What is a ‘Data Standard’?
Data standards are authority-backed, shared protocols, definitions, and formats that help to ensure efficient and accurate information exchange. Standards are a critical component of interoperability, which is the useful exchange of information between systems. Put simply, standards help computers talk to each other, understand each others’ words, form complete sentences for meaning, and keep the conversation private. For convenience, we classify health data standards as one (or more) of types:1
- Terminology Standards define data elements. Medical terms and other concepts are assigned codes rather than using the actual medical term. Codes are often much shorter than the medical term and strive to include all synonyms and alternate representations. For example, the ICD-10-CM code for Type 2 diabetes mellitus without complications is E11.9. Easy peazy, right?
- Transport Standards define the underlying electronic methods for transmitting data from one computer to another. Also known as data interchange formats, transport standards define 1) The electronic signal for requesting data, 2) the electronic signal that returns the data, and 3) what should happen if there are errors. Transport standards may also include content standards that structure the sent data in some order, or ensure that required data are present in the message.
- Content standards, document architectures, and knowledge representation are standard methods for electronically representing things that are more complex than a singe data element. These standards define collections of data elements and the relationships between them. A content standard can define something as simple as insurance claims form or as complex as the foundational model of human anatomy. Clinical guidelines and decision support rules are often represented by content standards.
- Privacy/security standards define security technology, processes, and security-specific data elements used to prevent the unauthorized access and use of healthcare data. Various privacy & security standards might protect data while it is stored, transmitted, or displayed.
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How do you pick which standard to use?
There may be more than one data standard suitable for the same purpose. You may not have a choice if your Health IT vendor, insurance clearinghouse, or other partner is aligned with a specific standard. Aside from this, there three ways for standards to become standards:
- Government mandate– Uncle Sugar says “everyone switch to ICD-10-PCS for inpatient hospital procedure coding on October 1, 2015″
- Consensus – When multiple parties agree to use a specific standard it is called a consensus standard. Consensus standards are sometimes called “voluntary standards” (especially by the government) because there is no law requiring their use. However, they might not feel ‘voluntary’ because there is no other option for your organization.
- Common conventional use (aka de facto) standards are expected because they are just the typical way to do things
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Standards Development Organizations
Standards Development Organizations (SDOs) create, maintain and distribute standards. SDO’s may be international, such as the World Health Organization Family of International Classifications or unique to the U.S. such as the American Medical Association’s (AMA) Current Procedural Terminology (CPT) codes. Although SDOs are often not-for-profit organizations, governments also have a role. The National Institute of Standards and Technology (NIST) is the US government’s cross-industry standards organization, while the Office of the National Coordinator for Health IT (ONC) is concerned with “harmonizing” US health IT standards, and more specifically curating standards that support interoperability and health information exchanges.
An SDO may have only one standard, or may have many standards across many industries and applications. In true American bureaucratic flair, even the accreditation organizations have accreditation organizations. The American National Standards Institute (ANSI) is the primary standards and conformity authority in the US.
How Standards are Developed
ANSI-accredited SDOs have similar processes for standards evaluation and development. The end-goal is a standard that is fair to all stakeholders and consensus-based. The following are some of ANSI’s principles of due process:
- Lack of Dominance
- Coordination and harmonization
- Notification (proactive communication)
- Consideration of views and objections
ONC estimates that there are more than 40 SDOs representing hundreds of standards in healthcare IT. As you learn and use specific standards, think about whether they meet the ANSI expectations of Openness, Lack of Dominance, etc.