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Index - Major Sections
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IntroductionThis section was to be an introduction on Coding, however, it was so detailed that I decided to put only a brief introduction in this section and a downloadable paper. HistoryIn many cases, the International coding standards where design years ago for a paper base system and for a single purpose, that of being able to communicate the information to another individual.
Today, many of these International coding systems simply do not work with computer systems and data analysis. Examples include both the ICD10 codes...mostly...and the SNOMED codes which do not work at all. The CPT codes are adapted for US use.
Therefore, InHCc is adapting many of the coding systems to ones that can be used in an Analysis System with Data mining. The InHCc coding system is atomic where there is only one concept. Attributes or modifiers of the Concept are coded separately.
The InHCc Coding system will be mapped to the Original Codes when ever possible. The InHCc HMIS system itself provides the ability to change Coding systems as required.
Standards Develop Organization (SDO). Organizations that develop and maintain the models, data dictionaries, structure, syntax, and implementation materials for electronic transaction standards between and within providers. All designated SDOs maintain policies that meet the requirements of the American National Standards Institute (ANSI), which accredits standards committees and provides an open forum for participants to identify, plan and agree on standards an assurance of due process
Hierarchical Structure
The Coding structure of many "standards" and "classification" systems attempt to create "hierarchical structures." In fact, hierarchical structures are cultural sensitive, dependant on the specialty, dependant on what is popular at the moment, and so on....An example of this is the ICD codes and the SNOMED codes that seem to change with the weather. All of these systems attempt to do little more than to "classify" labels, and yet translations between them is almost impossible.
The requirement for healthcare communication and analysis is that the "atomic" value (at the lowest granularity) be recorded and any hierarchical schema can be can be created on this base as needed. Hierarchical classification systems can then be mapped to other systems.
There will be higher order hierarchical "classes" such as disease, anatomic sites, and others as outlined in this web site. "Subclasses" can also be created in some classes, but there is no automatic requirement. After that, each individual Standards Organizations can create what ever classes they want as long as it is mapped to the atomic (lowest granular term).
Requirements are:
It seems that everyone is getting into the Measuring Business. It is difficult to keep up with all the "Standards" that are now being developed. At first, I was going to write up a short summary of each standard...I cannot do it...do not have the time...Thererfore as I find them, I will add them to the page...or if you see one that I need, please email me...and thanks in advance. When viewing these indicators, it is very important to determine how to use these indicators;
Several Organizations have developed "Indicators" for "Monitoring and Evaluation" [not for management]. These core Indicators for the various organizations are listed below. Standardization of DataThe benefits of forcing standardization may be one of the key benefits to the proposed system. Today, organizations are attempting to maintain their different information systems independent of others. With the data warehouse, this is still possible and at the same time have standardization through the data warehouse. Inside of attempting to adapt these legacy systems to work with one another, it is far easier and cheaper, to have these systems upload all their information to a centralized server. Only one interface is needed and that is a very simple process. (See section on Standardization)
Language and Medical Vocabulary Health care professionals (HCP) often use a rich and varied vocabulary to describe events relating to the direct care of the client. In most cases this information is not needed by other HCP’s, management or research. For example, a sketch of a jagged wound may not be useful to anyone other than the direct care giver during the care of the client. After the care is given the text or the drawing is not needed or used by the care given. Only information that can be coded for searching or manipulation is historically useful. Drawings may still be used as a means of communication to the client, but these drawing may be based on templates developed for this type of communication (more effective than the HCP’s free hand “work of art!) And they are easily printed from a computerized list. Although the InHCc system provides the ability for the local user to describe these events for his or her use, it is not “coded” and may or may not be stored in the historical database in text form. The event of giving to the client the health care drawing or instructions can be recorded in the client’s file without the need to historically store the document itself. The InHCc system codes events with numerical codes in order to provide for the distribution of data across organizations and international borders. There is only a very small percentage (if any) of the data that is in text form. In order to translate from one language to another, the installer develops a “Mapping” of the local language and vocabulary used by the user HCP to the “standardized” numerical data while insuring that the meaning of the terms remains the same. An example may be the simple translation of the descriptive terms male and female to the numerical numbers 1 and 2 respectively. In another location the terms muchacho and muchacha may be used as the descriptive terms. In general, InHCc attempts to use standardized world recognized coding (WHO for example) and often these codes have already been translated into a number of different languages. The InHCc system goes farther in that it also lets the local user “rewrite” the description for their own use…provided the meaning is the same. Once the mapping is preformed (using columns in Microsoft Excel) the system can automatically