The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was signed into law on August 21, 1996. The administrative simplification portion of HIPAA requires the Secretary of Health and Human Services (HHS) to adopt standards for the electronic transmission of specific administrative health transactions. These standards will apply to health plans, health care clearinghouses, and health care providers who transmit any health information in electronic form in connection with the following transaction:
- Health Claims or equivalent encounter information
- Health Claims Attachments
- Enrollment and Disenrollment in a Health Plan
- Eligibility For a Health Plan
- Health Care Payment and Remittance Advice
- Health Plan Premium Payments
- First Report of Injury
- Health Claim Status
- Referral Certification and Authorization
- Coordination of Benefits
Unless there is no existing standard, or a different standard will substantially reduce administrative costs to health care providers and health plans, the Secretary must adopt "a standard that has been developed, adopted, or modified by a standard setting organization."
The American National Standards Institute's Healthcare Informatics Standards Board (ANSI HISB) provides an open, public forum for the voluntary coordination of healthcare informatics standards among all United States' standard developing organizations. Every major developer of healthcare informatics standards in the United States participates in ANSI HISB. The ANSI HISB has 34 voting members and more than 100 participants, including ANSI-accredited and other standards developing organizations, professional societies, trade associations, private companies, federal agencies, and others.
In response to the passage of HIPAA, ANSI HISB offered its services to the Secretary of HHS to prepare an inventory of existing healthcare information standards that pertained to the transactions specified by P.L. 104-191. It also offered to assign them into appropriate HIPAA transaction categories and supporting standards sections. The Secretary accepted the offer and this report is the result.
The purpose of this report is to supply the Secretary of HHS with an inventory of existing healthcare informatics standards appropriate for the administrative simplification requirements of HIPAA and to map them into the relevant categories. To obtain the information for this report, HISB developed a set of templates (Appendix A) asking for the following characteristics for each standard or set of standards:
- Category/classification of standard
- Standards Development Organization
- ANSI accreditation status
- Name of standard
- Contact for more information
- Description of standard
- Readiness of standard
- Indicators of market acceptance
- Level of specificity
- Relationships with other standards
- Identifiable costs
These templates were distributed to HISB participants with a request for a quick turnaround. Responses were received from ANSI-accredited standards developers, other organizations, and government agencies. The responses were coordinated into the administrative simplification standards categories, reviewed by HISB for appropriate classification and accuracy, and returned to the submitting standards organizations following the review for revision and resubmission. The final judgment for the placement of the existing standards in these categories and the accuracy of the information rests with the standard developing organization submitting the information, such as level of specificity and market acceptance. This report does not recommend specific standards but provides relevant comparative information to support the Secretary's analyses and decisions.
The vision for improved efficiency and effectiveness of the U.S. health care system through applications of information technology to health care is shared by Congress, the Secretary of HHS, and ANSI HISB. Administrative and clinical data standards are nationally important to improve the uniformity, accuracy, and automation of patient care data. Such data will support the development and dissemination of timely information needed to make good health care and payment decisions. By providing this report on existing administrative data standards and making it widely available, ANSI HISB hopes to contribute to a foundation that will improve the cost and medical effectiveness of health care in the public and private sectors, nationally and internationally.