1. United States Health Information Knowledgebase: An Online Metadata Registry
J. Michael Fitzmaurice
Agency for Healthcare Research and Quality
ANSI HITSP Foundation Committee
Small-Scale Harmonization
May 16, 2007

2. United States Health Information Knowledgebase (USHIK)
Metadata Registry
Advantages of Metadata
Metadata role in Data Standards Adoption
Methods of Standards Development Organizations
USHIK Metadata Capabilities / Maintenance of USHIK
What I would like to do today in the time we have is to give an overview of USHIK and also tell you that
USHIK is available to the HITSP and ANSI to identify gaps between the data elements in the draft use case standards and support identification of the data needed to satisfy the use case
And for HITSP use case for the HER, USHIK can assess the comparability—definition and representation of data elements across the standards chosen for a use cases (EHR, Bio-Surveillance, Customer). USHIK can promote harmonization of HITSP use case data elements by providing feedback on internal inconsistencies
And because USHIK is customer centered - USHIK supports the implementation of national standards by giving the data customer (Developers, managers, administrator, clinicians) a customer perspective of data to better understand the relationship between data and the importance of data elements in comparison of data

3. Secretary Michael Leavitt created America’s Health Information Community, a FACA to advise him on national health information infrastructure issues
Mandate by President George W. Bush for the Office of the National Coordinator (ONC) to lead the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care
Executive Order–August 22, 2006
AHIC breakthrough use cases require the ANSI Health Information Technology Standards Panel (HITSP) Technical Committees to choose standards and data elements for the exchange of relevant health information with other providers to support the clinical delivery of care at a different time and/or setting. Laboratory data and patient registry data, for example
AHIC use cases are being developed that illustrate health data transmission and/or exchange for public health purposes, such as bio-surveillance, outbreak management, alerting and communication with health providers, and public health detecting and reporting
HITSP-chooses standards, data elements, and identifies any obstacles to attaining use case success. Use case success depends on implementation of the health data elements from health information technology standards.
USHIK enables the browsing, comparison, synchronization and harmonization of facts about health data in a uniform query and interface environment that allows customers (developers, managers, clinicians, administrators, SDO) to identify and manage multiple data elements in an electronic health record across organizations to facilitate the comparison and collection of customer-centered or patient-centered data.
evidenced-based medicine, disease management,
The United States Health Information Knowledgebase is a ne repository built to an international standard format—ISO/IEC standard for Metadata Registries that is available for HITSP and ANSI to use right now to compare and harmonize standards, use case interventions, results and outcomes. Th
The United States Health Information Knowledgebase could be used by the Office of the National Coordinator for Health Information Technology (ONCHIT) as a method for the Regional Health Information Organizations (RHIOs) to compare data and outcomes or with the Integrating the Healthcare Enterprise (IHE) initiative to maintain the documentation for each organization involved in the adoption of health information technology standards and compare the interoperable validation data for clinically coordinated departments.  

4. Advantages of USHIK for health data and information programs:
A metadata registry addresses a significant barrier to standards adoption for hospital systems and others with health-related missions to exchange data
- by identifying the individual data elements from mandated (“adopted,” “recognized”) health standards for information comparisons and harmonization across systems and organizations
Advantages of USHIK for health data and information programs:
Faster identification of health data information gaps and inconsistencies
Synchronized clinical data for evidenced-based medicine, research, and disease management research (USHIK, DoD, NLM, NCI CaBIG)
Interoperable software products, EHRs and exchanges that can lead to:
Reduced software development time because of pre–coordinated health IT data elements selection
Improved quality and efficiency of health care
Improved patient safety
Reduced error rates
Lowering of administrative costs
Strengthened national public health and disaster preparedness
a controlled clinical vocabulary
The United States Health Information Knowledgebase is a ne repository built to an international standard format—ISO/IEC standard for Metadata Registries that is available for HITSP and ANSI to use right now to compare and harmonize standards, use case interventions, results and outcomes. Th

5. – and another advantage –
USHIK is a Metadata Registry. The role of metadata in standards adoption is to describe and make available for use nearly all the data elements found in health standards adopted by federal agencies in the Consolidated Health Informatics Standards (CHI)
– and –
Nearly all the data elements and definitions in the CHI- and HIPAA-designated standards from organizations such as ANSI HL7, ANSI X12, ANSI ASTM, NCPDP, American Dental Association, the Health Industry Business Communications Council (HIBCC), IEEE: Medical Device Communications Industry Group (IEEE 1073) are available and monitored for updates. USHIK also includes select DoD Military Health System and NCVHS-recommended data elements and definitions
– and another advantage –
USHIK is build on the Metadata Registry Standard from the International Organization for Standardization (ISO), ISO/IEC 11179, Information Technology – Metadata Registries (MDR)
USHIK has been government designated standards and each SDO has many standards that we have not loaded.
The United States Health Information Knowledgebase is a ne repository built to an international standard format—ISO/IEC standard for Metadata Registries that is available for HITSP and ANSI to use right now to compare and harmonize standards, use case interventions, results and outcomes. Th

