Federal
agencies with health-related
missions need to find a way to share their health
information. This health data sharing will enable
them to make significant strides towards improving
patient safety, reducing error rates, lowering
administrative costs, and strengthening national
public health and disaster preparedness. To share
health data, agencies need to adopt the same clinical
vocabularies and the same ways of transmitting
that information. For example, today "cold"
can mean many different things (temperature, mood,
illness, influenza, and so forth). With common
vocabulary standards, agencies are able to understand
what "cold” means; with common messaging
standards, they are able to transmit that information
in a way that maintains its meaning. This sharing
information within and between agencies establishes
“interoperability.” Public and private
groups have emphasized how interoperability through
standards will enable us to share a common electronic
patient medical record and in turn greatly improve
the quality of US healthcare.
The Consolidated Health Informatics
(CHI) initiative will establish a portfolio of
existing clinical vocabularies and messaging standards
enabling federal agencies to build interoperable
federal health data systems. This commonality
will enable all federal agencies to “speak
the same language” and share that information
without the high cost of translation or data re-entry.
Federal agencies could then pursue projects meeting
their individual business needs aimed at initiatives
such as sharing electronic medical records and
electronic patient identification. CHI standards
will work in conjunction with the Health Insurance
Portability and Accountability Act (HIPAA) transaction
records and code sets and HIPAA security and privacy
provisions.
About 20 department/agencies
including HHS, VA, DOD, SSA, GSA, and NIST are
active in the CHI governance process. Through
the CHI governance process, all federal agencies
will incorporate the adopted standards into their
individual agency health data enterprise architecture
used to build all new systems or modify existing
ones. There is a Consolidated Health Informatics
Council that leads the work. CHI conducts outreach
to the private sector through the National Committee
on Vital and Health Statistics; records and schedules
are available at www.ncvhs.hhs.gov.
An “electronic health”
or “eHealth” movement in the health
care industry has formed and is driven by several
private, public and private-public initiatives
and consortiums seeking improvements in health
care activities through technology. There is consensus
that the time is right to establish universal
clinical vocabulary and messaging standards to
enable technology development which better supports
exchange and sharing in a secure environment.
Leaders in the health care industry have communicated
how important the federal government’s leadership
role is in the adoption of standards. As the federal
government is involved in providing and paying
for health care, standards we use significantly
influence the decisions on standards made by the
rest of the health marketplace. As good business
partners, federal agencies working through CHI
will openly share information on the CHI standards
portfolio as it is assembled. At the same time,
private sector consortiums seeking standards solutions
are sharing their information with CHI.
Standards Announced on
March 21, 2003
On March 21, 2003, the Departments of
Health and Human Services, Defense, and Veterans
Affairs announced the first set of uniform standards
for the electronic exchange of clinical health
information to be adopted across the federal government.
The standards all federal agencies will adopt
are:
- Health Level 7® (HL7®)
messaging standards to ensure that each federal
agency can share information that will improve
coordinated care for patients such as entries
of orders, scheduling appointments and tests
and better coordination of the admittance, discharge
and transfer of patients.
- National Council on Prescription
Drug Programs (NCDCP) standards for ordering
drugs from retail pharmacies to standardize
information between health care providers and
the pharmacies. These standards already have
been adopted under the Health Insurance Portability
and Accountability Act (HIPAA) of 1996, and
ensures that parts of the three federal departments
that aren't covered by HIPAA will also use the
same standards.
- The Institute of Electrical
and Electronics Engineers 1073 (IEEE1073) series
of standards that allow for health care providers
to plug medical devices into information and
computer systems that allow health care providers
to monitor information from an ICU or through
telehealth services on Indian reservations,
and in other circumstances.
- Digital Imaging Communications
in Medicine® (DICOM®) standards that
enable images and associated diagnostic information
to be retrieved and transferred from various
manufacturers' devices as well as medical staff
workstations.
- Laboratory Logical Observation
Identifier name Codes® (LOINC®) to standardize
the electronic exchange of clinical laboratory
results.
