Healthcare is already one of the most information intensive industries in the United States. As the adoption of health information technology gains momentum we should expect to see exponential growth in the amount of digitized healthcare data being collected. The question is whether we are prepared to turn that data into information, and subsequently turn that information into knowledge that can drive improvements in the quality, cost, and accessibility of healthcare. This blog entry is intended to provide a very brief overview of the healthcare information landscape, including some of the vocabularies, classifications, and standards being developed by and for the sector. This is by no means exhaustive or even extensive, but it will point you to some important resources if you’re interested in learning more about the management of healthcare information.
Classifications & Billing Codes
ICD – International Classification of Diseases
The most recognized classification system in healthcare is the International Classification of Diseases. Owned and published by the World Health Organization (WHO), the ICD is currently in its 10th revision (ICD-10). It was originally used only to clasify causes of mortality but expanded to include morbidity in its 6th revision. The National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) oversee the clinical modifications (CM) to the ICD that are necessary for assigning codes to diagnoses and procedures associated with clinical utilization in the US. The medical industry, at the behest of CMS, is still using the 9th revision (ICD-9-CM) and have lagged in the adoption of ICD-10-CM, but the Department of Health and Human Services (HHS) has proposed a switch effective October 1, 2013.
CPT – Current Procedural Terminology
The American Medical Association (AMA) owns, maintains, and distributes the Current Procedural Terminology which was originally developed in 1966, and has since been widely adopted for use in medical billing. CPT codes describe medical, surgical, and diagnostic services and are used primarily for financial and administrative purposes, but can also provide analytical value. Use of CPT is mandated by both CMS and the Health Insurance Portability and Accountability Act (HIPAA).
DRG – Diagnostic Related Group
Diagnostic Related Group codes were originally developed for the Health Care Financing Administration (HCFA), now known as CMS, as a patient classification system. The goal was to classify inpatient hospital cases into groups that required similar hospital resources so that CMS could establish reimbursement rates. DRGs are determined (assigned) by a grouper program that considers diagnostics (ICD-9), procedures (CPT), and additional data such as patient age and sex, and the presense of complications or comorbidities. A number of different DRG systems have been created for classifying hospital patients but the CMS-DRGs and MS-DRGs are the most widely used. The National Technical Information Service (NTIS), part of the U.S. Department of Commerce, sells the grouper software that has the algorithms for assigning CMS-DRG codes.
NDC – National Drug Code
The National Drug Code is a directory of universal product identifiers (UPC) used for identifying and reporting human drugs. The NDC is owned, maintained, and distributed by the Food and Drug Administration (FDA) which is part of HHS.
Information Standards
HL7 – Health Level 7
Health Level 7 is a non-profit organization, accredited by the American National Standards Institute (ANSI), whose mission is to develop standards for the electronic interchange of clinical, financial, and administrative information among health care oriented computer systems. Level 7 is a reference to the application layer of the Open Systems Interconnection (OSI) model for network architecture and communications. While version 3 of the HL7 standard was published in 2005, most people still use some variation of version 2.x. An important part of version 3 is its support for the Clinical Document Architecture (CDA) which specifies XML-based markup standards for clinical documents.
DICOM – Digital Imaging and Communications in Medicine
The Digital Imaging and Communications in Medicine (DICOM) standard is managed by the Medical Imaging and Technology Alliance (MITA) which is a division of the National Electrical Manufacturers Association (NEMA). The purpose of the standard is to facilitate the storage, printing, and transmission of medical images and their associated information (metadata). The standard includes both a file format definition and a network communications protocol utilizing TCP/IP.
Vocabularies & Ontologies
SNOMED CT – Systematized Nomenclature of Medicine Clinical Terms
The most mature effort to develop an international medical vocabulary is owned, maintained, and distributed by the International Health Terminology Standards Development Organization (IHTSDO) based in Denmark. Originally created by the College of American Pathologists (CAP), the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) is a comprehensive clinical healthcare terminology spanning a number of languages. The National Library of Medicine (NLM), which is part of the National Institute of Health (NIH), is the American member of the IHTSDO and they handle its distribution in the U.S., primarily through Unified Medical Language System (UMLS) resources.
LOINC – Logical Observation Identifiers Names and Codes
The purpose of the Logical Observation Identifiers Names and Codes (LOINC) is “to facilitate the exchange and pooling of clinical results for clinical care, outcomes management, and research by providing a set of universal codes and names to identify laboratory and other clinical observations.” Primarily used for coding and communicating lab results, the LOINC database and standards are developed and maintained by the Regenstrief Institute, a non-profit medical research organization. LOINC is endorsed by the American Clinical Laboratory Association as well as the CAP and is one of the standards used by U.S. Federal Government systems for information exchange.
ICNP – International Council of Nursing
The International Council of Nursing owns and maintains the International Classification for Nursing Practice (ICNP) which is made available via the Unified Nursing Language System (UNLS).
I’ve officially begun my summer administrative residency at UCSF Medical Center. With almost a week under my belt I can already say that this is a great opportunity. The executives here are all very supportive of the program and seem open to accommodating any interests that I might have. This of course means I have to figure out what exactly those interests are, but that process is well underway. I’ll be getting my hands dirty with a portion of the EMR project which should give me some great exposure to Health IT. I’ll also be learning more about clinical business intelligence, an area that has lots of room for growth and something that I may consider for my 
While this process is of obvious importance, it’s a significant administrative undertaking for the hospital. It was very interesting to hear from the various departmental representatives and to see how they identify and address potential non-compliant areas. Of particular interest to me was the question of how to regulate and audit state of the art procedures that are only performed by one physician in the world. While this is probably not an issue for most hospitals, it’s definitely something that UCSF has to think about.
