University of Minnesota



Nursing Knowledge: Big Data Research for Transforming

University of Minnesota, School of Nursing, Center for Nursing Informatics

August 12 – 13, 2013

Developed by: Judith Warren, PhD, RN, FAAN, FACMI

Informatics Enablers and Resources: The Regulation and Standards Landscape

1 HITECH, ACA, and Meaningful Use

▪ The following are Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the American Recovery and Reinvestment Act (ARRA), programs as specified in the ARRA legislation:

o Most of the work is coordinated and planned by the Office of the National Coordinator for Health Information Technology (ONC, ).

▪ Health IT Policy Committee, , has numerous workgroups that conduct projects for the committee.

▪ Health IT Standards Committee, , also has numerous workgroups that conduct the projects for the committee.

▪ To participate in the workgroups apply at .

o Beacon Communities test innovative approaches, and make measurable improvements through building and strengthening local health IT infrastructure,

o Strategic Health IT Advanced Projects on Security (SHARPS) program and challenges, and

o Workforce programs developed curricula, certificates and advanced degrees in informatics. The funding is expiring this year.

o Certified Electronic Health Record software,

o Nationwide Privacy and Security Framework to support HIPAA and HIPAA 2, and

o Personal Health Records, ,

o Mobile devices, . See the following demo of a mobile app for pressure ulcers that was based on all the standards work that has been done in that area, ,

o Blue Button,

▪ Meaningful Use,

o Stage One,

o Stage Two,

o National Learning Consortium,

o Regional Extension Centers,

o CMS incentive program,

3 HIPAA

The National Provider Identifier

5 The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

o This identifier can be used by all clinicians, not just physicians and nurse practitioners. Though, it is most commonly used by those who use it for billing purposes.

o Apply at the national Plan and Provider Enumeration System,

▪ Transaction and Code Set Standards

o Transactions are electronic exchanges involving the transfer of information between two parties for specific purposes.

o Versions 5010 and D.0 & 3.0,

▪ Version 5010 -  the new version of the X12 standards for HIPAA transactions;

▪ Version D.0 - the new version of the National Council for Prescription Drug  Program (NCPDP) standards for pharmacy and supplier transactions;

▪ Version 3.0 - a new NCPDP standard for Medicaid pharmacy subrogation

7 National Quality Forum and eMeasures

▪ NQF reviews, endorses, and recommends use of standardized healthcare performance measures. Performance measures, also called quality measures, are essential tools used to evaluate how well healthcare services are being delivered, .

▪ Care can be safer, more affordable, and better coordinated when electronic health records capture data needed to measure performance, and when that data is easily shared between healthcare providers and their patients. NQF's health IT initiatives are designed to support the complex but important move toward electronic measurement—eMeasures, .

o The Quality Data Model has been developed to promote this transition, .

o The Quality Data Model is harmonized with HL7’s HQMF.

o NLM’s Value Set Authority Center stores all the value sets for each eMeasure,

▪ Field Guide to NQF Resources, .

▪ Quality Positioning System lets you view the endorsed measures and if they are in the federal program requirements, .

▪ Appointed groups that do the work of NQF

o Health Information Technology Advisory Committee (HITAC),

o National Priorities Partnership,

o Measure Applications Partnership,

o Consensus Standards Approval Committee,

8 Health Level Seven International (HL7)

▪ HL7 is the global authority on standards for interoperability of health information technology with members in over 55 countries, . It is accredited by ANSI and has a relationship with ISO.

▪ Go to for an overview of HL7 standards and to see the ones adopted in the HHS Final Rule. Technical Committees (TC) , , do the work of the organization. You do not need to be a member to participate in the development of the standards. You do need to be a member to vote on the standards. TCs of interest to nursing are Clinical Decision Support, Clinical Quality Information, Electronic Health Records, Orders and Observations, Patient Care, Structured Documents, Vocabulary.

▪ There is a Nursing Group, , that meets to coordinate work among all the TCs so that the needs of Nursing are met.

▪ Standards to follow are the Reference Information Model (RIM), Clinical Document Architecture (CDA), Continuity of Care Document (CCD), Quality Reporting Document Architecture (QRDA), Virtual Medical Record (vMR) and, Health Quality Message Format (HQMF)

▪ Domain Analysis Models (DAM) and Clinical Detailed Models (CDM) are deliverables that specify content, information and relationships. Pressure Ulcer Prevention was one of the first DAMs to be developed, .

▪ [pic] Double click on the icon to open the document.

9 Federal Health Architecture (FHA)

▪ The FHA was established as an Office of Management and Budget E-Government Line of Business in 2004. The program supports federal activities related to the development and adoption of health IT standards, and ensures that federal agencies seamlessly and securely exchange health data with other public and private organizations. The FHA works with more than 20 federal partners to emphasize federal advancement of the national agenda for health IT, including the Department of Health & Human Services, Department of Defense, Department of Veterans Affairs, and the Social Security Administration, .