Full Reports:
- Laboratory
Result Names
- adopted
- Messaging
Standards: Includes scheduling, medical record/image
management, patient administration, observation
reporting, financial management, patient care
- adopted
- Messaging
Standards: Includes retail pharmacy transactions
- adopted
- Messaging
Standards: Connectivity - adopted
- Messaging
Standards: Includes Image Information to Workstations
- adopted
Standards Announced on
May 6, 2004:
On May 6, 2004, the Departments
of Health and Human Services, Defense, and Veterans
Affairs announced the adoption of 15 additional
standards agreed to by the CHI initiative to allow
for electronic exchange of clinical information
across the federal government. The 15 new standards
build on the existing set of five standards adopted
by HHS in March 2003 and complete the first phase
of the CHI initiative. The new standards agreed
to by federal agencies will be used as agencies
develop and implement new information technology
systems.
The specific new standards are:
- Health Level 7® (HL7®)
vocabulary standards for demographic information,
units of measure, immunizations, and clinical
encounters, and HL7®’s Clinical Document
Architecture standard for text based reports.
(Five standards)
- The College of American Pathologists
Systematized Nomenclature of Medicine Clinical
Terms® (SNOMED CT®) for laboratory result
contents, non-laboratory interventions and procedures,
anatomy, diagnosis and problems, and nursing.
HHS is making SNOMED-CT® available for use
in the U.S. at no charge to users. (Five standards)
- Laboratory Logical Observation
Identifier Name Codes® (LOINC®) to standardize
the electronic exchange of laboratory test orders
and drug label section headers. (One standard.)
- The Health Insurance Portability
and Accountability Act (HIPAA) transactions
and code sets for electronic exchange of health
related information to perform billing or administrative
functions. These are the same standards now
required under HIPAA for health plans, health
care clearinghouses and those health care providers
who engage in certain electronic transactions.
(One standard.)
- A set of federal terminologies
related to medications, including the Food and
Drug Administration’s names and codes
for ingredients, manufactured dosage forms,
drug products and medication packages, the National
Library of Medicine’s RxNORM for describing
clinical drugs, and the Veterans Administration’s
National Drug File Reference Terminology (NDF-RT)
for specific drug classifications. (One standard.)
- The Human Gene Nomenclature
(HUGN) for exchanging information regarding
the role of genes in biomedical research in
the federal health sector. (One standard.)
- The Environmental Protection
Agency’s Substance Registry System for
non- medicinal chemicals of importance to health
care. (One standard.)
Link
to Executive Summaries
Full Reports:
-
Medications: Summary report including Special
Populations and Drug Classifications
- adopted
- Medications:
Structured Product Labeling Sections
- adopted
- Medications:
Drug Product
- adopted
- Medications:
Package - adopted
- Medications:
Active Ingredients
- adopted
- Medications:
Clinical Drug
- adopted
- Medications:
Manufactured Dosage Form
- adopted
-
Anatomy
- adopted
- Billing
/ Financial
- adopted
- Chemicals
- adopted
- Clinical
Encounters
- adopted
- Demographics
- adopted
- Diagnosis
and Problem Lists
- adopted
- Genes
and Proteins
- adopted
- Immunizations
- adopted
- Interventions
& Procedures Laboratory Test Order Names
- adopted
- Interventions
and Procedures, non-Laboratory
- adopted
-
Laboratory Result Contents
- adopted
- Nursing
- adopted
- Text
Based Reports
- adopted
- Units
- adopted
No standard ready to
be adopted. Report contains recommendations for
follow-up work.
-
Disability
- History
and Physical
- Medical
Devices and Supplies
- Multimedia
- Population
Health
Table
1
Consolidated
Health Informatics Federal Partner Departments
& Agencies
As of November 2003
Department-Level |
Agency-level |
Veterans Affairs |
Veterans Health Administration |
Defense |
|
Health & Human Services |
Office of the Secretary |
Health &
Human Services |
Centers for Medicare &
Medicaid Services |
Health & Human Services |
Centers for Disease Control
& Prevention |
Health & Human Services |
Indian Health Service |
Health & Human Services |
National Institutes of Health |
Health & Human Services |
National Library of Medicine |
Health & Human Services |
Agency for Health Research
& Quality |
Health & Human Services |
Administration for Children
& Families |
Health & Human Services |
Health Resources & Services
Administration |
Health & Human Services |
Substance Abuse & Mental
Health Services Administration |
Social Security Administration |
|
General Services Administration |
|
Office of Management &
Budget |
|
Environmental Protection
Agency |
|
Department of Energy |
Los Alamos National Laboratories |
|
National Institute of Standards
& Technology |
|
US Agency for International
Development |
State |
|
Education |
|
Justice |
|
|