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Transaction Standards

Health Claims or Equivalent Encounter Information

ASTM Committee E31 on Healthcare Informatics

The category/classification of this standard is: Data Content Vocabulary for Computer-Based Patient Records

The standards development organization is ASTM. ASTM is an ANSI accredited standards development organization.

Organized in 1898, ASTM (the American Society for Testing and Materials) has grown into one of the largest voluntary standards development systems in the world. ASTM is a not-for profit organization that provides a forum for producers, users, ultimate consumers, and those having a general interest (representatives of government and academia) to meet on common ground and write standards for materials, products, systems, and services. From the work of 132 standards-writing committees, ASTM publishes more that 9000 standards. ASTM headquarters has no technical research or testing facilities; such work is done voluntarily by 35,000 technically qualified ASTM members located throughout the world. ASTM provides continuing education and training in the use and application of ASTM standards through Technical and Professional Training courses. In 1987, ASTM formed the Institute for Standards and Research (ISR). The purpose of the Institute is to provide a mechanism for conducting research to improve the quality and timeliness of ASTM standards. It does no research, but serves as the intermediary between the standards-writing community and the public or private agencies that could provide appropriate research and technical services, or supply funding for such research.

Accreditation

ASTM is an ANSI Accredited by the Organization Method. All ASTM Committee E31 standards are approved as American National Standards

ASTM E1384-96 Standard Guide for Content and Structure of the Computer-Based Patient Record

Contact: Manager - Committee E31, ASTM

100 Barr Harbor Drive

West Conshohocken, PA 19373

Ph: 610-832-9500

Fax: 610-832-9666

Standard Description

This standard guide is intended to provide the framework vocabulary for the computer-based patient record content. It proposes a minimum essential content drawn from a developing annex of dictionary elements.

Elements are populated using master tables which range from standard code systems to reference tables harmonized with HL-7 Version 2.2. It calls for unique data views specified

for clinical settings. The standard contains an annex of dictionary items intended as a reference standard for designers and developers.

Functions: Implementation Independent Content Organization

Master Tables

Data Views

User Environment: Administrative And Clinical Users

Software Developers - Data Base Design

Educators - Health Informatics

Systems Environment: Does Not Specify System Environment

Evolving Standard - Ongoing Development

Most Complete CPR Content Standard

Value

There are no other standards that address the overall content vocabulary for computer-based patient records. This standard offers an initial data model intended for application in all healthcare settings. It currently serves as a reference model for vendors and institutions working to build data base content for CPRs.

Readiness of the Standard

A) This standard is a guideline that addresses policy and design. Since it offers an overall data model, users would incorporate the elements of the standard that apply to their situation. For example, requests for this standard come from designers working on the data content of the CPR. The proposed content is being used as a base data model and for data definitions.

B)This standard does not require a separate implementation guide. It should be used in conjunction with the Standard Specification for Coded Values for the Computer-Based Patient Record E1633 to achieve more specificity. Vocabulary data elements are defined in E1384, which include limited code values and pointers to E1633 for the specific master tables and code systems and values needed for the data elements. Code sets are assumed, referenced in E1633 for data elements; and harmonized with code sets in HL-7 where feasible.

C)How can the standard be obtained? ASTM standards are available through the ASTM Customer Service Department by calling 610-832-9585. Standards can also be ordered through the ASTM Web Site at www. astm.org

The standard is fully usable now as a reference guide for designers/developers of Computer-Based Patient Records.

Milestones

Milestones identified are additional content, harmonization with companion standards and joint development work on new vocabulary. The most recent ballot was in l996. Proposed revisions are already in development and updates will be balloted in l997.

Indicator Of Market Acceptance

A)If the standard is a guideline, how many copies have been requested and distributed? Approximately 2300 copies of the E31 standards have been distributed.

B)If the standard is an implementable standard, how many vendors, healthcare organizations, and/or government agencies are using it?

This type of information is difficult to obtain for the E31 standards. It is indicated where available under the document specific information to follow.

This standard is included in the ASTM l996 Book of standards made available to people who join ASTM. Currently, the membership of E31 Committee on Healthcare Informatics is over 300. Actual numbers of interested individuals who have requested this standard far exceeds the membership.

