SHIB PROJECT Coding Standards CCHI Data Dictionary

Transcription

1 SHIB SHIB PROJECT Coding Standards CCHI Data Dictionary

2 Context of the CCHI Data Dictionary Coding Standards The purpose is to define the core coding standards which are integral to the health insurance business processing. These standards will be mandated for all stakeholders who will be integrating and exchanging information through the Saudi Health Insurance Bus (SHIB).

3 Terminology / Vocabulary Modern health care and health insurance communications and data storage makes heavy use of encoded information. In the standards world, this is referred to as terminology and vocabulary. Electronic messaging standards define several different types of objects that implement various characteristics of vocabulary. Whereas other elements of the messaging standards are primarily concerned with structure, vocabulary deals with content.

4 Role of Vocabulary Vocabulary defines the meaning of data Changes data to information through instantiation of semantic rules It is the Human readable value a user sees Allows for intersystem interoperability by creating a single semantic interpretation of the message payload Required for o data translation o data aggregation Is probably the single most important component for interoperability

5 Terminology/Vocabulary A Crucial Requirement Without having Terminology/Vocabulary Standards... Health insurance data is non-comparable Aggregation is difficult if not impossible Healthcare and Health Insurance Systems cannot semantically interchange data Secondary use of data (for example research or risk management) are not possible Creating and utilizing linkage to decision support resources is not possible

6 Diagnosis Coding Including Dental and Optical Mandated for use by CCHI, CHS, MOH ICD10-AM International Classification for Diseases Australian Modification Provides accurate information and greater efficiency in claims submission Accurate information and greater efficiency in claims submission Reduces claim rejection rates by adding clarity and removing ambiguity in terms

7 Procedures Including Dental and Optical Companion coding system to the ICD10-AM used for Diagnosis coding ACHI Australian Codes for Health Interventions Structured by body system, site and procedure type Provides a common accepted terminology Includes codes and concepts for dentistry, imaging and allied health interventions

8 Laboratory Test and Results LOINC Will reduce ambiguity in understanding the laboratory information/data Logical Observation Identifiers Names and Codes Stakeholders will only be required to maintain one coding system for laboratory related activities Improve communication between the healthcare provider and health insurance delivery networks Over 70,000 observation terms that can be accessed and understood universally

9 Measurements Provides a distinct coding system for units that is comprehensive and complete UCUM Unified Codes for Units of Measure Free of all vagueness or ambiguity Assigns to each defined unit a concise semantic Implementable in all health care service domains

10 Pharmaceutical Drugs/Medications Provides a unique identifier for over 6,000 medications SFDA Drug Registration Code Includes generic, biological, and over the counter (OTC) drugs Provides a common accepted terminology Registration codes available as downloadable Excel spreadsheet from SFDA website

11 Messaging ANSI-accredited standards developing organization (SDO) HL7 Health Level 7 Provides a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, evaluation and payment of health services. Allows healthcare information to be communicated across and between healthcare enterprises and communities

12 Dental Tooth Identification Standard FDI TWO-DIGIT NOTATION / ISO 3950:2009 Upper Right -1x PERMANENT TEETH Upper Left 2x Lower Right 4x Lower Left 3x DECIDUOUS TEETH (BABY TEETH) Upper Right 5x Upper Left 6x Lower Right 8x Lower Left 7x

13 CCHI Dictionary CODING STANDARDS By making endorsed standards readily available, all stakeholders are assured that they can use these standards with confidence and that they will enable enhanced decisions for the treatment and management of the patient/client under their care; improve the communication process between stakeholders, and strengthen the validity of claims submissions, adjudications and payments. OPTIMIZED FOR SAUDI ARABIA S e-health STANDARDS