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									                                                                         TIGER STANDARDS & INTEROPERABILITY

                                      WORKGROUP 1: Catalogue and develop an inventory of the most rele

Framing Statement: Interoperable systems are critical in order to assist clinicians in delivering sa
and patient-centered care. Clinical data standards are the essential building blocks towards intero
including Electronic Health Records (EHRs), Electronic Medical Records (EMRs), and Personal He
standards and their impact on care delivery.

Standard - A definition or format that has been approved by a recognized standards organization or is accepted as a de facto s
formats, communications protocols, and electrical interfaces.
                                                                              HIMSS Dictionary of HIT Terms 2006

A standard specifies a well-defined approach that supports a business process and: (1) has been agreed upon by a group of e
to ensure that materials, products, processes, and services are fit for their intended purpose; (5) is available in an accessible fo

Standards mean the structure and content of health care data, information, or concepts that are usefully exchanged or provide
methods used to facilitate these exchanges.
                                                                     Dr. John Halamka, Chair of the Health Information Tech
that for HITSP work

Interoperability - The ability of two or more systems or components to exchange information and to use the information that ha
                                                                              IEEE Dictionary
Interoperability means the ability of different information systems, software applications and networks to communicate and ex

The current landscape of standards does not ensure interoperability due to many factors, such as conflicts and gaps. Further, f
standards that do not traditionally fall into the commonly accepted health care standards arena (e.g., broader technology standa

Harmonization means the function of developing, reconciling, setting and maintaining standards required to achieve interoperab
                                                                              Department of Health and Human Services (HH

                                                                 Workgroup Members

First Name       Last Name          Email                                           Business Phone

Ginny            Meadows            ginny.meadows@sharedhealth.com                  770-319-7295
Carlene          Anteau             carlene.anteau@mckesson.com

Melita           Howell             mjhowell@texaschildrenshospital.org             832-824-4434

Cyndie           Lundberg           clundbe@cap.org                                 1-847-832-7673
Myrna        Mamaril      myrna.mamaril@uch.edu     720-848-0951
Carol        Petersen     cpeters@aorn.org
Virginia     Saba         vsaba@att.net             703-521-6132

Kathleen      Smith       ksmith1963@verizon.net    301-869-7428
Anna          Poker       apoker@comcast.net        301-299-6778
TIGER Support Team
Donna         DuLong      donna@tigersummit.com     303-333-3246
Elizabeth     Halley      ehalley@mitre.org         703-983-1076
Joyce         Sensmeier   jsensmeier@himss.org      312-915-9281

Pat          Walker       phintonwalker@usuhs.mil   (240) 426-8268

op an inventory of the most relevant health IT standard setting efforts and resources

 ssist clinicians in delivering safe, effective, efficient
  building blocks towards interoperable systems,
 cords (EMRs), and Personal Health Records (PHRs). It is important that nurses understand these

 ganization or is accepted as a de facto standard by the industry. Standards exist for programming languages, operating systems, data

 Dictionary of HIT Terms 2006

 ) has been agreed upon by a group of experts; (2) has been publicly vetted; (3) provides rules, guidelines, or characteristics; (4) helps
 pose; (5) is available in an accessible format; and (6) is subject to an ongoing review and revision process.

 s that are usefully exchanged or provided between and among care providers and public health authorities, and the interchange

mka, Chair of the Health Information Technology Standards Panel (HITSP), explained to the American Health Information Community

mation and to use the information that has been exchanged.
ns and networks to communicate and exchange information in an accurate, effective, useful, and consistent manner.

 s, such as conflicts and gaps. Further, for true interoperability to be realized, many standards need to be harmonized, including
 s arena (e.g., broader technology standards for data interchange).

tandards required to achieve interoperability.
ment of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC)


              Organization                    Standard Type
              Shared Health, Inc: Workgroup 1 Organizations,
              Leader                          Documentation
              McKesson                        None
                                              No longer
              Texas Children's Hospital       participating
              SNOMED Terminology Solutions Documentation
ASPAN                              Documentation
AORN                               None
CCC                                Terminology
                                   Data Exchange/
ICCE, L.L.C.                       Messaging

TIGER Initiative
The MITRE Corporation
Uniformed Services University of
Health Sciences, School of
 tand these

perating systems, data

aracteristics; (4) helps

 the interchange

ormation Community


nized, including
                                                Types of Standards

Standard Type           Definition
Data                    These standards allow transactions to flow consistently between systems,
Exchange/Messaging      as they contain specifications for format, data elements, and structure

Terminology Standards These vocabularies provide specfic codes for clinical concepts such as
                      diseases, problem lists, allergies, medications, and diagnosis that might
                      have varying textual descriptions in a paper chart or a transcription.
                      Examples of terminologies would include LOINC for lab results, SNOMED
                      CT for clinical terms, and ICD for medical diagnoses.

Standards Initiatives   What are the key standards initiatives in healthcare information technology
Standards               What organizations are involved in creating different standards used in
Development             healthcare information technology? This section will provide an overview of
Organizations           all of those organizations, and the standards they are responsible for.
Document Standards      These indicate what type of information is included in a document and
                        where it can be found. A common standard in paper medical records is the
                        SOAP format (Subjective, Objective, Assement, Plan) The CCR
                        (Continuity of Care Record) provides a standard format for inter-provider

Infrastructure          The overall framework or architecture used. This would include an
Standards               information model.
                        Gap Identified - Usability/UI Standards (There are no standards defined for
                        this area)

Braden Scale
Pain Assessment

                                                                  Date Exchange/Messaging Standard Type

Standard          Acronym   Description                                       Developer/Standard
Accredited        ASC X12   Standards to facilitate electronic interchange    http://www.disa.org/x12o
Standards                   relating to order processing, shipping,           rg/index.cfm
Committee X 12              receiving, invoicing, payment insurance
                            transactions, etc. related to the provision of
                            products and services.

Clinical Data     CDISC     Format for reporting data collected in clinical   Clinical Data
Interchange                 trials                                            Interchange Standards
Standards                                                                     Consortium
Consortium                                                                    www.cdisc.org

Common Object     CORBA      Develops object oriented interoperability        http://www.omg.org/getti
Request Broker              standards.                                        ngstarted/corbafaq.htm

CORBA           CORBA       Aims to improve adaptability and simplify the
Component Model CCM         task of writing distributed applications.

Digital Imaging and DICOM   Format for communicating radiology images         National Electronics
Communications in           and data                                          Manufacturers
Medicine                                                                      Association
Committee                                                                     www.nema.org
Health Level 7     HL7 V2.x Electronic Message Formats for Clinical,          Health Level Seven
Messaging          HL7 V3   Financial and Administrative Data. "Level         www.hl7.org
Standards, Version          Seven" refers to the highest level of the
2 and Version 3             International Organization for Standardization
                            (ISO) communications model for Open
                            Systems Interconnection (OSI) - the
                            application level. The application level
                            addresses definition of the data to be
                            exchanged, the timing of the interchange, and
                            the communication of certain errors to the
Institute of      IEE MEDIX Standard for the exchange of data between         http://aspe.hhs.gov/adm
electrical and              hospital computer systems.                        nsimp/hisbinvb.htm
Engineers P1157
Medical Data

Integrating the   IHE         IHE Profiles organize and leverage the           Integrating the
Healthcare                    integration capabilities that can be achieved by Healthcare Enterprise
Enterprise                    coordinated implementation of communication www.ihe.net
                              standards, such as DICOM, HL7 W3C and
                              security standards. They provide precise
                              definitions of how standards can be
                              implemented to meet specific clinical needs.

NCPDP SCRIPT      NCPDP       NCPDP creates and promotes standards for         National Council for
standard for                  the transfer of data to and from the pharmacy Prescription Drug
ePrescribing                  services sector of the healthcare industry. The Programs
(Version 10.0                 organization provides a forum and support
                              wherein our diverse membership can
                              efficiently and effectively develop and maintain
                              these standards through a consensus building
                              process. NCPDP also offers its members
                              resources, including educational opportunities
                              and database services, to better manage their
ssaging Standard Type
         Contact                 SME (Subject Matter Experts)   Resources
         Don Bechtel
         Foundation Enterprise
         Standards and
         Regulatory Compliance
         Chief Privacy Officer,
         65 Valley Stream
         Parkway, Malvern, PA,
         Phone: +01 610 219 1695
         Fax: +01 610 219 1655

         Rebecca Kush
         President & CEO
         Phone: 512-327-0738

         Fax: 512-327-0517
         Cell: 512-791-7612
         Email: rkush@cdisc.org

         Telephone: +1-781-444-
         Fax: +1-781-444-0320
         Email: info@omg.org


         Howard E. Clark, Ph.D.                                 http://medical.n
         DICOM Secretariat                                      ema.org/dicom/
         National Electrical                                    http://medical.n
         Manufacturers                                          ema.org/dicom/
Mark McDougall              Linda Fischetti RN MS, U.S. Department
Executive Director          of Veterans Affairs, Phone: 301-734-0417
Health Level Seven          Email: linda.fischetti@med.va.gov, Term
3300 Washtenaw              Expires on: 31-Dec-2009
Avenue, Suite 227
Ann Arbor, MI 48104-
Phone: (734) 677-7777
Fax: (734) 677-6622
Phone: +1 800 701 IEEE
(USA and Canada)
  +1 732 981 0060

Fax: +1 732 981 9667

Joyce Sensmeier VP,         Didi Davis Director, IHE, HIMSS
Informatics, HIMSS          ddavis@himss.org Audrey Dickerson ,
jsensmeier@himss.org        Manager, Standards, HIMSS

See Standards                                                          www.ncpdp.org
                                                                                            Terminology Standard Type
Standard                                 Acronym        Description

Definition: Interface vs. Reference Terminology
In simple terms, an interface terminology, commonly called point-of-care terminology, is one that is used by clinicians to record
that comparisons can be made even when different terminologies are used. Terminology used at the point-of-care is encoded b
nursing diagnosis from the North American Nursing Diagnosis Association International (NANDA I) (point-of-care terminology) c


Systemized Nomenclature of               SNOMED CT SNOMED Clinical Terms (SNOMED CT) is a dynamic,
Medicine - Clinical Terms V3             / IHTSDO scientifically validated clinical health care terminology
                                                   and infrastructure that makes health care knowledge
                                                   more usable and accessible. It provides a common
                                                   language that enables a consistent way of capturing,
                                                   sharing and aggregating health data across specialties
                                                   and sites of care. SNOMED CT is comprised of
                                                   concepts, terms, and relationships used to define
                                                   concepts precisely that represents clinical information.
                                                   SNOMED CT consists of hierarchies, e.g.: clinical
                                                   findings, procedures, observable entity, and
                                                   pharmaceutical/biological product,etc. SNOMED CT
                                                   combines the content and structure of the SNOMED
                                                   Reference Terminology (SNOMED RT) with the
                                                   United Kingdom’s Clinical Terms Version 3 (formerly
                                                   known as the Read Codes). The following American
                                                   Nurses Association recognized nursing classifications
                                                   are integrated within SNOMED CT include the Clinical
                                                   Care Classification, NANDA I, Nursing Interventions
                                                   Classification, Nursing Outcomes Classification,
                                                   Omaha System, and Perioperopative Nursing Data
Logical Observation Identifiers   LOINC (LAB)   The purpose of LOINC is to facilitate the exchange
Names and Codes - Laboratory      2.22,         and pooling of clinical results for clinical care,
                                  RELMA 3.23    outcomes management and research by providing a
                                  Regenstrief   set of universal codes and names to identify laboratory
                                  Loinc         and other clinical observations.

