instructor’s guide for icd-9-cm diagnostic coding and ...media.lanecc.edu/users/scottl/hi 209...

Component 9: Networking and

Health Information Exchange

Instructor’s Manual

Version 1.0/Fall 2010

Notes to Instructors

This Instructor Manual is a resource for instructors using the Networking and Health Information Exchange component. Each component is broken down into Units, each of which will include the following elements:

Learning objectives Suggested student readings, texts, reference links to supplement the narrated

and scripted PowerPoint slides Lectures (narrated and scripted PowerPoint slides) Application Exercises (may include Discussion Questions, Assignments,

Projects) with instructor guidelines and answer key and/or expected outcomes Quiz or Other Assessment reflecting Unit Objectives Optional Materials (may include videos, links, tutorials, diagrams/charts, etc.)

Component 9 Networking and Health Information Exchange 2Version 1.0/Fall 2010

Contents Component Overview.......................................................................................................5Component Authors......................................................................................................6Workforce Roles “Set Table”........................................................................................7Unit 9.1: Hardware Communication..............................................................................8

Learning Objectives......................................................................................................8List of Readings, Texts, References.............................................................................8List of external resources, includes description and URL for each resource................8Instructor Guidelines and Expected Outcomes for Application Activities......................9Unit 1 Quiz Items........................................................................................................10Answer Key for Quiz Items.........................................................................................11

Unit 9.2: Hardware Communication............................................................................12Learning Objectives....................................................................................................12List of Readings, Texts, References...........................................................................12List of external resources, includes description and URL for each resource..............12Instructor Guidelines and Expected Outcomes for Application Activities....................13Unit 2 Quiz Items........................................................................................................14Answer Key for Quiz Items.........................................................................................14

Unit 9.3: National and International Standards Developing Organizations............16Learning Objectives:...................................................................................................16List of Readings, Texts, References...........................................................................16List of external resources, includes description and URL for each resource..............16Instructor Guidelines and Expected Outcomes for Application Activities....................17Unit 3 Quiz Items........................................................................................................17Answer Key for Quiz Items.........................................................................................19

Unit 9.4: Basic Health Data Standards.......................................................................21Unit Objectives:..........................................................................................................21List of Readings, Texts, References...........................................................................21List of external resources, includes description and URL for each resource..............21Instructor Guidelines and Expected Outcomes for Application Activities....................22Unit 4 Quiz Items........................................................................................................22Answer Key for Quiz Items.........................................................................................25

Unit 9-5: EHR Functional Model Standards...............................................................26Unit Objectives:..........................................................................................................27List of Readings, Texts, References...........................................................................27List of external resources, includes description and URL for each resource..............27Instructor Guidelines and Expected Outcomes for Application Activities....................28

Unit 9-6: Health Data Interchange Standards............................................................29Unit Objectives:..........................................................................................................29List of Readings, Texts, References...........................................................................29List of external resources, includes description and URL for each resource..............29Instructor Guidelines and Expected Outcomes for Application Activities....................29


Unit 9-7: Supporting Standards for EHR Applications.............................................31Unit Objectives:..........................................................................................................31List of Readings, Texts, References...........................................................................31List of external resources, includes description and URL for each resource..............31Instructor Guidelines and Expected Outcomes for Application Activities....................32

Unit 9-8: Enterprise Architecture Models...................................................................34Unit Objectives:..........................................................................................................34List of Readings, Texts, References...........................................................................34List of external resources, includes description and URL for each resource..............34Instructor Guidelines and Expected Outcomes for Application Activities....................35

Unit 9-9: Privacy Confidentiality, and Security Issues and Standards....................36Unit Objectives:..........................................................................................................36List of Readings, Texts, References...........................................................................?6List of external resources, includes description and URL for each resource..............37Instructor Guidelines and Expected Outcomes for Application Activities....................36


Component Overview

In-depth analysis of data mobility including the hardware infrastructure (wires, wireless, and devices supporting them) , the ISO stack, standards, Internet protocols, federations and grids, the NHIN and other nationwide approaches.

Each Learning Unit is estimated to require 3-6 contact (or instructional) hours and an additional 6-10 hours of independent or teamwork on the part of the student.

Unit 1: ISO Open Systems Interconnection (OSI) stack Unit 2: Hardware communication Unit 3: National and international standards developing organizations Unit 4: Basic health data standards Unit 5: EHR functional model standardsUnit 6: Health data interchange standardsUnit 7: Supporting standards for EHR applicationsUnit 8: Enterprise architecture modelsUnit 9: Privacy, confidentiality, and security

This entire Component is estimated to require approximately 36 total contact/instructional hours plus 25-40 additional hours of independent or teamwork.


Component Authors

Michele Parrish, Durham Technical Community CollegeMs. Parrish has an AAS in Microcomputer Systems Technology and an AAS Information Systems, Network Administration and Support from Durham Technical Community College. She is currently pursuing her BS degree in Information Science from UNC-CH. She is CCNA, CCAI, A+ and Network+ certified.

Ed Hammond, PhD, Duke Center for Health Informatics

Harry Bulbrook, Durham Technical Community College

Charlene West, Durham Technical Community College


Workforce Roles “Set Table”

This component applies most directly to the following workforce roles:- Practice workflow and information management redesign specialist- Clinician/practitioner consultants- Implementation support specialists

ONC will provide other content for this section


Unit 9.1: Hardware CommunicationThis unit will address the OSI, including the purpose and content of each of its seven layers: physical, data link, network, transport, session, presentation, and application. Products, processes, protocols and tools at each level will be explained. This unit will also focus on the flow of data through the models as data is transmitted and receive by end devices.

