This trend is changing, and efforts are currently under way that constitute important building blocks toward a national infrastructure for the promulgation of health care reporting requirements and standards. These efforts include AHRQ’s EPCs and the work of QuIC, discussed earlier in this chapter, as well as the partnership between NCVHS and the CHI initiative.

A significant effort to establish common data standards is in progress under the leadership of NCVHS (National Committee on Vital and Health Statistics, 2000). NCVHS, first established in 1949 as a federal advisory committee on heath statistics issues, is made up of 18 members from the private sector. Its role was broadened by HIPAA to include identifying and recommending standards for administrative simplification and for the privacy and security of health care information, as well as to “study the issues related to the adoption of uniform data standards for patient medical record information (PMRI) and the electronic exchange of such information.” While NCVHS has the lead in identifying and recommending clinical data standards, it has only an advisory role to DHHS and has not been empowered to designate or mandate standards.

Specifically, the HIPAA standards accomplished the following:

• Designated specific SDOs for the development and maintenance of HIPAA standards.

• Approved the ANSI ASC X12N standard as the EDI messaging format standard for eight administrative/financial transactions and NCPDP as the messaging standard for pharmacy billing transactions.

• Selected code sets for diagnoses and procedures for administrative/ financial transactions, i.e., ICD-9 Clinical Modification (CM); Healthcare Financing Administration Common Procedure Coding System (HCPCS); CPT-4; NDCs; and Common Dental Terminology, Second Edition (CDT-2).

• Mandated identifiers for employers.

• Established privacy rules and security safeguards for the protection of personal health information.

Compliance deadlines have been established for all of the above HIPAA standards. In addition, the use of unique identifiers for health care providers has undergone the Notice of Proposed Rulemaking process and is awaiting announcement of the final rule. The HIPAA standard for claims attachments is being developed.