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Promoting Health Data Standards With Public Health at the Table
HL7 Trimester Meeting
Government Project Special Interest Group
September 13, 2000
Suzie Burke-Bebee, NCHS
Centers for Disease Control and Prevention
Presentation Agenda
• The case for Data Standards
• Importance of HIPAA to Public Health and Health Services Research
• Establishment of Public Health Data Standards Consortium
• Consortium accomplishments 1999-2000
• Consortium Work Plan
• Early lessons learned
The Vision
• Enhancing the comparability, quality and integrity 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
What Data Standards?
• Uniform or core data sets– Standard Certificates for Deaths, Live Births
and Fetal Deaths– Uniform Hospital Discharge Data Set (UHDDS)– Uniform Ambulatory Care Data Set (UACDS)– Long-term care data sets– Core Health Data Elements (1996)– CIPHER
What Data Standards?
• Classifications and Terminologies– International Classification of Diseases (ICD)– International Classification of Impairments,
Disabilities and Handicaps (ICIDH)– International Classification of Primary Care– Procedure classifications (e.g., ICD, CPT-4)– Systematized Nomenclature of Human and
Veterinary Medicine (SNOMED)– Unified Medical Language System (UMLS)
Health Insurance Portability and Accountability Act of 1996
(HIPAA)
• Reimbursement
Utility of Information for Public Health and Research
• Reimbursement• Risk Adjustment• Quality Assessment• Performance
Measurement
• Outcomes Research• Monitor Health Status,
Access and Utilization• Public Health
Surveillance
Current Public Health Electronic Standards Activities
• Data Elements for Emergency Departments (DEEDS)
• Immunization messages and registries
• Laboratory findings on communicable diseases
• Standards for reporting Notifiable Diseases
• Electronic birth and death registration
Implications for Public Health and Research
• Take advantage of standardization– Comply with standards to reduce provider
burden and improve comparability of data– Influence evolution of standards to meet needs
• Seize opportunity for enhanced information capabilities
• Address challenges to data access
HIPAA Workshop: Implications for Public Health and Health
Services Research• Held November 2-3, 1998
• Sponsored by NCHS and CDC in conjunction with AHRQ and NCVHS
• Attended by 85 organizational representatives
Consensus Recommendation: Develop Public Health and Health Services Research CONSORTIUM
• Convene organizations around data standards issues Identify high priority data needs
• Seek formal representation on data content committees (NUBC, NUCC)
Consensus Recommendation: Develop Public Health and Health Services Research CONSORTIUM
• Organize representation on standards development bodies (ANSI ASC X12 and HL-7)
• Educate public health and research communities about data standards issues
• Participate in efforts to assure continued access to information
Public Health Data StandardsConsortium
Scope of Data Interests
• HIPAA claims-related data
• Birth and death data
• Disease registry and surveillance data
• Birth defects data
• Laboratory data
• ETC.
Follow-up to HIPAA Workshop
• Established Consortium Listserv to facilitate communication among members and with the public– Send e-mail to [email protected]
with the following text in the message body: SUBSCRIBE PH-CONSORTIUM-L YOUR NAME
• Established web presence: www.cdc.gov/nchs/otheract/phdsc/phdsc. htm
Follow-up to HIPAA Workshop
• First meeting of consortium convened on January 24 -25, 1999 at NAHDO meeting
• Approximately 45-50 participants• Identified organizations to participate in a
steering committee - NCHS/CDC, AHRQ, HCFA, NCVHS, NAHDO, NAPHSIS, CSTE, ASTHO, AHSR, NACCHO, AMCHP, APHL, State Medicaid Directors, cancer registries, mental health
January 1999 Meeting Discussed Next Steps
• Agreed on need for a federal and state representative on National Uniform Billing Committee (NUBC) and National Uniform Claim Committee (NUCC)
• Decided to test consensus process with consideration on listserv of two new data elements for the claim - race and ethnicity of patient and, for newborn claims, mother’s medical record number
Consortium Progress
• Business cases developed for collection of 1) race and ethnicity and 2) mother’s medical record number on claim/encounter
• Active discussion took place on the list serv
• Discussion on race and ethnicity contributed to a panel presentation at June 1999 NCVHS meeting and to HHS Data Council proposal to ANSI ASC X12 in Feb. 2000
Consortium Progress
• At February 2000 X12 meeting, 837 Work Group approved Department request to change 4031 Institutional Implementation Guide to allow collection of race/ethnicity on claim.