Learning Objectives:

By the end of this unit the student will be able to:

1. Explain the OSI representation of the various layers involved in networking, including the general functions of each layer and their interconnections

2. Explain the concept of the Application layer 3. Explain the concept of the Presentation layer 4. Explain the concept of the Session Layer 5. Explain the concept of the Transport layer 6. Explain the concept of the Network layer 7. Explain the concept of the Data Link layer8. Explain the concept of the Physical layer9. Explain connection-oriented versus connectionless communication10. Explain the use of network addressing including security considerations and

vulnerabilities

List of external resources, includes description and URL for each resource

Internetworking BasicsThis article includes terminology used in networking, networking basics and an in-depth look at each layer of the OSI model.http://www.cisco.com/en/US/docs/internetworking/technology/handbook/Intro-to-Internet.html

External Data Representation (XDR)More information about XDRhttp://en.wikipedia.org/wiki/External_Data_Representation

Minimal Lower Layer Protocol (MLLP)More information about MMLPhttp://www.hl7.org/v3ballot/html/infrastructure/transport/transport-mllp.htm#MLLP-intro

Port NumbersThis is the official IANA document that lists all port numbers and their associated protocols/applications.http://www.iana.org/assignments/port-numbersComponent 9 Networking and Health Information Exchange 8


http://www.iana.org/assignments/port-numbers

http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-mllp.htm#MLLP-intro

http://en.wikipedia.org/wiki/External_Data_Representation

http://www.cisco.com/en/US/docs/internetworking/technology/handbook/Intro-to-Internet.html

http://www.cisco.com/en/US/docs/internetworking/technology/handbook/Intro-to-Internet.html

Frame Relay More information about frame relayhttp://www.cisco.com/en/US/docs/internetworking/technology/handbook/Frame-Relay.html

PPP More information about PPPhttp://www.cisco.com/en/US/docs/internetworking/technology/handbook/PPP.html

ATM More information about ATMhttp://www.telecomspace.com/vop-atm.html

NRZ EncodingMore information about NRZhttp://www.erg.abdn.ac.uk/users/gorry/course/phy-pages/nrz.html

Manchester EncodingMore information about Manchesterhttp://www.erg.abdn.ac.uk/users/gorry/course/phy-pages/man.html

Instructor Guidelines and Expected Outcomes for Application Activities

Application 1:

Fill in the following chart with the correct components.USER

TCP/IP OSI Model PDU

NETWORK MEDIA


http://www.erg.abdn.ac.uk/users/gorry/course/phy-pages/man.html

http://www.erg.abdn.ac.uk/users/gorry/course/phy-pages/nrz.html

http://www.telecomspace.com/vop-atm.html

http://www.cisco.com/en/US/docs/internetworking/technology/handbook/PPP.html

http://www.cisco.com/en/US/docs/internetworking/technology/handbook/Frame-Relay.html

http://www.cisco.com/en/US/docs/internetworking/technology/handbook/Frame-Relay.html

Answer USER

TCP/IP OSI Model PDU

Application

Application

DataPresentation

Session

Transport Transport Segments

Internetwork Network Packets

Network AccessData Link Frames

Physical Bits

NETWORK MEDIA

Unit 1 Quiz Items

Instructions: Choose the best answer for each of the following questions.

1. Starting with the layer that is closest to the user what is the correct order of layers of the OSI model?

a. Physical, Data Link, Network, Transport, Session, Presentation, Applicationb. Presentation, Data Link, Network, Transport, Session, Physical, Applicationc. Application, Presentation, Session, Transport, Network, Data Link, Physicald. Application, Physical, Session, Transport, Network, Data Link, Presentation

2. Starting with the layer closet to the network media/medium what is the correct order of the layers of the TCP/IP model?

a. Network Access, Internetwork, Transport, Applicationb. Network Access, Network, Transport, Applicationc. Application, Transport, Internet, Network Accessd. Physical, Transport, Internet, Application

3. What is the protocol data unit (PDU) of the Network layer of the OSI model?a. Datab. Packetsc. Segmentsd. Frames

4. Which Application layer protocol is used for converting host names and domain names into IP addresses?

a. DHCPb. SMTPc. HTTPd. DNS


5. Which Presentation layer protocol specifies how messages must be formatted so that they can be exchanged between different email systems?

a. SMTPb. MIMEc. SSLd. XDR

6. T/F IPv4 has 128 bits.7. 132.16.9.0 is what class of IPv4 address?

a. Class Ab. Class Bc. Class Cd. Class D

8. A ____ is a term used to describe the movement of data from one router to another.a. hopb. skipc. routed. jump

9. T/F Ethernet uses CSMA/CA.10. A _______________ is a unique address assigned to most network interface cards

(NICs) by the manufacturer for identification. a. IP addressb. Unicastc. Ethernet addressd. MAC address

Answer Key for Quiz Items1. C Slide 1a-92. A Slide 1a-93. B Slide 1a-104. D Slide 1a-125. B Slide 1a-156. F Slide 1b-37. B Slide 1b-48. A Slide 1b-119. F Slide 1b-1910.D Slide 1b-16


Unit 9.2: Hardware CommunicationThis unit is designed to help the student understand network media, hardware devices, and how to select appropriate items to meet the guidelines for usage.



1. Select appropriate network media types (such as Ethernet and Wireless) to facilitate networking and data exchange, taking into account access and regulatory requirements

2. Select appropriate hardware devices (such as routers, switches, and access points) to facilitate networking and data exchange, taking into account access and regulatory requirements


How Digital Television WorksOn June 12, 2009 the United States transitioned from analog tv signals to all digital tv signals. Read about the difference between analog and digital tv and why the change was made. http://electronics.howstuffworks.com/dtv.htm

List of device bit ratesThis article contains listings of the bandwidth for LANs, WANs, wireless networks and other devices. Bandwidth is important in determining the “pipe” that your data will be able to travel down. The bigger the bandwidth, the bigger the “pipe”.http://en.wikipedia.org/wiki/List_of_device_bandwidths

CablingThis article includes information about the different types of network media including the categories of twisted pair and media connectors. http://fcit.usf.edu/network/chap4/chap4.htm

GetConnected - Tech Talk - Ethernet Cables and Router Speed This video presents information about Ethernet cables and router speed. It discusses the type of cabling that you would use in a home or small network. 5 minutes and 50 seconds long.http://www.youtube.com/watch?v=QIibd2Fu3bo

