National Interoperability Standards and USHIK Public Health Data Consortium’s 2009 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality November 12, 2009

Does anything exist? Cogito, Ergo Sum Cogito, Ergo Sum – Rene Descartes 2

When I think of all the HITSP products My brain hurts—so many “constructs” My brain hurts—so many “constructs” How do I grasp the power of what HITSP has done? How do I grasp the power of what HITSP has done? USHIK.ahrq.gov USHIK.ahrq.gov 3

4 USHIK—a National Metadata Registry AHRQ-USHIK US Health Information Knowledgebase

5 USHIK—a National Metadata Registry AHRQ-USHIK is an AHRQ-funded and managed metadata registry of AHRQ-USHIK is an AHRQ-funded and managed metadata registry of – Data elements endorsed, accepted, and recognized by the HHS Secretary for federal agencies’ use An organized collection of data elements and their characteristics (metadata)—ISO/IEC An organized collection of data elements and their characteristics (metadata)—ISO/IEC USHIK contains data elements from National Interoperability Standards for USHIK contains data elements from National Interoperability Standards for – HIPAA transactions – Consolidated Health Informatics Domains – Health Information Technology Standards Panel (HITSP)

6 AHRQ-USHIK Mission: To represent AHRQ with excellent service Mission: To represent AHRQ with excellent service Specific Goal: To be an organized set of repositories that coordinates the data elements and their metadata from health data standards that the HHS Secretary has endorsed, accepted, and recognized, including ARRA data elements, plus AHRQ’s patient safety elements Specific Goal: To be an organized set of repositories that coordinates the data elements and their metadata from health data standards that the HHS Secretary has endorsed, accepted, and recognized, including ARRA data elements, plus AHRQ’s patient safety elements Why: To improve the uniformity, accuracy, and computerization of health data for researchers and decision makers, including providers, patients, plans, and payers Why: To improve the uniformity, accuracy, and computerization of health data for researchers and decision makers, including providers, patients, plans, and payers – Improves clinical and administrative data used for research – Speeds applications of research tools developed from these data

7 Bridge: Normal Deck of 52 Cards Data element name(1 of 52): 4 of spades Data element name(1 of 52): 4 of spades Attributes (Metadata): Attributes (Metadata): – Definitionplaying card – Number4 – Suitspades – Odd/eveneven – Picture cardNo – AuthorityYou, or Hoyle – Version or date effective – Bridge deck memberYes – Pinochle deck memberNo – Euchre deck memberNo – Poker deck memberYes

8 Card Metadata Registry Each game master is the authority for its game’s cards Each game master is the authority for its game’s cards The same card can be used in different games The same card can be used in different games The same metadata about a card can be reused many times, in a metadata registry The same metadata about a card can be reused many times, in a metadata registry Bridge: all 52 cards Bridge: all 52 cards Euchre: 24 cards, all higher than an 8 Euchre: 24 cards, all higher than an 8 Pinochle: 48 cards, all higher than an 8, duplicated Pinochle: 48 cards, all higher than an 8, duplicated Poker: all 52 cards Poker: all 52 cards In total, it would take 176 cards for each of you to display the cards for your games with separate decks In total, it would take 176 cards for each of you to display the cards for your games with separate decks

9 What cards are needed to play? Bridge PinochleEuchrePoker Deck of 52 CARDS Not 176

10 AHRQ-USHIK Data Element Data Element: Gender code Data Element: Gender code Attributes (Metadata): Attributes (Metadata): – DefinitionFor eligibility, id gender of the individual member – ContextNCPDP Data Dictionary – Registration. AuthorityNCPDP – Effective date – Data typeNumeric extended – Represent. LayoutX(1) – Value DomainGender, coded_VD – CodesM (male), F (female), U (unknown)

11 Comparison Matrix Aids in Harmonizing Data Elements

12 What data elements are needed for ARRA meaningful use? X12N NCPDPHL7HITSP USHIK AHRQ Patient Safety

13 Do the data elements in my EHR fit HITSP specifications? X12N NCPDPHL7HITSP USHIK Are My EHR data defined the same as HITSP’s?

14 How does each authority express gender? X12N NCPDPHL7HITSP USHIK Gender

15 ARRA Incentive Payments to Providers American Recovery and Reinvestment Act of 2009 (Feb. 17, 2009) provides American Recovery and Reinvestment Act of 2009 (Feb. 17, 2009) provides Up to $44,000 starting in 2011 through 2015 for Meaningful Use of Certified EHRs by eligible Providers Up to $44,000 starting in 2011 through 2015 for Meaningful Use of Certified EHRs by eligible Providers – Meaningful Use --- so that patients will get value – Certified --- to reduce market risk to EHR purchasers about the EHR’s capabilities for them to engage in Meaningful Use activities

16 HIT Policy ONC ARRA CMS/ONC HIT Standards HITSP HHS Secretary Simple Hypothetical Diagram Meaningful use definition Standards Recommendations for Meaningful Use and 8 other areas Health providers

17 HIT Policy ONC ARRA ONC HIT Standards HITSP Other bodies HHS Secretary Federal Agencies CCHIT Other bodies Simple Hypothetical Diagram

18 HIT Policy ONC ARRA ONC HIT Standards HITSP Other bodies HHS Secretary Federal Agencies CCHIT Other bodies Simple Hypothetical Diagram AHRQ USHIK

19 HIT Policy ONC ARRA ONC HIT Standards HITSP Other bodies HHS Secretary Federal Agencies CCHIT Other bodies Simple Hypothetical Diagram AHRQ USHIK

20 Federal Agencies As required by ARRA, when federal agencies implement, acquire, or upgrade HI systems for exchanging personal health information, they must use systems that meet standards adopted by the HHS Secretary under ARRA. As required by ARRA, when federal agencies implement, acquire, or upgrade HI systems for exchanging personal health information, they must use systems that meet standards adopted by the HHS Secretary under ARRA. Federal agencies are similarly bound by Executive Order (Aug. 2006) to use standards recognized by the HHS Secretary. Federal agencies are similarly bound by Executive Order (Aug. 2006) to use standards recognized by the HHS Secretary.