Logical Observation Identifiers   LOINC         The clinical portion of the LOINC database includes
Names and Codes- Clinical         (Clinical)    entries for vital signs, hemodynamics, intake/output,
                                  2.22,         EKG, obstetric ultrasound, cardiac echo, urologic
                                  RELMA 3.23    imaging, gastroendoscopic procedures, pulmonary
                                  Regenstrief   ventilator management, selected survey instruments,
                                  Loinc         and other clinical observations.
International Classification of       ICNP        The ICNP® is a unified nursing language system. It is
Nursing Practice (ICNP) Version 1.0               a compositional terminology for nursing practice that
                                                  facilitates the development of and the cross-mapping
                                                  among local terms and existing terminologies.The
                                                  ICNP data elements consist of 1) nursing
                                                  phenonomen, 2) nursing actions, and 3) nursing

ABC Coding Manual for Integrative     ABC codes   ABC codes were designed to fill gaps in existing code
Healthcare (ABC) 1st Release                      sets to support compl;iance with Health Insurance
                                                  Portability and Accountability Act of 1996 (HIPAA).
                                                  ABC codes are part of a comprehensive coding
                                                  system that supports research., management, and
                                                  commerce in the fields of alternative medicine, nursing
                                                  and other forms if integrative healthcare. All related
                                                  coding processes and systems , including the five -
                                                  character alphabetic ABC codes, two-character
                                                  practitioner identifiers, terminology, product and
                                                  service descriptions, expanded definitions practitioner-
                                                  specific tools (such as scope of practice, relative value
                                                  units, decision support and training standards to
                                                  different practitioner types) and other materials are the
                                                  intellectual property of Alternative Link, Inc. or its
                                                  affiliates Relative Value Studies, Inc.
Clinical Care Classification System   CCC system CCC System is a standardized terminology of
(CCC) Version 2.0                                concepts/terms for the electronic documentation of
                                                 patient care primarily by nurses in all healthcare
                                                 settings enabling ongoing analysis and generation of
                                                 evidence-based care guidelines. The system consists
                                                 of two interrelated terminologies: CCC of Nursing
                                                 Diagnoses and Outcomes and CCC of Nursing
                                                 Interventions and Actions, which are organized into a
                                                 single system categorized by Care Components
                                                 representing the functional, physiological,
                                                 psychological, and health behavioral patterns of care.
                                                 CCC links diagnoses, interventions and outcomes to
                                                 each other and enables them to be mapped to other
                                                 health-related terminologies such as SNOMED CT.
                                                 CCC is used to track and measure patient/client care
                                                 holistically over time, across settings, population
                                                 groups, and geographic locations.

North American Nursing Diagnosis      NANDA I      NANDA International is a member driven, grassroots
Association International (NANDA)                  organization committed to the development of nursing
2007-2008                                          diagnostic terminology. The desired outcome of the
                                                   Association's work is to provide nurses at all levels
                                                   and in all areas of practice with a standardized nursing
                                                   terminology with which to:
                                                   - client responses to actual or potential health
                                                   problems, life processes, and wellness;
                                                   - care for reimbursement of nursing services;
                                                   - contribute to the development of informatics and
                                                   information standards, ensuring the inclusion of
                                                   nursing terminology in electronic health care records;
                                                   facilitate study of the phenomena of concern to nurses
                                                   for the purpose of improving patient care.
Nursing Interventions Classification NIC   The Nursing Interventions Classification (NIC) is a
(NIC) 5th Edition                          comprehensive, standardized language describing
                                           treatments that nurses perform in all settings and in all
                                           specialties. NIC interventions include both the
                                           physiological (e.g. Acid-Base Management) and the
                                           psychosocial (e.g. Anxiety Reduction). There are
                                           interventions for illness treatment (e.g. Hyperglycemia
                                           Management), illness prevention (e.g. Fall
                                           Prevention), and health promotion (e.g. Exercise
                                           Promotion). Interventions are for individuals or for
                                           families (e.g. Family Integrity Promotion). Indirect care
                                           interventions (e.g. Emergency Cart Checking) and
                                           some interventions for communities (e.g.
                                           Environmental Management: Community) are also
                                           included. NIC consists of 542 Interventions, all
                                           domains, classes, and interventions have definitions,
                                           and the four level taxonomy structure is coded. NIC
                                           has a system in place for regular updates.

Nursing Minimum Data Set (NMDS)     NMDS   Minimum set of items of information with uniform
                                           definitions and categories concerning the specific
                                           dimension of professional nursing, which meets the
                                           information needs of multiple data users in the health
                                           care system. Nursing minimum data set consists of
                                           nursing diagnosis, nursing intervention, nursing
                                           outcome, intensity of nursing care.
Nursing Management Minimum Data NMMDS      Data variables categorized into environment, nurse
Set (NMMDS)                                resources, and financial resources that are needed to
                                           inform the decision making process of nurse
                                           executives related to leading and managing nursing
                                           services delivery and care coordination.

Nursing Outcome Classification 4th   NOC   The Nursing Outcomes Classification (NOC) is a
Edition                                    comprehensive, standardized classification of
                                           patient/client outcomes developed to evaluate the
                                           effects of nursing interventions. Standardized
                                           outcomes are necessary for documentation in
                                           electronic records, for use in clinical information
                                           systems, for the development of nursing knowledge
                                           and the education of professional nurses. An outcome
                                           is a measurable individual, family, or community state,
                                           behavior or perception that is measured along a
                                           continuum and is responsive to nursing interventions.
                                           The outcomes are developed for use in all settings
                                           and with all patient populations. Clinical sites used to
                                           test the NOC included tertiary care hospitals,
                                           community hospitals, community agencies, nursing
                                           centers, and a nursing home. The outcomes are
                                           developed for use in all settings and can be used
                                           across the care continuum to follow patient outcomes
                                           throughout an illness episode or over an extended
                                           period of care. Since the outcomes describe
                                           patient/client status, other disciplines may find them
                                           useful for the evaluation of their interventions.
Omaha System 2005 Edition        N/A    The Omaha System is a research-based,
                                        comprehensive and standardized taxonomy designed
                                        to enhance practice, documentation, and information
                                        management. It provides the framework and terms for
                                        diverse EHRs. It consists of an assessment
                                        component (Problem Classification Scheme), an
                                        intervention component (Intervention Scheme), and an
                                        outcomes component (Problem Rating Scale for
                                        Outcomes). Multidisciplinary health care practitioners
                                        in any setting use the terms, definitions, and codes
                                        from the time they admit individuals, families, and
                                        communities to service until discharge. The Omaha
                                        System provides a structure to document client needs
                                        and strengths, describe care plans and services, and
                                        measure client outcomes in a simple, yet
                                        comprehensive, manner.

Perioperative Nursing Data Set   PNDS   The Perioperative Nursing Data Set (PNDS) is a
(PNDS) Version 2                        standardized nursing vocabulary that addresses the
                                        perioperative patient experience from pre-admission
                                        until discharge. As a nursing language, PNDS is
                                        parsimonious, validated, reliable, and useful for clinical
                                        The PNDS can serve many purposes, depending on
                                        the audience and user. A few examples of these
                                        potential uses include:
                                        --Providing a framework to standardize documentation
                                        --Providing a universal language for perioperative
                                        nursing practice and education
                                        --Assisting in the measurement and evaluation of
                                        patient care outcomes
                                        --Providing a foundation for perioperative nursing
                                        research and evaluation of patient outcomes
                                        --Informing decisions about the relationship of staffing
                                        to patient outcomes
                                        --Providing data about the contributions of nurses to
                                        patient outcomes in the perioperative arena
International Classification of       (ICD-9-CM)   The ICD-9-CM id published by the US Government in
Diseases- Ninth Revision – Clinical                recognition of its responsibility to promulgate this
Modification                                       classification throughout the United States for
                                                   morbidity coding . The ICD-9 Revision published by
                                                   the World Health Organization (WHO) is the
                                                   foundation of the ICD-9-CM and continues to be the
                                                   classification employed in the cause-of-death coding
                                                   in the United States. The ICD-9-CM is completely
                                                   compatible with the ICD-9. The WHO Center for
                                                   Classification of Diseases for North America serves as
                                                   Liaison between the international obligations of
                                                   comparable classifications and the national health
                                                   data needs of the United States.

                                                   The ICD-9-CM is recommended for use in all clinical
                                                   settings but is required for reporting diagnoses and
                                                   diseases to all U.S. Public Health Service and Health
                                                   Care Financing Administration (now Center for
                                                   Medicare and Medicaid Services (CMS) programs.
                                                   Volume 3 is the CM and refers to procedures and
                                                   operations. Reimbursed by the federal government.