The Veterans Administration reports using this as a reference standard.

Other indicators of market acceptance include users who are currently involved in developing CPR applications within individual hospitals and hospital consortiums; vendors who are working on CPR data repository models; and CPR project planners who are in the process of defining content standards for their enterprise.

This standard is also included in a l996 publication that has been adopted by all Health Information Administration programs in the United States.

Level of Specificity

This standard is a guide. It calls for standard content expressed in a uniform manner. It does not provide data dictionary specificity. It identifies the common information framework that is part of patient records in multiple settings.

Relationship With Other Standards

As indicated, this standard depends on ASTM E1633 for specified coded values; uses some HL-7 data elements and a limited number of master tables. Ongoing analysis is performed to continue work on harmonizing elements with collaborative work, e.g. the Minimum Data Set from the National Committee on Vital and Health Statistics. Harmonization with message standards are proposed for revisions where possible. Functionality will be strengthened by coordination. Conditions assumed for coordination to be effective include joint work initiatives among standards developers and representatives from the user community who currently use this standard.

E1384 can be obtained from ASTM at:

100 Barr Harbor Drive, West Conshohocken, PA 19428

(610) 832-9500 Web Site: http://www.astm.org

Category/Classification Of The Standard

Health Claim Attachments

ASTM E1769-95 Standard Guide for Properties of Electronic Health Records and Record Systems

Contact For More Information

Manager - Committee E31, ASTM

100 Barr Harbor Drive

West Conshohocken, PA 19373

Ph: 610-832-9500

Fax: 610-832-9666

Description Of Standard

This standard defines the requirements, properties, and attributes of a computer-based patient record. It serves as an agreement among all the parties about the goals and constraints of the computer-based patient record, and provides criteria for making tradeoffs and decisions about how the record will be configured. The guide defines a computer-based record as the structured set of demographic, environmental, social, financial, and clinical data elements in electronic form needed to document the healthcare given to a single patient. It discusses how information is entered, dealing with such questions as who can enter, how is information identified, how is it validated, and who is accountable. It describes data attributes, such as permanence, accessibility, reliability, internal consistency, and security. System response time and the ability to process data are considered. Output criteria are addressed, including who can access information, the level of fact detail available, customization of display, multimedia outputs, and export to other systems. The system must protect the rights of the patient to confidentiality and the rights of the care provider to privacy. The concept of connecting together various encounter records of a patient to produce a longitudinal patient record is described. Systems to implement computer-based medical records must support local clinical functions. In addition, they should also be considered nodes of a national clinical network. The data content of the records must meet the needs of all legitimate users, such as payers, regulatory agencies, public health workers, researchers, and quality of care/outcome studies personnel. The records must be mobile and accessible to all authorized users. This ensures easy transport of records when patients move or change care providers. It also permits the extraction of billing, monitoring, and research data into other computer systems. Full logical compatibility among data banks is essential for these purposes.

Readiness Of Standard

The standard is published and is an American National Standard. How can the standard be obtained? ASTM standards are available through the ASTM Customer Service Department by calling 610-832-9585. Standards can also be ordered through the ASTM Web Site at www. astm.org

Indicators Of Market Acceptance

Approximately 2300 copies of the E31 standards have been distributed.

A wide variety of vendors are implementing EHR systems. The standard describes many of the features which are being incorporated into these systems and includes many features which have yet to be implemented by vendors. There has been no feedback to the standards committee from vendors indicating any objection to the features described in the standard other than the technical difficulty of achieving some of the functions described therein.

Level Of Specificity

The standard describes EHR functions at a functional level. It makes no attempt to recommend a specific implementation strategy but rather attempts to outline how the various functions described can interact to provide a functional EHR.

Relationship With Other Standards

Related ASTM standards, notably E 1384, provide information on topics such as the data elements which should be included in an EHR system. Numerous additional standards such as HL7 for data exchange and various coding schemes to determine data content are also relevant.

Identifiable Costs

The cost to implement this standard depends heavily on the technology and methodologies chosen by a specific vendor.

