Interoperability & Standards (3)

Types of Standards

Content Standards

• Content standards relate to the data content within exchanges of information. They define the structure and organization of the electronic message or document’s content. This standard category also includes the definition of common sets of data for specific message types.
• Consolidated CDA (C-CDA): A library of CDA templates, incorporating and harmonizing previous efforts from HL7, IHE, and Health Information Technology Standards Panel (HITSP). It represents harmonization of the HL7 Health Story guides, HITSP C32, related components of IHE Patient Care Coordination and Continuity of Care Documents, or CCD.
• HL7’s Version 2.x (V2): A widely implemented messaging standard that allows the exchange of clinical data between systems. It is designed to support a central patient care system as well as a more distributed environment where data resides in departmental systems.
• HL7 Version 3 Clinical Document Architecture (CDA®): An XML-based document markup standard that specifies the structure and semantics of “clinical documents” for the purpose of exchange between healthcare providers and patients. It defines a clinical document as having the following six characteristics: persistence, stewardship, potential for authentication, context, wholeness and human readability.

Transport Standards

Transport standards address the format of messages exchanged between computer systems, document architecture, clinical templates, user interface and patient data linkage. Standards center on “push” and “pull” methods for exchanging health information.

• Digital Imaging and Communications in Medicine (DICOM): The standard for the communication and management of medical imaging information and related data. DICOM enables the transfer of medical images across systems and facilitates the development and expansion of picture archiving and communication systems.
• Direct StandardTM: Defines a set of standards and protocols to allow participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet. Two primary specifications are the Applicability Statement for Secure Health Transport v1.2 and the XDR and XDM for Direct Messaging.
• Fast Healthcare Interoperability Resources (FHIR®): An HL7 standard for exchanging healthcare information electronically. The basic building blocks of FHIR are “resources,” which describe exchangeable health data formats and elements. FHIR also provides standardization for application programming interfaces (APIs). FHIR provides a number of benefits and improvements as a modern healthcare standard including facilitating interoperable exchange with legacy standards, lower overhead, shorter learning curve, an ability to transmit only the necessary pieces of information, potential for patient mediated data, and an energized community of supporters and implementers.
• IHE provides a number of specifications that can be used in the exchange of health information.
• PCHAlliance co-sponsors the Personal Health Device (PHD) efforts within the IHE Devices Domain, which are focused on developing IHE profiles that leverage and build upon the Continua Design Guidelines and are also updated to support FHIR. These profiles provide guidance to implement globally recognized, consensus-based approaches to connect and test both personal and clinical devices and integrate them into health information systems. The specifications being developed support both medical devices and mainstream consumer facing apps to enable scalable interoperability of the rapidly expanding connected health ecosystem.

Privacy and Security Standards

Privacy standards aim to protect an individual’s (or organization’s) right to determine whether, what, when, by whom and for what purpose their personal health information is collected, accessed, used or disclosed. Security standards define a set of administrative, physical and technical actions to protect the confidentiality, availability and integrity of health information.

In the U.S., the Health Insurance Portability and Accountability Act (HIPAA) outlines standards that safeguard the privacy and security of protected health information.

• HIPAA Privacy Rule: Establishes national standards to protect individuals’ medical records and other personal health information. It applies to health plans, healthcare clearinghouses, and healthcare providers that conduct certain healthcare transactions electrically. The rule applies safeguards to protect the privacy of personal health information and sets limits and conditions on the uses and disclosures of such information without patient authorization. The rule also gives patients’ rights over their own health information, including the right to examine and obtain a copy of their records, and to request corrections.
• HIPAA Security Rule: Sets national standards for protecting the confidentiality, integrity, and availability of electronically protected health information. Compliance with the Security Rule was required as of April 20, 2005 (April 20, 2006 for small health plans). The rule addresses the technical and non-technical safeguards that “covered entities” must have in place to secure an individual’s electronic protected health information. Prior to HIPAA, there were no generally accepted requirements or security standards for protecting health information.

In Europe, the General Data Protection Regulation (GDPR) outlines privacy and security regulations for all processing and storage of data relating to data subjects—or people—in the European Union (EU). This regulation extends to health information and any organization that may process or store data on these subjects, meaning it has extensive reach to many organizations worldwide and related to the sharing of data across organizations.

Identifier Standards

Entities use identifier standards to uniquely identify patients or providers.

• Enterprise Master Patient Index (EMPI): A data registry used across a healthcare organization to maintain consistent and accurate data on the patients treated and managed within its departments.
• Medical Record Number (MRN): An organization specific code used as a systematic documentation of a patient’s history and care during a hospital stay.
• National Council of State Boards of Nursing ID (NCSBN ID): A unique identifier automatically generated for each registered nurse and licensed practical/vocational nurse, freely available via the Nursys database and maintained by NCSBN.
• National Provider ID (NPI): A unique 10-digit number for a healthcare provider to create a standard identification. These NPIs are included in the free NPI Registry. Object ID (OID): A globally unique ISO identifier and a preferred

Resource: https://www.himss.org