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
–
Rene Descartes
2
When I think of all the HITSP products
 My brain hurts—so many “constructs”
 How do I grasp the power of what HITSP has done?

USHIK.ahrq.gov
3
USHIK—a National
Metadata Registry
US Health Information Knowledgebase
AHRQ-USHIK
4
USHIK—a National
Metadata Registry
 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 11179
 USHIK contains data elements from National
Interoperability Standards for
– HIPAA transactions
– Consolidated Health Informatics Domains
– Health Information Technology
Standards Panel (HITSP)
5
AHRQ-USHIK
 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
 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
6
Bridge: Normal Deck of 52 Cards
 Data element name(1 of 52):
 Attributes (Metadata):
–
–
–
–
–
–
–
–
–
–
–
Definition
Number
Suit
Odd/even
Picture card
Authority
Version or date effective
Bridge deck member
Pinochle deck member
Euchre deck member
Poker deck member
7
4 of spades
playing card
4
spades
even
No
You, or Hoyle
12-14-1917
Yes
No
No
Yes
Card Metadata Registry
 Each game master is the authority for its game’s cards
 The same card can be used in different games
 The same metadata about a card can be reused many
times, in a metadata registry
 Bridge: all 52 cards
 Euchre: 24 cards, all higher than an 8
 Pinochle: 48 cards, all higher than an 8, duplicated
 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
8
What cards are needed to play?
Bridge
Euchre
Pinochle
Deck of
52 CARDS
9
Poker
Not 176
AHRQ-USHIK Data Element
 Data Element: Gender code
 Attributes (Metadata):
– Definition
– Context
– Registration. Authority
– Effective date
– Data type
– Represent. Layout
– Value Domain
– Codes
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For eligibility, id gender of
the individual member
NCPDP Data Dictionary
NCPDP
2001-11-27
Numeric extended
X(1)
Gender, coded_VD
M (male), F (female), U
(unknown)
Comparison Matrix Aids in Harmonizing Data Elements
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www.USHIK.org
What data elements are needed for
ARRA meaningful use?
AHRQ Patient Safety
X12N
HL7
NCPDP
USHIK
12
HITSP
Do the data elements in my EHR fit
HITSP specifications?
X12N
Are My
EHR data
defined
the same
as
HITSP’s?
HL7
NCPDP
USHIK
13
HITSP
How does each authority express
gender?
X12N
HL7
NCPDP
USHIK
HITSP
Gender
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ARRA Incentive Payments to
Providers
 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
– 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
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Simple Hypothetical Diagram
Standards Recommendations for
Meaningful Use and 8 other areas
ARRA
Health providers
HHS
Secretary
CMS/ONC
ONCuse
Meaningful
definition
HIT Policy HIT Standards
HITSP
16
Simple Hypothetical Diagram
ARRA
HHS
Secretary
ONC
ONC
HITSP
HIT Policy HIT Standards
Other bodies
17
Federal
Agencies
CCHIT
Other bodies
Simple Hypothetical Diagram
ARRA
AHRQ
USHIK
HHS
Secretary
ONC
ONC
HIT Policy HIT Standards
HITSP
Other bodies
18
Federal
Agencies
CCHIT
Other bodies
Simple Hypothetical Diagram
ARRA
AHRQ
USHIK
HHS
Secretary
ONC
ONC
HIT Policy HIT Standards
HITSP
Other bodies
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Federal
Agencies
CCHIT
Other bodies
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.
 Federal agencies are similarly bound by
Executive Order 13410 (Aug. 2006) to use
standards recognized by the HHS Secretary.
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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
21
three years after the date of such adoption.
Vendors of Certified EHR Systems
 The standards and certification criteria are
forthcoming in the Federal Register by
December 31, 2009, as mandated by ARRA.
22
ushik.ahrq.gov promotes
 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
 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
 Federal agency and private sector comparisons of their
program and product data needs with HITSP data elements
23
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
 Developing new, faster data loader
 Updating SDO information: X12, NCPDP, HL7
– X12 data elements are being updated in USHIK
 4010 in the USHIK staging server now
 4050 and 5010 generic elements developed next week for
loading the following week [Thank you, Steve Bass]
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What’s New in USHIK
 X12 is taking responsibility for properly loading its data
elements into USHIK; HITSP should reference them there
 NCPDP and HL7 are proposed to follow
 **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:
– 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
26
Where is Value?
 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
 Supporting federal and private sector efforts to
match their programs and products’ data elements
with those of Federal Interoperability Standards
27
Finale
 See the HITSP Portal Information Models at
Ushik.ahrq.gov
 See also CDC’s PHIN VADS for public health data
value set information at
Phinvads.cdc.gov
28
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
USHIK Metadata Registry Contents, data elements from
 IEEE: Medical Device
 X12
Communications Industry
 ASTM
Group (IEEE/ISO 11073)
 NCPDP SCRIPT, Batch, Data
 DoD Military Health System
Dictionary
 NCVHS
 American Dental Association
 Clinical Care Classification
 HIPAA
(Nursing Taxonomy)
 HL7
 HITSP
 MHS Functional Area Model
 AHRQ Patient Safety
 Public Health Care Data
Events
Standards
 LOINC
 Other sources
30