workgroup

http://www.hl7.org/Special/committees/Vocab/index.cfm

Demographics (Religion) /Emerging. As needed

Expansion generated 19 Apr 2017

http://www.hl7.org/documentcenter/public_temp_B00EF680-1C23-BA17-0CFE565B0CC17A3A/standards/vocabulary/vocabulary_tables/infrastructure/vocabulary/ReligiousAffiliation.html


None available

Cerner Multum

http://www.cerner.com/multum_solutions/

Multum is used in Cerner’s commercial EHR products. Although there is evidence that Multum is also used by some other commercial products, there is not enough publicly available information about Multum or about its development processes for its consideration as a national standard. The National Library of Medicine’s (NLM) Unified Medical Language System (UMLS) lists Multum as a contributing terminology, but also communicates that the UMLS representation contains only a subset of the entirety of Multum. In other words, the Multum drug lexicon gets submitted to UMLS (for RxNorm), and only a portion of that (the Multum drug lexicon) gets in to UMLS (via RxNorm).

Multum is a proprietary lexicon owned by Cerner

https://www.cerner.com/

Multum will be added to the I2TP future release. Not available Not available None available

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https://www.cerner.com/














Standard (web page)




Update Frequency



RFC 5646https://tools.ietf.org/html/rfc5646

Request for Comments: 5646- Language Tags. This RFC was published in 2009. http://www.iana.org. Demographics (preferred langauage) /

Required. As needed

September 2009Download: http://www.rfc-base.org/txt/rfc-5645.txtNo scheduled release date

Note that the Language Tag Registry is now obsolete and should instead look for the Language Subtag Registry.RFC 5646 is replacing ISO 639-2alpha-3 codes.

Logical Observation Identifiers Names and Codes (LOINC)

https://loinc.org/

Logical Observations Identifiers, Names, Codes, LOINC, is a clinical terminology for laboratory test orders and results, produced by the Regenstrief Institute. It is a designated standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information. It was identified by the HL7 Standards Development Organization as a preferred code set for laboratory test names in transactions between health care facilities, laboratories, laboratory testing devices, and public health authorities. LOINC is likely to become a HIPAA standard.

Regenstrief Institute

https://www.regenstrief.org/

• Vital Signs /Required• Document Type /Required• Results - Lab Chemistry & Hematology /Required• Results - Lab Anatomic Pathology /Required• Results - Lab Microbiology /Required• Results - Radiology Reports /Required• Scanned & Imported Paper Records & Non-Radiology Images (Document Type) /Required • Plan of Care- Pending Orders (Lab Order; Rad Order) /Required• Questionnaires (Document Type) /Required

Full releases Bi-Annual (June and December)

12/15/2017 (LOINC 2.63)

https://loinc.org/download/loinc-and-relma-complete-download-file/

Next release - June 2018

Some highlights of the new content in this version include:1) Over 300 new microbiology terms2) Approximately 200 new drug/tox terms, including those for human and veterinary testing3) 50 new chemistry terms4) New panels for laboratory terms5) Nearly 350 new radiology terms, including new terms with the Method "{Imaging modality}" for modality-agnostic procedures to complete the harmonization between the RSNA Playbook and LOINC Radiology6) Approximately 50 Document Ontology terms7) New clinical and survey panelsApproximately 50 new mappings between LOINC terms and concepts from the IEEE 11073 10101 Nomenclature and 10101a Nomenclature Amendment.For more details, go to:https://loinc.org/download/loinc-release-notes/https://loinc.org/downloads/loinc/

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https://loinc.org/downloads/loinc/

https://loinc.org/download/loinc-release-notes/





https://loinc.org/

http://www.rfc-base.org/txt/rfc-5645.txt

http://www.rfc-base.org/txt/rfc-5645.txt

http://www.iana.org/

https://tools.ietf.org/html/rfc5646




Standard (web page)




Update Frequency



Health Care Provider Taxonomy Code Set

http://www.nucc.org/index.php?option=com_content&view=article&id=107&Itemid=132

The Health Care Provider Taxonomy code set is a non-medical data code set designed for use in an electronic environment, specifically within the ASC X12N Health Care transactions. It is a unique alphanumeric code, ten characters in length. The National Uniform Claim Committee (NUCC) is presently maintaining the code set. It is used in transactions specified in HIPAA and the National Provider Identifier (NPI) application for enumeration.

