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
Version 1.0/Fall 2010
2
Contents
Component Overview ................................................................................................... 5
Component Authors...................................................................................................... 6
Workforce Roles “Set Table” ....................................................................................... 7
Unit 9.1: Hardware Communication ............................................................................. 8
Learning Objectives ..................................................................................................... 8
List of Readings, Texts, References ............................................................................ 8
List of external resources, includes description and URL for each resource ............... 8
Instructor Guidelines and Expected Outcomes for Application Activities ..................... 9
Unit 1 Quiz Items ....................................................................................................... 10
Answer Key for Quiz Items ........................................................................................ 11
Unit 9.2: Hardware Communication ........................................................................... 12
Learning Objectives ................................................................................................... 12
List of Readings, Texts, References .......................................................................... 12
List of external resources, includes description and URL for each resource ............. 12
Instructor Guidelines and Expected Outcomes for Application Activities ................... 13
Unit 2 Quiz Items ....................................................................................................... 14
Answer Key for Quiz Items ........................................................................................ 14
Unit 9.3: National and International Standards Developing Organizations ............ 16
Learning Objectives: .................................................................................................. 16
List of Readings, Texts, References .......................................................................... 16
List of external resources, includes description and URL for each resource ............. 16
Instructor Guidelines and Expected Outcomes for Application Activities ................... 17
Unit 3 Quiz Items ....................................................................................................... 17
Answer Key for Quiz Items ........................................................................................ 19
Unit 9.4: Basic Health Data Standards ...................................................................... 21
Unit Objectives:.......................................................................................................... 21
List of Readings, Texts, References .......................................................................... 21
List of external resources, includes description and URL for each resource ............. 21
Instructor Guidelines and Expected Outcomes for Application Activities ................... 22
Unit 4 Quiz Items ....................................................................................................... 22
Answer Key for Quiz Items ........................................................................................ 25
Unit 9-5: EHR Functional Model Standards .............................................................. 26
Unit Objectives:.......................................................................................................... 27
List of Readings, Texts, References .......................................................................... 27
List of external resources, includes description and URL for each resource ............. 27
Instructor Guidelines and Expected Outcomes for Application Activities ................... 28
Unit 9-6: Health Data Interchange Standards ......................................................... 299
Unit Objectives:.......................................................................................................... 29
List of Readings, Texts, References .......................................................................... 29
List of external resources, includes description and URL for each resource ............. 29
Instructor Guidelines and Expected Outcomes for Application Activities ................... 29
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
3
Unit 9-7: Supporting Standards for EHR Applications............................................. 31
Unit Objectives:.......................................................................................................... 31
List of Readings, Texts, References .......................................................................... 31
List of external resources, includes description and URL for each resource ............. 31
Instructor Guidelines and Expected Outcomes for Application Activities ................... 32
Unit 9-8: Enterprise Architecture Models .................................................................. 34
Unit Objectives:.......................................................................................................... 34
List of Readings, Texts, References .......................................................................... 34
List of external resources, includes description and URL for each resource ............. 34
Instructor Guidelines and Expected Outcomes for Application Activities ................... 35
Unit 9-9: Privacy Confidentiality, and Security Issues and Standards ................... 36
Unit Objectives:.......................................................................................................... 36
List of Readings, Texts, References .......................................................................... ?6
List of external resources, includes description and URL for each resource ............. 37
Instructor Guidelines and Expected Outcomes for Application Activities ................... 36
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
4
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:
Unit 2:
Unit 3:
Unit 4:
Unit 5:
Unit 6:
Unit 7:
Unit 8:
Unit 9:
ISO Open Systems Interconnection (OSI) stack
Hardware communication
National and international standards developing organizations
Basic health data standards
EHR functional model standards
Health data interchange standards
Supporting standards for EHR applications
Enterprise architecture models
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 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
5
Component Authors
Michele Parrish, Durham Technical Community College
Ms. 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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
6
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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
7
Unit 9.1: Hardware Communication
This 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 layer
8. Explain the concept of the Physical layer
9. Explain connection-oriented versus connectionless communication
10. Explain the use of network addressing including security considerations and
vulnerabilities
List of external resources, includes description and URL for each resource
Internetworking Basics
This 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-toInternet.html
External Data Representation (XDR)
More information about XDR
http://en.wikipedia.org/wiki/External_Data_Representation
Minimal Lower Layer Protocol (MLLP)
More information about MMLP
http://www.hl7.org/v3ballot/html/infrastructure/transport/transport-mllp.htm#MLLP-intro
Port Numbers
This is the official IANA document that lists all port numbers and their associated
protocols/applications.
