In all healthcare settings across the globe, we need to be able to exchange information reliably and then interpret and use it effectively: interoperability is essential. Reducing duplication of effort and redundancy are also important goals, as are making manufacture, supply and trade easier. However, there is something missing from this list of purposes for Health information (HI) standards and that is the safe, effective integration of information management and Health Information and Communications Technology (ICT) into clinical practice. One of the greatest challenges in the standards world is that there are multiple sources for standards. Many different ‘recognized bodies’ and other organizations publish rules, guidelines and ‘agreed ways of doing things’, even in the specialised field of health informatics. Governments, Health Departments, Regulators and others adopt or develop their own HI standards for use in their countries and regions.

Other organizations, such as the World Health Organization (WHO) and the International Council of Nurses (ICN), produce artefacts that are adopted as HI standards, for example, the WHO International Classification of Functioning Disability and Health (ICF) has been adopted in a number of countries as the standard to describe and measure health and disability

Purpose of Health information standards

According to ISO, their specific purpose is ‘ to promote interoperability between independent systems , to enable compatibility and consistency for health information and data , as well as to reduce duplication of effort and redundancies ’. Interoperability is ‘ the ability of two or more systems or components to exchange information and to use the information that has been exchanged ’

A document, established from evidence and by consensus and approved by a recognized body, that provides rules, guidelines or characteristics for activities or their results, in the field of information for health, and Health Information and Communications Technology (ICT).

The purpose of HI standards is to:

• Support safe, effective HI practice;
• Promote interoperability between independent systems;
• Enable compatibility and consistency for health information and data;
• Reduce duplication of effort and redundancies.

HI standards should meet the needs of users, be practical to implement and be sufficiently well specifi ed to enable assessment of conformance. Clinicians and consumers of health care should be involved in the development, implementation and review of HI standards.

Implementation of Standards

In healthcare, data standards will be implemented with one (or a mix of) of three primary goals in mind:

• To improve the outcome of an individual patient’s diagnostic and treatment process by involving (a team of) healthcare professionals, for example: Computer-based clinical guidance based on patient characteristics has prompted the standardisation of several parameters in breast cancer diagnostics to aid the creation of optimal personal treatment plans.
• To serve the local/national health system’s goals (such as reimbursement, quality reporting, public health, health technology assessment, clinical research, and so on), for example, monitoring the quality of diabetes patients’ care has resulted in the systematic recording of key process indicators as well as proximal and distal outcomes.
• To increase commercial interest in investing in solutions needed by patients and/or professionals in health management and the delivery of healthcare services, for example: the diversity of equipment in a typical radiology department has led to the early and nearly complete implementation of DICOM standards for digital imaging, allowing multiple vendors access to the market.

Key standard developers and types of standards

Main standards created by Standards Development Organizations (SDOs) and widely used across healthcare organizations fall into four large groups:

Terminology standards:

IC-10-CM-diagnosis, diseaes
CPT – Outpatient services and procedures
HCPCS- medical equipment and supplies
CDT- Dental services
SNOMED CT – clinical concepts
LOINC- Laboratory observations
NDC -pharmacy products
RxNorm- Clinical drugs

Content standards:

C-CDA- clinical documents
HL7 V2 and V3 – Clinical messages
USCDI- Set of exchange data elements

Data exchange or transport standards:

FHIR -API patient data exchange
Direct -Secure messge exchange
DICOM- Medical image exchange
SCRIPT – e-prescritption exchange
CDISC – Clinical trial data exchange

Privacy and security standards:

HIPAA – for the USA
GDPR -for the EU

Terminology standards

Health data may be exchanged without terminology standards, but there’s no guarantee that all parties will be able to understand and use it. Imagine that each system calls the same disease or process by a different name. Or, vice versa, gives the same name to different elements. The absence of a unified vocabulary leads to miscommunication, and in healthcare it can literally be a matter of life and death.