National Uniform Claim Committee

http://www.nucc.org/

Providers NPI (Provider Types) / Required

Bi-Annual Jan & July) Note: The July publication is effective for use on October 1st and the January publication is effective on April 1st. The time in between is considered an implementation period.

1/1/2018


July 2018- next release

This new version has 2 additions under the ophthalmology classification: ● 207WX0109X Neuro-ophthalmology● 207WX0110X Pediatric Ophthalmology and Strabismus Specialist

http://www.nucc.org/images/stories/CSV/nucc_taxonomy_180.csv

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http://www.nucc.org/





Standard (web page)




Update Frequency



Unified Medical Language System (UMLS)

https://www.nlm.nih.gov/research/umls/

The Unified Medical Language System (UMLS) is a set of files and software that brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems. The UMLS integrates and distributes key terminology, classification and coding standards, and associated resources to promote creation of more interoperable services. The UMLS has three tools (also known as Knowledge Sources):•Metathesaurus: Terms and codes from many vocabularies (CPT, ICD-10-CM, LOINC, RxNorm, and SNOMED CT)•Semantic Network: Broad categories (semantic types) and their relationships (semantic relations)•SPECIALIST Lexicon and Lexical Tools: Natural language processing tools.



Allergies (Drug Allergens) / Interim

Medical Equipment (Med Equipment type) / Emerging

The UMLS Metathesaurus Source Terminologies is an updated source in each Metathesaurus release.

06/11/2017


The 2017AB Metathesaurus contains approximately 3.64 million concepts and 13.9 million unique concept names from 201 source vocabularies.

• One new NCI sub-source:

NCI_NCI-HGNC (NCI HUGO Gene Nomenclature)

• One removed source:

Medi-Span data (SAB=MDDB) has been removed from RxNorm at Wolters Kluwer’s request. As of October 2017, Medi-Span data will not be included in the RxNorm or UMLS releases.

• 59 English sources and 30 translation sources were updated.


CVX -- Vaccines Administered

https://www2a.cdc.gov/vaccines/iis/iisstandards/vaccines.asp?rpt=cvx

The CDC's National Center of Immunization and Respiratory Diseases (NCIRD) developed and maintains the CVX (vaccine administered) code set. CVX codes for inactive vaccines allow transmission of historical immunization records.

A CVX code is sometimes paired with a manufacturer code MVX (vaccine administered).

Centers for Disease Control and Prevention https://www.cdc.gov/

Immunizations / RequiredUpdates are based on vaccine status changes

Latest vaccine status change took place 10/27/2017


No scheduled release date

• CVX code 145: RSV-MAb (new) - Never Active• CVX code 187: zoster subunit - Active• CVX code 32: meningococcal MPSV4 - Inactive• CVX code 09:Td (adult), 2 Lf tetanus toxoid, preservative free, adsorbed- Active• CVX code 113:Td (adult), 5 Lf tetanus toxoid, preservative free, adsorbed - Active• CVX code 188: zoster, unspecified formulation-Inactive• CVX code 77: tick-borne encephalitis- Non-US• CVX code 189: Hep B, adjuvanted- Active

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Table 3 - Unchanged Transport Standards Summary

Standard (web page)




Update FrequencyLast Update / Download URL/

Next updateKey Updates/Release Notes

Direct Protocol

https://www.healthit.gov/policy-researchers-implementers/direct-project

The Direct Protocol is the other primary health exchange framework promoted by the ONC. It is a push method that is being used to support certain use cases (e.g., referrals) and was designed to be a lightweight health exchange framework that could be supported by even the smallest provider organizations