http://www.iana.org/assignments/port-numbers
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
8
Frame Relay
More information about frame relay
http://www.cisco.com/en/US/docs/internetworking/technology/handbook/FrameRelay.html
PPP
More information about PPP
http://www.cisco.com/en/US/docs/internetworking/technology/handbook/PPP.html
ATM
More information about ATM
http://www.telecomspace.com/vop-atm.html
NRZ Encoding
More information about NRZ
http://www.erg.abdn.ac.uk/users/gorry/course/phy-pages/nrz.html
Manchester Encoding
More information about Manchester
http://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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
9
Answer
TCP/IP
USER
OSI Model
Application
Application
Presentation
PDU
Data
Session
Transport
Transport
Segments
Internetwork
Network
Packets
Data Link
Frames
Physical
Bits
Network Access
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, Application
b. Presentation, Data Link, Network, Transport, Session, Physical, Application
c. Application, Presentation, Session, Transport, Network, Data Link, Physical
d. 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, Application
b. Network Access, Network, Transport, Application
c. Application, Transport, Internet, Network Access
d. Physical, Transport, Internet, Application
3. What is the protocol data unit (PDU) of the Network layer of the OSI model?
a. Data
b. Packets
c. Segments
d. Frames
4. Which Application layer protocol is used for converting host names and domain
names into IP addresses?
a. DHCP
b. SMTP
c. HTTP
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
10
d. DNS
5. Which Presentation layer protocol specifies how messages must be formatted so
that they can be exchanged between different email systems?
a. SMTP
b. MIME
c. SSL
d. XDR
6. T/F IPv4 has 128 bits.
7. 132.16.9.0 is what class of IPv4 address?
a. Class A
b. Class B
c. Class C
d. Class D
8. A ____ is a term used to describe the movement of data from one router to another.
a. hop
b. skip
c. route
d. 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 address
b. Unicast
c. Ethernet address
d. MAC address
Answer Key for Quiz Items
1. C Slide 1a-9
2. A Slide 1a-9
3. B Slide 1a-10
4. D Slide 1a-12
5. B Slide 1a-15
6. F Slide 1b-3
7. B Slide 1b-4
8. A Slide 1b-11
9. F Slide 1b-19
10. D Slide 1b-16
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
11
Unit 9.2: Hardware Communication
This unit is designed to help the student understand network media, hardware devices,
and how to select appropriate items to meet the guidelines for usage.
Learning Objectives:
By the end of this unit the student will be able to:
1.
2.
Select appropriate network media types (such as Ethernet and Wireless) to
facilitate networking and data exchange, taking into account access and regulatory
requirements
Select appropriate hardware devices (such as routers, switches, and access
points) to facilitate networking and data exchange, taking into account access and
regulatory requirements
List of external resources, includes description and URL for each resource
How Digital Television Works
On 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 rates
This 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
Cabling
This 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 Cabling
This 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.pdf
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
12
IEEE 802.11
This 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=8B1DE1B35CA2
15B2&playnext_from=PL&index=14
How to Make an Ethernet Cat5e/Cat6 Cable
This 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
Instructor Guidelines and Expected Outcomes for Application Activities
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
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
13
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
Instructions: Choose the best answer for each of the following questions.