To avoid ambiguity and enhance the clarity of content, healthcare systems rely on code sets and classification systems representing health concepts.

ICD-10-CM codes for diagnoses

The ICD-10, Clinical Modification (CM) is the US version of the International Classification of Diseases, created and maintained by the World Health Organization (WHO). In the United States, ICD codes are revised by the Centers for Medicare and Medical Services (CMS) and the National Center for Health Statistics (NCHS).

In October 2020, the 10th revision of the code replaced the previous ICD-9-CM version. It contains over 500 updates, including new codes for vaping-related disorders and COVID-19. The number of codes in the new version amounts to 68,000.

Hospitals mainly use these codes for billing and reimbursement. Nationally and globally, the ICD serves as a universal tool to track morbidity and mortality statistics.

Under the ICD-10-CM, every disease or health condition is assigned a unique code three to seven characters long.

The first three elements represent a unique category, the second three digits describe etiology, anatomic site, severity, and other vital details, while the seventh character — or extension — specifies an episode of care for injuries, poisonings, and other conditions with external causes.

In 2022, the 11th revision of ICD codes will take effect, adding two numbers for a more detailed diagnosis.

CPT codes for medical procedures

The Current Procedure Terminology or CPT is a code system maintained by the American Medical Association (AMA). It describes outpatient services and procedures for treatment tracking and billing purposes.

Each code contains five digits or four digits and one letter and is assigned to a particular procedure. It is essential for getting payments from health plans. In a bill for reimbursement, a CPT number is paired with an ICD-10-CM code. If the service is not relevant to the diagnosis, the insurance company can reject the claim. Say, a doctor is not supposed to send a patient with stomach ulcers for a chest X-ray.

HCPCS codes for all kinds of health-related services

Healthcare Common Procedure Coding System is an extended version of the CPT used to bill Medicare, Medicaid, and other health plans. HCPCS (pronounced hick-picks) has two levels.

Level 1 duplicates CPT codes and identifies services and procedures ordered or delivered by physicians.

Level 2 contains codes with one letter followed by four numbers. Supported by the CMS, it identifies services, supplies, and products not included in the CPT — like durable medical equipment, prosthetics, or drugs.

So, when are HCPCS codes used instead of CPT codes? If a service is described the same by both systems, then the CPT is valid. If there is a need to add more information, the HCPCS becomes operational.

CDT codes for dental treatment

Current Dental Terminology is developed and maintained by the American Dental Association (ADA) for electronic communication of dental services. Basically, CDT code covers oral health and plays the same role in dentistry as CPT code in general healthcare.

A CDT code always starts with “D” and has a twin in the CPT code system as many health plans don’t accept CDT codes for reimbursement.

SNOMED CT codes for clinical information

SNOMED CT stands for Systematized Nomenclature of Medicine – Clinical Terms and is owned by the IHTSDO. Recognized as a common language for medical terms in 50 countries, it enables care providers to accurately input patient data to the EHR system, aggregate information, and share it across health systems.

SNOMED CT encompasses far more concepts than ICD-10-CT. While the latter is limited to disease classification, the former covers symptoms, clinical findings, procedures, situations, substances, devices, and family history — in other words, almost any aspect related to healthcare delivery.

On the darker side, SNOMED CT is too granular to be applied for reporting. So, when it comes to billing, ICD-10-CT and CPT/HCPCS codes are used to capture a diagnosis and course of treatment and request reimbursement.

LOINC codes for lab orders and results

Logical Observation Identifiers Names and Codes or LOINC is a set of identifiers for laboratory tests and clinical observations. It was created by the Regenstrief Institute with HL7 interoperability standards in mind. It covers the entire scope of existing lab tests and a broad range of clinical concepts and measurements.

Backed by the American Clinical Laboratory Association (ACLA) and the College of American Pathologists, LOINC codes are widely adopted by large commercial laboratories, hospitals, research institutions, and government agencies related to healthcare.