21 Federal Agencies must use these Standards per ARRA a) SPENDING ON HEALTH INFORMATION TECHNOLOGY SYSTEMS.—As each agency … implements, acquires, or upgrades health information technology systems used for the direct exchange of individually identifiable health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet standards and implementation specifications adopted under [ARRA]... (b) FEDERAL INFORMATION COLLECTION ACTIVITIES.— With respect to a standard or implementation specification adopted under [ARRA] …, the President shall take measures to ensure that Federal activities involving the broad collection and submission of health information are consistent with such standard or implementation specification, respectively, within three years after the date of such adoption.

22 Vendors of Certified EHR Systems The standards and certification criteria are forthcoming in the Federal Register by December 31, 2009, as mandated by ARRA. The standards and certification criteria are forthcoming in the Federal Register by December 31, 2009, as mandated by ARRA.

23 ushik.ahrq.gov promotes One-stop shopping for HITSP data elements One-stop shopping for HITSP data elements – Reduced resources for implementing HITSP standards – And for reporting patient safety events in hospitals Defined authorities for data elements’ meanings Defined authorities for data elements’ meanings Uniformity of certified EHR content Uniformity of certified EHR content – Movement toward identical data elements – Reconciling inconsistencies within and among HITSP documents and SDO standards Making available data information from other sources in USHIK for HITSP comparisons and choices Making available data information from other sources in USHIK for HITSP comparisons and choices Federal agency and private sector comparisons of their program and product data needs with HITSP data elements Federal agency and private sector comparisons of their program and product data needs with HITSP data elements

What’s New in USHIK As of July 15, 2009, every HITSP-specified data element is in USHIK and linked to every HITSP construct (document) in which it appears As of July 15, 2009, every HITSP-specified data element is in USHIK and linked to every HITSP construct (document) in which it appears Developing new, faster data loader Developing new, faster data loader Updating SDO information: X12, NCPDP, HL7 Updating SDO information: X12, NCPDP, HL7 – X12 data elements are being updated in USHIK 4010 in the USHIK staging server now 4010 in the USHIK staging server now 4050 and 5010 generic elements developed next week for loading the following week [Thank you, Steve Bass] 4050 and 5010 generic elements developed next week for loading the following week [Thank you, Steve Bass] 24

What’s New in USHIK X12 is taking responsibility for properly loading its data elements into USHIK; HITSP should reference them there X12 is taking responsibility for properly loading its data elements into USHIK; HITSP should reference them there NCPDP and HL7 are proposed to follow NCPDP and HL7 are proposed to follow **USHIK has a preliminary view of HITSP’s Capabilities and Services Collaborations** **USHIK has a preliminary view of HITSP’s Capabilities and Services Collaborations** – Within IS 07 – EHR Centric Context with links to capabilities, service collaborations, all constructs, data elements, value sets – Not official, but presented for improving understanding and obtaining user comments 25

What’s New in USHIK AHRQ has recently funded USHIK to: AHRQ has recently funded USHIK to: – Develop a State All-Payer Data (SAPD) Metadata Portal – Develop a Meaningful Use Metadata Measure (MUMM) Metadata Analysis and Portal (with Abt Associates, Inc.) – Continue developing AHRQ’s Patient Safety Common Formats Portal – Put HITSP T66 compliant web services in place for external queries of/by USHIK AHRQ and VA will continue their USHIK partnership— HITSP data elements  Quality Measure domain AHRQ and VA will continue their USHIK partnership— HITSP data elements  Quality Measure domain 26

27 Where is Value? Publishing in one place the data elements from the standards’ processes ONC has developed Publishing in one place the data elements from the standards’ processes ONC has developed Being a source for what is required by the President’s and HHS Secretary’s Interoperability Standards—Federal Agencies, Federal Contracts Being a source for what is required by the President’s and HHS Secretary’s Interoperability Standards—Federal Agencies, Federal Contracts Supporting federal and private sector efforts to match their programs and products’ data elements with those of Federal Interoperability Standards Supporting federal and private sector efforts to match their programs and products’ data elements with those of Federal Interoperability Standards

28 Finale See the HITSP Portal Information Models at See the HITSP Portal Information Models atUshik.ahrq.gov See also CDC’s PHIN VADS for public health data value set information at See also CDC’s PHIN VADS for public health data value set information at Phinvads.cdc.gov Phinvads.cdc.gov

National Interoperability Standards and USHIK Public Health Data Consortium’s 2009 Annual Meeting J. Michael Fitzmaurice, Ph.D. Agency for Healthcare Research and Quality November 12, 2009

30 USHIK Metadata Registry Contents, data elements from X12 X12 ASTM ASTM NCPDP SCRIPT, Batch, Data Dictionary NCPDP SCRIPT, Batch, Data Dictionary American Dental Association American Dental Association HIPAA HIPAA HL7 HL7 MHS Functional Area Model MHS Functional Area Model Public Health Care Data Standards Public Health Care Data Standards LOINC LOINC IEEE: Medical Device Communications Industry Group (IEEE/ISO 11073) IEEE: Medical Device Communications Industry Group (IEEE/ISO 11073) DoD Military Health System DoD Military Health System NCVHS NCVHS Clinical Care Classification (Nursing Taxonomy ) Clinical Care Classification (Nursing Taxonomy ) HITSP HITSP AHRQ Patient Safety Events AHRQ Patient Safety Events Other sources Other sources