Healthcare Data Standards: Codes and Exchange Formats

Posted in Healthcare

In the intricate landscape of healthcare, data standards play a pivotal role in ensuring interoperability, accuracy, and efficiency. From standardized codes that streamline medical billing to structured document formats that facilitate seamless information exchange, the realm of healthcare data standards is vast and essential. According to a 2018 RAND Corporation strategy, adopting interoperable health data standards results in savings between $7 billion and $34 billion.

This blog delves into the significance of codes, documents, and exchange formats in healthcare, shedding light on their impact on patient care, operational workflows, and the broader healthcare ecosystem. Whether you want to learn how to start a healthcare business or educate yourself with healthcare data standards, this is the right place to be. 

Why Are Healthcare Data Standards Important?

Patient data is essential and sensitive. It is used to understand a patient’s condition, develop treatment plans, and prescribe medicines. Ensuring this data is safely transmitted requires adherence to specific guidelines and regulations. 

Using data standards in healthcare results in the following:

• Better patient coordination between different healthcare providers. Hospitals, clinics, and specialists can accurately and safely share patient information, giving everyone a clear picture of the patient’s condition.
• Healthcare Data standards ensure patient data is transmitted and stored safely. This prevents unauthorized access to data or errors due to misinterpretation. The last thing a patient needs is for their data to be misinterpreted. 
• Using standardized data standards helps researchers combine data from different sources for better research. These researchers can make more significant breakthroughs with more primary and secondary data.
• A standardized data format streamlines data exchange, saving time and money on integrations and conversions. Industry-wide standardization also removes any language barriers that slow down conversions.

This section should answer why are data standards important in healthcare. There is extensive coverage of the most common data collection standards used in healthcare industry. 

Healthcare Data Standards Protect Sensitive Information

Patient information contains personal information (diagnosis, medication, names, addresses). Healthcare data integration standards safeguard this information, ensuring it is confidential and secure. 

Here, we address how data interchange standards in healthcare ensure data security and the importance of protecting said data. The most obvious ways include:

• Regulating access controls to ensure only authorized people have access to patient information. This prevents data breaches and other unauthorized access.
• Leveraging encryption standards for sensitive information so it is stored and transmitted safely. Both situations keep the data in unreadable form unless appropriately accessed. 
• Keeping data access and modification logs that ensure data integrity and security are maintained. Knowing every step is logged keeps prying eyes at bay and data safe.

Healthcare data exchange standards are essential because of the consequences if data gets into the wrong hands. The most common consequences include:

• Heightened risk of identity theft, financial loss, or reputation damage if sensitive data (medical records, social security number) gets into the wrong hands. 
• Not adhering to data healthcare data standards could lead to legal consequences. Fines and bans could be imposed depending on which regulation was violated in a particular region. 
• You could lose trust in your organization as an unreliable and untrustworthy entity, resulting in lost business and legal complications. 

Protecting patient data is paramount at all times. Using the proper healthcare data quality standards ensures all rules and regulations are followed. The short—and long-term benefits of healthcare data standards in the healthcare industry include patient and public trust and data security. This next section is a list of data interchange standards in healthcare.

Key Standard Developers and Types of Healthcare Data Standards

There are several key players in healthcare data collection standards. The most essential data standard organizations include:

• Health Level Seven (HL7) to develop electronic exchange standards. They help transmit lab results, prescriptions, and discharge summaries, among other things. 
• LOINC (Logical Observation Identifiers Names and Codes) was developed to develop universal codes for lab tests and medical observations. 
• SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) provides the correct terminology for medications, diagnoses, procedures, body structures, etc. 
• The American Medical Association (AMA) is tasked with developing CPT codes for doctors and other healthcare providers to use in medical procedures. 

This isn’t the complete list, along with several other standard developers focusing on various healthcare disciplines. These data exchange standards in healthcare are segmented into terminology, content, and transport. Examples of data standards in healthcare include:

Terminology Standards

There are eight terminology standards to know of. These are:

ICD-10-CM Codes for Diagnoses (International Classification of Diseases, Tenth Revision, Clinical Modification) 

ICD-10-CM is used to assign a standard code to a symptom or diagnosis. It follows a hierarchal structure to classify signs, symptoms, and diseases using alphanumeric codes (for example, B23 for kidney stones). 

The ICD-10-CM code is the diagnostic reporting standard used by various healthcare providers. It helps with precise medical billing and insurance claims, facilitating significantly improved healthcare research and public health surveillance. 