• At June 2000 X12 meeting, 837 Work Group, Healthcare Task Group and X12N Insurance Subcommittee all approved Consortium request to add Mother’s Medical Record Number to the 837 Standard.
Consortium Progress
• NUBC and NUCC both approved two Consortium representatives for membership – NUBC: Bob Davis (NY) State perspective and
Marjorie Greenberg (NCHS) Federal perspective
– NUCC: Walter Suarez (MN) State perspective and Denise Koo (CDC) Federal perspective
Consortium Progress
• Organized representation at trimester meetings of Standards Development Organizations– Consortium reports on activities at HL-7
through Government Special Interest Group– Public Health Caucus held first meeting at
ANSI ASC X12 on June 5, 2000
Consortium Progress
• Contract was awarded to NAHDO to identify and characterize public health and research data needs for State encounter data sets, building on HCUP survey
• Sponsored with NAHDO an educational teleconference on December 7, 1999
• Consortium members have made presentations at a variety of national and regional conferences
Consortium Steering Committee Held Meeting on March 21, 2000• 45 individuals representing a broad range of
organizations participated in a meeting of the Consortium Steering Committee on March 21, 2000
Objectives of March 21, 2000Steering Committee Meeting
• To receive and discuss presentation from NAHDO on results of its study
• To prioritize data needs identified by NAHDO and develop work plan
• To solidify Consortium organizational structure
Outcomes of March 21Steering Committee Meeting
• Organizations were asked to affirm membership on Steering Committee by naming a principal and alternate member (approximately 20 organizations have done this, including, NCHS/CDC, CDC, AHRQ, HCFA, SAMHSA, AHSR, APHL, ASTHO, CSTE, NACCHO, NAPHSIS, NAHDO,)
• Established a Planning Group to perform administrative functions of Consortium
Outcomes of March 21Steering Committee Meeting
• Established a Standing Work Group on Education
• Prioritized data elements identified in NAHDO Study
• Solicited members for ad hoc work groups to address high priority data elements and develop recommendations for inclusion or expansion in the HIPAA standard
Outcomes of March 21Steering Committee Meeting
• Ad hoc Work Groups:– External Cause-of Injury Codes– Payer Type– Mother’s Medical Record Number– Readmission and Individual Identifier– Source of Admission– Functional Status
Education Work Group
• Held two conference calls
• Established Charter with Goals to:– Develop and implement an educational strategy
that includes evaluation and feedback– Formulate a plan for developing and delivering
educational messages and materials– Communicate work products and
accomplishments of ad hoc work groups
E-code Work Group
• Held three conference calls
• Review “business case” developed by NAHDO for standardizing and expanding E-code collection in claim transaction
• Provide additional documentation on current practice, other recommendations
• Recommend next steps
Payer Type Work Group
• Held one conference call• Identified public health need for standard
coding scheme (e.g., distinguish between managed care and fee-for-service)
• Identified inadequacies of X12 code set• Considered potential of HIPAA PlanID• Agreed on process for developing public
health-focused Payer Type code set
Early Lessons Learned
• Need for education on HIPAA and data standards within the public health and research communities is considerable
• Response to Consortium concept has been very positive
• Partnership between federal and state levels is key
• There is strength in numbers
Early Lessons Learned
• Standards Development Organizations and Data Content Committees would like Public Health and Research to speak to them with one voice!
Contacts for more information about the Consortium
• Marjorie Greenberg [email protected]
• Denise Koo [email protected]
• Suzie Burke-Bebee [email protected]
• Bob Davis [email protected]
• Walter Suarez [email protected]
Resources
• http://www.ncvhs.hhs.gov• http://www.cdc.gov/nchs/otheract/phdsc/
phdsc.htm
• http://aspe.os.dhhs.gov/admnsimp
• http://www.wpc-edi.com/hipaa• http://www.hl7.org
• http://www.ansi.org
