# Presentation: 809989

## Improving the Population’s Health Through Standards

- National Center for Health Statistics
- 2002 Data Users Conference
- July 16, 2002
- Data Policy and Standards Staff
- National Center for Health Statistics
- Centers for Disease Control and Prevention

## Presentation Agenda

- The Case for Data Standards
- National Committee on Vital and Health Statistics
- Marjorie S. Greenberg
- Clinical Modification of ICD-10
- Dr. David Berglund
- International Classification of Functioning, Disability and Health (ICF)
- Dr. Paul Placek
- Public Health Data Standards Consortium
- Suzie Burke-Bebee

## Lessons from September 11

- The unimaginable can happen
- Our information systems are inadequate
- There’s some urgency
- We have to do it right

## Doing it RightIncludes Data Standards

- Essential Building Blocks of Information Systems
- Classification Systems and Terminologies (e.g., ICD, ICF, SNOMED)
- Core Data Sets (vital statistics, hospital discharge data)
- Identifiers (provider, plan, individual)
- Message formats (e.g., HL-7 and X12)
- Implementation Guides
- Privacy and Security

## The Case for Data Standards

- Data Standards are the common language that allows:
- sharing information
- communication across disciplines
- integration of disparate data systems
- comparisons among data sets
- linkage of data in a secure environment

## The Case for Data Standards

- Data Standards are the fundamental building blocks for :
- an effective and efficient health care system
- disease surveillance
- monitoring the health and health care of the nation
- performing outcomes research
- providing information for decision
- 	making and policy development

## The Vision

- Enhancing the comparability, quality, integrity and *utility* of health information from a wide variety of public and private sources - at the local, national and international levels - through more uniform data policies and standards

## The Challenge

- Participate in the standards development process
- Influence evolution of standards to assure that they meet the needs of public health, health services research and health policy
- Comply with standards to reduce provider burden and improve comparability of data
- Seize the opportunities for enhanced information capabilities provided by standardization

## Standards Momentum

- Congress passed and has reaffirmed commitment to Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification Provisions
- National Committee on Vital and Health Statistics (NCVHS) is promoting standards in PMRI, NHII, 21st century health statistics and other reports
- Public Health Data Standards Consortium established in 1999 and continues to grow in membership and scope

## Standards Momentum

- National Electronic Disease Surveillance System (NEDSS) developed and is model for bioterrorism grants
- NCHS and States reengineer vital records
- State Medicaid agencies embrace standards
- eHealth Initiative launches Public-Private Partnership

## Brief Introduction to Data Policy and Standards Staff

- Classifications
- Executive Secretariat for National Committee on Vital and Health Statistics
- Informatics and the Public Health Data Standards Consortium

## Classifications Activities

- Maintain ICD-9-CM and develop and implement ICD-10-CM
- Revise and implement International Classification of Functioning, Disability and Health (ICF)
- WHO Collaborating Center for the Family of International Classifications for North America
- Departmental representative to SNOMED Editorial Board
- Co-Chair HIPAA Implementation Team on Coding and Classification
- http://www.cdc.gov/nchs/icd9.htm

## WHO Collaborating Centres for International Classifications 

- ICD and ICF are maintained and promoted by an international network of WHO Collaborating Centres for the Family of International Classifications
- Centres are established by language and geography; North American Center was established at NCHS in 1976
- http://www.who.int/whosis/icd10/collabor.htm

## The WHO Family of International Classifications

**Associated Products**   **Main Classifications   Adaptations**

## National Committee on Vital and Health Statistics (NCVHS)

- Established in 1949
- Legislatively authorized since 1974
- Advisory to Secretary of HHS on national health information policy
- History of involvement in
- classifications
- uniform and core data sets
- surveys, vital statistics, population-based data
- data for populations at special risk
- http://www.ncvhs.hhs.gov/

## National Committee on Vital and Health Statistics

- Advises DHHS on implementation of the Health Insurance Portability and Accountability Act (HIPAA) administrative simplification provisions
- Administrative standards
- Transactions
- Code sets
- Identifiers
- Security
- Clinical standards
- Privacy rule
- http://aspe.hhs.gov/admnsimp/