International Statistical             ICD-10       The International Classification of Diseases is
Classification of Diseases and                     published by the World Health Organization. The ICD
Related Health Problems- Tenth                     is used world-wide for morbidity and mortality
Revision (ICD-10)                                  statistics, reimbursement systems and automated
                                                   decision support in medicine. This system is designed
                                                   to promote international comparability in the collection,
                                                   processing, classification, and presentation of these
                                                   statistics. The ICD is a core classification of the WHO
                                                   Family of International Classifications (WHO-FIC). It
                                                   provides codes to classify diseases and a wide variety
                                                   of signs, symptoms, abnormal findings, complaints,
                                                   social circumstances and external causes of injury or
                                                   disease. ICD-10 is used world-wide for only Mortality
                                                   Statistics. The world nations also use it for Morbidity
                                                   Statistics except the Unites States which has not yet
                                                   initiated it into their coding systems.
The International Classification of   ICF   The ICF is WHO's framework for measuring health
Functioning and Health (ICF)                and disability at both individual and population levels.
                                            It acknowledges that every human being can
                                            experience a decrement in health and therheby
                                            experience some degree of disability. ICF
                                            'mainstreams' the experience of disability and
                                            recognises it as a universal human experience. By
                                            shifting the focus from cause to impact it places all
                                            health conditions on an equal footing allowing them to
                                            be compared using a common metric - the ruler of
                                            health and disability. Furthermore ICF takes into
                                            account the social aspects of disability and does not
                                            see disability only as 'medical' or 'biological'
                                            dysfunction. By including Contextual Factors, in which
                                            environmental factors are listed, ICF allows to record
                                            the impact of the environment on the person's

Current Procedual Terminology         CPT   CPT® is Current Procedural Terminology, and was
                                            developed by the American Medical Association in
                                            1966. Each year, an annual publication is prepared,
                                            that makes changes corresponding with significant
                                            updates in medical technology and practice. The
                                            American Medical Association, through its Department
                                            of CPT Editorial Research and Development, provides
                                            staff support to the process of adding, modifying, and
                                            deleting CPT codes. The 17-member CPT Editorial
                                            Panel meets 3 times a year and considers proposals
                                            for changes to CPT.
RxNorm   RxNorm   RxNorm, a standardized nomenclature for clinical
                  drugs, is produced by the National Library of Medicine
                  (NLM). In this context, a clinical drug is a
                  pharmaceutical product given to (or taken by) a patient
                  with a therapeutic or diagnostic intent. In RxNorm, the
                  name of a clinical drug combines its ingredients,
                  strengths, and form. RxNorm’s standard names for
                  clinical drugs are connected to the varying names of
                  drugs present in many different controlled
                  vocabularies within the Unified Medical Language
                  System (UMLS) Metathesaurus, including those in
                  commercially available drug information sources.
                  These connections are intended to facilitate
                  interoperability among the computerized systems that
                  record or process data dealing with clinical drugs.
inology Standard Type
              Developer                   Contact                  SME (Subject Matter             Standards
                                                                   Experts)                        Recognitions

s used by clinicians to record data. A reference terminology is a set of terms to which the terminology in the point-of-care terminologies is ma
 he point-of-care is encoded behind the scenes so that data can be extracted and analyzed to improved patient care outcomes. For example,
) (point-of-care terminology) can be mapped to a “Clinical Finding” in SNOMED CT (Reference Terminology).

                                          ****FOR MORE
                                          PLEASE ACCESS
                                          EACH OF THE
              International Health        http://www.ihtsdo.org/   Cynthia B Lundberg RN, BSN Consolidated Health
              Terminology Standards       www.capsts.org           CAP - STS Phone:           Informatics (CHI);
              Development Organization                             1--847-832-7673            Healthcare Information
              (IHTSDO)       And                                                              Technology Standards
              College of American                                                             Panel (HITSP) ;
              Pathologist - SNOMED                                                            American Nurses
              Terminology Solutions                                                           Association (ANA);
                                                                                              American National
                                                                                              Standards Institute
                                                                                              (ANSI ) ;
                                                                                              National Committee on
                                                                                              Vital and Health
                                                                                              Statistics (NCVHS)
                                                                                              “Subcommittee on
                                                                                              Standards and Safety”
                                                                                              (United States)
Kathy Mercer                 loinc@regenstrief.org   Healthcare Information
LOINC c/o Medical                                    Technology Standards
Informatics                                          Panel (HITSP);
The Regenstrief Institute,                           American Nurses
Inc                                                  Association (ANA);
410 West 10th Street,                                National Committee on
Suite 2000                                           Vital and Health
Indianapolis, IN 46202-                              Statistics (NCVHS)
3012                                                 “Subcommittee on
                                                     Standards and
Phone: 317-423-5558                                  Safety”(United States)
Fax: 317-423-5695
IU campus mail address:
HS, 2000

Susan Matney, MSN, RN loinc@regenstrief.org          American Nurses
Sr. Content Engineer                                 Association (ANA);
Office of the Associate VP                           National Committee on
for Health Sciences                                  Vital and Health
Information Technology,                              Statistics (NCVHS)
University of Utah                                   “Subcommittee on
26 South 2000 East                                   Standards and Safety”
(HSEB suite 5725C)                                   (United States)
Salt Lake City, Utah
Phone: 801 585-9871
Fax: 801 581-4297
International Council of   http://www.icn.ch/icnp_r For Nursing Content:         American Nurses
Nursing                    eview.htm                Amy Coenen, PhD, RN,         Association (ANA)
                                                    FAAN, Associate Professor
                                                    Director, International
                                                    Classification for Nursing
                                                    Practice (ICNP®)
                                                    International Council of
                                                    University of Wisconsin -
                                                    College of Nursing
                                                    P.O. Box 413
                                                    Milwaukee, WI 53201-0413
                                                    Phone: 414 299-5146
                                                    Fax: 414 299-6474
                                                    E-mail: coenena@uwm.edu

Alternative Link, Inc. Or its www.ABCcodes.com                                   American Nurses
affiliates Relative Value                                                        Association (ANA);
Studies, Inc                                                                     National Committee on
Albuquerque, NM 87110.                                                           Vital & Health Statistics
ABC Coding Solution-                                                             (NCVHS)
Alternative Link                                                                 Subcommittee on
Albuquerque, NM                                                                  Standards and Security
Tel: (505) 875-0001
Toll Free: 877-621-LINK
Fax: 505-875-0002
Virginia K. Saba (EdD,    www.sabacare.com          Healthcare Information
RN, FAAN, FACMI) and     And                        Technology Standards
Colleagues               www.clinicalcareclassifi   Panel (HITSP) ;
CEO & President          cation.com                 American Nurses
Sabacare Inc.                                       Association (ANA)
Arlington, VA
Distinguished Scholar,
Georgetown University
Washington, DC

NANDA International        info@nanda.org           American Nurses
Diagnositic Development                             Association (ANA)
100 N. 20th Street, 4th
Philadelphia, PA 19103
Protocol for Submission or
Revision of Diagnoses
found at
Editor: Gloria Bulechek, classification-                                American Nurses
PhD, FAAN, Professor      center@uiowa.edu                              Association (ANA)
Phone: 319/335-7115
Email: gloria-
Howard K. Butcher, PhD,
Joanne McCloskey
Dochterman, PhD, RN,
 Center for Nursing
Classification & Clinical
The University of Iowa,
College of Nursing 407 NB
Iowa City IA 52242-1121
319-335-7051 Fax: 319-

Connie Delaney, PhD, RN,                     Diane Huber, PhD, RN,      American Nurses
FAAN, FACMI                                  FAAN, CNAA                 Association (ANA)
Co-PI, NMMDS                                 NMMDS
School of Nursing                            1222 Oakes Drive
5-160 Weaver Densford                        Iowa City, IA 52245-0113
Hall                                         Phone: 319-335-7122
The University of                            FAX: 319-354-0113
308 Harvard Street SE
Minneapolis, MN 55455
Phone: 612-624-5959
Fax: 612-624-3174
Connie Delaney, PhD, RN, diane-              American Nurses
FAAN                     huber@uiowa.edu     Association (ANA)
College of Nursing,
University of Iowa
Iowa City, IA 52242-1121
Phone: 319-335-7113

Sue Moorhead Phone:       classification-    American Nurses
319/335-7110              center@uiowa.edu   Association (ANA)
Center for Nursing
Classification & Clinical
The University of Iowa,
College of Nursing 407 NB
Iowa City IA 52242-1121
319-335-7051 Fax: 319-
Email: sue-
Karen S. Martin, RN,    www.omahasystem.org   Healthcare Information
MSN, FAAN                                     Technology Standards
Martin Associates                             Panel (HITSP) ;
2115 S. 130th St.                             American Nurses
Omaha, NE 68144                               Association (ANA)
Phone: 402-333-1962

Association of           pnds@aorn.org        American Nurses
periOperative Registered                      Association (ANA)
Nurses (AORN)
2170 South Parker Road,
Suite 300
Denver, CO 80231
Toll Free: 800-755-2676
Local: 303-755-6304 Ext.
WHO Center for             http://www.ICD9.chrise
Classification of Diseased ndres.com
for North America
National Center for Health
Statistics (NCHS)
Public Health Service
(PHS), Health & Human
Services (HHS)

World Health Organization http://www.who.int/class
World Health Organization http://www.who.int/class

American Medical          http://www.ama-
Association               assn.org/ama/pub/cate
National Library of   http://www.nlm.nih.gov/r
Medicine              esearch/umls/rxnorm/o
8600 Rockville Pike   verview.html
Bethesda, MD 20894
             Other Resources

oint-of-care terminologies is mapped so
nt care outcomes. For example, a
Leann Scroggins, MS,
Geralyn Meyer, PhD, RN;
T. Heather Herdman,
PhD, RN; Margaret
Lunney, PhD, RN; Lynda
Juall Moyet, RN, CRNP,
MSN; Dorothy Jones,
EdD, RN, FAAN; Marlene
Lindeman, RN, MSN, CS;
Sara E. Lister, MSN; Lina
Rahal, BScN, MEd,
RN;Barbara Vassallo,
Johnson,M., Bulechek,
G.M., Butcher, H.,
Dochterman, J.M., Maas,
M., Moorhead, S. &
Swanson, E. (2006).
linkages: Nursing
Diagnoses, Outcomes
and Interventions. (2cd
Ed.) Philadelphia:
Elsevier Inc.
                                                      Standards Initiatives Standard Type
What are the key standards initiatives in healthcare information technology today?

Standard Initiatives Acronym   Description                                                Contact

Agency for          AHRQ       AHRQ funds health information technology research
Healthcare                     and development with $166 million in grants and
Research and                   contracts. This money is awarded to programs
Quality                        across the country to support and stimulate
                               investment in health IT, especially in rural and
                               underserved areas. AHRQ also created the National
                               Resource Center for Health Information Technology,
                               which provides technical assistance and shares
                               knowledge and findings that have the potential to
                               transform every day clinical practice.

American Health     AHIC       The AHIC is a federal advisory body, chartered to          Department of Health
Information                    make recommendations to the Secretary of HHS on            and Human Services -
Community                      how to accelerate the development and adoption of          Office of the National
                               Health IT. The AHIC pursues breakthroughs that will        Coordinator
                               produce tangible value to the health care consumer
                               in the near-term, while building toward long-term
                               goals for a broad and robust system.

Centers for         CMS        CMS sets the standards for many HIT Initiatives, for
Medicare &                     example, HIPAA, the ePrescribing standards, etc.
Medicaid Services
                               CMS’s new Electronic Health Record (EHR)
                               demonstration is designed to show that widespread
                               adoption and use of interoperable EHRs will reduce
                               medical errors and improve the quality of care for an
                               estimated 3.6 million consumers. Over a five-year
                               period, the project will provide financial incentives to
                               as many as 1,200 physician practices that use
                               certified EHRs to improve quality as measured by
                               their performance on specific clinical quality
                               measures. Additional bonus payments will be
                               available, based on a standardized survey
                               measuring the number of EHR functionalities a
                               physician practice has incorporated. To further
                               amplify the effect of this demonstration project, CMS
                               is encouraging private and public payers to offer
                               similar financial incentives consistent with applicable
Certification      CCHIT   The Certification Commission is a recognized          Sue Reber, CCHIT
Commission for             certification body for electronic health records and  (503) 703-0813
Healthcare                 their networks, and a private, nonprofit initiative.  sreber@cchit.org
Information                Their mission is to accelerate the adoption of health
Technology                 information technology by creating an efficient,
                           credible and sustainable certification program.