Category/Classification Of The Standard

Health Claim Attachments

ASTM E1633-95 Standard Specification for Coded Values Used in the Computer-Based Patient Record

Contact For More Information

Manager - Committee E31, ASTM

100 Barr Harbor Drive

West Conshohocken, PA 19373

Ph: 610-832-9500

Fax: 610-832-9666

Description Of Standard

This specification identifies the lexicons to be used for the data elements identified in the Annex portion of Standard E1384, Guide for the Content and Structure of the Computer-Based Patient Record. It is intended to unify the representations for (1) the identified data elements for the computer-based patient record, (2) data elements contained in other standard statistical data standards, (3) data elements used in other healthcare data message exchange format standards, or (4) in data gathering forms for this purpose, and (5) in data derived from these elements so that data recorded in the course of patient care can be exchangeable and provide consistent devel0pment of CPR content vocabulary that can also provide an accurate source for statistical and resource management data. Code values are specified using master tables which range from standard code value sets identified directly for the data element to standard code systems such as ICD9 to reference tables harmonized with HL7 Version 2.2. It promotes consistent data views specified for clinical settings. The standard is intended as a reference standard for designers and developers.

Functions: Implementation independent content organization

Identifies data representation for vocabulary elements

Includes an initial catalog of coded value sets

References known mater tables

User Environment: Administrative and clinical users

Software developers - data base design

Educators - health informatics

Systems Environment: Does not specify system environment

Evolving standard - ongoing development is focused on alignment with value sets used in companion standards

Value: Provides the 2nd edition of detailed representation for the listed data

elements contained in the vocabulary content in Standard ASTM E1384. It currently serves as a reference model for vendors and institutions working to build data base content for CPRs.

Readiness Of Standard

This standard is a specification that addresses data structure and data dictionary design. Since it combines with E1384 to offer an overall data model, users would incorporate the elements of the standard that apply to their situation. Requests for this standard come from designers working on the data content of the CPR. The proposed content is being used as a base data model and for data definitions.

This standard does not require a separate implementation guide. It should be used in conjunction with the Standard E1384. Vocabulary data elements are defined in E1384, which include limited code values and point to this specification for the specific delineations for the data form, coded values to be used in representing the element and where appropriate, and more formally identified master tables and code systems needed for the data elements. Code sets are assumed, referenced in E1633 for data elements and harmonized with code sets is ASTM Standards E 1238, E1239 and HL7 where feasible.

The standard is fully usable now as a reference guide for designers/developers of computer-based patient records.

Milestones identified are continued code value expansions, harmonization with companion standards and joint development work on new vocabulary. The most recent ballot was 1996. Proposed revisions and updates will be balloted in early 1997.

The standard is published and is an American National Standard. How can the standard be obtained? ASTM standards are available through the ASTM Customer Service Department by calling 610-832-9585. Standards can also be ordered through the ASTM Web Site at www. astm.org

Indicators Of Market Acceptance

Approximately 2300 copies of the E31 standards have been distributed.

The Veterans Administration reports using this as a reference standard. Other indicators include users who are currently involved in developing CPR applications within individual hospitals and hospital consortiums; vendors who are working on CPR data repository models; and CPR project planners who are in the process of defining content standards for their enterprise.

This standard is also included in a 1996 publication that has been adopted by all Health Information Administration programs in the United States. Another text due out in 1997 on data dictionaries for healthcare recommends usage of this specification in conjunction with E1384 for constructing data dictionaries in healthcare organizations.

Level Of Specificity

This standard calls for content to be expressed in a uniform manner. It does provide some data dictionary specificity. It identifies the common representation for data to be part of computer-based patient records in multiple settings.

Relationship With Other Standards

As indicated, this standard is written to provide the detailed specificity to ASTM E1384 for specified code values. Major work on this standard continues to be comparison and reconciliation with other standards and evolving data sets such as the Minimum Data Set from the National Committee on Vital and Health Statistics; and the National Provider Identification efforts underway in the Health Care Financing Administration. Harmonization with message standards and data element values included in X12 are proposed for revisions where possible. Functionality will be strengthened by coordination. Conditions assumed for coordination to be effective include joint work initiatives among standard developers and representatives from the user community who currently use this standard.

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