1. In _____ transmission signals may travel in both directions but in only one direction
at a time.
a. simplex
b. full-duplex
c. synchronous
d. half-duplex
2. ______ is amount of data the medium transmits during a given period of time
a. throughput
b. bandwidth
c. goodput
d. data flow
3. A signal losses strength as the data transmission travels away from source. This is
called ______.
a. crosstalk
b. attenuation
c. latency
d. modulation
4. A ____ is any device on the network that has an address and can send and/or
receive data.
a. media
b. connector
c. node
d. router
5. There are ___ wires in a twisted pair cable.
a. 8
b. 6
c. 4
d. 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
Answer Key for Quiz Items
11. d
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
14
12. a
13. b
14. c
15. a
6. T – because it transmits light signals not electrical signals
7. a
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
15
Unit 9.3: National and International Standards Developing Organizations
This unit introduces students to the national and international organizations that create
standards used in networking and health information exchange.
Learning Objectives:
By the end of this unit the student will be able to:
1.
2.
3.
4.
Explain why standards related to networking and health information exchange are
important, particularly in the current environment.
Describe how standards are developed, who develops them, and how they are
selected and accredited.
Explain the most common categories of standards (e.g., basic networking,
application).
Demonstrate how to find, obtain, and use standards that are needed to facilitate
networking and health information exchange.
List of external resources, includes description and URL for each resource
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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
16
Instructor Guidelines and Expected Outcomes for Application Activities
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
Instructions: Choose the best answer for each of the following questions.
1. Standards are a necessary and useful part of life because:
a. Enable people to work together
b. Avoid chaos
c. Enable components to work together
d. All of the above
2. Which of these objects probably would not profit from a standard?
a. Baseball
b. Sock sizes
c. Light bulb
d. a piece of art
3. Interoperability permits us to _________
a. Aggregate data across different sites of care
b. Reuse data for purposes other than why is was primarily collected
c. Share data with other places of care
d. All of the above
4. The US Interstate Highway System is an example of interoperability.
a. True
b. False
5. Which of the following is not required to enable end–to-end interoperability for health
care?
a. We must use the same data elements.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
17
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. True
b. False
7. People should have a choice about which standards they wish to use.
a. True
b. False
8. Microsoft Standards are created using what method
a. Consensus
b. ad hoc
c. de facto
d. none of the above
9. Which of the following is not an International SDO?
a. ISO TC 215
b. HL7
c. IEEE
d. NCPD
10. Which organization is a collaborative organization for international SDOs?
a. SCO
b. ANSI
c. JIC
d. CDISC
11. The World Health Organization is not engaged in creating standards.
a. True
b. False
12. Which activity is not included in a workgroup of TC 215
a. EHR
b. Messaging standards
c. Internet standards
d. Terminology standards
13. Which of the following Groups cannot submit standards to ISO TC 215 to become
ISO standards?
a. HL7
b. CEN
c. ASTM
d. IEEE
14. CEN Standard 13606 defines standards for the following”
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
18
a. Archetypes
b. EHR Architecture
c. Reference Information Model
d. All of the above
15. Which of the following standards are not being defined in HL7?
a. Personal Identifier
b. Mental Health
c. None of the above
d. All of the above
16. Which is not an HL7 Steering Division?
a. Structure and Semantic Design
b. Clinical Decision Support
c. Domain Experts
d. Foundation and Technology
17. HL7 creates standards for which of the following
a. EHR Functional Model
b. Diets
c. Exercise protocols
d. Reimbursement
18. Which HL7 Standard is not mentioned in the HHS Final Rule?
a. CDA
b. v2.5.1 Messaging Standard
c. CCD
d. v3.0 Messaging standard
19. What SDO is likely to have created a standard for an Echo cardiogram?
a. ASC X12N
b. ASTM
c. DICOM
d. CDISC
20. Which SDO is likely to have created a standard for a medication refill?
a. DICOM
b. NCPDP
c. ASTM
d. All of the above
Answer Key for Quiz Items
1. D
2. D
3. D
4. A
5. C
6. B
7. B
8. C
9. D
10. C
11. B
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
19
12. C
13. C
14. D
15. D
16. B
17. A
18. D
19. C
20. B
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
20
Unit 9.4: Basic Health Data Standards
This unit provides an orientation to the important data-related standards that enable
interoperable health data interchange.
Unit Objectives:
By the end of this unit the student will be able to:
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.