▪ One of the Work Groups is developing the Federal Health Information Model, . This model is important as it contributes to the overall national work on information models. The model can be seen on . They are also working on a model of the Care Plan, .

10 Standards and Interoperability (S&I) Framework

▪ The S&I Framework empowers healthcare stakeholders to establish standards, specifications and other implementation guidance that facilitate effective healthcare information exchange. The S&I Framework creates a forum – enabled by integrated functions, processes, and tools – where healthcare stakeholders can focus on solving real-world interoperability challenges, .

▪ Work is done by volunteers using phone conferences and wiki pages, .

▪ Samples of projects are Longitudinal Coordination of Care, BluButton Plus, Data Access Framework, Transitions of Care, CDA Harmonization.

▪ Criteria for evaluating a standard developed by the ONC’s HIT Standards Committee and S&I Framework.

▪ [pic]

11 Integrating the Healthcare Enterprise (IHE)

▪ IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care, .

▪ Domain Planning Committees coordinate the development of Technical Framework documents in the domain, and produce related marketing and education materials. They gather and analyze use cases and interoperability problems faced by users, prioritize these issues, and oversee development of IHE Profiles by the Technical Committee that ensure interoperability among the systems involved. Of importance are the Patient Care Coordination Profile and the Quality, Research and Public health Profile. Anyone can participate in the development of these profiles without being a member.

▪ Patient Care Coordination Technical Framework, .

▪ IHE USA is the USA centric chapter of the IHE,

▪ Download a free eBook, Interoperability fro Dummies,

▪ IHE Users’ Quick Reference Guide,

12 International Organization of Standards (ISO)

▪ ISO (International Organization for Standardization) is the world’s largest developer of voluntary International Standards. International Standards give state of the art specifications for products, services and good practice, helping to make industry more efficient and effective. Developed through global consensus, they help to break down barriers to international trade, .

▪ They have a Technical Committee for Health Informatics, . You must be a dues paying member to participate.

▪ Published ISO 18104:2003: Health Informatics—Integration of a Reference Terminology Model for Nursing, . The purpose of ISO 18104:2003 is to establish a nursing reference terminology model consistent with the goals and objectives of other specific health terminology models in order to provide a more unified reference health model. This International Standard includes the development of reference terminology models for nursing diagnoses and nursing actions and relevant terminology and definitions for its implementation. IHTSDO is a member so the Nursing SIG responds to requests for comments on this standard.

▪ [pic]Double click on icon to open the document.

13 Federal Mandate for Standardized Terminologies

• There are five (5) standard terminologies that are mandated by federal regulation for use in electronic health records and health information exchange. They are:

• SNOMED CT is developed by the international Health Terminology Standards Development Organization (IHTSDO, ). The National Library of Medicine is the National Release Center for the terminology as well as receiving suggestions for concepts to be included,

o US SNOMED CT Content Request System,

o IHTSDO has a Nursing Special Interest Group that facilitates the curation and evolution of the concepts of interest to nurses. Anyone is welcome to attend and there is no charge. There are monthly phone call meeting and one in-person meeting.

▪ The main purpose of the Nursing Problem List Subset of SNOMED CT is to facilitate the use of SNOMED CT as the primary coding terminology for nursing problems used in care planning, problem lists or other summary level clinical documentation. The use of a common list of SNOMED CT concepts will maximize data interoperability among institutions. Local problem list vocabularies often need to expand to satisfy specific user needs. Institutions that are using their own nursing problem list vocabularies are encouraged to map them to SNOMED CT with a focus on these nursing diagnosis concepts to facilitate data interoperability.

▪ Matney, S.A., Warren, J.J., Evans, J.L., Kim, T.Y., Coenen, A., & Auld, V.A. (2012). Development of the nursing problem list subset of SNOMED CT®. Journal of Biomedical Informatics, 45(4), 683-688.

• Logical observation Identifiers Names and Codes (LOINC) is a universal code system for identifying laboratory and clinical observations, .

o There is a Nursing Special Interest Group that the curation and evolution of the concepts of interest to nurses. Anyone is welcome to attend and there is no charge.

• International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), . The implementation of ICD-10 was delayed from October 1, 2013 to October 1, 2014 by final rule CMS-0040-F issued on August 24, 2012.

• RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, .

• Current Procedural Terminology (CPT), .

14 Institute of Medicine (IOM)

• The Computer-based Patient Record,

• The Quality of Care in America, . Includes the reports To Err Is Human and Crossing the quality Chasm. You may download executive summaries and the full text of these two reports.

• The Leaning Health System Series: To facilitate progress toward the development of a learning health system—in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience—the Roundtable on Value & Science-Driven Health Care has marshaled the insights of the nation’s leading experts to explore in detail the prospects, and the necessity, for transformational change in the fundamental elements of health and health care, .

[pic]Double click on the icon to open the document.

• Health IT and Patient Safety: Building Safer Systems for Better Care, .

• Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement, .

[pic] Double click on the icon to open the document.

• Roundtable on Health Literacy,

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download