Data Standards – US Healthcare

Lets take three hospitals, A,B and C which uses different data standards for defining Gender in their hospitals

A uses 0,1 for male and female.
B uses 1,0 for male and female,
C uses M,F,U for male, female and unknown.

The data of A and B are different syntactically while the data standards of A and C are different semantically. To achieve uniformity in these, Data standards are proposed. The simplest data standards are as follows:

National Drug Code System:

National Drug Code System  Maintained by US Food and Drug Administration (FDA)
This is a three segment code, that says “who made it / who labelled it”, “what drug is in it”, “what is the package size of this drug”. There are many commercial databases available which provides the same information.

For Example : Please find the below image which is basically a NDC for some medication called “Prozac”. Prozac tablets are basically anti-depressant tablets that will be used for treating/helping patients with Obsessive-Compulsion-Disorder (OCD), or other depression that includes even Bi-polar disorders.

NDC example

The first 4 digits represents the makers of the product. Here Prozac tablets are made by Dista Products. The next 4 digits represents the type the medication will be used, like Prozac as a medication is consumed as Capsule based tablets, it will come in bottle and with 20 mg of each tablets. Then the last two digits represents the count of the tablets, so the Prozac in general will come with the volume of 100 tablets.

As time progress on, many commercial pharmacy databases also started to use the same kind of information or code standards.

RxNorm:

To avoid the complexity of commercial databases who produce same information again and again on the medicines.  Another Standard was initiated by National Library of Medicine (NLM). They created something called RxNorm, which gave much more standard to the medication been used by a particular patient.

These RxNorm codes use a special unique number called RxCUI. which will be unique for different drug. Not all medications will have the same RxCUI code. The RxCUI code for the same drug Prozac and its composition can be found here in this link – RxNorm  Prozac

NLM has also created something called United Medical Language System (UMLS) containing the vast array of multiple healthcare terminologies, vocabularies allows u to download and learn them.

ICD:

Death certificates played a vital role in the development of ICD International classification of Diseases. Dates back to a fine history. Bertillion in chicago 1893 classified some of the possible causes  of death and diseases with a code, which are still used in ICD.

History ICD codes:

We’re gonna move now to standards for problems, diagnoses, the things that afflict patients. These have a very interesting history beginning in the mid 1400s in Northern Italy, when death certificates were first developed. Of course they specified a cause of the death.
200 years later, the bubonic plague erupted, and for the first time people wanted to look at these death certificates as a source of data for analysis. Trying to understand the dynamics this disastrous plague. A couple of decades later in England. Captain John Graunt got interested in why children die, and again, turned to death certificates as a source of information.
In the United States, as early as 1639, it was recognized in Massachusetts that death certificates were important in that they were a public trust, so they needed to be maintained and made available for research and analysis. In 1839, an important figure called William Farr discovered interoperability. That’s my term. Maybe a bit of an exaggeration, but not too much of one. When he noted that each disease has in fact been described in many ways on different certificates.
In 1851, in London, there was a famous Great Exposition. This is what I think was called the Crystal Hall. Countries demonstrated the latest in science and technology, in agriculture and so on and so forth. And people realized that it was very hard to compare across countries because there was no standard way of representing things.

LOINC :

Logical Observation Identifiers Names and Codes Specifically derived for the lab tests that’s been conducted on the patients and their outcomes. www.search.loinc.org/

SNOMED-CT:

ICD-10, LOINC and SNOMED-CT include a relationship, but there is a uniqueness in SNOMED-CT. SNOMED-CT is from IHTSDO. refer www.browser.ihtsdotools.org/ All SNOMED-CT code are followed by a OID code system, this is maintained and managed by a separate organisation. This code System also provides the mapping for the same SNOMED-CT code.

 

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