List of external resources, includes description and URL for each resource
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/
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
21
IHTSDO www.ihtsdo.org
ONC http://healthit.hhs.gov/portal/server.pt?open=512&objID=1200&mode=2
Instructor Guidelines and Expected Outcomes for Application Activities
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
Instructions: Choose the best answer for each of the following questions.
1. Which of the following is not a component of semantic interoperability?
a. Context understood
b. Meaning precise
c. Secure
d. Reusable
2. Codes assigned to data elements should include some meaning about the term.
For example, m = male.
a. True
b. False
3. The U.S. has identified a single controlled vocabulary for use in health care.
a. True
b. False
4. By using all the major controlled vocabularies we can achieve semantic
interoperability.
a. True
b. False
5. The U.S. currently uses ICD 10.
a. True
b. False
6. ICD is sponsored by ISO.
a. True
b. False
7. The advantage of a polyhierarchy is that a data element can be linked to multiple
higher level concepts.
a. True
b. False
8. CPT is owned and developed by:
a. HL7
b. NLM
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
22
c. AMA
d. IHTSDO
9. DRG is based on common diseases.
a. True
b. False
10. NDC codes are used to report
a. Diagnoses
b. Drugs
c. Lab tests
d. None of the above
11. LOINC is widely used in the US for the names of laboratory tests.
a. True
b. False
12. Daily Med is useful because it provides:
a. Billing information
b. Laboratory test names
c. Possible drug side effects
d. A record of drugs a person takes daily
13. SNOMED CT is developed and owned by:
a. CAP
b. NLM
c. IHTSDO
d. AMA
14. Use of SNOMED CT is available for free in the US.
a. True
b. False
15. Post coordinated terms are defined as an explicit part of a controlled vocabulary.
a. True
b. False
16. Nursing terminologies support all of these concepts except:
a. Diagnoses
b. Interventions
c. Outcomes
d. Length of stay
17. MeSH is used to index medical literature by NLM.
a. True
b. False
18. UMLS is a product of
a. ANSI
b. FDA
c. NLM
d. WHO
19. A licensing fee is not required to use which of the following controlled
terminologies:
a. ICD
b. CPT
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
23
c. MedDRA
d. LOINC
20. What terminology is likely to be use for drug data elements?
a. IDC
b. CPT
c. DRG
d. RxNorm
21. Mother’s maiden name would not be classified as a data element.
a. True
b. False
22. Which is not an attribute of a data element?
a. Synonym
b. Cost
c. Units
d. Data type
23. Which of the following is not a data type?
a. Numeric
b. Character
c. Synonym
d. Date-time
24. ISO 11179 is a standard for imaging.
a. True
b. False
25. The following has a metadictionary (caDSR) that is based on ISO 11179:
a. NCI
b. NLM
c. CDISC
d. None of the above
26. CDISC creates data elements for billing clinical charges
a. True
b. False
27. Which of the below is an example of a compound data element?
a. Heart murmur
b. Blood pressure
c. Person name
d. All of the above
28. A complex data element might contain
a. A logic statement
b. A calculation
c. A comparison of the value of two data elements
d. All of the above
29. A CMET is a clinical measurement using electronic technology.
a. True
b. False
30. A template if similar in function to a paper form.
a. True
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
24
b. False
31. CDAs are encoded with
a. UML
b. HTTP
c. XML
d. Symbolic delimiters
32. The main parts of a CDA are a header and the body.
a. True
b. False
33. All data in a CDA must be structured and coded.
a. True
b. False
34. CCR is a product of
a. HL7
b. ASTM
c. ANSI
d. ONC
35. The CCR may be used for the following:
a. Discharge summary
b. Claims attachment
c. Patient summary record
d. None of the above
Answer Key for Quiz Items
1. C
2. B
3. B
4. B
5. B
6. B
7. A
8. C
9. B
10. B
11. A
12. C
13. C
14. A
15. B
16. D
17. A
18. C
19. D
20. D
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
25
21. B
22. A
23. C
24. B
25. A
26. B
27. D
28. D
29. B
30. A
31. C
32. A
33. B
34. B
35. C
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
26
Unit 9-5: Unit Topic: EHR Functional Model Standards
This unit explores the functional requirements and standards for electronic health
records (EHRs).
