National Committee on Vital & Health Statistics

Hearing on standards for Patient Medical Record Information

Monday, March 28, 1999

Testimony of Gary Beatty (Mayo Foundation) representing ANSI X12

On behalf of the Accredited Standards Committee X12, I would like to thank you for this opportunity to address this committee on the subject of standardized patient medical record information. I represent Mayo Foundation within X12 as the chair of the Insurance Subcommittee (X12N) which develops Electronic Data Interchange (EDI) Standards for the healthcare, property & casualty, life insurance, and reinsurance industries. These standards facilitate inter-organizational communication of business transactions including the nine required transactions within the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Recently, X12 and Health Level 7 (HL7) in a joint development effort completed the implementation guide for the 275 Patient Information transaction. This implementation guide will be referenced within a Notice of Proposed Rulemaking in the near future as one of the nine required HIPAA transactions. This transaction merges the strengths of both these standards development organizations syntax to support the exchange of patient information between payers and providers as part of the healthcare billing process. Use of the X12 standard provides the same consistent electronic envelope for routing and delivery used by the other HIPAA transactions while HL7 provides the syntax for the patient information. The 275 Patient Information transaction set can carry other Patient Medical Record Information including images, voice, video, or any other type of information that can be put into digital format within the 275’s Binary Segment (BIN).

Within the Insurance Subcommittee we have long recognized the complexity of the data and business transactions within the healthcare industry. To assist us in developing consistent EDI transactions we have taken on the task of both business and data modeling to assure the transactions we develop are consistent with each other as well as with other business exchanges within the healthcare industry. Within the X12N subcommittee this function is facilitated by our Business and Information Modeling Task Group (Task Group 3). This Task Group has produced three very important documents as part of its deliverables to facilitate exploration of data and business requirements for the development of EDI/Electronic Commerce (EC) transactions.

• First, as required by HIPAA, the Task Group has created a clear and unambiguous data dictionary for the HIPAA mandated transactions. This data dictionary includes industry standard naming conventions, data element definitions, and cross references to the data elements to the transactions where they are used.
• Second, a data model that spans all X12N transactions similar to the HIPAA data dictionary. This allows cross Insurance Industry standardization of data definitions.
• Third, the business model defines the usage of the transactions from a business usage standpoint (including the exchange of Patient Medical Record Information). This is achieved by documenting the transactions relative to role play definition, functional definitions, business narratives, message standards, and interactions.

These documents are available on the X12N, Task Group 3 home page (http://www.disa.org/x12/x12n/tg3.htm). These are living documents and will continue to change as does the business and data needs changes within the industry. We hope these documents will be of assistance to the Secretary of Health and Human Services in the future as an aid in determining when it is time to select a newer version of the standards to be implemented under HIPAA.

Currently under HIPAA we have three set of data dictionaries and business models (X12, Health Level 7, and the National Council for Prescription Drugs). As we proceed into the development of the Patient Medical Record Information and others organizations play a role with this development, the need for coordination will grow. There is the need for a single business and data model that all can reference. A few years ago there was a movement started to coordinate the data dictionaries developed by the Standards Development Organizations. However this task was never completed. We would like to see the SDOs work together to restart and complete this project.

I would like to thank you again for the opportunity to testify and look forward to any questions you may have.

Gary A. Beatty

Mayo Foundation

Chair X12 Insurance Subcommittee

Phone: 507-266-5207

Email: beatty.gary@mayo.edu