Federal Adoption   FAST    Federal Adoption of Standards for health IT
of Standards for           (FAST) supports coordinated review, analysis,
Health IT (FAST)           architectural integration, and educational
                           awareness of health interoperability
                           - The FAST initiative’s tasks include:
                           - Interagency support and facilitation of
                           federally managed standards communications
                           - Cross-agency collaboration on various
                           aspects of the standards lifecycle, including
                           use case review, HITSP requirements, design
                           and standards selection (RDSS) and
                           interoperability specifications, and standards
Federal Health     FHA     The Federal Health Architecture (FHA) was
Architecture               established as an eGov Line of Business in
                           response to The President's Management Agenda
                           calling for increased efficiency and effectiveness in
                           government operations. The FHA is responsible for:
                           - Leveraging federal expertise in creating a federal
                           framework that would be derived from a national
                           health IT infrastructure.
                           - Supporting federal activities in the development
                           and adoption of health IT standards.
                           - Ensuring that federal agencies can seamlessly
                           exchange health data between and among
                           themselves, with state, local and tribal governments,
                           and with private sector healthcare organizations.
                           The Consolidated Health Informatics Initiative (CHI)
                           has been a high-level, collaborative segment of the
                           Federal Health Architecture (FHA) program tasked
                           with establishing a portfolio of existing and
                           commonly used clinical vocabularies and messaging
                           standards for Federal partners.
Health Resources    HRSA    The Health Resources and Services
and Services                Administration (HRSA), an agency of the U.S.
Administration              Department of Health and Human Services, is
                            the primary Federal agency for improving
                            access to health care services for people who
                            are uninsured, isolated or medically
                            HRSA oversees organ, tissue and blood cell
                            (bone marrow and cord blood) donation and
                            vaccine injury compensation programs, and
                            maintains databases that protect against
                            health care malpractice and health care
                            waste, fraud and abuse.
Healthcare          HITSP   Healthcare Information Technology Standards Panel American National
Information                 serves as a cooperative partnership between the          Standards Institute
Technology                  public and private sectors for the purpose of
Standards Panel             achieving a widely accepted and useful set of
                            standards specifically to enable and support
                            widespread interoperability among healthcare
                            software applications, as they will interact in a local,
                            regional and national health information network for
                            the United States.

National Alliance   NAHIT   Interagency support and facilitation of federally
for Health                  managed standards communications
Information                 Mission: Promote, influence, and support the
Technology                  effective and efficient application of health IT for the
                            purpose of achieving safe, high quality, affordable
                            health care.

                            NAHIT will accomplish its work in several defining
                             - By its role as a national convener/integrator of
                            diverse organizations and thought leaders to explore
                            and exchange innovative ideas, vet key issues and
                            help achieve industry-wide consensus.
                             - By identifying and disseminating evidence-based
                            practices and proven strategies for the adoption and
                            use of health IT, establishing a go-to and trusted
                            source in health care.
                            Approved May 22, 2008
                             - By concentrating on the engagement of C-level
                            leaders, with particular emphasis on the necessary
                            alignment of executive-clinical-technology decision-
National Institutes   NIH      Cross-agency collaboration on various
of Health                      aspects of the standards lifecycle, including
                               use case review, HITSP requirements,
                               design and standards selection (RDSS) and
                               interoperability specifications, and
                               standards lifecycle education

Nationwide Health     NHIN   The Nationwide Health Information Network (NHIN)           Department of Health
Information                  is the critical portion of the health IT agenda intended   and Human Services -
Network                      to provide a secure, nationwide, interoperable health      Office of the National
                             information infrastructure that will connect providers,    Coordinator
                             consumers, and others involved in supporting health
                             and healthcare.
Office of the         ONC    The Office of the National Coordinator for Health          Office of the National
National                     Information Technology provides leadership for the         Coordinator for Health
Coordinator                  development and implementation of a nationwide             Information
                             health IT infrastructure allowing secure and               Technology,
                             seamless exchange of data and records. The ONC             Department of Health
                             advises the Secretary of HHS on health IT policies         and Human Services,
                             and initiatives, and coordinates the Department’s          200 Independence
                             efforts to meet the President’s goal of making an          Ave. SW, Suite 729-D,
                             electronic medical record available for most               Washington, DC
                             Americans by 2014.                                         20201, Telephone:
                                                                                        Facsimile: 202-690-
                                                                                        6079, Email:

U.S. Department of DoD       Currently, thousands of military medical providers
Defense                      use the DoD’s electronic health record system,
                             AHLTA, and nearly 300,000 outpatient visits are
                             captured digitally every week. DoD’s vision is to
                             provide each patient with a continuously updated
                             digital medical record from the point of injury or care
                             on the battlefield to discharge from military clinics
                             and hospitals in the United States. These records
                             would be completely transferable electronically to the
                             Veterans Health Administration as part of the Joint
                             Patient Electronic Health Record (JPEHR).
U.S. Health       USHIK   The United States Health Information
Information               Knowledgebase (USHIK) is a health metadata
Knowledgebase             registry funded and directed by the Agency for
                          Healthcare Research and Quality with management
                          support in partnership with the Centers for Medicare
                          & Medicaid Services. USHIK provides and maintains
                          a metadata registry of health information data
                          element definitions, values and information models
                          that enable browsing, comparison, synchronization
                          and harmonization within an uniform query and
                          interface environment. It is populated with the data
                          elements and information models of Standards
                          Development Organizations (SDO) and other
                          healthcare organizations, in such a way that public
                          and private organizations can harmonize information
                          formats with healthcare standards. It also contains
                          data element information for government initiatives
                          that support the use and implementation of data
                          standards such as the Health Insurance Portability
                          and Accountability Act (HIPAA) and the Consolidated
                          Health Informatics (CHI) initiative. The U.S. Health
                          Information Knowledgebase established a metadata
                          registry methodology based on International
                          Organization for Standardizations®
                          (ISO®)/International Electrotechnical
                          Commission™(IEC) 11179 Information technology -
                          Specification and Standardization of Data Elements.
Veterans Health   VHA     The VHA is a division of the U.S. Department of
Administration            Veteran’s Affairs, and provides care for over five
                          million veterans of the United States Armed
                          Services. The VHA’s electronic health record
                          system, My HealtheVet, allows patients to refill
                          prescriptions online, and provides access to health
                          information, links to Federal and VA benefits and
                          resources, and the patient’s Personal Health
                          Journal. The VHA continues to add capabilities to My
                          HealtheVet, to empower consumers to take a more
                          active role in managing their health and health care.

      SME (Subject      Website/ Other
      Matter Experts)   Resources




                        Information Technology
                        general information:
Alisa Ray, Executive www.cchit.org



HITSP Secretariat: www.hitsp.org
Michelle Maas
org ; John Halamka,
MD, HITSP Chair,
p.harvard.edu; Joyce
Technical Manager,


Office of              www.nhin.com
Interoperability and


                                                       Standards Development Organizations Standar

Standard Organization
                         Acronym   Description                              Web Site
Accredited Standards     X12       In 1979, the American National           www.x12.org
Committee X12                      Standards Institute (ANSI) chartered the
                                   Accredited Standards Committee (ASC)
                                   X12 to build and support electronic
                                   exchange standards, related
                                   documents, and products intended for
                                   worldwide use.
American Dental          ADA       Code on Dental Procedures and            www.ada.org
Association                        Nomenclature (CDT): HIPAA standard
                                   used to code dental procedures for
                                   dental claims

American Health          AHIMA     AHIMA is the premier association of      www.ahima.org
Information Management             health information management (HIM)
Association                        professionals. AHIMA's members are
                                   dedicated to the effective menagement
                                   of personal health information needed to
American Medical         AMA       The AMA develps and maintains the        http://www.ama-
Association                        CPT codes                                assn.org/ama/pub/
American National        ANSI      The ANSI Federation’s primary goal is www.ansi.org
Standards Institute                to enhance the global competitiveness
                                   of U.S. business and the American
                                   quality of life by promoting and
                                   facilitating voluntary consensus
                                   standards and ensuring their integrity.

American Nurses          ANA       Recognition of Nursing Terminologies:   www.ana.org
Association                        NIDSEC

American Society for     ASTM      ASTM International is one of the largest www.astm.org
Testing and Materials              voluntary standards development
                                   organizations in the world-a trusted
                                   source for technical standards for
                                   materials, products, systems, and
America's Health Insurance AHIP      AHIP is the national association         www.ahip.org
Plans                                representing nearly 1.300 companies
                                     providing health insurance coverage to
                                     more than 200 million Americans.

Centers for Medicare and     CMS     CMS is the Centers for Medicare &        www.cms.hhs.gov/
Medicaid Services (CMS)              Medicaid Services. CMS is the HHS        medicare/hcpcs/
                                     agency responsible for administering the
                                     Medicare, Medicaid, SCHIP (State
                                     Children's Health Insurance), and
                                     several other health-related programs.

Clinicial Data Interchange   CDISC   CDISC develops and supports global,
Standards Consortium                 platform-independent data standards
                                     that enable information system
                                     interoperability to improve medical
College of American          CAP     research and related areas of of
                                     CAP is the original developer              www.cap.org
Pathologists                         SNOMED CT. SNOMED Terminology
                                     Solutions, part of CAP, provides
                                     education and consulting services to
                                     support the implementation of SNOMED-
Digital Imaging &            DICOM   The DICOM Standards Committee
Communications in                    exists to create and maintain
Medicine®                            international standards for
                                     communication of biomedical diagnostic
                                     and therapeutic information in
                                     disciplines that use digital images and
                                     associated data.
Health Information           HITSP   Healthcare Information Technology          www.hitsp.org
Technology Standards                 Standards Panel serves as a
Panel                                cooperative partnership between the
                                     public and private sectors for the
                                     purpose of achieving a widely accepted
                                     and useful set of standards specifically
                                     to enable and support widespread
                                     interoperability among healthcare
                                     software applications, as they will
                                     interact in a local, regional and national
                                     health information network for the
                                     United States.
Health Level Seven®          HL7    Health Level Seven is an American
                                    National Standards Institute-accredited
                                    Standards Developing Organization
                                    operating in the healthcare arena. HL7's
                                    domain is clinical and administrative
                                    data, and its mission is: "To provide
                                    standards for the exchange,
                                    management and integration of data
                                    that support clinical patient care and the
                                    management, delivery and evaluation of
                                    healthcare services."

Institute of Electrical and IEEE    A non-profit organization, IEEE is the   www.ieee.org
Electronics Engineers, Inc.         world's leading professional association
                                    for the advancement of technology

Integrating the Healthcare   IHE    IHE is an initiative by healthcare        www.ihe.net
Enterprise initiative               professionals and industry to improve
                                    the way computer systems in healthcare
                                    share information. IHE promotes the
                                    coordinates use of established
                                    standards such as DICOM and HL7 to
                                    address specific clinical need in support
                                    of optimal patient care.

