Healthcare Data Standards In nursing informatics, there are a lot if standards to be followed.

One of these is the Healthcare Data Standards. This standard is a critical component in the development and implementation of an Electronic Health Record Types of Standards
What is the difference between data, information and knowledge?

Data is raw material, for example numbers, text, images and sounds, in a form suitable for storage in or processing by a computer. It is without context or specific meaning. Information is the result of processing, manipulating and organising data. It is the context in which data is taken. Knowledge is the right information delivered to the right person just in time, in order to take the most appropriate decision. Wisdom is the knowledge and experience needed to make sensible decisions and judgements, or the good sense shown by the decisions and judgements made.

Standards can be divided into the following types, building from data to knowledge and wisdom:

Technical standards - e.g. those covering document formats or networking. Data standards - defining the structure and type of data. Information standards - a specification defining not just the structure of the data but how it should be used. Professional standards - specifying how professionals should manage information in the patient record.

Data Standard:
Data standards promote the consistent recording of information and are fundamental to the efficient exchange of information. They provide the rules for structuring information, so that the data entered

into a system can be reliably read, sorted, indexed, retrieved, communicated between systems, and shared. They help protect the long-term value of data.

Healthcare is fundamentally a process of communication. For much of history, verbal communication between a patient and a healthcare provider characterized this process. The temporal and physical proximity of the communicators provided ample opportunity to clarify ambiguity regarding the intended meaning of what was being communicated. Healthcare Data Interchange Standards -addresses, primarily, the format of messages that are exchanged between computer systems, document architecture, clinical templates, user interface, and patient data linkage. *to achieve data compatibility between systems, it is necessary to have prior agreement on the syntax of the messages to be exchanged.

Message Format Standards 1. 2. 3. 4. Medical device communications Digital Imaging Communications Administrative Data Exchange Clinical Data Exchange

The National Committee on Vital and Health Statistics was established by Congress to serve as an advisory body to the Department of Health and Human Services on health data, statistics and national health information policy. It fulfills important review and advisory functions relative to health data and statistical problems of national and international interest, stimulates or conducts studies of such problems and makes proposals for improvement of the Nations health statistics and information systems. In 1996, the Committee was restructured to meet expanded responsibilities under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Committee has been associated with ground-breaking contributions in such areas as disease classification, health surveys, uniform health data sets and other data standards, data needs for minority and other special populations, mental health statistics, State and community health data needs, and privacy protection for health information. The NCVHS is in a unique position to serve as a national forum for the collaboration of interested parties, with the longterm goal of improving the compatibility of private sector, state, and federal health information systems while assuring the confidentiality of the information collected. In particular, the new charter enables the NCVHS to foster collaboration on voluntary means to facilitate and accelerate the development of consensus across the public and private sectors around these key data standards and privacy issues. The National Committee on Vital and Health Statistics (NCVHS) was called upon to "study the issues related to the adoption of uniform data standards for patient medical record information [PMRI] and the electronic exchange of such information."

Adopted Message Format Standards Health Level Seven (HL7) is an all-volunteer, non-profit organization involved in development of international healthcare informatics interoperability standards. "HL7" is also used to refer to some of the specific standards created by the organization (e.g., HL7 v2.x, v3.0, HL7 RIM). HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. v2.x of the standards, which support clinical practice and the management, delivery, and evaluation of health services, are the most commonly used in the world. *

