This article originally appeared in the IT Healthcare e-newsletter.
On March 21, 2003, the departments of Health and Human Services (HHS), Defense (DOD), and Veterans Affairs (VA) announced the adoption of standards for the exchange of clinical health information. As one of the federal government's e-government proposals, the Consolidated Health Informatics (CHI) initiative will, for the first time, enable the three departments to electronically communicate using common coding schemes for clinical data.
The primary goals of these standards are to improve the quality of patient care while reducing costs by simplifying and expediting the sharing of healthcare information and, at the same time, ensuring privacy and security. The federal government is touting the adoption of the new standards as a key building block in the development of a portable patient medical record.
The new federal exchange standards are actually a formal adoption of a combination of well-established industry standards familiar to most healthcare IT professionals. These include:
- Health Level 7 (HL7): A veteran messaging standard for the programmatic communication of a wide range of patient care information; this standard includes demographic, clinical, ordering, scheduling, and other administrative information.
- National Council for Prescription Drug Programs (NCPDP): This is a HIPAA-compliant standard for the ordering of drugs from retail pharmacies.
- Digital Imaging and Communications in Medicine (DICOM): This is a veteran standard for the communication of biomedical, diagnostic, and therapeutic information using digital images and associated data. In addition to specifications for digital images and supporting documentation, DICOM provides standards for networking electronic devices that create or display such information.
- Logical Observation Identifiers Names and Codes (LOINC): A standard set of universal names and codes for identifying laboratory or clinical results, the LOINC database currently contains approximately 32,000 observation terms that organizations can use in coordination with other standards (such as HL7) for the communication of clinical information.
- Institute of Electrical and Electronics Engineers 1073 (IEEE 1073): A standard for the communication to and from point-of-care medical devices, IEEE1073 is actually a collection of standards that specifies networking, device interaction, and remote monitoring of mobile clinical care equipment.
The adoption of these standards is the first major deliverable of the CHI initiative. CHI plans to build on this announcement by continuing to adopt additional standards for several other clinical areas, including medications, interventions, immunizations, histories, genome, physiology, and nursing.
For IT professionals in the government sector, CHI’s announcement will lead to serious reevaluation of in-place healthcare information systems and how they communicate. For those systems not compliant with the new standards, substantial investment in both time and money could be required to bring systems up to date. It's unclear at this time how CHI will communicate the particulars of compliance and how it will monitor that compliance.
For IT professionals in the private sector, CHI’s announcement will not have an immediate impact on system development. However, as with any other federally mandated standard, adoption in the private sector will be encouraged.
Adoption will become more important particularly if the federal government and the healthcare industry continue to apply pressure for the development of a standardized electronic patient medical record. In this scenario, the federal government will most likely dictate the standards. The judicious avenue for new healthcare application development will be to consider adopting these standards as applicable and within cost limits.