Internation Council of       ICN    The Internation Council of Nurses is a    www.icn.ch
Nurses                              federation of national nurse's
                                    associations (NNA's) representing
                                    nurses in more than 128 countries.
                                    Founded in 1899, ICN is the world's first
International Classification ICNP   The ICNP is a unified nursing language www..icn.ch/icnp.h
for Nursing Practice                system. It is a compositional terminology tm
                                    for nursing practice that facilitates the
                                    development of and the cross-mapping
                                    among local terms and existing
International Health      IHTSDO   The IHTSDO® (International Health         www.ihtsdo.org
Terminology                        Terminology Standards Development
Standards                          Organisation) has been established as
Development                        an association under Danish Law, and
Organization                       its purpose is to:
                                    - Acquire, own and administer the rights
                                   to SNOMED CT® other health
                                   terminologies and/or related standards,
                                   and other relevant assets (collectively,
                                   the "Terminology Products")
                                   - Develop, maintain, promote and
                                   enable the uptake and correct use of its
                                   Terminology Products in health
                                   systems, services and products around
                                   the world
                                    - Undertake any or all activities
                                   incidental and conducive to achieving
                                   the purpose of the Association for the
                                   benefit of the Members.

International Health     IHTSDO    The IHTSDO is a non-for-profit
Terminology Standards              association and has the responsibilty for
Development Organization           the ongoing development, quality
                                   assurance, and distribution of SNOMED-

International Medical     IMIA     Internation not-for-profit organization www.imia.org
Informatics Association            promoting medical infomatics in
                                   healthcare and biomedical research.
Medicomp Systems                   Medicomp Systems, Inc. is a Virginia
                                   corporation specializing in the
                                   development of point-of-care tools for
                                   Electronic Medical Records. Medicomp www.medicomp.com
                                   was founded in 1978 by Peter S. Goltra
National Committee on         NCVHS   Standardization has been a priority for www.hhs.ncvhs.go
Vital and Health Statistics           NCVHS for most of its 58 years,           v
                                      beginning with its historic (and ongoing)
                                      work on the International Classification
                                      of Diseases (ICD). Soon after HIPAA
                                      was enacted, the Committee created
                                      the Subcommittee on Standards and
                                      Security to manage its additional
                                      responsibilities for advising the
                                      Secretary on the adoption of health data
                                      standards, monitoring their
                                      implementation, and regularly reporting
                                      to Congress on their status

National Council of           NCPDP   NCPDP creates and promotes                www.ncpdp.org
Prescription Drug                     standards for the transfer of data to and
Programs®                             from the pharmacy services sector of
                                      the healthcare industry. The
                                      organization provides a forum and
                                      support wherein our diverse
                                      membership can efficiently and
                                      effectively develop and maintain these
                                      standards through a consensus building
                                      process. NCPDP also offers its
                                      members resources, including
                                      educational opportunities and database
                                      services, to better manage their
National Uniform Billing      NUBC    The National Uniform Billing Committee www.nubc.org
Committee                             (NUBC) was brought together by the
                                      American Hospital Association (AHA) in
                                      1975 and it includes the participation of
                                      all the major national provider and payer
                                      organizations. The NUBC was formed to
                                      develop a single billing form and
                                      standard data set that could be used
                                      nationwide by institutional providers and
                                      payers for handling health care claims.
National Uniform Claim     NUCC    The National Uniform Claim Committee www.nucc.org
Committee                          (NUCC) is a voluntary organization that
                                   replaced the Uniform Claim Form Task
                                   Force in 1995. The committee was
                                   created to develop a standardized data
                                   set for use by the non-institutional health
                                   care community to transmit claim and
                                   encounter information to and from all
                                   third-party payers. It is chaired by the
                                   American Medical Association (AMA),
                                   with the Centers for Medicare and
                                   Medicaid Services (CMS) as a critical
                                   partner. The committee includes
                                   representation from key provider and
                                   payer organizations, as well as
                                   designated standards maintenance
National Health Information NHIN   As a key element of the national health
Network                            information technology strategy, the
                                   advancement of the Nationwide Health
                                   Information Network initiative will
                                   provide the foundation for interoperable,
                                   secure and standards-based health
                                   information exchange nationally.

Office of the National     ONC     The Office of the National Coordinator http://www.hhs.go
Coordinator                        for Health Information Technology        v/healthit/onc/miss
                                   provides leadership for the development ion/
                                   and implementation of a nationwide
                                   health IT infrastructure allowing secure
                                   and seamless exchange of data and
                                   records. The ONC advises the
                                   Secretary of HHS on health IT policies
                                   and initiatives, and coordinates the
                                   Department’s efforts to meet the
                                   President’s goal of making an electronic
                                   medical record available for most
                                   Americans by 2014.

Public Health Data         PHDSC   The Public Health Data Standards         www.phdatastand
Standards Consortium               Consortium (PHDSC) committed to          ards.info/
                                   bring a common voice from the public
                                   health community to the national efforts
                                   of standardization of health and
                                   healthcare information.
VA’s National Drug File   NDF-RT   The VHA National Drug File Reference
Reference Terminology              Terminology (NDF-RT) maintains
                                   terminology used to code these
                                   medication properties:
                                   Mechanism of Action
                                   Physiologic Effect
                                   Structural Class

Workgroup on Electronic   WEDI     Provides a forum for facilitating          www.wedi.org
Data Interchange                   improvements in information exchange
                                   and management including the
                                   development of strategies and tactics,
                                   definition of standards, the resolution of
                                   implementation issues, identification of
                                   best practices and the development and
                                   delivery of education and training
ent Organizations Standard Type
                                                           SME (Subject
         Standard(s)              Contact                  Matter Experts)   Other Resources
                                  Contact information is
                                  found on the web site

         Code Revision            ADA Members, please                        E-mail:
         Committee (CRC)          use the toll-free                          dentalcode@ada.org
                                  number on the back of
                                  your membership card;
                                  Direct dial, 312-440-

         Physicians’ Current
         Terminology® (CPT)

         Healthcare Informatics
         Standards Board,
         recognizing standards
         for HIT and Medical
         Devices. Works closely
         with HITSP and HIMSS
         on their initiatives

         Recognition of Nursing Dr. Carol J. Bickford by                     NIDSEC site:
         Terminologies: NIDSEC telephone at 301-628-                         http://nursingworld.org/
                                5060 or via e-mail                           MainMenuCategories/T
                                (carol.bickford@ana.or                       hePracticeofProfession
                                g) for more                                  alNursing/DocInfo/NIDS
                                information.                                 EC.aspx

         Healthcare Informatics
         (E31); (Continuity of
         Care Record)
Healthcare Common
Procedure Coding
System (HCPCS)

Electronic billing & EDI

ICD code updates and

DRG Grouper

Nomenclature of
Medicine Clinical
Terms® (SNOMED

                           American National     HITSP Secretariat:
                           Standards Institute   Michelle Maas
                                                 org ; John Halamka,
                                                 MD, HITSP Chair,
                                                 p.harvard.edu; Joyce
                                                 Technical Manager,
HL7 Transactions      Mark McDougall         Linda Fischetti RN
CCOW                  Executive Director     MS, U.S.
CDA                   Health Level Seven     Department of
Arden Syntax          3300 Washtenaw         Veterans Affairs,
                      Avenue, Suite 227      Phone: 301-734-
                      Ann Arbor, MI 48104-   0417 Email:
                      4261                   linda.fischetti@med.
                      Phone: (734) 677-      va.gov, Term
                      7777                   Expires on: 31-Dec-
                      Fax: (734) 677-6622    2009

Wireless standards,

IHE profiles
SNOMED-CT           Contact Information:

Systematized        Rued Langgaards Vej
Nomenclature of     7, 5 ; 2300
Medicine Clinical   Copenhagen S;
Terms® (SNOMED      Denmark
CT®) (SEE CAP)      E-mail:
                    Tel: +45 36 44 87 36
                    Fax: +45 36 44 87 36
                    CVR No: 30363434
                    NATO Cage Code No:
                    DUNS No: 311306794
                    CCR and ORKLA
                    Contact persons:
                    Jennifer Zelmer, CEO
                    Service Requests:

Standards include the   9240 East Raintree       http://www.ncpdp.org/P
SCRIPT standard for     Drive, Scottsdale, AZ    DF/NCPDP_101.pdf:
ePrescribing (Version   85260-7518 Phone:        NCDPD 101
10.0)                   (480) 477-1000           presentation
                        Fax: (480) 767-1042
                        Pharmacy Services
                        Fax: (480) 767-1043

                        Contact Names and


1500 billing form
Condition codes
Provider Characteristic
Provider taxonomy

                          POC: John Loonsk
                                                   Document Standards Standard Ty

Standard                              Category
AAMR Adaptive Behavior Scale          Psyche

Abnormal Involuntary Movement Scale   Neuro
(AIMS)                                Assessment

Alzehemier Assessment Scale           Psyche
AIS (Abbreviated Injury Scale)           Anatomical
                                         scoring tool

Aldrete Scale (admission and discharge   Anesthesia
numerical scoring scale used for )       Assessment

Slade Anorexic Behaviour Scale
Apgar Score   Newborn

AVPU Scale    Neuro
Barthel Index                  ADL

Beck Depression Inventory II   Determine
                               presence and
                               severity of
                               symptoms of
BIERI Scale(faces scale revised)    Pain

Braden Scale                        Pressure sore

Bristol Language Assessment Scale   Neuro

Chest Pain Scale – (0-10)           Chest Pain
Children's Coma Scale (Modified Glascow Neuro
Scale)                                  Assessment

CIWA- Clinical Institute Withdrawal      Alcohol
Assessment for Alcohol (CIWA-Ar) scale   Assessment
Denver Developmental Scale

Disability Rating Scale (0-29)   Disability Scale
FLACC (face legs activity cry       Pain
consolability) Observational Tool   Assessment

Glasgow Coma Scale                  Neuro

Glasgow Outcome Scale               Neuro
Geriatric Depression Scale (GDS)

Hendrich II Fall Risk Scale        Falls

Continuity of Care Record (CCR)    Document

Care Record Summary (CRS)          Document
HL7 Version 3.0 Clinical Document        Document
Architecture (CDA/CDA R2)                Architecture

HL7 Version 3.0 Continuity of Care       Document
Document (CCD)                           Architecture

Likert Scale                             Rating/Respon
                                         se Scale

Lund and Browder Chart - Rule of Nines   Burn
Mini Mental State Exam (MMSE)            Mental

Modified Wong-Baker Faces Scale (0-10)   Pain

Morse Falls Scale                        Falls

NIH Stroke Scale (NIHSS)                 Stroke Scale

Neonatal Infant pain Scale (NIPS)        Pain
Numerical Rating Scale (0-10) (NRS)      Pain