NDC codes for pharmacy products

The National Drug Code (NDC) is a unique digit identifier for human medications in the US. The coding system was created to facilitate processing of claims and drug data sharing. Currently, the codes are published on all drug packages and inserts.

The code contains three segments. The first five numbers represent a labeler (manufacturer, repackager, or distributor) and are assigned by the US Food and Drug Administration (FDA). The next two sections — 3-digit product and 2-digit package codes — are created by the labeler.

For example, if a manufacturer offers a drug in packages of two different sizes, each will have its own NDC. The same medication produced by two companies will also be assigned two different identifiers. For billing, the code can be rearranged into an 11-digit string.

It may come as a surprise, but not every drug that has an NDC number was approved by the FDA.

RxNorm codes for clinical drugs

RxNorm is a catalog of all clinical drugs and drug delivery devices, available in the US. Managed by the US National Library of Medicine (NLM), it serves the purposes of interoperability, enabling clear communication between health systems, no matter the software they run.

The RxNorm code combines active ingredients, strength, and dose form. So, if these three attributes are identical, drug products will have the same identifier, regardless of brand or packaging. For example, Aspirin 325 Mg Oral Tablet has a single RxNorm ID — 211874. However, it can be marketed under dozens of different NDC codes — depending on manufacturer and package size.

Besides normalizing drug names, RxNorm links its codes to related brand-name and generic medications, as well as to other commonly used drug vocabularies.

Content standards

Content or document standards dictate the structure of electronic documents and types of data they must contain. They ensure that medical data is properly organized and represented in a clear and easy to understand form.

C-CDA for arranging clinical documents

Consolidated Clinical Document Architecture designed by HL7 is the primary framework for creating electronic clinical documents in the US. It specifies how to structure medical records and how to encode data elements for exchange.

The standard allows for capturing, storing, accessing, displaying, and transmitting both structured and unstructured information, including texts, images, and sounds. Care providers can use different C-CDA document templates satisfying various data exchange scenarios — such as the following:

• The Consultation Note template representing a response to the request of a practitioner for an opinion from another practitioner;
• The Continuity of Care Document (CCD) template to capture content that is critical to effectively continue care. This includes family history, allergies, information on recent hospital encounters. The primary purpose of the CCD document is to exchange data on a patient being transferred from one healthcare setting to another;
• The Discharge Summary template to capture information about a patient’s admission to a hospital and the continuation of care after discharge; and
• The Diagnostic Imaging Report template to convey an interpretation of image data.
• C-CDA documents contain a human-readable part that can be displayed on a web browser, and a machine-readable Extensible Markup Language (XML) part intended for automated data processing.

HL7 version 2 and 3 for packaging data

A key difference between an HL7 document (C-CDA) and an HL7 message is that the former is basically an electronic representation of a physical document while the latter is a packet of data sent from one system to another.

US healthcare relies primarily on version 2 and 2.x messaging that is supported by every EHR system. Version 3 is widely adopted across the world, but not in the USA.

Each HL7 message does its specific job identified by its name that contains 3 characters. The widely-used message types are

• VXU messages to send vaccination history,
• ADT messages so send demographic updates,
• QBP messages to request immunization history, and
• RSP messages to return immunization history.

Each message is composed of several string-like segments, each starting with a 3-character name. Segments, in turn, contain fields that carry data elements.

USCDI for specifying electronically available content

US Core Data for Interoperability or USCDI is not a document or messaging standard, but a mandatory set of content pieces hospitals must share on a patient’s request via APIs. The most granular parts of information — data elements — are aggregated in larger data classes like Patient Demographics, Health Concerns, Medications, Procedures, and more.

In 2020, the Office of the National Coordinator for Healthcare IT (the ONC) finalized the first version of the USCDI standard. The second release will be available for public feedback in 2021

The next versions are expected to receive additional data elements and classes. But besides specifying content to be exchanged, USCDI identifies terminology systems to be used. The list of recommended code systems includes LOINC, SNOMED CT, and RxNorm.