CPT Codes for Medical Procedures (Current Procedural Terminology)

CPT codes are used to identify procedures done by doctors. A five-digit numeric code is used to classify various surgical, medical, and healthcare processes and services. Each code is categorized by procedure type, and the AMA updates the body system annually. 

For example, combining cloud-based veterinary practice management software and CPT codes for medical procedures ensures consistent reporting for doctors’ medical procedures. These codes streamline billing and insurance claim filing, making it easier to analyze healthcare data. 

HCPCS Codes for All Kinds of Health-Related Services (Healthcare Common Procedure Coding System)

The HCPCS codes are used for several healthcare processes, including ambulance services, durable medical equipment, some medications, and physician procedures. For various purposes, an alphanumeric code is used instead of CPT codes. The Centers for Medicare and Medicaid Services maintain these HCPCS codes.

The benefits of HCPCS codes include the following:

• Using standardized codes across several healthcare services.
• Creating accurate billing for non-physician services 
• Being able to track healthcare resource usage. 

CDT Codes for Dental Treatment (Current Dental Terminology)

A CDT code is the standardized code used in dental procedures and services. The American Dental Association (ADA) develops and maintains these codes. Each code is categorized by treatment type (tooth extraction, fillings, root canal). 

CDT codes are the standardized dental codes used in billing and communication. Using a CDT code with dental practice management software helps ensure accurate insurance claims are filed, resources are allocated, and dental care trends are studied. 

SNOMED CT Codes for Clinical Information (Systematized Nomenclature of Medicine – Clinical Terms)

The SNOMED CT codes systematically name all medical terms (procedures, diagnoses, medications, etc.). Various codes exist for terminologies, hierarchical structures, and definable relationships between multilingual support and concepts. 

A SNOMED CT code has significant details, allows smooth data exchange, reduces coding burdens, facilitates advanced analytics, and fosters global communication. It extends beyond codes, being a common language for the intricacies of patient data.

LOINC Codes for Lab Orders and Results (Logical Observation Identifiers Names and Codes)

LOINC codes translate lab tests and other clinical observations. Each test has a unique code with comprehensive coverage. Additionally, it links test names to their specific procedure to ensure lab test requests and results come through effortlessly. 

Using LOINC codes removes barriers between healthcare providers and testing labs, resulting in better and clearer data transmission. LOINC codes also ensure that different users speak the same language regarding the many lab tests available. 

NDC Codes for Pharmacy Products (National Drug Code)

An NDC is used to identify different medications, drugs, and pharmaceutical products in the US. Each component is assigned a ten-digit numeric NDC with labeler, product, and package size sections.

The Food and Drug Administration (FDA) assigns and maintains various NDCs to ensure accurate drug tracking and identification. These NDCs make monitoring drug dispensing patterns and potential drug shortages easier and prevent medication errors. 

RXNORM Codes for Clinical Drugs

An RXNORM code is used to standardize medication nomenclature. The US National Library of Medicine maintains RXNORM codes linking generic and branded drugs to a single concept. 

Using RXNORM codes comes with several benefits. These include:

• Additional clarity in medication dispensing and prescriptions. 
• Reduced medication errors thanks to individual RXNORM codes for each medication. 
• This information can be used for better medication analysis and research.

Content Standards

There are three content standards to know of. These are:

C-CDA for Arranging Clinical Documents (Consolidated Clinical Document Architecture)

The C-CDA architecture is a document exchange standard for patient care plans, discharge summaries, progress notes, and similar documents. It defines the document format and structure to ensure consistent terminology. 

C-CDA helps improve care coordination by making it easier to share different clinical documents. This allows patients to engage with their medical records and streamlines data transfer with their healthcare providers. 

HL7 Version 2 and 3 for Packaging Data (Health Level Seven)

The HL7 standard ensures a secure electronic exchange of patient health information. HL7 v2 and v3 meet different data exchange requirements. HL7 v2 is used for messaging on specific transactions (medication orders, lab results). HL7 v3 is used for broader information exchange. 

HL7 standards help streamline workflows by reducing errors due to misinterpretations and improving data integration between healthcare information systems. This significantly enhances interoperability for doctors, patients, and healthcare organizations. A Journal of the American Medical Informatics Association study showed that better data-sharing practices curbed disease outbreaks by up to 50%.

USCDI for Specifying Electronically Available Content (Unified Social Care and Disability Instrument)

USCDIs are standardized elements used to specify social care and disability information. They focus on various social determinants of functional abilities, social care needs, and overall health. 

Using USCDI helps improve communication between social care providers and healthcare providers. Patients with complex needs get better support thanks to a holistic view of their situations.