HL7, which stands for health level seven, provides the messaging standard that aims to connect healthcare organizations that speak different languages.
Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or "interface") when they receive new information but not all do so. HL7 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information. Theoretically, this ability to exchange information should help to minimize the tendency for medical care to be geographically isolated and highly variable. HL7 develops conceptual standards (e.g., HL7 RIM), document standards (e.g., HL7 CDA), application standards (e.g., HL7 CCOW), and messaging standards (e.g., HL7 v2.x and v3.0). Messaging standards are particularly important because they define how information is packaged and communicated from one party to another. Such standards set the language, structure and data types required for seamless integration from one system to another. Digital Imaging Communication in Medicine Standards Committee (DIGICOM) STANDARD Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems. DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. The National Electrical Manufacturers Association (NEMA) holds the copyright to this standard. It was developed by the DICOM Standards Committee, whose members are also partly members of NEMA. DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system (PACS). The different devices come with DICOM conformance statements which clearly state the DICOM classes they support. DICOM has been widely adopted by hospitals and is making inroads in smaller applications like dentists' and doctors' offices. National Council for Prescription Drug Programs (NCPDP) National Council for Prescription Drug Programs (NCPDP) was founded in 1977 as the extension of a Drug Ad Hoc Committee that made recommendations for the US National Drug Code (NDC). NCPDP is a not-for-profit, ANSI-accredited, standards development organization with over 1575 members representing virtually every sector of the pharmacy services industry. The diverse membership provides leadership and healthcare business solutions through education and standards, created using the consensus building process. NCPDP has been named in US federal legislation, including Health Insurance Portability and Accountability Act and the Medicare Prescription Drug, Improvement, and Modernization Act. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for Electronic Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. NCPDP has twelve active work groups where electronic standards for transmission of pharmacy data are created and modified. Accredited Standards Committee x12N/Insurance- The Accredited Standards Committee (ASC) X12, chartered by the American National Standards Institute in 1979, develops electronic data interchange (EDI) standards and related documents for national and global markets. With more than 315 X12 EDI standards and a growing collection of X12 XML schemas, ASC X12 enhances business processes, reduces costs and expands organizational reach. ASC X12's diverse

member base includes 3,000+ standards experts representing over 340 companies from multiple business domains, including communications, finance, government, insurance, supply chain and transportation. Institute of Electrical and Electronic Engineers The IEEE has developed a series of standards known collectively as P1073 Medical Information Bus (MIB), which support real-time, continuous, and comprehensive capture and communication of data from bedside medical devices such as those found in intensive care units, operating rooms, and emergency departments. These data include physiologic parameter measurements and device settings. Terminologies

A fundamental requirement for effective communication is the ability to represent concepts in an ambiguous fashion between both the sender and receiver of the message. Standardized terminologies enable data collection at the point of care, and retrieval of data, information, and knowledge in support of clinical practice.

Major Systems: TERMINOLOGIES: ICD 9 CM The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain (ex. ICD9-cm).

List of ICD-9 codes 001139: infectious and parasitic diseases List of ICD-9 codes 140239: neoplasms List of ICD-9 codes 240279: endocrine, nutritional and metabolic diseases, and immunity disorders List of ICD-9 codes 280289: diseases of the blood and blood-forming organs List of ICD-9 codes 290319: mental disorders List of ICD-9 codes 320359: diseases of the nervous system List of ICD-9 codes 360389: diseases of the sense organs List of ICD-9 codes 390459: diseases of the circulatory system List of ICD-9 codes 460519: diseases of the respiratory system List of ICD-9 codes 520579: diseases of the digestive system List of ICD-9 codes 580629: diseases of the genitourinary system List of ICD-9 codes 630679: complications of pregnancy, childbirth, and the puerperium List of ICD-9 codes 680709: diseases of the skin and subcutaneous tissue List of ICD-9 codes 710739: diseases of the musculoskeletal system and connective tissue List of ICD-9 codes 740759: congenital anomalies List of ICD-9 codes 760779: certain conditions originating in the perinatal period List of ICD-9 codes 780799: symptoms, signs, and ill-defined conditions List of ICD-9 codes 800999: injury and poisoning List of ICD-9 codes E and V codes: external causes of injury and supplemental classification

ICD 10 CM International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), for medical coding and reporting in the United States. The ICD-10-CM is a morbidity classification for classifying diagnoses and reason for visits in all American health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO) which replaces ICD-9. 1 Conventions