Transport standards

Transport standards facilitate data exchange between different health systems. They define what formats, document architecture, data elements, methods, and APIs to use for achieving interoperability.

FHIR for patient access to medical records

Fast Healthcare Interoperability Resources or FHIR is an HL7 standard for transmitting healthcare information electronically. The Interoperability and Patient Access final rule, issued by the CMS in 2020, requires all CMS-regulated payers to adopt version 4 of FHIR. Unlike previous releases, the fourth iteration is backward compatible so software providers can be sure that their products won’t become obsolete once a new FHIR version comes out.

The FHIR (pronounced “fire”) standard provides a set of HTTP-based RESTful APIs, enabling healthcare platforms to communicate and share data represented in XML or JSON formats. FHIR supports mobile apps that patients may download from the Apple App Store or Google Play to get their medical records and claims data.

The basic exchangeable data element of FHIR is called resource. Each resource is structured the same way and contains nearly the same amount of data. Depending on its type, it provides information on patient demographics, diagnoses, medications, allergies, care plans, family history, claims, etc. Altogether, they cover the entire healthcare workflow and can be used separately or as a part of a broader document.

Each resource is assigned its unique ID and multiple stakeholders — health systems, insurers, patients, or software developers — can retrieve the underlying data element via API.

Direct for exchanging personal health information

Direct maintained by DirectTrust is a well-known technical standard in use since 2010. It is widely adopted by EHR systems across the US for the secure exchange of personal health information.

Direct messaging resembles email, but with an added layer of security. Instead of SMPT (Simple Mail Transfer Protocol) servers, it employs HISPs (Health Information Service Providers) to handle data exchange. HISPs provides encryption and digital signing of each message.

Currently, over 251,000 companies have DirectTrust addresses exchanging nearly 141 million messages in three months. And this number will grow with the release of the Trusted Instant Messaging (TIM+) standard, which is already available for testing. When approved for use, it will allow all connected parties to exchange data in real-time.

DICOM for transmitting medical images

Digital Imaging and Communications in Medicine (DICOM) is an international communication protocol and file format for exchanging medical images and related data across devices from different vendors. The devices in question include not only CT, MRI, and other scanners, but also printers, image viewers, and picture archiving and communication systems (PACS) to name a few.

It’s important to say that widely-used image file formats — JPEG, TIFF, or BNP — tell nothing about the patient or image acquisition parameters. The standard addresses this problem, adding information necessary for diagnostic purposes. DICOM files with the .DCM extension contain a header with metadata and zero to several image pages.

SCRIPT for electronic prescribing

The Script by NCPDP is an industry standard for exchanging electronic prescriptions and related data between care providers, pharmacies, and health plans. Besides the submission of new prescriptions, it supports canceling and changing prescriptions, refilling requests, and other operations.

SCRIPT uses RxNorm codes for drug info and SNOMED codes for describing allergies. It also allows for adding a Continuity of Care Document attachment.

CDISC for medical research data exchange

Clinical Data Interchange Standards Consortium or CDISC standards are developed to improve the electronic exchange of clinical trial data between pharma companies and researchers. In 2016, the standards became mandatory for submitting trial data to regulatory authorities like the Food and Drug Administration (FDA).

Privacy and security standards

Privacy and security standards establish administrative and technical rules to protect sensitive health data from misuse, unauthorized access, or disclosure.

HIPAA for health data across the US

In the US, the privacy and security standards for medical information are outlined by the Health Insurance Portability and Accountability Act (HIPAA). Among other things, it formalizes the use of ICD-10-CM, CPT, HCPCS, CDT, and NDC codes in medical billing.

HIPAA Privacy Rule applies to individual medical records and other personal health information. It sets limits on the use and sharing of patient data for health plans, healthcare providers, and other players. The rule also empowers patients to freely access their medical records and request corrections to them.

