Standards

Resource Links

Standards Pocket Reference Guide

  • HL7 (Health Level 7), the standard for electronic interchange of clinical, financial and administrative info among healthcare oriented computer systems. A not-for-profit volunteer organization, it develops specifications, the most widely used of which is the messaging standard that enables disparate health care applications to exchange key sets of clinical and administrative data.
  • CCD (Continuity of Care Document), Prior to the approval of the CCD as an ANSI Standard in 2007, electronic clinical document exchange could utilize one of two formats: HL7 Clinical Document Architecture (CDA) or ASTM Continuity of Care Record (CCR). In an effort to combine the two closely related formats, the Continuity of Care Document was created. CCD harmonizes the two separate standards by using CCR within the broader context of CDA. It shares summary information about the patient in an easy-to-read format, using CCD templates to constrain the data. The information can be read by the human eye or processed by a machine (such as an EMR system), and can be sent electronically or manually carried by the patient.
  • NCPDP Script (National Counsil for Prescription Drug Programs), the SCRIPT document was developed for transmitting prescription information electronically between prescribers, providers, and other entities. The standard addresses the electronic transmission of new prescriptions, changes of prescriptions, prescription refill requests, prescription fill status notifications, cancellation notifications, relaying of medication history, and transactions for long-term care.
  • X12 v.4010A1, the standards provide structure for the electronic representation of health care claims between entities. The standards provide a means to encode business documents so that they may be interpreted by a computer application. The documents are organized as delimited data, meaning data is separated by “delimiter” characters rather than by fixed length fields and records. The standards provide means to organize this data into business documents called Transaction Sets, group these into groups of related documents called Functional Groups, and wrap these in an envelope called an Interchange.
  • QRDA (Quality Reporting Document Architecture), an electronic data standard for healthcare information systems to use in communicating patient level quality measurement data across disparate systems.
  • GIPSE (Geocoded Interoperable Population Summary Exchange, formerly AMDS, Aggregate Minimal Data Set), a simple web-enabled user interface (UI) that will allow public health professionals to select biosurveillance services that adhere to the AMDS.
  • NQF (National Quality Forum), a nonprofit organization that aims to improve the quality of healthcare for all Americans through fulfillment of its three-part mission, Setting national priorities and goals for performance improvement; endorsing national consensus standards for measuring and publicly reporting on performance; and promoting the attainment of national goals through education and outreach programs.

Vocabulary Standards

  • SNOMED CT (Systematized Nomenclature of Medicine — Clinical Terms), used for clinical problems and procedures. It is a systematically organized computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, pharmaceuticals etc. It allows a consistent way to index, store, retrieve, and aggregate clinical data across specialties and sites of care. It also helps organizing the content of medical records, reducing the variability in the way data is captured, encoded and used for clinical care of patients and research.
  • UNII (Unique Ingredient Identifier),used for ingredient allergies. The UNII is a non- proprietary, free, unique, unambiguous, non semantic, alphanumeric identifier based on a substance’s molecular structure and/or descriptive information.
  • LOINC (Logical Observation Identifiers Names and Codes), used for Lab tests. facilitate the exchange and pooling of clinical results for clinical care, outcomes management, and research by providing a set of universal codes and names to identify laboratory and other clinical observations.
  • UCUM (Unified Code for Units of Measure), used for units of measure. A code system intended to include all units of measures being contemporarily used in international science, engineering, and business. The purpose is to facilitate unambiguous electronic communication of quantities together with their units. The focus is on electronic communication, as opposed to communication between humans. A typical application of The Unified Code for Units of Measure are electronic data interchange (EDI) protocols.

Administrative Terminology

  • CAQH (Council for Affordable Quality Healthcare), an unprecedented nonprofit alliance of health plans and trade associations, is simplifying healthcare administration through industry initiatives.
  • CORE (Committee on Operating Rules for Information Exchange), a multi-stakeholder initiative created, organized and facilitated by CAQH. The operating rules enable healthcare providers to quickly and securely obtain reliable healthcare eligibility and benefits information, Check claim status transactions and receipts electronically.
  • HIPAA (Health Insurance Portability and Accountability Act), the Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

Legacy and Proprietary Coding