Unit Objectives:
By the end of this unit the student will be able to:
1. Understand linking and aggregating data at all levels
2. Understand how data may be interchanged among heterogeneous settings without
loss of information
3. Understand HL7 v2.x messaging communication standard
4. Understand HL7 v3.0 messaging standards
5. Understand other data interchange standards including DICOM, IEEE, and IHE
6. Explain how model-based standards are created
7. Define the methodology development framework
8. Describe HL7 v3.0 messaging standards
9. Discuss other data interchange standards including DICOM
10. Understand imaging standards
11. Understand standards for pharmacy services
12. Understand interface standards for medical devices
13. Understanding claims and reimbursement standards
14. Understand concept of profiling
15. Understand the use and value of implementation guides
List of external resources, includes description and URL for each resource
Heath Level Seven International
Read more about HL7 including standards and how to implement.
http://www.hl7.org/index.cfm
Ascend HL7 Interface Specification
Describes HL7 message standards for Hann's On Software (HOS).
http://www.hosinc.com/Products/Interfaces/interface_documentation.htm
HL7 ADT Message Overview
This 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/
IHE
Integrating the Healthcare Enterprise homepage.
http://www.ihe.net/
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
27
Standardization of Terminology
This 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 – Healthcare
Articles about information systems and security in the healthcare field.
http://www.informationweek.com/healthcare/index.jhtml
Instructor Guidelines and Expected Outcomes for Application Activities
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
28
Unit 9-6--Unit Topic: Health data interchange standards
This unit emphasizes the importance of adhering to health data interchange these
standards in order to ensure compatibility between systems.
Unit Objectives:
By the end of this unit the student will be able to:
1.
2.
3.
4.
5.
Analyze fundamental structure and components of data (e.g., standards-based data
elements, terminology, templates, and archetypes)
Explain the relevance of health data interchange standards (specifically HL7 v2.x
and HL7 v3.0) for data mobility for health records.
Explain the relevance of document and imaging standards (specifically CDA, CCD,
CCR, and DICOM) for data mobility for health records
Explain the relevance of medical device standards (specifically IEEE 110-73 series)
for data mobility for health records
Explain the concept of profiling and the role of IHE in defining profiles.
List of external resources, includes description and URL for each resource
http://www.hl7.org/index.cfm
Read more about HL7 including standards and how to implement.
http://www.himss.org/ASP/topics_ehr.asp
Info and news concerning EHR.
http://www.ahraonline.org/Downloads/onlineinstitute/quickcredit/oiqc_elechealthrecord.p
df
An 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.html
Information about openEHR
Instructor Guidelines and Expected Outcomes for Application Activities
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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
29
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/FamilyCircleJune2010_HealthQ-A_EdHammond.pdf
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
30
Unit 9-7: Unit Topic: Supporting standards for EHR applications
This unit presents a set of standards that support the application layer of the OSI and
extend EHR functionality.
Unit Objectives:
By the end of this unit the student will be able to:
1.
2.
3.
4.
5.
Identify and discuss a family of clinical decision support standards, including Arden
Syntax, Clinical Guideline standards, and the Infobutton
Discuss single sign-on standards and the HL7 Clinical Context Object Workgroup
(CCOW) standard
Define and discuss regulatory standards, standards enhancing patient safety,
including reporting requirements
Bar code standards
Master patient index, patient registries, and record locating standards
List of external resources, includes description and URL for each resource
Using Features of Arden Syntax with Object-Oriented Medical Data Models for
Guideline Modeling
This 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 Syntax
A 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 Information
This link provides HL7's product brief about Infobuttons.
http://wiki.hl7.org/index.php?title=Product_Infobutton
Infobuttons at Intermountain Healthcare: Utilization and Infrastructure
This article “describes the infobuttons infrastructure at Intermountain Healthcare and
assesses their use after 4 years of their initial release.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839474/
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
31
Getting Patients to Meaningful Use: Using the HL7 Infobutton Standard for Information
Prescriptions
This article explains the usefulness of Infobuttons and a particular company's
implementation.
http://hwinfo.healthwise.org/docs/DOCUMENT/8325.pdf
HL7 CCOW standard
This page is HL7's CCOW standard page providing information about CCOW.
http://www.hl7.org.au/CCOW.htm
CCOW Information for the Healthcare Industry
This site provides information about CCOW including what it is, how it works and its
benefits.