HIPAA Security Rule defines what electronic health information must be protected and what technologies, policies, and procedures must be in place to ensure the appropriate level of security.

GDPR for health data across the EU

In the European Union, health information falls within the scope of the General Data Protection Regulation (GDPR).

• To meet the standards, healthcare organizations must appoint a Data Protection Officer (DPO);
• conduct a Data Protection Impact Assessment (DPIA) — or, in other words, evaluate data protection risks;
• implement a cybersecurity strategy; and
• report data breaches within 72 hours.
• Similar to HIPAA standards, GDPR also gives patients the right to access their personal data.

Health data standards challenges and possible solutions to them

Obviously, the healthcare industry doesn’t lack data standards. SDOs have developed plenty of them to cover virtually every aspect of communication between disparate health systems. But the mere fact of their existence and availability doesn’t tackle all the problems related to interoperability. Below we’ll list some vexing challenges related to standards and potential ways to address them.

Medical coding speed and accuracy issues

Transformation of diagnoses, procedures, services, treatment plans, and other concepts into medical codes involves a lot of manual work, performed by specially trained professionals. Today coders rely on computer-assisted coding systems. However, the speed and accuracy of the translating process are far from perfect.

To that end, big hopes are pinned on AI-fueled software capable of identifying correct codes and suggesting them for experts to review. Currently, such intelligent systems make coding faster, however, they can’t fully replace humans and automate the entire process.

Need for mapping between codes

Each code in healthcare does its own job: SNOMED enables physicians to draw a detailed clinical picture of a patient treated, ICD-10 briefly describes diagnoses, CPT summarizes services.

That said, there are situations when translation from one code system to another is needed. For example, as we mentioned before, SNOMED can’t be used for billing purposes and must be translated to ICD-10-CT.

Standard development organizations try different options to address mapping challenges. Say, SNOMED CT runs Mapping Project Group that is working on automated methods of linking two terminologies.

Lack of compatibility between old and new standards

To comply with existing interoperability rules, hospitals must ensure the availability of content defined by USCDI through FHIR-based APIs. But let’s face the truth: Most EHR systems were built with a view to old standards. Some of them can do no more than importing and exporting HL7 v2 messages. Others mainly rely on C-CDA documents.

Neither v2 nor C-CDA fits into granular USCDI data elements or FHIR basic exchangeable data blocks — resources. So, hospitals need additional digital tools and human resources to extract data from older formats and convert them into FHIR and USCDI compatible elements. There are several initiatives to address this problem like the C-CDA on FHIR implementation guide or v2-to-FHIR project.

No two-way communication between patients and EHRs

FHIR standard allows patients to get health data via apps of their choice. However, this is a one-way street as EHRs grant read-only access to their systems. A person can request information but have no means to control and change it through the app.

Many industry experts argue that the lack of two-way communication between medical apps and EHR systems is the next biggest challenge for healthcare. And sooner or later, it will require creating new data standards.

How can stakeholders impact the situation and contribute to better communication between all parties? The answer is to actively participate in standard development processes, submit feedback, and share their ideas with the standards community.

Other SDOs

• Accredited Standards Committee X12 — ASC-X12
• American Dental Association — ADA-ADA Joint Project Statement
• American Society for Testing Materials — ASTM
• CEN/TC 251
• Clinical Data Interchange Standards Consortium — CDISC
• Digital Imaging and Communication In Medicine — DICOM
• eHealth
• Institute for Electrical and Electronic Engineers — IEEE
• Integrating the Healthcare Enterprise — IHE
• Medbiquitous
• National Council for Prescription Drug Program — NCPDP
• OASIS
• Object Management Group — OMG
• University of Nevada Las Vegas — UNLV
• College of American Pathologists – SNOMED International Division — SNOMED
• CHCF Associate Charter Agreement
• Liberty Alliance Project Associate Charter Agreement
• Workgroup for Electronic Data Interchange — WEDI
HL7 / ISO / CEN Collaboration • SDO Plan of Action for Global Health Informatics Standards
• Status of US/SDO Pilot Projects (Agenda Item 7) — ISO

Standard codes & organizations

HL7 – What Does it Mean?