The Office of the National Coordinator for Health Information Technology (ONC)

https://www.healthit.gov/

NA / Required As needed

8/3/2015 Version 1.2 Document title: Applicability Statement for Secure Health Transporthttp://wiki.directproject.org/file/view/Applicability+Statement+for+Secure+Health+Transport+v1.2.pdf

3/9/2011Version 1.0Document title: XDR and XDM for Direct Messaging Specificationhttp://wiki.directproject.org/file/view/2011-03-09%20PDF%20-%20XDR%20and%20XDM%20for%20Direct%20Messaging%20Specification_FINAL.pdf No scheduled release date.

Version 1.2 Document title: Applicability Statement for Secure Health TransportThere has been edits the following sections:1.1 Health Domain Name2.5 Signatures3.0 Mail System Reports

DoD/VA REST & SOAP Protocols

Department-specific Web-Services, including the Veterans Health Information Systems and Technology Architecture [VistA] Data Services and VistA Exchange. A collection of exchanges currently occur via custom Department-developed web services, using either Simple Object Access Protocol (SOAP) or Representational State Transfer (RESTful) frameworks.



NA / Interim As neededNone available

No scheduled release date.None available

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http://wiki.directproject.org/file/view/2011-03-09%20PDF%20-%20XDR%20and%20XDM%20for%20Direct%20Messaging%20Specification_FINAL.pdf



http://wiki.directproject.org/file/view/Applicability+Statement+for+Secure+Health+Transport+v1.2.pdf



https://www.healthit.gov/





Standard (web page)






Health Insurance Type (ASC X12N 837)

https://www.va.gov/TRM/StandardPage.asp?tid=6347

The ASC X12N 837 Health Care Claim and associated addenda are recognized by the United States Federal Government as the standard for electronically transmitting professional, dental, and institutional health care claims in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Please contact the Chief Business Office for information pertaining to this standard.

X12

http://www.x12.org/ • Payers / Required

X12N standards are updated continuously using 2 methods – public reviews and X12N subcommittee meetings.

December 2017

http://store.x12.org/store/asc-x12-generic-table-data

http://store.x12.org/store/


http://forums.x12.org/

17





http://www.x12.org/





Table 4 – Unchanged Content and Structure Standards Summary

Standard (web page)






Clinical Data Repository/Health Data Repository (HL7 2.4)

https://www.va.gov/vdl/application.asp?appid=155

The Department of Defense (DoD) and the Department of Veterans Affairs (VA) in partnership, designed and implemented a Clinical Data Repository/Health Data Repository (CHDR) system that generates standards-based, computable electronic health records that can be exchanged and shared between the two agencies healthcare systems. The computable data can then be divided into fields and can be sorted, rather than provided as unsortable text.



NA / Required Annual / supplemental releases as needed

April 2013 – Version 2.1.3


https://www.va.gov/vdl/documents/Clinical/Clinical_Health_Data_Repository_(CHDR)/chdr213_release_notes.pdf

Consolidated-Clinical Document Architecture (C-CDA) 1.1 Unstructured Document

http://www.hl7.org/implement/standards/product_brief.cfm?product_id=259

This Implementation Guide provides consistent guidance for sending/receiving unstructured clinical documents including images, scanned documents, faxed and word processor output.

Health Level Seven International

http://www.hl7.org/




None available

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http://www.hl7.org/













Standard (web page)






Consolidated-Clinical Document Architecture 1.1 Continuity of Care Document (CCD)


The Continuity of Care Document (CCD) is a joint effort of HL7 International and ASTM. CCD promotes interoperability of clinical data. It is an implementation guide for sharing Continuity of Care Record (CCR) patient summary data using the HL7 Version 3 Clinical Document Architecture (CDA), Release 2. CCD establishes a rich set of templates representing the typical sections of a summary record, and expresses these templates as constraints on CDA. These same templates for vital signs, family history, plan of care, can then be reused in other CDA document types, establishing interoperability across a wide range of clinical use cases.


http://www.hl7.org/

American Section of the International Association for Testing Materials (ASTM)

https://www.astm.org/


April 01, 2007



None available

Healthcare Services Request for Review and Response (ASC X12N 278)


The ASC X12N 278 Health Care Services Review: Request for Review and Response transaction, is recognized by the United States Federal Government as the standard for the electronic exchange of health plan prior authorization information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). This standard excludes the area of outpatient pharmacy, which is covered under the National Council for Prescription Drug Programs (NCPDP) Retail pharmacy transactions.