1.1 Level of Detail in Coding 1.2 Seventh character and placeholders 1.3 Excludes Notes

2 CHAPTER 1 - Certain infectious and parasitic diseases (A00-B99) 3 CHAPTER 2 - Neoplasms (C00-D48) 4 CHAPTER 3 - Diseases of the blood and blood-forming organs and certain disorders involving the Immune mechanism (D50-D89) 5 CHAPTER 4 - Endocrine, nutritional and metabolic diseases (E00-E90) 6 CHAPTER 5 - Mental and behavioral disorders (F01-F99) 7 CHAPTER 6 - Diseases of the nervous system (G00-G99) 8 CHAPTER 7 - Diseases of the eye and adnexa (H00-H59) 9 CHAPTER 8 - Diseases of the ear and mastoid process (H60-H95) 10 CHAPTER 9 - Diseases of the circulatory system (I00-I99) 11 CHAPTER 10 - Diseases of the respiratory system (J00-J99) 12 CHAPTER 11 - Diseases of the digestive system (K00-K93) 13 CHAPTER 12 - Diseases of the skin and subcutaneous tissue (L00-L99) 14 CHAPTER 13 - Diseases of the musculoskeletal system and connective tissue (M00-M99)= 15 CHAPTER 14 - Diseases of the genitourinary system (N00-N99) 16 CHAPTER 15 - Pregnancy, childbirth and the puerperium (O00-O99) 17 CHAPTER 16 - Certain conditions originating in the perinatal period (P00-P96) 18 CHAPTER 17 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 19 CHAPTER 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 20 CHAPTER 19 - Injury, poisoning and certain other consequences of external causes (S00-T98) 21 CHAPTER 20 - External causes of morbidity (V01-Y99) 22 CHAPTER 21 - Factors influencing health status and contact with health services (Z00-Z99) 23 7th Character

23.1 M1a 23.2 M48.4 - M48.5 23.3 M80, M84.3 - M84.6 23.4 O31 - O32, O33.4 - O33.7, O35 - O41, O60.1 - O60.2, O64, O69, 23.5 R40.21, R40.22, R40.23 23.6 S00 - S78 23.7 S79.0, S79.1 23.8 S79.8, S79.9, S80 - S81, S83 - S88, S89.8, S89.9, S90 - S99 23.9 S82 23.10 S89.0, S89.1, S89.2, S89.3 23.11 T15 - T28, T33 - T85, T88 23.12 V00 - V99, W00 - W99, X00 - X99, Y00 - Y04, Y08 - Y38,

CPT-4 CODE SET The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. The current version is the CPT 2010. There are three types of CPT codes:

Category I CPT Code(s) Category II CPT Code(s) Performance Measurement Category III CPT Code(s) Emerging Technology

CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Health Care Procedure Coding System. SNOMED SNOMED CT (Systematized Nomenclature of Medicine -- Clinical Terms), is a systematically organized computer processable collection of medical terminology covering most areas of clinical information such as diseases, findings, procedures, microorganisms, pharmaceuticals etc. It allows a consistent way to index, store, retrieve, and aggregate clinical data across specialties and sites of care. It also helps organizing the content of medical records, reducing the variability in the way data is captured, encoded and used for clinical care of patients and research. SNOMED CT consists of over a million medical Concepts. For example 22298006 means myocardial infarction (MI). The Concepts are arranged in a type or IS-A hierarchy. For example, Viral pneumonia IS-A Infectious pneumonia IS-A Pneumonia IS-A Lung disease. Concepts may have multiple parents, for example Infectious pneumonia is also an Infectious disease. The Concept graph must be acyclic a parent cannot be its own child. Concepts can have Roles, e.g. Viral pneumonia has a role Causitive Agent which must be a Virus. Some Concepts can be Primitive, such as Virus. But SNOMED also allows concepts to be Defined by a predicate. For example Viral pneumonia might be defined as Pneumonia that is caused by a Virus. Defined concepts are based on Description Logic. Descriptions are Terms or names (synonyms) assigned to a concept. Concepts often have several Descriptions, and a description may sometimes refer to more than one concept. For example, Immunosuppression might be a Therapy or a Finding. Upper level concepts include Procedure, Pharmaceutical/biologic product, Clinical finding, Event, Body structure, Organism. SNOMED concepts are often referred to by an information model such as HL7. Sample Computer Applications Using SNOMED CT

Electronic Health Record Systems Computerized Provider Order Entry CPOE Such As E-Prescribing Or Laboratory Order Entry Catalogues of clinical services e.g. for Diagnostic Imaging procedures Knowledge databases used in clinical decision support CDSS Remote Intensive Care Unit Monitoring Laboratory Reporting Emergency Room Charting Cancer Reporting Genetic Databases

