Survey of Medical Informatics

CS 493 – Fall 2004

September 13, 2004

Federal Leadership and Public-Private Partnerships

Chapter 3: Patient Safety - Achieving a New Standard of Care.

IOM Report

Federal Leadership Needed

To streamline standards development process

To promote public-private partnerships

Standards in three different areas Interchange standards Terminology standards Knowledge representation standards

Data Interchange Standards

Data Interchange Standards

Three mechanisms in play Federal mandates Consensus balloting in voluntary organizations De-facto standards

Figure 3.1, pg 98 of the IOM book Box 3-1, pg 99

Consensus Balloting Process

Process used by HL7, IEEE and NCPDP Draft circulated to Standards Development

Organization (SDO) members and other interested parties

Reviewers cannot be all vendors – a 50% balance is maintained between vendors and users

All comments reviewed and negative ballots has to be reconciled

90% or greater consensus needed to pass the standard for data interchange. Majority in most other cases.

ANSI process

ANSI approves the standards proposed by SDOs. Once approved, they become American National Standards.

Standards need to be reviewed at least every 5 years for relevance.

Implementing Standards

Conformance assurance for standards compliance

Accreditors check compliance Can be either be public – National Voluntary

Laboratory Accreditation program run by NIST Or private – American Association for Laboratory

Accreditation

European Standards and overlapping efforts Comite’ European de Normalisation (CEN)

ANSI counterpart in Europe Significant overlap in standards body roles

and responsibilities (Table 3-1 – page 102) Standards in US are formulated by voluntary

participation by vendors and providers Europe, Japanese, Australian and others rely

on government funds to establish standards for their country.

Terminologies

Terminologies

Over 150 terminology systems in use Very little standardization – not interoperable International Classification of Diseases [ICD] Box 3-2 – pg 104

Knowledge Representation standards

Knowledge representation

1997 Report by the National Committee on Quality Assurance National rate for an annual diabetic eye exam is 38.4%

AHRQ Evidence-based practice centers (EPCs http://www.ahrq.gov/clinic/epc/ ), primary care practice-based research networks (PBRNs - http://www.ahrq.gov/research/pbrnfact.htm ) and Integrated Delivery System Research Network (IDSRN - http://www.ahrq.gov/research/idsrn.htm )

Evidence-based guidelines

13 EPCs Goal is to develop guidelines based on rigorous analysis of scientific literature To translate these guidelines into computer readable format is the challenge to the

informatics community. PBRN for example the role of antibiotics in the care of acute otitis media (ear

infection) IDSRN 44 IDSRN projects funded – quality measurement and improvement,

bioterrorism, information technology, organization and financing, disparities in access to care.

Cochrane Collaboration: UK-based effort at developing reliable guidelines for practice http://www.cochrane.org/index0.htm

The Centers for Education and Research on Therapeutics (CERTs) – program of AHRQ in consort with FDA to conduct research and provide education on the optimal use of drugs, medical devices, and biological products. http://www.certs.hhs.gov/

MedBiquitous : consortium with goals to create educational environment that is tied to the practice of medicine. http://www.medbiq.org/index.html

Reporting Standards

CMS & Premier demonstration: http://www.cms.hhs.gov/researchers/demos/phqidemo.asp http://www.cms.hhs.gov/quality/hospital/

PremierMeasures.pdf Medicare Equity and Access Act:

http://www.theorator.com/bills108/hr2033.html DHHS has given a contract to Kevric Corp to

integrate patient safety reporting within DHHS. Appendix C [need to check] Quality Interagency Coordination Task Force (QuIC)

http://www.quic.gov/index.htm Diabetes Quality Improvement Project

Reporting Standards

National Quality Forum (NQF) http://www.qualityforum.org/

National Committee for Quality Assurance (NCQA) http://www.ncqa.org/ HEDIS – Health Plan Employer Data and Information Set – to compare

commercial, Medicaid and Medicare managed health plans Consumer Assessment of Health Plans, the Diabetes Quality Improvement

Project, and the Health Outcomes Survey. JCAHO

http://www.jcaho.org/ Core Measures: http://www.jcaho.org/pms/core+measures/index.htm

FACCT – Foundation for Accountability http://www.facct.org/facct/site/facct/facct/home Consumer Information Framework: Basics, staying healthy, getting better,

living with illness, and changing needs IOM Recommendation: QuIC be given the lead role to coordinate

reporting standards and work with NQF, NCQA, JCAHO & FACCT.

National Committee on Vital and Health Statistics Has the lead role in identifying and recommending

clinical data standards. HIPAA standards established:

ANSI ASC X12N EDI standard for administrative and financial transactions

NCPDP standard for pharmacy billing transactions. Adopted: ICD-9 CM, HCPCS, NDCs, Common Dental

Terminology – CDT-2 Identifiers for employers Privacy rules that safeguards personal health information Rules for claims attachment are in progress

Consolidated Health Informatics Initiative CHI members include:

DHHS, NCVHS, VHA, DoD, Indian Health Service, Dept of Agriculture, EPA & FDA.

Goal of CHI is to articulate and execute a coherent vision and strategy for the adoption of interoperability standards in healthcare.

DHHS, DoD & VHA have announced that they will adopt: HL7, NCPDP, IEEE 1073, DICOM & LOINC based largely on the recommendations from CHI.

Public Health Data Standards Consortium http://www.phdatastandards.info/ Organization that promote data standards

that serve the interest of public health services

Membership includes: CDC, AHRQ, CMS, managed care organizations,

business coalitions and consumer groups

National Alliance for Health Information Technology http://www.aha.org/nahit/about.html Over 100 members from:

Providers: Hospitals, health systems, medical groups Payors: Insurance companies, managed care organizations Supply chain: pharmaceutical, medical device

manufacturers Other stakeholders: government, standards bodies

Promote adoption of consensus-based standards leading to a national health information infrastructure

Integrating the Healthcare Enterprise HIMSS, RSNA started this collaborative effort

in 1998. Process overview:

Identify integration scenarios/problems Specify applicable technology standards that can

address the integration profile Recruit vendors to implement and showcase

solution to the integration problem Development and dissemination of integration

profile documents

IOM recommendations

Figure 3-2, pg 120