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-49KC744F0&_user=5961205&_coverDate=11%2F27%2F1993&_rdoc=1&_fmt=high&_orig=sear
ch&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000068954&_version=1&_
urlVersion=0&_userid=5961205&md5=f6a8456e396d21342396879a39f4cfbd&searchty
pe=a
National Guideline Clearinghouse
NGC is a public resource for evidence-based clinical practice guidelines.
http://www.guideline.gov/
Single Sign-On
Wikipedia article about single sign-on.
http://en.wikipedia.org/wiki/Single_sign-on
Instructor Guidelines and Expected Outcomes for Application Activities
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
32
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
33
Unit 9-8: Unit Topic: Enterprise Architecture Models
This unit addresses different enterprise architecture models that provide an
infrastructure for healthcare networks.
Unit Objectives:
By the end of this unit the student will be able to:
1.
2.
3.
4.
5.
Explain the significance of Service Oriented Architecture in networking and health
information exchange networks
Explain the value of an Enterprise Architecture in networking and health
information exchange networks
Describe key elements of various service oriented architecture platforms and
infrastructure options
Explain regional healthcare networks – policy and implementation strategies
Explain the concept of a Nationwide Healthcare Information network
List of external resources, includes description and URL for each resource
OMG Healthcare Domain Task Force
This site contains information about the Healthcare Service Specification Project.
http://healthcare.omg.org
Health Information Sharing Environment
Information about creating a framework for sharing personal medical information.
http://www.cisco.com/web/about/ac79/docs/pov/Health_Information_Sharing_Environm
ent_0526FINAL.pdf
NIHN Enterprise Architecture Overview
This document from ONC provides an overview of EA.
http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910398_0_0_18/NH
INEnterpriseArchitectureOverview.doc
SOA Solutions
This 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 Improvement
This site is home to The Network for Regional Healthcare Improvement (NRHI), a
National coalition of Regional Health Improvement Collaboratives.
http://www.nrhi.org/
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
34
Nationwide Health Information Network
This site developed by ONC covers information about HIN.
http://healthit.hhs.gov/portal/server.pt?open=512&objID=1142&parentname=Community
Page&parentid=4&mode=2
A Service Oriented Architecture based Medical Grid Application
This 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
Instructor Guidelines and Expected Outcomes for Application Activities
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.”
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
35
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:
By the end of this unit the student will be able to:
1.
2.
3.
4.
Explain the concepts of privacy and confidentiality requirements and policies and
learn how to implement the requirements
Define access control methods
Describe how to secure data storage and transmission using data encryption,
signatures, validation, non-repudiation, and integrity (PKI, certificates, and security
protocols)
Analyze access restrictions to data storage and retrieval (physical and software)
List of external resources, includes description and URL for each resource
Microsoft – The Latest in Computer Security
This site contains information about security products, updates, tools and news.
http://www.microsoft.com/security/default.aspx
Orange Book Certification
This 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/OrangeIII.html#toc5
http://en.wikipedia.org/wiki/Trusted_Computer_System_Evaluation_Criteria
Hashes
This article contains information about hashes.
http://en.wikipedia.org/wiki/Cryptographic_hash_function
Encryption
This 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
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
36
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 Passwords
This 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 Policies
These 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-oneoverview-policies
HIPPA
Information 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
Information
This 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
Patients
These guidelines were produced by the Ohio State Medical Association.
http://www.osma.org/files/documents/tools-and-resources/running-a-practice/socialmedia-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_lo
w.pdf
Proposed HIPPA Rule Change
On 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.
http://www.himss.org/handouts/20100714_ProposedRegsHHS.pdf
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
37
Instructor Guidelines and Expected Outcomes for Application Activities
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=G212YMIREP2U1QE1
GHRSKH4ATMY32JVN?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?
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
38
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 working
The 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).
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
39
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
40
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.
Component 9
Networking and Health Information Exchange
Version 1.0/Fall 2010
41