LOINC STANDARDS Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, Inc., a US non-profit medical research organization, in 1994. LOINC was created in response to the demand for an electronic database for clinical care and management and is publicly available at no cost. It is endorsed by the American Clinical Laboratory Association and the College of American Pathologist. Since its inception, the database has expanded to include not just medical and laboratory code names, but also: nursing diagnosis, nursing interventions, outcomes classification, and patient care data set. LOINC applies universal code names and identifiers to medical terminology related to the Electronic health record. The purpose is to assist in the electronic exchange and gathering of clinical results (such as laboratory tests, clinical observations, outcomes management and research). Several standards, such as IHE, HL7 or openEHR, to electronically transfer results from different reporting systems to the appropriate healthcare networks. However, the health information enclosed is identified by a multiplicity of code values that may vary according to the entity producing those results. This has obvious disadvantages to the healthcare network that may need to adopt different codes to access and manage information coming from multiple sources. Managed care providers, for example, often have negotiated contracts that reimburse episodes of care and unique coding to trigger

automated claim payment. Mapping each entity-specific code to its corresponding universal code can represent a significant investment of both human and financial capital. A universal code system will enable facilities and departments across the world to receive and send results from their areas for comparison and consultation and contribute toward a larger public health initiative of improving clinical outcomes and quality of care. LOINC is one of the standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information. In 1999, it was identified by the HL7 Standards Development Organization as a preferred code set for laboratory test names in transactions between health care facilities, laboratories, laboratory testing devices, and public health authorities. A formal, distinct, and unique 6-part name is given to each term for test or observation identity. The database currently has over 58,000 observation terms that can be accessed and understood universally. Each database record includes six fields for the unique specification of each identified single test, observation, or measurement: 1. 2. 3. 4. 5. 6. Component- what is measured, evaluated, or observed (example: urea,...) Kind of property- characteristics of what is measured, such as length, mass, volume, time stamp and so on Time aspect- interval of time over which the observation or measurement was made System- context or specimen type within which the observation was made (example: blood, urine,...) Type of scale- the scale of measure. The scale may be quantitative, ordinal, nominal or narrative Type of method- procedure used to make the measurement or observation

A unique code (format: nnnnn-n) is assigned to each entry upon registration. Other database fields include status and mapping information for database change management, synonyms, related terms, substance information (e.g. molar mass, CAS registry number), choices of answers for nominal scales, translations. Some of the advantages resulting from adopting LOINC may include improved communication in integrated healthcare delivery networks, improved community wide electronic health records, the automatic transfer to public health authorities of case reports for reportable diseases (e.g. for disease control or detection of epidemics), improved transfer of payment information for services rendered and a significant improvement in the overall quality of health care by reducing errors in the system. The fact that universal standards are being promoted (if not adopted by national organizations and agencies) is an indication that the dialogue will continue regarding the development, structure, financing, monitoring, enforcement, and integration of standards within the broader health care system. International interest in LOINC continues to grow. A number of efforts have been undertaken to translate the LOINC documents and terms into various languages, such as Simplified Chinese, German, Spanish. For more information on LOINC International, see LOINC International. Currently(as of January, 2009), the software RELMA (Regenstrief LOINC Mapping Assistant) is available in separate downloads that contain an additional word index in Spanish, Simplified Chinese, or Korean, which allows searching in these languages in addition to English RxNORM STANDARDS RxNorm provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, MediSpan, Gold Standard Alchemy, and Multum. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary. RxNorm now includes the National Drug File - Reference Terminology (NDF-RT) from the Veterans Health Administration. NDF-RT is a terminology used to code clinical drug properties, including mechanism of action, physiologic effect, and therapeutic category. UNIFIED MEDICAL LANGUAGE SYSTEM