Introduction to Structured CablingThis paper describes why the structured cabling standard should be followed and what the standard entails. Note: Since this is a 2000 document some of the bandwidth information may be out of date.http://www.dit.gov.bt/guidelines/cablingstandard.pdfComponent 9 Networking and Health Information Exchange 12


http://www.dit.gov.bt/guidelines/cablingstandard.pdf

http://www.youtube.com/watch?v=QIibd2Fu3bo

http://fcit.usf.edu/network/chap4/chap4.htm

http://en.wikipedia.org/wiki/List_of_device_bandwidths

http://electronics.howstuffworks.com/dtv.htm

IEEE 802.11This article contains information about the different types of wireless networks including bandwidth, implementation and security issues.http://en.wikipedia.org/wiki/IEEE_802.11

Computer Basics: What Is a Computer Router? This video explains what a router does. It includes captions. 2 minutes and 5 seconds long.http://www.youtube.com/watch?v=9LhkW_dkZvU&feature=PlayList&p=8B1DE1B35CA215B2&playnext_from=PL&index=14

How to Make an Ethernet Cat5e/Cat6 CableThis page shows how to make a twisted pair cable. It shows the tools that are needed to make the cable. It also includes a video showing the process. Video is 7 minutes and 18 seconds long.http://discountlowvoltage.blogspot.com/2009/10/how-to-make-ethernet-cat5e-cable.html


Application 1: Research the types of media that were covered in the presentation (UTP, STP, Fiber Optic and Wireless) on the Internet and create a table that compares Media Type, Maximum Segment Length, Bandwidth (speed), Comparative Cost, Advantages and Disadvantages. It is recommended that you use Wikipedia to obtain the most up to date information about bandwidth.

Solution: http://www.ciscopress.com/articles/article.asp?p=169686 – needs to be updated

Application 2: You have a small office network with 4 desktop systems and 2 mobile laptops. You would like to network them all together. What hardware would you need to connect the desktops and laptops to each other so that they can share information?

Solution: Answers may vary. Minimally you would need NICs for the desktop and laptops and a WAP. Student may choose to have all devices be connected together wirelessly through the WAP. Student may choose wireless connections for the laptops and wired connections for the desktops. In that case a switch would be needed for the desktop computers and cabling (preferably TP).

Application 3: Most people either have Internet connectivity via DSL or cable. Discuss the kind of connectivity you have and your experience with it, including cost, how the network is set up, and problems actually experienced or anticipated as possibilities. If you don’t have DSL or cable Internet connectivity, explore both have them research the methods by reviewing the literature or resources provided below, and do the same kind


http://www.ciscopress.com/articles/article.asp?p=169686

http://discountlowvoltage.blogspot.com/2009/10/how-to-make-ethernet-cat5e-cable.html

http://www.youtube.com/watch?v=9LhkW_dkZvU&feature=PlayList&p=8B1DE1B35CA215B2&playnext_from=PL&index=14



http://en.wikipedia.org/wiki/IEEE_802.11

of analysis. Make sure to point out to student that even though DSL and cable are systems that are available 24/7 there can still be periods of downtime.

Application 4: Explore ways to secure a wireless network and present your findings in a brief report to the class. Talk about your own experiences with using a wireless network, including the things you do to keep the network secure.

Solution: http://compnetworking.about.com/od/wirelesssecurity/tp/wifisecurity.htm

Unit 2 Quiz Items


1. In _____ transmission signals may travel in both directions but in only one direction at a time.a. simplexb. full-duplexc. synchronousd. half-duplex

2. ______ is amount of data the medium transmits during a given period of timea. throughputb. bandwidthc. goodputd. data flow

3. A signal losses strength as the data transmission travels away from source. This is called ______.a. crosstalkb. attenuationc. latencyd. modulation

4. A ____ is any device on the network that has an address and can send and/or receive data.a. mediab. connectorc. noded. router

5. There are ___ wires in a twisted pair cable.a. 8b. 6c. 4d. 10

6. T/F Fiber optic cables are not susceptible to EMI and RFI. 7. _____ has a bandwidth of 11 Mbps. a. 802.11b b. 802.11g c. 802.11a d. 802.11n


http://compnetworking.about.com/od/wirelesssecurity/tp/wifisecurity.htm

Answer Key for Quiz Items11.d12.a13.b14.c15.a6. T – because it transmits light signals not electrical signals7. a


Unit 9.3: National and International Standards Developing OrganizationsThis unit introduces students to the national and international organizations that create standards used in networking and health information exchange.



1. Explain why standards related to networking and health information exchange are important, particularly in the current environment.

2. Describe how standards are developed, who develops them, and how they are selected and accredited.

3. Explain the most common categories of standards (e.g., basic networking, application).

4. Demonstrate how to find, obtain, and use standards that are needed to facilitate networking and health information exchange.


ISO TC 215 www.iso.org/iso/iso_technical_committee?commid=54960

Health Level 7 www.hl7.org

CDISC www.cdisc.org

CEN www.cen.eu/cen/Sectors/Sectors/ISSS/Committees

GS1 www.gs1.org

NCPDP www.ncpdp.org

ASC X12N www.x12n.org

ASTM E31 www.astm.org/COMMIT/COMMITTEE/E31

IHE www.himss.org/ASP/topics_ihe

DICOM http://medical.nema.org/

IHTSDO www.ihtsdo.org

ONC http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2


http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2

http://www.ihtsdo.org/

http://medical.nema.org/

http://www.himss.org/ASP/topics_ihe

http://www.astm.org/COMMIT/COMMITTEE/E31

http://www.x12n.org/

http://www.ncpdp.org/

http://www.gs1.org/

http://www.cen.eu/cen/Sectors/Sectors/ISSS/Committees

http://www.cdisc.org/

http://www.hl7.org/

http://www.iso.org/iso/iso_technical_committee?commid=54960


Application 1 : Go to the URL below

www.skmtglossary.org

or

https://www.ctnbestpractices.org/standards-inventory

and list three standards you think you might need to use in your work. Discuss why for each standard you select. Also discuss how easy or difficult to navigate the space.