## Informatics and Public Health Data Standards Consortium

- Represent NCHS at Standards Development Organizations (HL-7 and ANSI X12) and Data Content Committees (e.g., NUBC)
- Participate in HHS Data Council and its Health Data Standards Committee
- Founding members and “secretariat” for Public Health Data Standards Consortium

## Public Health Data StandardsConsortium (PHDSC)

- Outgrowth of consensus recommendation at November 1998 “Workshop on Implications of HIPAA for Public Health and Health Services Research”
- A coalition of 37 organizations committed to the promotion of data standards for public health and health services research

## NCVHS Standards Visions

- Report on National Health Information Infrastructure
- Standards for Patient Medical Record Information
- Vision for 21st Century Health Statistics
- Report on Classifying and Reporting Functional Status

## NCVHS Report on a National Health Information Infrastructure

- We as a nation have a timely opportunity and an urgent need to build a twenty-first century health support system—the national health information infrastructure (NHII).
- Final report, _Information for Health: A Strategy for Building the NHII_, was approved in November 2001

## NCVHS Report on a National Health Information Infrastructure

- NHII includes not just technologies but values, practices, relationships, laws,  **standards**, systems and applications that support all facets of individual health, health care, and public health
- It is not a centralized data base but an infrastructure
- Broad goal is to deliver information to individuals when and where they need it

## NCVHS Report on a National Health Information Infrastructure

- Equal importance is attached to personal (consumer), healthcare provider (clinical) and population health dimensions
- The recommended strategy gives the U.S. Department of Health and Human Services a key leadership role at the center of a broadly collaborative process for the public and private sectors

## Standards for Patient Medical Record Information (PMRI)

- HIPAA required NCVHS to study issues and report to Secretary by August 2000 on recommendations and legislative proposals for
- Uniform data standards for patient medical record information
- Electronic exchange of such information
- Premise of NCVHS 2000 report:  Capture clinically specific data once at the point of care and derive information for every other legitimate use from those data

## Standards for Patient Medical Record Information (PMRI)

- NCVHS held hearings on message format standards in 2000-2001 and issued specific recommendations in February:
- Recognize HL7 as core PMRI standard
- HL7 versions 2.2+ are current standard
- HL7 version 3 is emerging standard
- Recognize DICOM, NCPDP SCRIPT and IEEE 1073 as standards for specific market segments
- Vocabulary standards will be next

## Vision for 21st Century Health Statistics

- Collaborative project of NCVHS, NCHS and HHS Data Council; interim report issued June 2000
- Final vision includes ten guiding principles and an overarching conceptual framework
- Compatible standards serving multiple purposes is one of guiding principles
- NCVHS has approved recommendations for implementing principles and framework

## Addressing a Gap:  NCVHS Report on Functional Status

- Issued report in June 2001, based on 18-month long review and hearings
- Recognized significant value of functional status information in clinical and administrative records
- Identified International Classification of Functioning, Disability and Health (ICF)
- 	as only viable candidate for a code set to classify functional status, using a common language (i.e., standard)

## Report Findings and Recommendations

- Health care and health policy must go beyond a narrow disease-based focus
- ICF is a promising approach to coding functional status and deserves careful study
- Thorough work is needed before recommendations are made about widespread implementation of ICF
- A special issue of *Health Care Financing Review *is being planned on the topic

## Resources

- _[http://www.cdc.gov/nchs.icd9.htm](http://interdev2.nchs.cdc.gov/nchs/)_
- _[http://](http://www.ncvhs.hhs.gov/)__[www.ncvhs.hhs.gov](http://www.ncvhs.hhs.gov/)_
- _[http://www.cdc.gov/nchs/otheract/phdsc/phdsc.htm](http://www.cdc.gov/nchs/otheract/phdsc/phdsc.htm)_
- _[http://](http://interdev2.nchs.cdc.gov/nchs/)__[aspe.os.dhhs.gov/admnsimp](http://interdev2.nchs.cdc.gov/nchs/)_
- _[http://www.hl7.org](http://www.hl7.org/)_
- _[http://](http://www.ansi.org/)__[www.ansi.org](http://www.ansi.org/)__[/](http://www.ansi.org/)_
- _[http://www.wedi.org](http://interdev2.nchs.cdc.gov/nchs/)_