The Unified Medical Language System (UMLS) is a compendium of many controlled vocabularies in the biomedical sciences (created 1986[1]). It provides a mapping structure among these vocabularies and thus allows one to translate among the various terminology systems; it may also be viewed as a comprehensive thesaurus and ontology of biomedical concepts. UMLS further provides facilities for natural language processing. It is intended to be used mainly by developers of systems in medical informatics. UMLS consists of Knowledge Sources (databases) and a set of software tools. The UMLS was designed and is maintained by the US National Library of Medicine, is updated quarterly and may be used for free. The project was initiated in 1986 by Donald A. B. Lindberg, M.D., then and current Director of the Library of Medicine. The number of biomedical resources available to researchers is enormous. Often this is a problem due to the large volume of documents retrieved when the medical literature is searched. The purpose of the UMLS is to enhance access to this literature by facilitating the development of computer systems that understand biomedical language. This is achieved by overcoming two significant barriers: "the variety of ways the same concepts are expressed in different machine-readable sources & by different people" and "the distribution of useful information among many disparate databases & systems". The UMLS can be used to design information retrieval or patient record systems, to facilitate the communication between different systems, or to develop systems that parse the biomedical literature. For many of these applications, the UMLS will have to be customized locally according to one's particular needs. The Library of Medicine itself uses it for its PubMed and ClinicalTrials.gov systems. Integrating health care enterprise (IHE) IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. In 1997, a consortium of radiologists and information technology experts formed IHE, or "Integrating the Healthcare Enterprise." IHE created and operates a process through which interoperability of health care IT systems can be improved. The group gathers case requirements, identifies available standards, and develops technical guidelines that manufacturers can implement. IHE also stages "connectathons" and "interoperability showcases" in which vendors assemble to demonstrate the interoperability of their products. IHE is an international organization that focuses on the development of open and global IHE Integration Profiles and on the regional deployment of interoperable IT systems. Because of its limited resources, IHE concentrates on specific projects. It solicits proposals; and after surveying its members to better understand their priorities, it chooses areas to focus on. IHE Integration Profiles describe a clinical information need or workflow scenario and document how to use established standards (e.g. HL7, DICOM, LOINC...) to accomplish it. A group of systems that implement the same Integration Profile address the need/scenario in a mutually compatible way. Integration Profiles describe basic functional elements and therefore are reusable in many IT applications. More characteristics are:

each Integration Profile is based on relevant use-cases described by real users Integration Profiles are independent of manufacturers or products Integration Profiles are stable once published and may be extended by amendments - rather than rewritten. Integration Profiles provide an implementation guide for equipment vendors Integration Profiles are an effective shorthand for healthcare providers to specify integration requirements when purchasing systems and therefore achieved considerable recognition in the market.

IHE Integration Statements are simple documents prepared and published by a vendor to list the IHE Profiles supported by a specific release of a specific product. IHE Technical Frameworks are the detailed documents which specify the Integration Profiles and the associated actors (systems) and transactions.

IHE Connectathons are annual events where equipment vendors bring products with IHE Profiles and test them with other vendors. American society for testing and materials(ASTM) ASTM International (ASTM), originally known as the American Society for Testing and Materials, is an international standards organization that develops and publishes voluntary consensus technical standards for a wide range of materials, products, systems, and services. The organization's headquarters is in West Conshohocken, Pennsylvania, about 5 miles (8 km) northwest of Philadelphia. ASTM has a dominant role among standards developers in the USA, and claims to be the world's largest developer of standards. Using a consensus process, ASTM supports thousands of volunteer technical committees, which draw their members from around the world and collectively develop and maintain more than 12,000 standards. International Organization of Standardization (ISO) The International Organization for Standardization widely known as ISO, is an international standard-setting body composed of representatives from various national standards organizations. Founded on February 23, 1947, the organization promulgates worldwide proprietary industrial and commercial standards. It has its headquarters in Geneva, Switzerland. While ISO defines itself as a non-governmental organization, its ability to set standards that often become law, either through treaties or national standards, makes it more powerful than most non-governmental organizations. American National Standards Institute The American National Standards Institute or ANSI is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organization also coordinates U.S. standards with international standards so that American products can be used worldwide. For example, standards ensure that people who own cameras can find the film they need for that camera anywhere around the globe. ANSI accredits standards that are developed by representatives of standards developing organizations, government agencies, consumer groups, companies, and others. These standards ensure that the characteristics and performance of products are consistent, that people use the same definitions and terms, and that products are tested the same way. ANSI also accredits organizations that carry out product or personnel certification in accordance with requirements defined in international standards. The organization's headquarters are in Washington, DC. ANSI's operations office is located in New York City. The ANSI annual operating budget is funded by the sale of publications, membership dues and fees, accreditation services, feebased programs, and international standards programs. HIPAA The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104-191) [HIPAA] was enacted by the U.S. Congress in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum. According to the Centers for Medicare and Medicaid Services (CMS) website, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. The Administration Simplification provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system. Consolidated Health Informatics (CHI) CHI is a collaborative effort to adopt health information interoperability standards, particularly health vocabulary and messaging standards, for implementation in federal government systems.

