Important Terms in Health Care Solutions

Health Level Seven(HL7)

HL7 refers to a set of international standards for the transfer of clinical and administrative data between software applications used by various healthcare providers. In OSI (Open system interconnect) model in networking, these standards focus mainly on the application layer. These standards generally send health-related information in the form of one or more messages includes patient records, billing information, etc.

HL7 Benefits:

• It helps in creating the National health information network like SHR.
• It helps in facilitating the development of interoperable systems.
• It facilitates easy communications between systems.
• It implements cost-effective solutions for healthcare.
• Make a fresh database for research on the medical sector which will make more effective service in the health sector.

HL7 version two Encoding Rules

Every message begins with information about the message itself.
| => Field Separator
^ => Component Separator
~ = Repetition Separator
\ => Escape Character
& => Sub-component Separator

Types of Message in HL7 version 2

ADT => Admission Transfer Discharge
ORM => Order (Pharmacy/ Treatment)
ORU => Observation Result
BAR => (Add/ Change) Billing Account
ACK=> General Acknowledgement
DFT => Detailed Financial Transaction
MDM => Medical Document Management
MFN => Master Files Notification
RAS => Pharmacy/ Treatment Administration
RDE => Pharmacy/ Treatment Encoded Order
RGV => Pharmacy/ Treatment Give

Segment ID

Each segment is identified by a three-letter code. The three-letter code will be at the beginning of each segment. Common segment Id’s are:

MSH => Message header
PID => patient identity
PV1 => patient visit information
NK1 => patient’s Next of Kin
EVN => event type
OBX => observation/result
AL1 => Allergy information
DG1 => Diagnosis information
DRG => Diagnosis related group
PR1 => procedures
ROL => Role
IN1 => Insurance
ACC => Accident information
ROL => Role
PDA => Patient death and autopsy

Source: dzone

FHIR

Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) is a standard describing data formats and elements (known as “resources”) and an application programming interface (API) for exchanging electronic health records. The standard was created by the Health Level Seven International (HL7) health-care standards organization. (source: wiki)

Shared Health Record(SHR)

HIE Components

• Terminology Registry: A system that serves to uniquely identify and manage terminology set (mapped to International Standards) that refer to clinical activities/references during care delivery. for example: ICD10, LOINC, CPT etc.
• Facility Registry: A system that serves to uniquely identify and manage all health services administered in the country. For example Hospitals, Community Health Clinics, and Laboratories, etc.
• Provider Registry: A system that is used for maintaining the unique identities of health providers in the country. For example Doctors, Community Health Workers, etc.
• Geolocation Registry: A system that will contain all addressable locations consisting of geolocations, postal address hierarchy. Like other registries, this will act as the reference point for addresses, locations.
• Master Client Index (Client Registry): A system that will manage the unique identity of citizens receiving health services. MCI will also generate unique health IDs for all the patients registered with it.
• Shared Health Record: A repository containing person-centric records for patients. SHR houses a subset of data from various EMRs from different care delivery organizations. This record is shared between different institutions and systems.

Source: sharedhealth.github.io

HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection.

At a glance, HIPPA does the following:

• It provides the ability to transfer and continue health insurance coverage for the workers and their families when they change or lose their jobs.
• Reduces health care fraud and abuse.
• Mandates industry-wide standards for health care information on electronic billing and other processes.
• Requires the protection and confidential handling of protected health information

The act, which was signed into law by President Bill Clinton on Aug. 21, 1996, contains five sections, or titles.

Title I: HIPAA Health Insurance Reform

Title I protects health insurance coverage for individuals who lose or change jobs. It also prohibits group health plans from denying coverage to individuals with specific diseases and pre-existing conditions, and from setting lifetime coverage limits.

Title II: HIPAA Administrative Simplification

Title II directs the U.S. Department of Health and Human Services (HHS) to establish national standards for processing electronic healthcare transactions. It also requires healthcare organizations to implement secure electronic access to health data and to remain in compliance with privacy regulations set by HHS.

Title III: HIPAA Tax-Related Health Provisions

Title III includes tax-related provisions and guidelines for medical care.

Title IV: Application and Enforcement of Group Health Plan Requirements

Title IV further defines health insurance reform, including provisions for individuals with pre-existing conditions and those seeking continued coverage.

Title V: Revenue Offsets

Title V includes provisions on company-owned life insurance and the treatment of those who lose their U.S. citizenship for income tax purposes.