PABS (Pain assessment behavioral scale) Pain
PIPP (Premature Infant Pain profile) –   Pain
neonates                                 Assessment

Poker Chip Scale (faces scale)?          Pain
Ramsay Scale                             Sedation

Rancho Los Amigos – original and         Cognitive
revised                                  Function

Respiratory Index

Riker Sedation Agitation Scale           Sedation

Social Adjustment Scale                  Neuro
Stroke Risk Assessment             Neuro

Suicide Intent Scale               Psyche

Beck Scale for Suicide Ideation    Psyche

Trauma and Injury Severity Scale   Trauma
VDS (Verbal Descriptor Scale)      Pain
VRS (Verbal Rating Scale)           Pain

Visual Analog Scale (Faces Scale)   Pain
*research with other faces scales   Assessment

Waterloo Pressure Sore Risk Score   Pressure sore
                      Document Standards Standard Type
Description                                            Developer
Assesses the ability of individuals who are mentally   American Association            Lambert, Nadine,
retarded, emotionally maladjusted, or developmentally on Mental Retardation            Nihira, Kazuo,
disabled to cope with the natural and social demands                                   Leland, Henry,
of their environment. It is available in two versions,                                 http://www3.parinc.c
one for residential and community settings, the other                                  om/products/product
for schools.                                                                           .aspx?Productid=AB

This tool helps to detect and assess the level of          National Mental Health http://www.dr-
possible dyskinesias in patients taking antipsychotic      Association            bob.org/
medications. Comes complete with an instructional
video showing what the symptoms look like and how
to score them. Persons taking any kind of
antipsychotic medication need to be monitored for
movement disorders. The AIMS (Abnormal
Involuntary Movement Scale) aids in the early
detection of tardive dyskinesia as well as providing a
method for on-going surveillance.

The Alzheimer's Disease Assessment Scale (ADAS)            Paul R. Solomon, PhD;
takes 45 minutes administered by a trained observer        Aliina Hirschoff; Bridget
and is a standardised assessment of cognitive              Kelly; Mahri Relin;
function and non-cognitive features. The cognitive         Michael Brush; Richard
section of the scale (ADAS-Cog) is the gold standard       D. DeVeaux, PhD;
for measuring change in cognitive function in drug         William W. Pendlebury,
trials. Deterioration of about 10% per year in cognitive   MD
tests in patients with Alzheimer's disease is regarded
as average. The cognitive domains include
components of memory, language and praxis, while
the non-cognitive features include mood state and
behavioural changes. There are 11 main sections
testing cognitive function and 10 assessing non-
cognitive features.
The Abbreviated Injury Scale (AIS) is an anatomical       Association for the      http://www.fernoedu
scoring system first introduced in 1969. Since this       Advancement of           cation.it/en/Abbrevia
time it has been revised and updated against survival     Automotive Medicine,     ted%20Injury%20Sc
so that it now provides a reasonably accurrate was of     Baltimore, MA, USA       ale.pdf.
ranking the severity of injury. The latest incarnation of 205-218
the AIS score is the 1990 revision. The AIS is            Association for the
monitored by a scaling committee of the Association       Advancement of
for the Advancement of Automotive Medicine.               Automotive
                                                          Medicine2340 Des
Injuries are ranked on a scale of 1 to 6, with 1 being Plaines Avenue, Suite
minor, 5 severe and 6 an unsurvivable injury. This        106Des PlainesIllinois
represents the 'threat to life' associated with an injury 60018USA
and is not meant to represent a comprehensive
measure of severity. The AIS is not an injury scale, in
that the difference between AIS1 and AIS2 is not the
same as that between AIS4 and AIS5. Organ Injury
Scales of the American Association for the Surgery of
Trauma are mapped to the AIS score for calculation
of the Injury Severity Score.

The patient is discharged from the PACU when he or                                 http://www.virginia.e
she meets established criteria for discharge, as                                   du/uvaprint/HSC/pdf
determined by a scale. One example is the Aldrete                                  /33467.pdf
scale, which scores the patient's mobility, respiratory
status, circulation, consciousness, and pulse
oximetry. Depending on the type of surgery and the
patient's condition, the patient may be admitted to
either a general surgical floor or the intensive care
unit. Since the patient may still be sedated from
anesthesia, safety is a primary goal. The patient's call
light should be in the hand and side rails up. Patients
in a day surgery setting are either discharged from the
PACU to the unit, or are directly discharged home
after they have urinated, gotten out of bed, and
tolerated a small amount of oral intake.

A 22 item scale for assessing anorexic behaviour.     P.D. Slade
Measures 3 dimensions of behaviour: 1)Resistance to
eating; (2)methods of disposing of food; and (3)
'overactivity'. It was designed to be administered by
observers who would evaluate patients on a hospital
The very first test given to your newborn, the Apgar      Virginia Apgar   http://www.childbirth.
score occurs right after your baby's birth in the                          org/articles/apgar.ht
delivery or birthing room. The test was designed to                        ml
quickly evaluate a newborn's physical condition after
delivery and to determine any immediate need for
extra medical or emergency care.

Although the Apgar score was developed in 1952 by
an anesthesiologist named Virginia Apgar, you may
have also heard it referred to as an acronym for:
Activity, Pulse, Grimace, Appearance, and

The Apgar test is usually given to your baby twice:
once at 1 minute after birth, and again at 5 minutes
after birth. Rarely, if there are concerns about the
baby's condition and the first two scores are low, the
test may be scored for a third time at 10 minutes after

The AVPU scale is a system by which a First aider,                         http://www.mindef.g
Ambulance crew or other suitably trained person, can                       ov.sg/joint/smti/wap/
measure and record the consciousness level of a                            avpu.htm
The Barthel Index consists of 10 items that measure Barthel DW:   http://www.dundee.a
a person's daily functioning specifically the activities          c.uk/medther/Stroke
of daily living and mobility. The items include feeding,          /Scales/barthel.htm
moving from wheelchair to bed and return, grooming,
transferring to and from a toilet, bathing, walking on
level surface, going up and down stairs, dressing,
continence of bowels and bladder.

How is the Barthel Index used?

The assessment can be used to determine a baseline
level of functioning and can be used to monitor
improvement in activities of daily living over time. The
items are weighted according to a scheme developed
by the authors. The person receives a score based on
whether they have received help while doing the task.
The scores for each of the items are summed to
create a total score. The higher the score the more
"independent" the person. Independence means that
the person needs no assistance at any part of the
task. If a persons does about 50% independently
then the "middle" score would apply.

In the United Kingdom quite frequently the 5, 10 and
15 scores are substituted by 1, 2, and 3. This gives a
potential maximum of 20 rather than 100.

The Beck Depression Inventory Second Edition (BDI-                http://www.cps.nova.
II) is a 21-item self-report instrument intended to               edu/~cpphelp/BDI2.
assess the existence and severity of symptoms of                  html
depression as listed in the American Psychiatric
Association's Diagnostic and Statistical Manual of
Mental Disorders Fourth Edition (DSM-IV; 1994).
This new revised edition replaces the BDI and the BDI-
1A, and includes items intending to index symptoms
of severe depression, which would require
hospitalization. Items have been changed to indicate
increases or decreases in sleep and appetite, items
labeled body image, work difficulty, weight loss, and
somatic preoccupation were replaced with items
labeled agitation, concentration difficulty and loss of
energy, and many statements were reworded
resulting in a substantial revision of the original BDI
and BDI-1A. When presented with the BDI-II, a
patient is asked to consider each statement as it
relates to the way they have felt for the past two
weeks, to more accurately correspond to the DSM-IV
Faces scale- a scale for measurement of pain              Bieri D      http://painsourceboo
intensity in children by self-report, in English, French               k.ca/pdfs/pps92.pdf
and other languages. The Faces Pain Scale - Revised
(FPS-R) was adapted from the Faces Pain Scale
(Bieri et al, 1990) in order to make it possible to score
on the widely accepted 0-to-10 metric. It shows a
close linear relationship with visual analog pain scales
across the age range 4 through 16 years. It is easy to
administer and requires no equipment except for the
photocopied faces. The absence of smiles and tears
in this faces scale may be advantageous. The FPS-R
is recommended for use with younger children in
parallel with numerical self-rating scales (0-to-10) for
older children and behavioural observation scales for
those unable to provide self-report.

Braden scale is the assessment of presure sore ulcer Barfbara Braden   http://www.bradensc
risk of measured of the total score of the Braden                      ale.com/braden.PDF
score as defined by the Braden scale.

Bristol laanguage development scale (And UK used
scale) is a scale of a 30 minute audiotaped sample of
the child's spontaneous verbal output scored from 0
to 10 on the Bristol language development scales
One of the components of the Glasgow coma scale is        Institute for
the best verbal response, which cannot be assessed        Algorithmic
in nonverbal small children. A modification of the        Medicine, Houston,
original Glasgow coma scale was created for children      TX, USA
too young to talk. Parameters:                            http://trauma.ucsd.e
(1) eyes opening                                          GCS.pdf

(2) best verbal or nonverbal response (depending on
development status)

(3) best motor response

Older adults do not always show withdrawal signs in
the same way that that younger adults do. For
example, older adults may not demonstrate signs of
anxiety, shakes, or sweating. Alternatively, the signs
may be confused with other medical conditions that
the older adult has, such as Parkinson's disease. In
other cases, the person may have some degree of
cognitive impairment and may not be able to
accurately tell you how she or he is feeling. For that
reason, monitoring vital signs before withdrawal (and
having a baseline of what is normal for this person)
and during withdrawal can provide very important
This clinical tool assesses 10 common withdrawal
signs. A score of 15 + points means the patient may
be at increased risk of alcohol withdrawal effects such
as confusion or seizures. Clinicians working with older
adults note that a lower cutoff is advisable for older
adults, as a score of more than 15 may mean a
potential health crisis.
The Denver Developmental Screening Test (DDST), William K. Frankenburg http://www.patient.c
commonly known as the Denver Scale, is a test for                      o.uk/showdoc/40000
screening cognitive and behavioural problems in                        554/
preschool children. It was developed by William K.
Frankenburg and first introduced by him and J.B.
Dobbs in 1967.[1] The test is currently marketed by
Denver Developmental Materials, Inc., in Denver,
Colorado, hence the name.The scale reflects what
percentage of a certain age group is able to perform a
certain task. In a test to be administered by a
pediatrician or other health or social service
professional, a subject's performance against the
regular age distribution is noted. Tasks are grouped
into four categories (social contact, fine motor skill,
language, and gross motor skill) and include items
such as smiles spontaneously (performed by 90% of
three-month-olds), knocks two building blocks against
each other (90% of 13-month-olds), speaks three
words other than "mom" and "dad" (90% of 21-month-
olds), or hops on one leg (90% of 5-year-olds).