Application 2: Make a matrix for standards that might be used in a regional network, and identify a potential source for each standard

Application 3: Create a glossary for the acronyms mentioned in this section.List of external resources, includes description and URL for each resource

Unit 3 Quiz Items


1. Standards are a necessary and useful part of life because:a. Enable people to work togetherb. Avoid chaosc. Enable components to work togetherd. All of the above

2. Which of these objects probably would not profit from a standard?a. Baseballb. Sock sizesc. Light bulbd. a piece of art

3. Interoperability permits us to _________a. Aggregate data across different sites of careb. Reuse data for purposes other than why is was primarily collectedc. Share data with other places of cared. All of the above

4. The US Interstate Highway System is an example of interoperability.a. Trueb. False

5. Which of the following is not required to enable end–to-end interoperability for health care?


https://www.ctnbestpractices.org/standards-inventory

http://www.skmtglossary.org/

a. We must use the same data elements.b. We must have a standard way to exchange the data.c. We can only exchange with one other site.d. Standards are required.

6. All of the standards we need for health care already exist. We just need to use them.a. Trueb. False

7. People should have a choice about which standards they wish to use.a. Trueb. False

8. Microsoft Standards are created using what methoda. Consensusb. ad hocc. de factod. none of the above

9. Which of the following is not an International SDO?a. ISO TC 215b. HL7c. IEEEd. NCPD

10.Which organization is a collaborative organization for international SDOs?a. SCOb. ANSIc. JICd. CDISC

11.The World Health Organization is not engaged in creating standards.a. Trueb. False

12.Which activity is not included in a workgroup of TC 215a. EHRb. Messaging standardsc. Internet standardsd. Terminology standards

13.Which of the following Groups cannot submit standards to ISO TC 215 to become ISO standards?a. HL7b. CENc. ASTMd. IEEE


14.CEN Standard 13606 defines standards for the following”a. Archetypesb. EHR Architecturec. Reference Information Modeld. All of the above

15.Which of the following standards are not being defined in HL7?a. Personal Identifierb. Mental Health c. None of the aboved. All of the above

16.Which is not an HL7 Steering Division?a. Structure and Semantic Designb. Clinical Decision Supportc. Domain Expertsd. Foundation and Technology

17.HL7 creates standards for which of the followinga. EHR Functional Modelb. Dietsc. Exercise protocolsd. Reimbursement

18.Which HL7 Standard is not mentioned in the HHS Final Rule?a. CDAb. v2.5.1 Messaging Standardc. CCDd. v3.0 Messaging standard

19.What SDO is likely to have created a standard for an Echo cardiogram?a. ASC X12Nb. ASTMc. DICOMd. CDISC

20.Which SDO is likely to have created a standard for a medication refill?a. DICOMb. NCPDPc. ASTMd. All of the above

Answer Key for Quiz Items1. D2. D3. D4. A5. C6. B7. B8. C9. D10.C


11.B12.C13.C14.D15.D16.B17.A18.D19.C20.B


Unit 9.4: Basic Health Data StandardsThis unit provides an orientation to the important data-related standards that enable interoperable health data interchange.

Unit Objectives:


1. Identify the set of standards necessary to establish semantic interoperability.

2. Describe the use, purpose and interrelation among sets of controlled vocabularies in use today (e.g., SNOMED – CT, ICD-9 and ICD 10, LOINC, RxNorm, nursing terminologies, UMLS).

3. Understand data elements; attributes of data elements, the relevant standard - ISO 11179, creation and purpose.

4. Explain how templates and archetypes facilitate networking and information exchange.

5. Discuss Clinical Data Architecture, Continuity of Care Record, Continuity of Care Document standards and describe the relationship among these standards.


ISO TC 215 www.iso.org/iso/iso_technical_committee?commid=54960

Health Level 7 www.hl7.org

CDISC www.cdisc.org

CEN www.cen.eu/cen/Sectors/Sectors/ISSS/Committees

GS1 www.gs1.org

NCPDP www.ncpdp.org

ASC X12N www.x12n.org

ASTM E31 www.astm.org/COMMIT/COMMITTEE/E31

IHE www.himss.org/ASP/topics_ihe

DICOM http://medical.nema.org/



http://www.himss.org/ASP/topics_ihe

http://www.astm.org/COMMIT/COMMITTEE/E31

http://www.x12n.org/

http://www.ncpdp.org/

http://www.gs1.org/

http://www.cen.eu/cen/Sectors/Sectors/ISSS/Committees

http://www.cdisc.org/

http://www.hl7.org/

http://www.iso.org/iso/iso_technical_committee?commid=54960

IHTSDO www.ihtsdo.org

ONC http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2


Application 1 : Go to the NCI URL and explore the tools that are available. Chose 5 clinical data elements. Are they included in caDSR?

Application 2: Using the outline for a CDA, create a section for reporting a height and a weight measurement.

Unit 4 Quiz Items


1. Which of the following is not a component of semantic interoperability?a. Context understoodb. Meaning precisec. Secured. Reusable

2. Codes assigned to data elements should include some meaning about the term. For example, m = male.

a. Trueb. False

3. The U.S. has identified a single controlled vocabulary for use in health care.a. Trueb. False

4. By using all the major controlled vocabularies we can achieve semantic interoperability.

a. Trueb. False

5. The U.S. currently uses ICD 10.a. Trueb. False

6. ICD is sponsored by ISO.a. Trueb. False

7. The advantage of a polyhierarchy is that a data element can be linked to multiple higher level concepts.

a. Trueb. False

8. CPT is owned and developed by:a. HL7b. NLM


http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2

http://www.ihtsdo.org/

c. AMAd. IHTSDO

9. DRG is based on common diseases.a. Trueb. False

10.NDC codes are used to reporta. Diagnosesb. Drugsc. Lab testsd. None of the above

11.LOINC is widely used in the US for the names of laboratory tests.a. Trueb. False

12.Daily Med is useful because it provides:a. Billing informationb. Laboratory test namesc. Possible drug side effectsd. A record of drugs a person takes daily