X12

http://www.x12.org/ NA / Required

X12N standards are updated continuously using 2 methods public reviews and X12N subcommittee meetings.

December 2017




• Change log: Healthcare Services Request for Review and Response (278)

19



http://www.x12.org/








http://www.hl7.org/





Standard (web page)






Consolidated-Clinical Document Architecture 2.1 Continuity of Care Document


The Continuity of Care Document (CCD) is a joint effort of HL7 International and ASTM. CCD promotes interoperability of clinical data. It is an implementation guide for sharing Continuity of Care Record (CCR) patient summary data using the HL7 Version 3 Clinical Document Architecture (CDA), Release 2. CCD establishes a rich set of templates representing the typical sections of a summary record, and expresses these templates as constraints on CDA. These same templates for vital signs, family history, plan of care, can then be reused in other CDA document types, establishing interoperability across a wide range of clinical use cases.


http://www.hl7.org/

American Section of the International Association for Testing Materials (ASTM)



April 01, 2007



None available

HL7 2.5.1 Public Health Information Network (PHIN) Messaging Guide for Syndromic Surveillance

https://www.cdc.gov/ehrmeaningfuluse/Syndromic.html

The PHIN is a content /structure standards used with standard terminology to support semantic interoperability. PHIN supports the exchange of the HL7 2.5.1 S&I Framework Lab Results Interface terminology standard.

Centers for Disease Control and Prevention (CDC)https://www.cdc.gov/

Public Health Information Network (PHIN)https://www.cdc.gov/phin/index.html


4/21/2015

https://www.cdc.gov/nssp/documents/guides/syndrsurvmessagguide2_messagingguide_phn.pdf


Updates to ADT MESSAGES A01, A03, A04 and A08Optional ORU^R01 Message Notation for Laboratory Data can be reviewed in the document below:


20






https://www.cdc.gov/phin/index.html

https://www.cdc.gov/phin/index.html









http://www.hl7.org/





Standard (web page)






HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.5

https://www.cdc.gov/vaccines/programs/iis/technical-guidance/hl7.html

Immunization Information Systems (IIS) are centralized population based repositories of immunization related information. They receive and share data on individual clients/patients with a number of other systems, including Electronic Health Record systems (EHR-S).

Centers for Disease Control and Prevention (CDC)https://www.cdc.gov/

Public Health Information Network (PHIN) VADShttps://phinvads.cdc.gov/vads/SearchVocab.action


10/1/2014Release 1.5

https://www.cdc.gov/vaccines/programs/iis/technical-guidance/downloads/hl7guide-1-5-2014-11.pdf


Some of the changes in this release:• LOINC was added for Serological Evidence of Immunity (to the Observation Identifier table)• Deprecated existing table and created 2 new tables. One for history of disease and one for serological evidence of immunity

all updates can be found: https://www.cdc.gov/vaccines/programs/iis/technical-guidance/downloads/hl7guide-1-5-2014-11.pdf

HL7 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health


Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health (US Realm), Release 1 describes the transmission of laboratory-reportable findings to appropriate local, state, territorial and federal health agencies using the message. This guide addresses messaging content and dynamics related to the transmission of Laboratory Reportable Result Messages (i.e.,. Electronic Laboratory Reporting, or ELR). It is designed to align the Version 2.5.1 Implementation Guide: Interoperable Laboratory Result Reporting to EHR.