Transport Standards

There are five transport standards to know of. These are:

FHIR for Patient Access to Medical Records (Fast Healthcare Interoperability Resources)

The FHIR standards are used for all web-based API-related healthcare data transmission. They use data elements from different clinical concepts, simplifying flexible data exchange for specific use case scenarios. 

Using FHR standards lets patients access medical records using patient portals. This process simplifies data transfer between EHR systems and healthcare applications, reducing friction and improving efficiency. If developing a medical app or building your app hospital is on your to-do list, keep FHIR in mind. 

DIRECT for Exchanging Personal Health Information 

DIRECT is a healthcare security exchange specific for medication, lab results, care summaries, and other medical documentation. It leverages existing messaging protocols for smoother data transmission between patients and their healthcare providers. 

Using DIRECT creates safer and faster health information exchange. Patients can actively manage their healthcare using improved communication with their doctors. 

DICOM for Transmitting Medical Images (Digital Imaging and Communications in Medicine)

The DICOM standards are used for medical image transmission. X-rays, CT scans, and MRIs are shared electronically, following a defined image file format. DICOM standards allow different imaging software and systems to work together effortlessly. 

DICOM standards significantly improve medical image transmission. A unified imaging standard benefits consultations, referrals, and telehealth. 

SCRIPT for Electronic Prescribing  (Secure Prescription Interconnect)

The SCRIPT data standards are used with electronic medication prescriptions between pharmacies and healthcare providers. SCRIP reduces prescription errors and fraud with secure electronic data interchange. This eliminates issues thanks to paper prescriptions (confusing writing, modifications)

SCRIPT streamlines prescriptions for pharmacies and doctors alike. Additionally, it ensures patients get the right medicine in the prescribed amount – nothing more, nothing less. 

CDISC for Medical Research Data Exchange (Clinical Data Interchange Standards Consortium)

The CDISC standard outlines how to exchange clinical research data with a common data elements language. It provides clear definitions for clinical trials, data collection, and analysis so researchers know the correct standards to adhere to.

Safely transmitting clinical research data is imperative for researchers making medicinal advancements. CDISC standards facilitate collaboration between pharmaceutical companies and clinical researchers, making better research possible. 

Privacy and Security Standards

There are two healthcare data security standards to work with. Here they are:

HIPAA for Health Data Across the US (Health Insurance Portability and Accountability Act)

The most well-known member of this list, HIPAA standards protect patient information in the USA. It outlines specific instructions for privacy, data security, and patient access to relevant medical records. 

The HIPAA standards protect patient data through robust handling of patient health information. This puts the patients in control of their medical records, giving them a more active role in managing their healthcare. 

GDPR for Health Data Across the EU (General Data Protection Regulation)

The EU uses GDPR as its data privacy and protection regulations. The GDPR allows individuals to access, amend, and delete personal data. Thanks to GDPR, organizations need user consent before collecting and processing data. 

GDPR ensures EU citizens retain control over personal data, including healthcare data. This is a step in the right direction for data handling accountability and transparency. 

Health Data Standards Challenges and Possible Solutions to Them

Data standards in healthcare are very important. However, they are not without challenges. The most common issues include:

Medical Coding Speed and Accuracy Issues

Manually assigning complex codes to medication, equipment, and procedures takes time and effort. However, potential solutions include:

• Using natural language processing tools to generate automated code suggestions using clinical notes.
• Using voice recognition for faster data entry by having clinicians dictate procedures and diagnoses. 
• Templates and decision support systems that reduce eros and help pick the correct code. 

Need for Mapping Between Codes

There are often variations between various coding systems. The differences hinder data exchange, slowing the entire process. Developing concrete code mapping tools to translate between different coding systems can solve data exchange issues. 

Lack of Compatibility Between Old and New Standards

Legacy systems often struggle to adapt to new healthcare data sets and standards, creating various integration challenges. The solution is phasing the new system into pieces. Leveraging backward compatibility features and integrating one phase at a time facilitates a smooth transition from old to new systems.

Conclusion 

Data standards in healthcare are essential for improving patient care quality, safety, and efficiency. By implementing standardized codes, documents, and exchange formats, healthcare organizations can facilitate seamless communication and data exchange, ultimately leading to better patient outcomes.

As healthcare technology evolves, staying up-to-date with the latest data standards and best practices is crucial. By doing so, healthcare providers can ensure they deliver the best possible care to their patients while complying with regulatory requirements. In summary, data standards in healthcare are not just a technical issue but a critical component of high-quality patient care. This blog should have all the answers for what are data standards in healthcare and then some.

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