13.SNOMED CT is developed and owned by:a. CAPb. NLMc. IHTSDOd. AMA

14.Use of SNOMED CT is available for free in the US.a. Trueb. False

15.Post coordinated terms are defined as an explicit part of a controlled vocabulary.a. Trueb. False

16.Nursing terminologies support all of these concepts except:a. Diagnosesb. Interventionsc. Outcomesd. Length of stay

17.MeSH is used to index medical literature by NLM.a. Trueb. False

18.UMLS is a product of a. ANSIb. FDAc. NLMd. WHO

19.A licensing fee is not required to use which of the following controlled terminologies:

a. ICDb. CPT


c. MedDRAd. LOINC

20.What terminology is likely to be use for drug data elements?a. IDCb. CPTc. DRGd. RxNorm

21.Mother’s maiden name would not be classified as a data element.a. Trueb. False

22.Which is not an attribute of a data element?a. Synonymb. Costc. Unitsd. Data type

23.Which of the following is not a data type?a. Numericb. Characterc. Synonymd. Date-time

24. ISO 11179 is a standard for imaging.a. Trueb. False

25.The following has a metadictionary (caDSR) that is based on ISO 11179:a. NCIb. NLMc. CDISCd. None of the above

26.CDISC creates data elements for billing clinical chargesa. Trueb. False

27.Which of the below is an example of a compound data element?a. Heart murmurb. Blood pressurec. Person named. All of the above

28.A complex data element might containa. A logic statementb. A calculationc. A comparison of the value of two data elementsd. All of the above

29.A CMET is a clinical measurement using electronic technology.a. Trueb. False

30.A template if similar in function to a paper form.a. True


b. False31.CDAs are encoded with

a. UMLb. HTTPc. XMLd. Symbolic delimiters

32.The main parts of a CDA are a header and the body.a. Trueb. False

33.All data in a CDA must be structured and coded.a. Trueb. False

34.CCR is a product ofa. HL7b. ASTMc. ANSId. ONC

35.The CCR may be used for the following:a. Discharge summaryb. Claims attachmentc. Patient summary recordd. None of the above

Answer Key for Quiz Items

1. C2. B3. B4. B5. B6. B7. A8. C9. B10.B11.A12.C13.C14.A15.B16.D17.A18.C19.D20.D


21.B22.A23.C24.B25.A26.B27.D28.D29.B30.A31.C32.A33.B34.B35.C


Unit 9-5: Unit Topic: EHR Functional Model StandardsThis unit explores the functional requirements and standards for electronic health records (EHRs).

Unit Objectives:


1. Understand linking and aggregating data at all levels2. Understand how data may be interchanged among heterogeneous settings without

loss of information3. Understand HL7 v2.x messaging communication standard4. Understand HL7 v3.0 messaging standards 5. Understand other data interchange standards including DICOM, IEEE, and IHE6. Explain how model-based standards are created7. Define the methodology development framework 8. Describe HL7 v3.0 messaging standards 9. Discuss other data interchange standards including DICOM10.Understand imaging standards11.Understand standards for pharmacy services12.Understand interface standards for medical devices13.Understanding claims and reimbursement standards14.Understand concept of profiling 15.Understand the use and value of implementation guides


Heath Level Seven InternationalRead more about HL7 including standards and how to implement.http://www.hl7.org/index.cfm

Ascend HL7 Interface SpecificationDescribes HL7 message standards for Hann's On Software (HOS).http://www.hosinc.com/Products/Interfaces/interface_documentation.htm

HL7 ADT Message OverviewThis article provides a simple overview of HL& ADT messages. http://knol.google.com/k/hl7-adt-message-overview#

DICOM Digital Imaging and Communications in Medicine homepage.http://medical.nema.org/

IHEIntegrating the Healthcare Enterprise homepage.http://www.ihe.net/Component 9 Networking and Health Information Exchange 27


http://www.ihe.net/


http://knol.google.com/k/hl7-adt-message-overview#

http://www.hosinc.com/Products/Interfaces/interface_documentation.htm

http://www.hl7.org/index.cfm

Standardization of TerminologyThis article talks about the importance of creating a standard for terminology so that different healthcare organizations can share information.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526413/?tool=pubmed

Information Week – HealthcareArticles about information systems and security in the healthcare field. HREF="http://www.informationweek.com/healthcare/index.jhtml"


Application 1 : If you had to select a standard to exchange data with another site, what standard would you choose and why?

Answer: The choices might include any of the HL7 v2.n messaging standards; HL7 v3.0 messaging standards; Clinical Data Architecture (HL7 CDA); ASTM Continuity of Care Record (CCR); HL7 Continuity of Care Document (CCD); or perhaps DICON for images, an X12N standard for reimbursement; or NCPDP for prescription-related data. In any case, the student needs to have a valid and clear reason for making that choice.

Application 2 : What are the weaknesses of HL7 v2.n and HL7 v 3.0 messages?

Answer: Basically, HL7 v2.n does not provide for interoperability among disparate and heterogeneous groups. HL7 v2.n provides too much optionality and is not based on a reference information model. HL7 v2.n also permits the use of “Z-segments” which are not standard but only has local meaning. Implementation guides, however, permits interoperable use among a known set.

The major problem with using HL7 v3.0 is its perceived complexity. There are also misunderstandings in who creates the messages and how they are to be used. This standard is based on an explicit model.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526413/?tool=pubmed

Unit 9-6--Unit Topic: Health data interchange standardsThis unit emphasizes the importance of adhering to health data interchange these standards in order to ensure compatibility between systems.

Unit Objectives:


1. Analyze fundamental structure and components of data (e.g., standards-based data elements, terminology, templates, and archetypes)

2. Explain the relevance of health data interchange standards (specifically HL7 v2.x and HL7 v3.0) for data mobility for health records.