Health Level Sevel International (HL7) is a non-for-profit, ANSI accredited standards developing organization founded in 1987, dedicted to providing a comprehensive framework and related standards for the exchange integration, sharing and retrieval of electronic helath information that supports clinical practice and the management delivery and evaluation of health services.

“Level Seven” refers to the seventh level of the International Organization for Standardization (ISO) seven-layer communications model for Open Systems Interconnection (OSI) – the application level. The application level interfaces directly to and performs common application services for the application processes. Although other protocols have largely superseded it, the OSI model remains valuable as a place to begin the study of network architecture.

National Electrical Manufacturers Association (NEMA)- DICOM

The standard for the sharing and management of medical imaging information and related data is Digital Imaging and Communications in Medicine (DICOM). DICOM is most widely used for storing and transferring medical images, and it allows for the integration of medical imaging devices from many manufacturers, such as scanners, servers, workstations, printers, network hardware, and picture archiving and communication systems (PACS). The copyright to the published standard, which was developed by the DICOM Standards Committee, whose members are also partly members of NEMA, is held by the National Electrical Manufacturers Association (NEMA). NEMA standard PS3 and ISO standard 12052:2017 “Health informatics — Digital imaging and communication in medicine (DICOM) including workflow and data management” are other names for it.

OpenEHR

The openEHR specifications are maintained by the openEHR Foundation, a not for profit foundation supporting the open research, development, and implementation of openEHR EHRs. openEHR is an open standard specification in health informatics that describes the management and storage, retrieval and exchange of health data in electronic health records (EHRs).

LOINC

LOINC stands for Logical Observation Identifiers Names and Codes, and it’s a database and international standard for identifying medical laboratory findings. The Regenstrief Institute, a non-profit medical research organisation based in the United States, established and maintains it. LOINC was formed in response to a need for an electronic database for clinical treatment and management, and it is free to use. It uses universal code names and identifiers to apply to medical terms in electronic health records. The goal is to make the electronic communication and collection of clinical results easier (such as laboratory tests, clinical observations, outcomes management and research). The LOINC system is divided into two parts: laboratory LOINC and clinical LOINC. Clinical LOINC is a subdomain of Document Ontology that captures different types of clinical reports and documents. Some of the benefits of using LOINC include improved communication in integrated healthcare delivery networks, improved community-wide electronic health records, and the automatic transmission of case reports for reportable diseases (e.g. for distemper).

SNOMED CT

SNOMED CT, or SNOMED Clinical Terminology, is a computer-processable, systematically ordered collection of medical phrases that includes codes, terms, synonyms, and meanings used in clinical recording and reporting. SNOMED CT is widely regarded as the world’s most complete and multilingual clinical healthcare vocabulary. SNOMED CT’s major goal is to encode the meanings employed in health information and to facilitate effective clinical data recording with the goal of enhancing patient care. The essential general terminology for electronic health records is provided by SNOMED CT. Clinical observations, symptoms, diagnoses, procedures, body structures, organisms and other etiologies, chemicals, medications, equipment, and specimens are all covered by SNOMED CT.

SNOMED CT is developed and maintained by SNOMED International, a non-profit standards development organisation based in London, United Kingdom. The International Health Terminology Standards Development Organisation (IHTSDO), which was founded in 2007, is known as SNOMED International.