Health Level Seven InternationalOrders and Observations & Public Health and Emergency Workgroups

http://www.hl7.org/Special/committees/orders/index.cfm

http://www.hl7.org/Special/committees/pher/index.cfm


May 2014 (release 2)

http://www.hl7.org/documentcenter/public_temp_64B53937-1C23-BA17-0CC66352D23ABF25/standards/dstu/V251_IG_LB_LABRPTPH_R2_DSTU_R1.1_2014MAY.pdf


None available

21


























Standard (web page)






HL7 2.5.1 Standards & Interoperability Framework Lab Results Interface


The Laboratory Results Interface Initiative focuses on identifying the requirements, specifications and standards, and on providing the implementation guidance for electronic reporting of ambulatory care laboratory test results in the US Realm. The scope of this Use Case includes requirements to enable the incorporation of clinical laboratory test results into an Electronic Health Record (EHR) as standardized structured data using the defined inter-organizational laboratory transaction.

Health Level Seven InternationalOrders and Observations Workgroup



September 2015

http://www.hl7.org/documentcenter/public_temp_96E7FFAE-1C23-BA17-0C30E5AE45B746EB/standards/dstu/V251_IG_SIF_LABRESULTS_R1_DSTUR2_2015SEP.pdf


None available

22











Standard (web page)






Patient Demographic Query HL7 V3

http://wiki.ihe.net/index.php/Patient_Demographics_Query_HL7_v3

The Patient Demographics Query for HL7v3 (PDQv3) Integration Profile provides ways for multiple organizations, or applications to query a patient information server for a list of patients, based on user-defined search criteria, and retrieve a patient‟s demographic information directly into the application.

The functionality of this profile is identical to the PDQ profile described in section 2.2.6 of the IT Infrastructure Technical Framework (Vol1). The differences are in the format of the messages, and in the use of SOAP-based web services. These changes make this profile well suited for use within an existing IT infrastructure for cross-enterprise data access and exchange.

Integrating the Healthcare Enterprise (IHE)

http://www.ihe.net/


08/10/2010

http://www.ihe.net/Technical_Framework/upload/IHE_ITI_Suppl_PIX_PDQ_HL7v3_Rev2-1_TI_2010-08-10.pdf


None available

Patient Identifier Cross-Reference HL7 V3

http://wiki.ihe.net/index.php/Patient_Identifier_Cross-Reference_HL7_v3

Patient Identifier Cross-referencing HL7 V3 (PIXV3) – provides cross-referencing of patient identifiers from multiple Patient Identifier Domains. These patient identifiers can then be used by identity consumer systems to correlate information about a single patient from sources that know the patient by different identifiers.

This profile uses HL7 V3 as the message format, and SOAP-based web services for transport.

Integrating the Healthcare Enterprise (IHE)

http://www.ihe.net/


08/10/2010



None available

23




http://www.ihe.net/







http://www.ihe.net/





Standard (web page)






Fast Healthcare Interoperability Resources (FHIR) US Core Profiles

http://hl7.org/fhir/us/core/

FHIR US Core Profiles provides profile related to 21 Common Clinical Data Set (CCDS) data elements, based on ONC 2015 Edition CCDS.

The following are example data elements: – Problems, medication, medication allergies, immunizations– Smoking status, vital signs, lab tests, lab results, device IDs– Patient attributes, care team members, goals, health concerns.


http://www.hl7.org/

NA / Emerging As needed

Apr-19 2017http://hl7.org/fhir/index.html

October 2018

Release 4 will include the transition of some of the content of the specification to Normative.

The US Core Implementation Guide is based on FHIR Version 3.0.0. In this release, HL7 changed from using “DSTU” (Draft Standard for Trial Use) to just simply “STU” (Standard for Trial Use) to reflect the maturity of the FHIR specification.

http://hl7.org/fhir/versions.html

HL7 C-CDA Clinical Notes R1 Companion Guide


The Companion Guide to Consolidated Clinical Document Architecture (C-CDA) provides supplemental guidance to the HL7 CDA R2 IG: C-CDA Templates for Clinical Notes STU Release 2.1 in support of the ONC 2015 Edition.