3. Explain the relevance of document and imaging standards (specifically CDA, CCD, CCR, and DICOM) for data mobility for health records

4. Explain the relevance of medical device standards (specifically IEEE 110-73 series) for data mobility for health records

5. Explain the concept of profiling and the role of IHE in defining profiles.


http://www.hl7.org/index.cfmRead more about HL7 including standards and how to implement.

http://www.himss.org/ASP/topics_ehr.aspInfo and news concerning EHR.

http://www.ahraonline.org/Downloads/onlineinstitute/quickcredit/oiqc_elechealthrecord.pdfAn article about choosing an EHR.

http://www.cchit.org/Information about EHR certification.http://www.healthdatamanagement.com/A resource for information regarding all aspects of health data management including HER, EDI, HIE and data security.

http://www.openehr.org/home.htmlInformation about openEHR


Application 1 : Visit http://myphr.com/ and read information about Personal Health Records. Should everyone have a PHR today? Why or why not? What is its value to


http://myphr.com/

http://www.openehr.org/home.html

http://www.healthdatamanagement.com/

http://www.cchit.org/

http://www.ahraonline.org/Downloads/onlineinstitute/quickcredit/oiqc_elechealthrecord.pdf

http://www.ahraonline.org/Downloads/onlineinstitute/quickcredit/oiqc_elechealthrecord.pdf

http://www.himss.org/ASP/topics_ehr.asp

http://www.hl7.org/index.cfm

you or to your family? How do you go about getting one? Should you worry about privacy?

Answer: https://www.dchi.duke.edu/publications/dchi-in-the-news/FamilyCircle-June2010_HealthQ-A_EdHammond.pdf


https://www.dchi.duke.edu/publications/dchi-in-the-news/FamilyCircle-June2010_HealthQ-A_EdHammond.pdf

https://www.dchi.duke.edu/publications/dchi-in-the-news/FamilyCircle-June2010_HealthQ-A_EdHammond.pdf

Unit 9-7: Unit Topic: Supporting standards for EHR applicationsThis unit presents a set of standards that support the application layer of the OSI and extend EHR functionality.

Unit Objectives:


1. Identify and discuss a family of clinical decision support standards, including Arden Syntax, Clinical Guideline standards, and the Infobutton

2. Discuss single sign-on standards and the HL7 Clinical Context Object Workgroup (CCOW) standard

3. Define and discuss regulatory standards, standards enhancing patient safety, including reporting requirements

4. Bar code standards5. Master patient index, patient registries, and record locating standards


Using Features of Arden Syntax with Object-Oriented Medical Data Models for Guideline ModelingThis article contains information about many of the clinical decision support standards.http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.24.5737

Arden SyntaxA table showing information about Arden syntax.http://www.openclinical.org/gmm_ardensyntax.html

GELLO: An Object-Oriented Query and Expression Language for Clinical Decision Support This is a paper that discusses the format of GELLO and its use.http://www.openclinical.org/docs/int/docs/gello.pdf

HL7 Infobutton Product InformationThis link provides HL7's product brief about Infobuttons.HREF="http://wiki.hl7.org/index.php?title=Product_Infobutton"

Infobuttons at Intermountain Healthcare: Utilization and InfrastructureThis article “describes the infobuttons infrastructure at Intermountain Healthcare and assesses their use after 4 years of their initial release.”HREF="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839474/"


http://www.openclinical.org/docs/int/docs/gello.pdf

http://www.openclinical.org/gmm_ardensyntax.html

http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.24.5737

Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information PrescriptionsThis article explains the usefulness of Infobuttons and a particular company's implementation.HREF="http://hwinfo.healthwise.org/docs/DOCUMENT/8325.pdf"

HL7 CCOW standardThis page is HL7's CCOW standard page providing information about CCOW.HREF="http://www.hl7.org.au/CCOW.htm"

CCOW Information for the Healthcare IndustryThis site provides information about CCOW including what it is, how it works and its benefits.HREF="http://www.cryptlib.orion.co.nz/"

Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations This article discusses the effects of clinical guidelines of medical practices. Registration is required to read the article but is free.http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-49KC744-F0&_user=5961205&_coverDate=11%2F27%2F1993&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000068954&_version=1&_urlVersion=0&_userid=5961205&md5=f6a8456e396d21342396879a39f4cfbd&searchtype=a

National Guideline ClearinghouseNGC is a public resource for evidence-based clinical practice guidelines.HREF="http://www.guideline.gov/"

Single Sign-OnWikipedia article about single sign-on.HREF="http://en.wikipedia.org/wiki/Single_sign-on"


Application 1: Name three areas in which you think clinical guidelines might be useful and why do you think these might be useful.

Solutions: Almost any disease or process that includes decisions or conditional pathways. Typical answers might include patients with diabetes, patients with asthma, or for teaching new mothers about breast-feeding. There are almost unlimited answers to this question. Of importance is the student’s response of why guidelines might be useful. Reasons might include complexity of flow and decision making, for consistency, for completeness, or for ease in documenting a procedure. There are other reasons that would be acceptable.


http://en.wikipedia.org/wiki/Single_sign-on

http://www.guideline.gov/

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-49KC744-F0&_user=5961205&_coverDate=11%2F27%2F1993&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000068954&_version=1&_urlVersion=0&_userid=5961205&md5=f6a8456e396d21342396879a39f4cfbd&searchtype=a



Application 2: Why do you think guidelines have not been generally accepted?

Solutions: Many think guidelines are constraining – limit free thinking. Some refer to guidelines as “cook-book” medicine. Others believe that guidelines are wrong or don’t fit their patient. For others, it is not the way they normally treat their patients. Others don’t take the time. There might be other creative answers.


Unit 9-8: Unit Topic: Enterprise Architecture ModelsThis unit addresses different enterprise architecture models that provide an infrastructure for healthcare networks.

