Inventory of Health Care Information Standards. ASTM E1633-95 Standard Specification for Coded Values Used in the Computer-Based Patient Record


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Description Of Standard

This specification identifies the lexicons to be used for the data elements identified in the Annex portion of Standard E1384, Guide for the Content and Structure of the Computer-Based Patient Record. It is intended to unify the representations for (1) the identified data elements for the computer-based patient record, (2) data elements contained in other standard statistical data standards, (3) data elements used in other healthcare data message exchange format standards, or (4) in data gathering forms for this purpose, and (5) in data derived from these elements so that data recorded in the course of patient care can be exchangeable and provide consistent devel0pment of CPR content vocabulary that can also provide an accurate source for statistical and resource management data. Code values are specified using master tables which range from standard code value sets identified directly for the data element to standard code systems such as ICD9 to reference tables harmonized with HL7 Version 2.2. It promotes consistent data views specified for clinical settings. The standard is intended as a reference standard for designers and developers.

Functions: Implementation independent content organization

Identifies data representation for vocabulary elements

Includes an initial catalog of coded value sets

References known mater tables

User Environment: Administrative and clinical users

Software developers - data base design

Educators - health informatics

Systems Environment: Does not specify system environment

Evolving standard - ongoing development is focused on alignment with value sets used in companion standards

Value: Provides the 2nd edition of detailed representation for the listed data

elements contained in the vocabulary content in Standard ASTM E1384. It currently serves as a reference model for vendors and institutions working to build data base content for CPRs.

Readiness Of Standard

This standard is a specification that addresses data structure and data dictionary design. Since it combines with E1384 to offer an overall data model, users would incorporate the elements of the standard that apply to their situation. Requests for this standard come from designers working on the data content of the CPR. The proposed content is being used as a base data model and for data definitions.

This standard does not require a separate implementation guide. It should be used in conjunction with the Standard E1384. Vocabulary data elements are defined in E1384, which include limited code values and point to this specification for the specific delineations for the data form, coded values to be used in representing the element and where appropriate, and more formally identified master tables and code systems needed for the data elements. Code sets are assumed, referenced in E1633 for data elements and harmonized with code sets is ASTM Standards E 1238, E1239 and HL7 where feasible.

The standard is fully usable now as a reference guide for designers/developers of computer-based patient records.

Milestones identified are continued code value expansions, harmonization with companion standards and joint development work on new vocabulary. The most recent ballot was 1996. Proposed revisions and updates will be balloted in early 1997.

The standard is published and is an American National Standard. How can the standard be obtained? ASTM standards are available through the ASTM Customer Service Department by calling 610-832-9585. Standards can also be ordered through the ASTM Web Site at www.

Indicators Of Market Acceptance

Approximately 2300 copies of the E31 standards have been distributed.

The Veterans Administration reports using this as a reference standard. Other indicators include users who are currently involved in developing CPR applications within individual hospitals and hospital consortiums; vendors who are working on CPR data repository models; and CPR project planners who are in the process of defining content standards for their enterprise.

This standard is also included in a 1996 publication that has been adopted by all Health Information Administration programs in the United States. Another text due out in 1997 on data dictionaries for healthcare recommends usage of this specification in conjunction with E1384 for constructing data dictionaries in healthcare organizations.

Level Of Specificity

This standard calls for content to be expressed in a uniform manner. It does provide some data dictionary specificity. It identifies the common representation for data to be part of computer-based patient records in multiple settings.

Relationship With Other Standards

As indicated, this standard is written to provide the detailed specificity to ASTM E1384 for specified code values. Major work on this standard continues to be comparison and reconciliation with other standards and evolving data sets such as the Minimum Data Set from the National Committee on Vital and Health Statistics; and the National Provider Identification efforts underway in the Health Care Financing Administration. Harmonization with message standards and data element values included in X12 are proposed for revisions where possible. Functionality will be strengthened by coordination. Conditions assumed for coordination to be effective include joint work initiatives among standard developers and representatives from the user community who currently use this standard.