Rappport et al developed a disability rating scale for
patients who have had severe head injury with coma.
This can help evaluate a patient's level of disability
and monitor rehabilitation into the community. The
authors are from the University of California in San
Francisco and the Santa Clara Valley Medical Center
in San Jose.
(1) arousability awareness and responsivity (based on
a modified Glasgow Coma Score using eye opening
verbalization and motor response)
(2) cognitive ability for self-care activities in: feeding
toileting grooming
(3) dependence on others and level of functioning
(4) psychosocial adaptability and employability
The FLACC scale was developed to reduce these
potential barriers by providing a simple framework for
assessment, while facilitating a reliable and objective
means of quantifying pain behaviors in children. This
tool includes five categories of pain behaviors,
including facial expression, leg movement, activity,
cry, and consolability. These behaviors are consistent
with those described by Büttner and Finke (2000) to
be reliably associated with pain in young children. The
acronym FLACC facilitates recall of these categories,
each of which is scored from 0-2 to provide a total
pain score ranging from 0-10. The FLACC tool was
shown to have good interrater reliability and excellent
validity as demonstrated by changes in pain scores
from before to after analgesic administration and
excellent correlation with the Objective Pain Scale
(OPS) in a study of children aged 2-7 years (Merkel et
al., 1997).

The Glasgow Coma Scale or GCS, sometimes also                The scale was
known as the Glasgow Coma Score is a neurological            published in 1974 by
scale which aims to give a reliable, objective way of        Graham Teasdale and
recording the conscious state of a person, for initial as    Bryan J. Jennett,
well as continuing assessment. A patient is assessed         professors of
against the criteria of the scale, and the resulting         neurosurgery at the
points give a patient score between 3 (indicating deep       University of Glasgow.
unconsciousness) and either 14 (original scale) or 15        The pair went on to
(the more widely used modified or revised scale).            author the textbook
GCS was initially used to assess level of                    Management of Head
consciousness after head injury, and the scale is now        Injuries (FA Davis
used by first aid, EMS and doctors as being                  1981, ISBN 0-8036-
applicable to all acute medical and trauma patients. In      5019-1), a celebrated
hospital it is also used in chronic patient monitoring, in   work in the field.
for instance, intensive care.

The Glasgow Outcome Scale (GOS) was commonly
used before other scales were developed. As a brief
descriptive outcome scale it has been replaced by the
DRS, although it is still seen occasionally in the
literature, especially in studies investigating early
acute medical predictors of gross outcome. The five
categories of the original scale are: dead, vegetative,
severely disabled, moderately disabled, and good
recovery. An extended version of the scale divides
each of the latter three categories in two, making
The GDS questions are answered "yes" or "no",                The GDS was first
instead of a five-category response set. This simplicity     developed in 1982 by
enables the scale to be used with ill or moderately          J.A. Yesavage and
cognitively impaired individuals. The scale is               others
commonly used as a routine part of a comprehensive
geriatric assessment. One point is assigned to each
answer and the cumulative score is rated on a scoring
grid. The grid sets a range of 0-9 as "normal", 10-19
as "mildly depressed", and 20-30 as "severely

A diagnosis of clinical depression should not be
based on GDS results alone. Although the test has
well-established reliability and validity evaluated
against other diagnostic criteria, responses should be
considered along with results from a comprehensive
diagnostic work-up. A short version of the GDS
containing 15 questions has been developed, and the
scale is available in languages other than English.

Derived from 20 years of research, the Hendrich II
Fall Risk Model®, is an evidenced based tool for
identification of patients at risk for falls. The AHI Fall
Prevention Program will help your organization meet
JACHO goals and Magnet standards. The Centers for
Medicare and Medicaid ( CMS) may soon add falls to
the list of events that should not occur in hospitals
–“Never Events”

Designed and implemented as a standard for a                 Specification developed
comprehensive data summary that aggregated data              jointly by ASTM
from multiple sources, health care records, medical          International, the
legal documents, and health encounters to form a             Massachusetts Medical
comprehensive overall clinical picture of a patient's        Society[1] (MMS),
current and relevant historical health care status. It is    HIMSS (HIMSS), the
officially balloted and approved as ASTM Standard            American Academy of
E2369-05                                                     Family Physicians
                                                             (AAFP), the American
                                                             Academy of
                                                             Pediatrics[2] (AAP),
                                                             and other health
                                                             informatics vendors.

Original HL7 attempt at patient care integration
standard, later incorporated into HL7 CDA
Designed to represent medical legal health care
encounter documents in a statndardized format. Uses
XML, The HL7 Reference Information Model (RIM)
and vocabulary.

Developed to resolve the CCR vs CDA. The CCD was            The CCD is a
developed as a harmonization between the CCR and            compromise, joint effort
the CDA, using the semantic model from CCR,                 of two rival standards-
expressed in the CDA XML schema. Though this                development
compromise was reached in the industry and ratified         organizations, ASTM
by HITSP, the debate over CCR vs. CDA remains.              International and Health
                                                            Level 7 but the CCD will
                                                            be a component of
                                                            HL7's overarching
                                                            Clinical Document
                                                            Architecture and thus
                                                            will be balloted by HL7
                                                            members only.

A psychometric response scale often used in                 Rensis Likert              N/A
questionnaires, and is the most widely used scale in
survey research. When responding to a Likert
questionnaire item, respondents specify their level of
agreement to a statement. The scale is named after
Rensis Likert, who published a report describing its
Introduced in the 1940s by Pulaski and Tennison as a
quick assessment took for determining the size of a
burn injury. Often used in pre-hospital settings or in
the ED to obtain a general estimate of the extent of
the burn. Based on the presumption that the body can
be divided into nine anatomic regions that represent
9% of the entire body surface. It is reasonably
accurate in individuals 9 years of age and older.
However, in infants and children, the rule of nines
calculation is different because of the relatively larger
surface area of the head and the smaller area of the
lower extemities.
The mini-mental state examination (MMSE) or
Folstein test is a brief 30-point questionnaire test that
is used to assess cognition. It is commonly used in
medicine to screen for dementia. In the time span of
about 10 minutes it samples various functions
including arithmetic, memory and orientation. It was
introduced by Folstein et al in 1975,[1] and is widely
used with small modifications. This test is not the
same thing as a mental status examination

A visual analog scale to assess pain in pediatric           Donna Wong, a nurse      Donna Wong, PhD,
patients                                                    consultant, and Connie   RN
                                                            Morain Baker, a child    Nursing Consultant
                                                            life specialist, were    & Assoc Professor
                                                            working in the burn      Univ of Oklahoma &
                                                            center at Hillcrest      Oral Roberts Univ
                                                            Medical Center, Tulsa,   7535 S Urbana
                                                            OK.                      Avenue
                                                                                     Tulsa, OK 74136-
Morse (1997) developed the Morse Falls Scale            Janice M. Morse
(MFS), which consists of six items: history of falling;
presence of a secondary diagnosis; use of an
ambulation aid; intravenous therapy; type of gait; and
mental status. It has the advantage of ease of scoring
through a chart audit or direct observation.

The National Institutes of Health Stroke Scale
(NIHSS) is a systematic assessment tool that
provides a quantitative measure of stroke-related
neurologic deficit. The NIHSS was originally designed
as a research tool to measure baseline data on
patients in acute stroke clinical trials. Now, the scale
is also widely used as a clinical assessment tool to
evaluate acuity of stroke patients, determine
appropriate treatment, and predict patient outcome

The Neonatal Infant Pain Scale (NIPS) is a behavioral developed at the
assessment tool for measurement of pain in preterm Children's Hospital of
and full-term neonates. This can be used to monitor a Eastern Ontario.
neonate before during and after a painful procedure
such as venipuncture.
On the numerical rating scale, the person is asked to
identify how much pain they are having by choosing a
number from 0 (no pain) to 10 (the worst pain

The Rancho Levels of Cognitive Functioning is an         Rancho Los Amigos
evaluation tool used by the rehabilitation team. The     National Rehabilitation
eight levels describe the patterns or stages of          Center.
recovery typically seen after a brain injury. This helps
the team understand and focus on the person's
abilities and design an appropriate treatment

Riker and colleagues performed a study to test the
Riker Sedation-Agitation Scale (SAS) for reliability
and validity in adult ICU patients (2). The SAS
includes seven levels of agitation, ranging from
dangerous agitation to unarousable. Paired
evaluators (experienced ICU nurses) simultaneously
and independently scored patients using the SAS,
Ramsey, and Harris scales. Reliability was confirmed
for all scales by the high interrater proportion of
agreement (0.95). Validity was established based on
a high correlation with the Ramsey and Harris scales.

The SAS of Weissman and colleagues (1974, 1976,
1978) was derived from The Structured and Scaled
Interview to Assess Maladjustment (SSIAM; Gurland,
Yorkston, Stone, Frank, and Fleiss, 1972) and has
been widely used in psychiatric and non-psychiatric
The suicide intent scale was developed by Aaron T.            Aaron T. Beck et al.
Beck and his colleagues at the University of
Pennsylvania for use with patients who attempt
suicide but survive. It is important to understand a
patient's will to die in order to assess the severity of
the suicide attempt. Some attempted suicides are
carried out with little to no intention of cessation of life,
while others clearly have no other goal. The suicide
intent scale is an attempt to redefine the meaning of
attempted suicide, placing them on a scale based on

The Beck Scale for Suicide Ideation (BSI; Beck &
Steer, 1991) is a 21-item self-report instrument for
detecting and measuring the current intensity of the
patients' specific attitudes, behaviors, and plans to
commit suicide during the past week. The BSI was
developed as a self-report version of the interviewer-
administered Scale for Suicide Ideation. The first 19
items consist of three options graded according to the
intensity of the suicidality and rated on a 3-point scale
ranging from 0 to 2. These ratings are then summed
to yield a total score, which ranges from 0 to 38.
Individual items assess characteristics such as wish
to die, desire to make an active or passive suicide
attempt, duration and frequency of ideation, sense of
control over making an attempt, number of deterrents,
and amount of actual preparation for a contemplated
attempt. The last two items assess the number of
previous suicide attempts and the seriousness of the
intent to die associated with the last attempt. As with
the SSI, the BSI consists of five screening items. If
the respondent reports any active or passive desire to
commit suicide, then an additional 14 items are
administered. The BSI takes approximately 10
minutes to administer.
The verbal rating scale (VRS) originated by Melzack
is a simple, commonly used pain rating scale.[17] To
complete it, subjects select one of six descriptors that
represent pain of progressive intensity: none, mild,
discomforting, distressing, horrible, or excruciating.
Another scale is a modified 21-point Box Scale. The
scale has a row of 21 boxes labeled from 0 to 100 in
increments of five. The 0 anchor is labeled "no pain,"
while the 100 anchor is labeled "pain as bad as it
could be." To complete the scale, respondents
indicate the box that best represents their pain.

