The Case For National Health Data Standards

Prologue: “Knowledge,” observed Samuel Johnson, “is of two kinds. We know a subject ourselves, or we know where we can find information upon it.” By this definition, many key players in health care might have to admit to some ignorance on the subject, particularly those who depend on the disparate data sources that constitute the “system” of health care information. A number of promising efforts are now under way that would standardize data collection and reporting, thereby improving the usefulness of health information. However, Rosanna Coffey and colleagues urge caution: They note that the development of standards is but one step in a much longer journey. The authors should know as well as anyone what challenges He ahead. All were deeply involved in the design and implementation of the Healthcare Cost and Utilization Project, a national database developed by the Agency for Health Care Policy and Research (AHCPR) that assembles information on hospital inpatient services from state governments and private organizations in almost twenty states. Coffey, who is currently a vice-president at The MEDSTAT Group, recently left AHCPR after twenty-three years of government service. Judy Ball is a senior researcher at AHCPR; she is also serving with the Office of the Assistant Secretary for Planning and Evaluation on the implementation of health data standards mandated by the Health Insurance Portability and Accountability Act. Meg Johantgen is currently a clinical associate with HSS, Inc., a Bethesda, Maryland-based software engineering firm. Anne Elixhauser recently joined MEDTAP International as a senior researcher after five years with AHCPR. Patrick Purcell is an analyst with the Congressional Research Service. Roxanne Andrews is a research scientist at the California Office of Statewide Health Planning and Development. ABSTRACT: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains groundbreaking provisions to encourage the development of a national health information system through the establishment of standards. This paper compares statewide inpatient data systems to one standard-the Uniform Bill (UB)—to understand how standards have been used and how they can be improved. We recommend changes to the UB, note the need for better compliance, and suggest new standards for common, derived elements.