SNOMED CT is essential for an interoperable electronic health record because it allows for consistent information transmission. It provides a standardised method for indexing, storing, retrieving, and aggregating clinical data across specialties and care settings. It also aids in the organisation of electronic health record material by reducing the diversity in the way data is recorded, encoded, and used for patient clinical care and research. Individual clinical information can be easily recorded in electronic patient records using SNOMED CT. It also provides the user with a number of links to clinical care pathways, shared care plans, and other knowledge resources in order to promote long-term patient care and facilitate informed decision-making. Free automatic coding tools and services that can return a ranked list of SNOMED CT descriptors to encode any clinical report could aid healthcare practitioners in navigating the vocabulary.SNOMED CT is a nomenclature that may be mapped to other international classifications and standards.

International Statistical Classification of Diseases and Related Health Problems (ICD)

The International Classification of Diseases (ICD-11) is the eleventh revision. It will eventually take the role of the ICD-10 as the global standard for coding health data and mortality causes. The World Health Organization created the ICD-11 and updates it on a regular basis (WHO). The ICD-11 is a huge taxonomy with thousands of items, often known as classes or nodes. Anything that has to do with health care can be considered an entity. It generally refers to a disease or a pathogen, but it can also refer to a single symptom or a bodily (developmental) aberration. The Foundation Component is a collection of all ICD-11 entities. Various subsets can be deduced from this common core; for example, the ICD-O is a derivative categorization tailored for use in oncology. A multilingual REST API can be used to access ICD-11. WHO hosts this API, which can be used online or downloaded and installed offline. The ICD-API home page contains detailed information about the API as well as some extra tools that aid in the integration of the classification into third-party applications.

The International Classification of Functioning, Disability and Health (ICF)

It is a classification of the health components of functioning and disability.The ICF classification complements WHO’s International Classification of Diseases-10th Revision (ICD), which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC). There are benefits of using the ICF for both the patient and the health professional. A major advantage for the patient is the integration of the physical, mental, and social aspects of his or her health condition. All aspects of a person’s life (development, participation and environment) are incorporated into the ICF instead of solely focusing on his or her diagnosis. A diagnosis reveals little about one’s functional abilities. Diagnoses are important for defining the cause and prognosis, but identifying the limitations of function is often the information used to plan and implement interventions

International nonproprietary name (INN)

An international nonproprietary name (INN) is an official generic and non-proprietary name given to a pharmaceutical drug or an active ingredient. INNs are intended to make communication more precise by providing a unique standard name for each active ingredient, to avoid prescribing errors.[1] The INN system has been coordinated by the World Health Organization (WHO) since 1953. Having unambiguous standard names for each drug (standardization of drug nomenclature) is important because a drug may be sold by many different brand names, or a branded medication may contain more than one drug.

The Anatomical Therapeutic Chemical (ATC)

The Anatomical Therapeutic Chemical (ATC) Classification System is a drug classification system that classifies the active ingredients of drugs according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties. Its purpose is an aid to monitor drug use and for research to improve quality medication use. It does not imply drug recommendation or efficacy.[1] It is controlled by the World Health Organization Collaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.

The International Classification of Primary Care (ICPC)

The International Classification of Primary Care (ICPC) is a classification method for primary care encounters. It allows for the classification of the patient’s reason for encounter (RFE), the problems/diagnosis managed, primary or general health care interventions, and the ordering of the data of the primary care session in an episode of care structure. It was developed by the WONCA International Classification Committee (WICC), and was first published in 1987 by Oxford University Press (OUP). A revision and inclusion of criteria and definitions was published in 1998. The second revision was accepted within the World Health Organization’s (WHO) Family of International Classifications.

The classification was developed in a context of increasing demand for quality information on primary care as part of growing worldwide attention to global primary health care objectives, including the WHO’s target of “health for all”.

Conclusion

Clinical data has always been influenced by unique requirements such as interprofessional communication, billing, and quality management. As a result, clinical data interpretation is heavily reliant on – often implicit – contexts, is largely unstructured and semi-structured, and even standardised data collected for a specific purpose, such as billing, is difficult to repurpose, for example, for clinical epidemiology, data analysis, or decision support. Data interoperability has just recently received increasing attention as a result of high expectations for the benefit of large-scale predictive data analysis.