About 20 department/agencies including the Department of Health and Human Services, the Department of Defense and the Department of Veteran's Affairs are active in the CHI governance process. Originally, CHI identified a portfolio of 24 health domains that later expanded to 27. CHI adopted 20 uniform standards for electronic exchange of clinical information to be used across the federal health enterprise. Phase I ended in May 2004. In Phase II, CHI is focusing on

Implementation of adopted standards, Maintenance of adopted standards, and Identification and adoption of new standards.

CHI is an integral element of the Federal Health Architecture (FHA) Program that is in the Office of the National Coordinator for Health Information Technology. STANDARDS DEVELOPMENT PROCESS ISO standards are developed according to the following principles.

Consensus The views of all interests are taken into account: manufacturers, vendors and users, consumer groups, testing laboratories, governments, engineering professions and research organizations. Industry wide Global solutions to satisfy industries and customers worldwide.

Voluntary International standardization is market driven and therefore based on voluntary involvement of all interests in the market-place.

There are three main phases in the ISO standards development process as follows. 1. The need for a standard is usually expressed by an industry sector, which communicates this need to a national member body. The latter proposes the new work item to ISO as a whole. Once the need for an International Standard has been recognized and formally agreed, the first phase involves definition of the technical scope of the future standard. This phase is usually carried out in working groups which comprise technical experts from countries interested in the subject matter. Once agreement has been reached on which technical aspects are to be covered in the standard, a second phase is entered during which countries negotiate the detailed specifications within the standard. This is the consensus-building phase. The final phase comprises the formal approval of the resulting draft International Standard (the acceptance criteria stipulate approval by two-thirds of the ISO members that have participated actively in the standards development process, and approval by 75% of all members that vote), following which the agreed text is published as an ISO International Standard.

2. 3.

It is also possible to publish interim documents at different stages in the standardization process. Most standards require periodic revision. Several factors combine to render a standard out of date: technological evolution, new methods and materials, new quality and safety requirements. To take account of these factors, ISO has established the general rule that all ISO standards should be reviewed at intervals of not more than five years. On occasion, it is necessary to revise a standard earlier.

ELECTRONIC HEALTH RECORD An electronic health record (EHR) (also electronic patient record (EPR) or computerised patient record) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in health care settings and increases safety through evidence-based decision support, quality management, and outcomes reporting. Benefits: Reduction of cost

In the U.S. a vast amount of funds are allocated towards the health care industrymore than $1.7 trillion per year. If savings are allocated using the current level of spending from the National Health Accounts, Medicare would receive about $23 billion of the potential savings per year, and private payers would receive $31 billion per year. Improve quality of care

The implementation of electronic health records (EHR) can help lessen patient sufferance due to medical errors and the inability of analysts to assess quality. Information Technology is being used today to automate day-to-day processes, thus helping to reduce administration costs which then in turn can free up time and money for patient care. EHR systems can help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine are hypothesised to enable proliferation of ongoing improvements in healthcare efficacy. Improved usage of EHR is achieved if the presentation on screen or on paper is not just longitudinal, but hierarchically ordered and layered. During compilation while hospitalisation or ambulant serving of the patient, easing to get access on details is improved with browser capabilities applied to screen presentations also cross referring to the respective coding concepts ICD, DRG and medical procedures information. Computerized Physician Order Entry (CPOE)one component of EHRincreases patient safety by listing instructions for physicians to follow when they prescribe drugs to patients. Naturally, CPOE can tremendously decrease medical errors: CPOE could eliminate 200,000 adverse drug events and save about $1 billion per year if installed in all hospitals. Promote evidence-based medicine

EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. Realistically, these benefits may only be realized if the EHR systems are interoperable and wide spread (for example, national or regional level) so that various systems can easily share information. Also, to avoid failures that can cause injury to the patient and violations to privacy, the best practices in software engineering and medical informatics must be deployed.

Record keeping and mobility

EHR systems have the advantages of being able to connect to many electronic medical record systems. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure.It is also easier to check in their records whether a patient as been admitted to such a medical centre or if they have any allergies since they have been admitted before.

Clearly the importance of data standards to enhancing the quality and efficiency of healthcare delivery is being recognized. Reviewing the business value of defining and using data standards is critical for driving the implementation of these standards into applications and systems.