This guide provides additional technical clarification and practical guidance to assist implementers to support best practice implementations of the 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification.


http://www.hl7.org/


March 2017

Download HL7 Informative Document:


None available

24




http://www.hl7.org/




http://hl7.org/fhir/versions.html

http://hl7.org/fhir/index.html

http://www.hl7.org/




Standard (web page)






HL7 CDA R2 Implementation Guide: Exchange of C-CDA Based Documents; Periodontal Attachment, Release 1 – US Realm


The Periodontal attachment is used to convey information about periodontal- related services. This includes the business use of claims attachments, prior authorization, and pre-determinations. It may also be used for other clinical data exchange functions. The items defined for electronic supporting documentation were developed by the Standards Committee on Dental Informatics of the American Dental Association (ADA).

This standard does not include diagnostic quality scanned images, or digital images in DICOM or other image file types to represent radiographs or pictures of patient conditions.


http://www.hl7.org/


July 2017


None available.

Note: The purpose of this implementation guide is to provide a HL7 CDA-based set of templates defining a standardized document that can be used to convey supporting clinical documentation from a dental provider to a payer (e.g., insurance company) to substantiate a claim for periodontal care. A secondary usage of these attachments to consume the clinical data included into dental care systems, but it was designed to explicitly align to existing requirements for dental care substantiation to payers.

25




http://www.hl7.org/





Appendix: AcronymsAcronym Definition

ADA American Dental Association

ASC X12N 278 Healthcare Services Request for Review and Response

ASC X12N 837 Health Insurance Type

ASTM American Section of the International Association for Testing Materials

CCD Continuity of Care Document

C-CDA Consolidated CIinical Document Architecture

CCDS Common Clinical Data Set

CDA Clinical Document Architecture

CDC Centers for Disease Control and Prevention

CDT Code on Dental Procedures and Nomenclature

CHDR Clinical Data Repository/Health Data Repository

CMS Centers of Medicare and Medicaid Services

CPT Current Procedural Terminology

CVX Vaccines Administered

DCMTK DICOM ToolKit

DICOM Digital Imaging and Communications in Medicine

DTU Draft Standard for Trial Use

EHR-S Electronic Health Record systems

ELR Electronic Laboratory Reporting

FDA Food and Drug Administration

FHIR Fast Healthcare Interoperability Resources

HCPCS Healthcare Common Procedure Coding System

HIBCC Health Industry Business Communications Council

HIPAA Health Insurance Portability and Accountability Act

HL7 Health Level Seven International

ICCBBA International Council for Commonality in Blood Banking Automation

I2TP Healthcare Information Interoperability Technical Package

IHE Integrating the Healthcare Enterprise

IHTSDO International Health Terminology Standards Development Organisation

IIS Immunization Information Systems

ISO International Organization for Standardization

GS1 Global Standards One

LOINC Logical Observation Identifiers Names and Codes

MED-RT Medication – Reference Terminology

NCPDP National Council for Prescription Drug Programs

NDC National Drug Codes

NDF-RT National Drug File - Reference Terminology

NEMA National Electrical Manufactures Association

NLM National Library of Medicine

NPI National Provider Identifier

NUCC National Uniform Claim Committee

ONC Office of the National Coordinator for Health Information Technology

PDQv3 Patient Demographics Query HL7v3

PHIN Public Health Information Network

PIXv3 Patient Identifier Cross-reference HL7 V3

RIM HL7 Reference Information Model

RFC Request For Comments

RxNORM Normalized Names for Clinical Drugs

SNOMED CT Systematized Nomenclature of Medicine-Clinical Terms

STU Standard for Trial Use

UDI Unique Device Identification

UMLS Unified Medical Language System

26


Acronym DefinitionVADS Vocabulary Access Distribution System

VHA Veterans Health Administration

VistA Veterans Health Information Systems and Technology Architecture

27