The horizontal visual analog scale (HVAS) consists of
a 10 cm line anchored by two extremes of pain: no
pain and extreme pain (Figure 1). Patients are asked
to position a sliding vertical marker to indicate the
level of pain they are currently experiencing; pain
severity is measured as the distance in centimetres
between the zero position and the marked spot.[11-
13] The vertical visual analog scale (VVAS) is similar
to the prior scale but is presented vertically, and the
line is replaced by a red triangle with its summit facing
downwards (no pain=0) and its base at the top
(maximum pain=10); the use of this scale has been
validated in children
SME (Subject                                     Recogntion
Matter Experts)   Other Resources

Hahn YS, Chyung C, et al.
Head injuries in children
under 36 months of age.
Child's Nerv Syst. 1988; 4:

Jaffe D, Wesson D.
Emergency management of
blunt trauma in children. N
Engl J Med. 1991; 324:1477-

Simpson D, Reilly P.
Pediatric Coma Scale
(Letter to the Editor).
Lancet. 1982; 2: 450
Ann Hendrich   http://www.ahincorp.com/
            HITSP Named

            HITSP Named

N/A   N/A   N/A
                  The Clinical Guide by
                  Marshal F. Folstein, MD,
                  Susan E. Folstein, MD, and
                  Gary Fanjiang, MD,
                  describes the development,
                  validation, administration,
                  and interpretation of the

Donna Wong, PhD, http://www.mosbysdrugcons
RN and Carol Baker, ult.com/WOW/facesReprod
PhD, RN             uctions.html
Family Education Resource:
                                                              Infrastructure Standards Standard Type
                              Acronym   Description
cancer Common Ontology        caCORE    caCORE is open source software and
Reference Envi-ronment                  services developed by the National
                                        Cancer Institute Center for
                                        Bioinformatics (NCICB) Core
                                        Infrastructure Group. Providing a data
                                        management and application
                                        development framework caCORE-
                                        based systems include the semantic
                                        underpinning for interoperable data and
                                        analytical services
Federal Health Architecture   FHA       The Federal Health Architecture (FHA)
                                        was established as an eGov Line of
                                        Business in response to The President's
                                        Management Agenda calling for
                                        increased efficiency and effectiveness in
                                        government operations. The FHA is
                                        responsible for leveraging federal
                                        expertise in creating a federal
                                        framework that would be derived from a
                                        national health IT infrastructure,
                                        supporting federal activities in the
                                        development and adoption of health IT
                                        standards, and ensuring that federal
                                        agencies can seamlessly exchange
                                        health data between and among
                                        themselves, with state, local and tribal
                                        governments, and with private sector
                                        healthcare organizations.
Information Technology (IT)   IT Infrastructure Integrating the Healthcare Enterprise
Infrastructure Technical      Technical         (IHE) Technical Frameworks, are a
Framework                     Framework         resources for users, developers and
                                                implementers of healthcare imaging and
                                                information systems. They define
                                                specific implementations of established
                                                standards to achieve effective systems
                                                integration, facilitate appropriate sharing
                                                of medical information and support
                                                optimal patient care. They are expanded
                                                annually, after a period of public review,
                                                and maintained regularly by the IHE
                                                Technical Committees through the
                                                identification and correction of
                                                errata.Ten IHE IT Infrastructure
                                                Integration Profiles are specified as
                                                Final Text in Version 4.0 of the ITI
                                                Technical Framework (ITI-TF v. 4.0):
                                                Cross-Enterprise Document Sharing
                                                (XDS), Patient Identifier Cross-
                                                Referencing (PIX), Patient
                                                Demographics Query (PDQ), Audit trail
                                                and Node Authentication (ATNA),
                                                Consistent Time (CT), Enterprise User
                                                Authentication (EUA), Retrieve
National Health Information   NHIN (formerly The Nationwide Health Information
Network (formerly National    NHII)             Network (NHIN) network of networks, is
Health Information                              the critical portion of the health IT
Infrastructure)                                 agenda intended to provide a secure,
                                                nationwide, interoperable health
                                                information infrastructure that will
                                                connect providers, consumers, and
                                                others involved in supporting health and
                                                healthcare. The NHIN will enable health
                                                information to follow the consumer, be
                                                available for clinical decision making,
                                                and support appropriate use of
                                                healthcare information beyond direct
                                                patient care so as to improve health.

Pulic Health Information      PHIN              PHIN is a national initiative to improve
Network                                         the capacity of public health to use and
                                                exchange information electronically by
                                                promoting the use of standards, defining
                                                functional and technical requirements.
                                                PHIN strives to improve public health by
                                                enhancing research and practice
                                                through best practices related to
                                                efficient, effective, and interoperable
                                                public health information systems
MedBiquitous is a non-profit,   MedBiquitous   Based on XML and Web services
dedicated to advancing                         standards, this blueprint will weave
healthcare education through                   together the many activities,
technology standards to                        organizations, and resources that
create a technology blueprint                  support the ongoing education and
for professional healthcare                    performance of healthcare
education.                                     professionals, creating more integrated
                                               access to educational resources,
                                               scientific journals, pharmaceutical and
                                               device product information, and clinical
                                               trials and registries. Ultimately, this
                                               blueprint will seamlessly support the
                                               learner in ways that will improve patient
                                               care and simplify the administrative
                                               work associated with education and
                                               competence assessment.

Consolidated Health             CHI            Adopts a portfolio of existing health
Informatics                                    information interoperability standards
                                               (health vocabulary and messaging)
                                               enabling all agencies in the federal
                                               health enterprise to “speak the same
                                               language” based on common enterprise-
                                               wide business and information
                                               technology architectures
structure Standards Standard Type
                                  Contact              SME (Subject
         Developer                                     Matter Experts)      Other Resources
         National Cancer Intitute Deering Mary Jo      Deering Mary Jo      1.Enterprise Vocabulary Services
         (NCI)                    deeringm@mail.nih.   deeringm@mail.nih.   (EVS); 2.Cancer Data Standards
                                  gov                  gov                  Repository (caDSR); 3. cancer
                                                                            Bioinformatics Infrastructure Objects
                                                                            (caBIO) model.

         HHS-Office of National fha@hhs.gov                                 Health Information Technology
         Coordinator (ONC)                                                  Policy Council (HITPC); Healthcare
                                                                            Information Technology Standards
                                                                            Panel (HITSP); Consolidated Health
                                                                            Informatics (CHI) is an integral
                                                                            element of the Federal Health
                                                                            Architecture (FHA).
Integrating the         http://www.ihe.net/T Didi Davis      IT Infrastructure White Papers
Healthcare Enterprise   echnical_Framewor bdavis@himss.org   The IHE IT Infrastructure Technical
(IHE)                   k/index.cfm                          Committee has published the
                                                             following white papers for public
                                                             comment. These white papers
                                                             facilitate the use of existing IHE ITI
                                                             profiles or scope the need for future
                                                             profiles.Comments can be
                                                             submitted to the online discussion
                                                             forums at http://forums.rsna.org

HHS-Office of National http://www.hhs.gov/                   Summary Report on the Prototype
Coordinator (ONC)      healthit/healthnetwor                 Architectures (PDF - 1.73MB)
                       k/forums/                             1st Executive Order
                                                             National Committee on Vital and
                                                             Health Statistics
                                                             Recommendations on the initial
                                                             functional requirements for a
                                                             Nationwide Health Information
                                                             Network (NHIN)

Centers for Disease    http://www.cdc.gov/p                  The National Electronic Disease
Control and Prevention hin/about.html                        Surveillance System (NEDSS);
(CDC)                                                        PHIN Vocabulary Services,
                                                             PHIN XForms Question Framework
                                                             PHIN Messaging Services
                                                             PHIN Messaging System
Office of Management   Vish Sankaran, FHA
and Budget's (OMB)     Acting Program
eGov initiatives.      Manager
                                                              Standards Workgroup 1 Review and Comments
Due: EOD Wednesday, May 28th. Conference call to discuss results Thursday, May 29, 11amEDT
Please register at https://www1.gotomeeting.com/register.970297086

Instructions: Enter your comments, additions, revisions, etc on this tab.
In the column for Tab name, use the dropdown list to select the spreadsheet tab you are referring to.
In the column "Line#/Standard" if you are referring to an existing entry, enter the spreadsheet line # and standard name.
In the column "comment by" enter your name.

Tab Name         Line           Comment by:

Terminology      Classification Cyndie Lundberg

Standards        CMS- row # 8 Cyndie Lundberg

Standards Orgs SNOMED           Cyndie Lundberg
               Row # 10

Document     Row #38            Cyndie Lundberg
Document                        Virginia Saba
Standards    Row 19             Ginny Meadows
Terminology                     Ginny Meadows
Terminology                     Ginny Meadows
Standards                       Ginny Meadows
Standards                       Ginny Meadows
Data                            Rita Zielsdorg
                     Standards Workgroup 1 Review and Comments
h. Conference call to discuss results Thursday, May 29, 11amEDT

ons, revisions, etc on this tab.
 down list to select the spreadsheet tab you are referring to.
 referring to an existing entry, enter the spreadsheet line # and standard name.


             I made changes in red throughout the document. In some cases I suggested
             deletions. I also suggested phone numbers be removed.

             For all of the classification systems, we need to rewrite the description of the
             classification in easier natural language so all can be understood.

             CMS is currently working with the Health and Human Services (HHS) to map
             the Minimum Data Set (CMS) Version # 3.0 to SNOMED CT and LOINC

             College of American Pathologist (CAP) is the original developer of SNOMED
             Reference Terminology that became SNOMED CT in 2002. In May, 2007
             SNOMED CT transitioned to the International Health Terminology Standards
             Development Organization (IHTSDO) to encourage global adoption. SNOMED
             Terminology Solutions, part of CAP, provides education and consulting
             services to support the implementation of SNOMED-CT globally.

             Geriatric Depression Scale

             Rosemary Kennedy can send a list of all these tools with descriptions.

             I added the USHIK to the list

             Changed the description of LOINC to incorporate the clinical observations
             Replaced Terminology Tab with new tab sent by Cindie Lundberg
             Should we delete the "Developer" column in this tab - as N/A?

             Need to complete the contact and SME columns, if applicable

             Add the National Council for Prescription Drug Programs (NCPDP)

             Need to complete this tab - see #10 above


     GM- I incorporated all of Joyces changes in the
     new document. We will keep the phone numbers
     as long as they are publicly available on the
     This will be done during the editing process

     Ginny will incorporate

                                                       Data Exchange_Messaging
     Ginny will incorporate


                                                       Standards Initiatives
     Virginia will contact Rosemary.
                                                       Standards Orgs
     Done, everyone OK with it.
                                                       Document Standards
     Done, Cindy OK with it.                           Infrastructure
     Done, Cindy OK with it.
     Yes, deleted

     Ginny will incorporate

     Ginny will incorporate

     Cyndie and Ginny will work on it.

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