Unit Objectives:


1. Explain the significance of Service Oriented Architecture in networking and health information exchange networks

2. Explain the value of an Enterprise Architecture in networking and health information exchange networks

3. Describe key elements of various service oriented architecture platforms and infrastructure options

4. Explain regional healthcare networks – policy and implementation strategies5. Explain the concept of a Nationwide Healthcare Information network


OMG Healthcare Domain Task ForceThis site contains information about the Healthcare Service Specification Project.http://healthcare.omg.org

Health Information Sharing EnvironmentInformation about creating a framework for sharing personal medical information.http://www.cisco.com/web/about/ac79/docs/pov/Health_Information_Sharing_Environment_0526FINAL.pdf

NIHN Enterprise Architecture OverviewThis document from ONC provides an overview of EA. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910398_0_0_18/NHINEnterpriseArchitectureOverview.doc

SOA SolutionsThis article from IBM describes how to develop SOA solutions for healthcare organizations using business-driven development.http://www.ibm.com/developerworks/webservices/library/ws-soa-bddhealth/

Network for Regional Healthcare ImprovementThis site is home to The Network for Regional Healthcare Improvement (NRHI), a National coalition of Regional Health Improvement Collaboratives.http://www.nrhi.org/


http://www.nrhi.org/

http://www.ibm.com/developerworks/webservices/library/ws-soa-bddhealth/

http://www.cisco.com/web/about/ac79/docs/pov/Health_Information_Sharing_Environment_0526FINAL.pdf

http://www.cisco.com/web/about/ac79/docs/pov/Health_Information_Sharing_Environment_0526FINAL.pdf

http://healthcare.omg.org/

Nationwide Health Information NetworkThis site developed by ONC covers information about HIN.http://healthit.hhs.gov/portal/server.pt?open=512&objID=1142&parentname=CommunityPage&parentid=4&mode=2

A Service Oriented Architecture based Medical Grid ApplicationThis article presents a case of using SOA for different medical entities to share mammogram images. http://arxiv4.library.cornell.edu/ftp/cs/papers/0405/0405074.pdf


Application 1 : Read the article at http://www.uweb.ucsb.edu/~miao/pdf/ehealth.pdf . What are some examples of how a SOA would improve patient care?

Solutions: Will vary. Solutions in the article include “To improve this process, the prescriptions could be communicated electronically from the physician to the pharmacist, and the human computer interfaces for the physicians, nurses, pharmacists and other healthcare professionals could be voice enabled.”


http://www.uweb.ucsb.edu/~miao/pdf/ehealth.pdf

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1142&parentname=CommunityPage&parentid=4&mode=2

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1142&parentname=CommunityPage&parentid=4&mode=2

Unit 9-9: Unit Topic: Privacy, confidentiality, and security issues and standards

This unit explores issues related to creating an environment in which to transport data in a secure manner that ensures privacy and confidentiality.

Unit Objectives:


1. Explain the concepts of privacy and confidentiality requirements and policies and learn how to implement the requirements

2. Define access control methods3. Describe how to secure data storage and transmission using data encryption,

signatures, validation, non-repudiation, and integrity (PKI, certificates, and security protocols)

4. Analyze access restrictions to data storage and retrieval (physical and software)


Microsoft – The Latest in Computer SecurityThis site contains information about security products, updates, tools and news.http://www.microsoft.com/security/default.aspx

Orange Book CertificationThis site contains the criteria for obtaining Orange Book certification. They also explain the different levels of Orange Book certification.ftp://ftp.all.kernel.org/pub/linux/libs/security/Orange-Linux/refs/Orange/OrangeI-II.html#toc5

http://en.wikipedia.org/wiki/Trusted_Computer_System_Evaluation_Criteria

HashesThis article contains information about hashes. http://en.wikipedia.org/wiki/Cryptographic_hash_function

EncryptionThis article contains information about encryption, symmetric and asymmetric.http://www.encryptionanddecryption.com/encryption/

Tutorial: An introduction to Public Key Infrastructure (PKI) This video is a tutorial about PKI. It explains the different pieces of the infrastructure including certificates and keys. 9 minutes and 34 seconds long.http://www.youtube.com/watch?v=EizeExsarH8


http://www.youtube.com/watch?v=EizeExsarH8

http://www.encryptionanddecryption.com/encryption/

http://en.wikipedia.org/wiki/Cryptographic_hash_function

http://en.wikipedia.org/wiki/Trusted_Computer_System_Evaluation_Criteria

ftp://ftp.all.kernel.org/pub/linux/libs/security/Orange-Linux/refs/Orange/OrangeI-II.html#toc5

ftp://ftp.all.kernel.org/pub/linux/libs/security/Orange-Linux/refs/Orange/OrangeI-II.html#toc5

http://www.microsoft.com/security/default.aspx

How to Choose a Good Password (And Why You Should) This article contains information about what you should do and what you shouldn’t do with passwords. It also includes information about why you should do these things. http://www.mit.edu/afs/sipb/project/doc/passwords/passwords.html

Guidelines for Strong PasswordsThis article discusses how to create strong passwords along with examples of weak passwords. http://en.wikipedia.org/wiki/Password_strength#Guidelines_for_strong_passwords

Security PoliciesThese sites discuss the use of security policies in an organization. The SANS site includes policy templates.http://www.sans.org/security-resources/policies/http://www.symantec.com/connect/articles/introduction-security-policies-part-one-overview-policies

HIPPAInformation about HIPPA including who must follow the law, what information is protected, what rights does the law provide to consumers and who can look at your health information.http://www.hhs.gov/ocr/privacy/

Assuring the Privacy and Security of Transmitting Sensitive Electronic Health InformationThis article discusses concerns about the security of transferring health information. Includes case studies.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815468/?tool=pubmed

Social Networking and the Medical Practice: Guidelines for Physicians, Office Staff and PatientsThese guidelines were produced by the Ohio State Medical Association.http://www.osma.org/files/documents/tools-and-resources/running-a-practice/social-media-policy.pdf

2009 Global Life Sciences & Health Care Security Study Findings from a 2009 study on cyber security, privacy and data protection. http://it.ouhsc.edu/services/infosecurity/documents/WP_ERS_SP_GSS_LSHC_final_low.pdf