6. USHIK is an access point to data elements metadata:
USHIK can maintain the integrity of the Consolidated Health Informatics Standards (CHI) for benefit of the Office of the National Coordinator (ONC)
USHIK is an access point to data elements metadata:
Names
Definitions
Representations and
Other attributes for designated health information technology standards
USHIK supports strategies to plan, evaluate and compare electronic health record system requirements, capabilities, and standards with HIPAA-, CHI- and HITSP- adopted standards--for many customers (government programs, vendors, organizations, clinicians, developers, analysts, and administrators)
USHIK is an online health metadata registry that public and private organizations may use to harmonize their health information data elements with standards for the national adoption of health information technology standards
USHIK enables the browsing, comparison, synchronization and harmonization of facts about health data in a uniform query and interface environment that allows customers (developers, managers, clinicians, administrators, SDO) to identify and manage multiple data elements in an electronic health record across organizations to facilitate the comparison and collection of customer-centered or patient-centered data.
evidenced-based medicine, disease management,
The United States Health Information Knowledgebase is a ne repository built to an international standard format—ISO/IEC standard for Metadata Registries that is available for HITSP and ANSI to use right now to compare and harmonize standards, use case interventions, results and outcomes. Th

7. USHIK enables the browsing, comparison, synchronization and harmonization of health data elements from multiple standards –> resulting in an online metadata comparison matrix (see next slide)
UHISK provides a uniform query and interface environment for data element comparisons that simplifies understanding the definitions of various health information standard terms
USHIK is a focal point to publish federally designated standards data elements and definitions (metadata) online that facilitates eGovernment, federal programs, and citizen business relationships
USHIK enables the browsing, comparison, synchronization and harmonization of facts about health data in a uniform query and interface environment that allows customers (developers, managers, clinicians, administrators, SDO) to identify and manage multiple data elements in an electronic health record across organizations to facilitate the comparison and collection of customer-centered or patient-centered data.
evidenced-based medicine, disease management,
The United States Health Information Knowledgebase is a ne repository built to an international standard format—ISO/IEC standard for Metadata Registries that is available for HITSP and ANSI to use right now to compare and harmonize standards, use case interventions, results and outcomes. Th

8. Comparison Matrix Aids in Harmonizing Data Elements

9. CHI Metadata Focal Point
High-level Consolidated Health Informatics United States Health Information Knowledgebase
Provides graphic overview of CHI standards
Viewpoint for the implementation of CHI Standards

10. Viewpoint for the implementation of ANSI HITSP Technical Committee use cases
Focal point to examine Technical Committee standards, data model relationships
Uniform environment to compare, synchronize, harmonize standards overlaps - gaps

11. USHIK maintains a document registry of all historical documents of record behind a data analysis (metadata of terms & definitions)
USHIK can maintain a record of SDO updates to standard data elements over time and provide dates of anticipated/future change
USHIK could link to the NIST LANDSCAPE for a drill down from Standards Organization activities to elements in the Standard
USHIK could provide a vocabulary service if that feature were added, or link to an existing vocabulary service
USHIK can help eliminate a barrier to health data interoperability with matrix comparisons of multiple health data standard data elements

12. Lessons Learned – (about the) Methods of Standards Development Organization
Standards have multiple means of versioning (e.g., major / minor numbering, re-release with corrections) and multiple versions available at any one point in time
Workload entailed in loading different identified items varies widely due to the different levels of standardization
A large amount of effort required in grooming the metadata to fit into the standard format as most exciting metadata does not exist in any kind of standard format

13. Lessons Learned – (about the) Methods of Standards Development Organization
New standards versions do not identify a delta between the versions, so a metadata difference analysis must be determined
Many points for data errors with a tremendous responsibility for Quality Assurance and large load on the team analyzing the standard, determining the differences between the versions, reformatting the metadata into the standard format, and loading the information
Metadata finds that changes to standards may be needed to correct errors
Changes may be in the structure of the standards
Changes may have a cascading affect that may change meaning
Changes need to be reviewed to determine if data elements still meet the needs of HITSP, ANSI and CHI

14. Contacts for www.USHIK.org
Michael Fitzmaurice, PhD, AHRQ
Senior Science Advisor for Information Technology, Office of the Director
Laura Reece, PhD
The USHIK team that is currently supported by AHRQ and DOD, and CMS could begin to work with HITSP and ANSI now and the workgroups to identify the data elements from the proposed use case standards - this would be very useful for commercial vendors and developers when the national use cases are published and USHIK is available to help HITSP and ANSI with this work.