update all screens to the local language in a few minutes. Because most all recorded date is coded with standard coding systems, it makes it possible for one person using one language to easily read the data collected in another language. The user will simply be using his or her own mapping. The InHCc system allows for both the use of the HCP of his or her own user-friendly vocabulary while at the same time providing for the standardization required for distribution of the data for management and research. The problem with most International Coding systems is that they were developed for manual entry data and where not developed for Electronic data entry and Analysis. Today, the importance of the Electronic Health Record is the ability to Analysis and Data Mine the data. The coding systems now being develop hinders that ability. Identification StandardsThere is a universal need for healthcare identifiers to uniquely specify each patient, provider, site-of-care, and product; however, there is not universal acceptance and/or satisfaction with these systems. Personal IdentifiersThis personal identifier is a very personal piece of information that could mean that an individual can have their identity stolen. In addition, there are other nefarious individuals that provide these identifying values (duplicate or not) to individuals needing ID's to get jobs or credit. In many countries, a government identification identifier has been assigned to each individual in the country. These identifiers, have ranged from the need by the government to tract money, criminal activity, or the individual. In most all cases this has failed. In Mexico the government is attempting to develop an identifier, created with the birth date, Fathers name, Mothers name, and other fixed information. However, in this case, many individuals do not know their date of birth, or may not know their mother or fathers family name. In this case the government must resort to an arbitrary calculation. Using this "algorithm" provides too much information about the person using this calculated identifier. To much personal information is disclosed about the person. The the USA the Social Security Number (SSN) is being considered for use as a patient identifier. The critics point out that not everyone has an SSN or that several individuals may use the same SSN. While these problems can easily be fixed, the true reason may be that people just do not want to be traced. These solutions still do not solve the problem of creating a world wide unique identifier...which may only be possible by creating an identifier based on a person's DNA or other biometric identifier. Provider IdentifiersIn the USA the The Health Care Financing Administration (HCFA) has created a widely used provider identifier known as the Universal Physician Identifier Number (UPIN). The Unique Medicare Physician Identification Number (UPIN) is established in a national Registry of Medicare Physician Identification and Eligibility Records. This file contains certain data elements from the physician in order to assure accurate physician identification. The UPIN is only assigned to physicians who handle Medicare patients. To address this limitation, HCFA is developing the National Provider File (NPF). It will create a new provider identifier for Medicare, which will include all caregivers and sites-of-care. The National Provider Identifier In other countries, the government may complete lose trace of providers. Once the physician serve his or her term required by the government for sending them to medical school, the physician may be free to move or work any where within the country. In some incidences, although the physician may be assigned to a clinic in rural area, he may actually be working in the city "illegally." Site-of-Care IdentifiersIn the USA the site-of-care identifier is the HCFA's National Provider File for Medicare usage as described above. Product and Supply Labeling IdentifiersThe USA uses three identifiers that are widely accepted. The Labeler Identification Code (LIC) identifies the manufacturer or distributor and is issued by HIBCC. The LIC is used both with and without bar codes for products and supplies distributed within a healthcare facility. The Universal Product Code (UPC) is maintained by the Uniform Code Council and is typically used to label products that are sold in retail settings. The National Drug Code (NDC) also serves as an identifier and is described later in the Clinical Data Representations section. In other countries there are very few if any product identifier. While WHO has developed codes, they are not consistent or widely available. As an example, WHO has 4 data sets for drugs, and in addition, charges an outlandish price for their distribution. Using Global Unique Identifiers (GUID's)The Global Unique Identifier is a text value that is guaranteed to be unique globally. It is a value that is generate by a computer. While an individual entity (person, location, object) can be assigned more than one value by different assigning agencies, it is impossible for the same Global Unique Identifier to be assigned twice. For example, an individual person may be assigned one value in one clinic and then another value in a different clinic If data is to be assigned and distributed over a wide area of use, the GUID is the only choice. It is impossible for two identical values to be assigned. Uses of the GUIDMultinational organizations are using GUID to index and uniquely identify data. The values or not entered manually into the system but rather or chosen from a list of individual items. The GUID is automatically entered into the identifying field of data automatically...without the user even seeing the value... Technical considerations:
DiscussionAdding "Local Items" to a International standardized list of items (local symptoms, local products, etc) can be done...well...locally...without worried that the identifications will overlap with the International coding system. It is possible that an "ALL standardized coding system" can be created. Nursing Standards I am a Certified Emergency Room Nurse and Nursing has a very special role to play in health care...but
Nursing classifications have been developed to code and classify the six steps of the Nursing Process:
Or using Terminology Domains
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