Proposed HIPPA Rule ChangeOn July 8, 2010 HISS announced a proposed change to HIPPA that would affect the privacy, security and enforcement rules. This pdf is the proposed change. HREF="http://www.himss.org/handouts/20100714_ProposedRegsHHS.pdf"


http://it.ouhsc.edu/services/infosecurity/documents/WP_ERS_SP_GSS_LSHC_final_low.pdf

http://it.ouhsc.edu/services/infosecurity/documents/WP_ERS_SP_GSS_LSHC_final_low.pdf

http://www.osma.org/files/documents/tools-and-resources/running-a-practice/social-media-policy.pdf

http://www.osma.org/files/documents/tools-and-resources/running-a-practice/social-media-policy.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815468/?tool=pubmed

http://www.hhs.gov/ocr/privacy/

http://www.symantec.com/connect/articles/introduction-security-policies-part-one-overview-policies

http://www.symantec.com/connect/articles/introduction-security-policies-part-one-overview-policies

http://www.sans.org/security-resources/policies/

http://en.wikipedia.org/wiki/Password_strength#Guidelines_for_strong_passwords

http://www.mit.edu/afs/sipb/project/doc/passwords/passwords.html


Application 1 : On the Internet search and find a recent (within last year) security breach. Create a PowerPoint presentation that describes the security breach. How did it take place? What the criminals caught? How? Tell how the breach could have been prevented and what type of security measures should be put in place to stop the incident from happening again. Be sure to include any terms or concepts covered in this chapter.

Solutions: Will vary. Good sources for information are http://www.informationweek.com/security/index.jhtml;jsessionid=G212YMIREP2U1QE1GHRSKH4ATMY32JVN?cid=iwk-header-navbar-security, http://www.itsecurity.com/ , http://www.privacyrights.org/data-breach or a Google search on “security news” or “security breaches”.

Application 2 : (also included in zip file as Component 9_unit9_application2)In the exercises in this activity, you will explore the security of your computer.

Remember that we are just scratching the surface of a very complex topic. Our goal is not to ensure that your computer is completely safe (we can't do that!) but to explore some of the issues and concepts and become familiar with them. If you want to know more technical details about protecting your computer, you can explore the wealth of information available online.

Also, please note that there is only one way to keep your computer and its info completely protected: don't connect to the Internet at all and never share data with anyone (via networks, diskettes, etc.) For most people, this defeats the whole purpose of having a computer! So, if we want to use the Internet, we have to accept that there will always be some risk.

Exercise 1 - Anti-virus (AV) software

Do you have anti-virus software installed on your computer?

If your answer is YES, answer items C through E below. (You can skip A and B)

If your answer is NO, answer items A through B below. (Then go to Exercise 2)

A. Do some research to find out about TWO anti-virus software products. For each product, find out the following info:

Product name = What company produces it?How much does it cost?Where can you buy it?


http://www.privacyrights.org/data-breach

http://www.itsecurity.com/

http://www.informationweek.com/security/index.jhtml;jsessionid=G212YMIREP2U1QE1GHRSKH4ATMY32JVN?cid=iwk-header-navbar-security

http://www.informationweek.com/security/index.jhtml;jsessionid=G212YMIREP2U1QE1GHRSKH4ATMY32JVN?cid=iwk-header-navbar-security

Product name = What company produces it?How much does it cost?Where can you buy it?

B. Would you buy either of the products you listed above? Why or why not? If you would buy one, which one would you choose? Why?

If you already have anti-virus software on your computer, answer these questions:(otherwise, go to Exercise 2)

C. What is the name and version number of your anti-virus software? (HINT: To find out, you can start the software--under Start menu/Programs, then check the Help menu/About)

D. Do you remember the last time you updated your virus definition files? See if you can find information that lists the DATES of your definition files. (These files might be called something like SIGN.DEF and MACRO.DEF. You may be able to find this info under Help/About.)

E. Test to see if your anti-virus software is workingThe following test will download to your computer a file that looks like a virus but has no destructive capabilities. It will help you determine if your anti-virus software is working.

1. Visit the web site http://www.eicar.org and click on the link to "The AntiVirus testfile eicar.com"

2. Scroll down to the bottom on the page. You will see 4 file names listed in the "Download area".

3. Click on the first file listed (on the left)---named eicar.com. If asked whether you want to Save or Open (Run) the file, choose Open (or Run).


http://www.eicar.org/anti_virus_test_file.htm

http://www.eicar.org/anti_virus_test_file.htm

Was the virus detected?

If so, then you have "dynamic protection" -- which checks for viruses as they enter your computer -- and it's working!

4. If it wasn't detected, try running a scan of your hard drive with your anti-virus software.

Was the virus detected?

If not, then your anti-virus software may not be protecting you.

Now go on to Exercise 2 below…

Exercise 2 - Assessing your computer's vulnerability to hackers

For this exercise, you will complete visit a web site and run two online tests to see if your computer is open to certain kinds of intrusion.

Before you start, read these important notes:

o Run these tests from your HOME computer---NOT from a work computer that is on a corporate network protected by a corporate firewall and preferably NOT from a computer at your school. If your home computer has its own firewall or is on a home network, that's ok.

o If your home computer is protected by a firewall, then when you run the test you may see an alert that there is an intrusion from an IP address in the range of 204.1.226.224 through 204.1.226.255. This is just the test and does not indicate a problem. In fact, it indicates that your firewall is working!

For this exercise, follow the steps below and then write a few sentences (in your own words!) about what the tests found.

1. Go to this web site: http://grc.com/default.htm

2. Scroll down (way down to the "Hot Spots" section) and click on the ShieldsUP! link.

3. You'll see an information screen. Read it, then click Proceed.


Now you should be on the ShieldsUP! screen (it has a picture of a computer with a globe spinning above it). Below some text, you will see a blue box with some sliver buttons across it.

4. Click on the "File Sharing" button and wait while the test runs. While you are waiting, record your IP address here:

5. When the "File Sharing" test finishes, read the info provided. Then describe here (in your own words) what the tests found about your computer:

Answers: Will vary. These exercises test the student’s security on their pcs.

6. Now click the Back button (or scroll down) and then run the "Common Ports" test. When the results screen appears, read it, and then summarize in your own words what the test found.


instructor’s guide for icd-9-cm diagnostic coding and ...media.lanecc.edu/users/scottl/hi 209...

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