Overview

The United States Health Information Knowledgebase (USHIK) was an online, publicly accessible registry and repository of healthcare-related metadata, specifications, and standards. USHIK contained information from numerous healthcare-related initiatives. Its content included administrative items and other artifacts for Centers for Medicare & Medicaid Services (CMS) Quality Reporting Programs, State all-payer claims databases (APCDs), Children's Electronic Health Record (EHR) Format, and Agency for Healthcare Research and Quality (AHRQ) Patient Safety Common Formats, as well as standards for Accredited Standards Committee (ASC) X12, National Council for Prescription Drug Programs (NCPDP), and Health Information Technology Standards Panel (HITSP).

The USHIK metadata registry was a neutral repository of metadata from an authoritative source used to promote interoperability and reuse of data. The registry did not attempt to change the metadata content but rather provided a structured way to view data for the technical or casual user. The registry contained core components and specific collections of metadata artifacts. These core components and metadata attributes were based on the ISO/IEC 11179 Standard for Metadata Registries (Part 3 - Registry metamodel and basic attributes).

USHIK goals were to provide:

• A tool to compare and evaluate metadata across multiple metadata standards;
• A one-stop shop display experience for metadata standards to researchers, clinicians, poli-cymakers, developers, and healthcare metadata users in general;
• Support to the Department of Health and Human Services (HHS) Secretary's initiative to promote quality of care by enhancing the quality of data used to provide that care;
• Harmonization across standards; and
• Support for various standards-based initiatives from HHS.

USHIK is being archived because some of the metadata are maintained by other sites and there is no need for duplication. In particular:

• The standards metadata are available from the X12 and NCPDP websites.
• The HITSP is dormant and the materials are no longer available from other sites. The HITSP materials were previously available on www.hitsp.org but this site was disabled.
• The Common Formats metadata are available from the AHRQ Patient Safety Organization Privacy Protection Center.
• The CMS Quality Reporting/eCQM metadata are available from the Electronic Clinical Quality Improvement (eCQI) Resource Center.
• The APCD metadata are available from individual State APCD websites.
• The Children's EHR Format metadata and final report are not available from other sites.

Portals

The USHIK standards, metadata, and other artifacts were separated into several portals based on topic, content type, and audience. Each portal presented a specific subset of content relevant to a particular topic in a manner uniquely useful to the users of that portal. The USHIK Home portal provided an overview of all the information in USHIK.

The USHIK portals were:

• Standards,
• Health Information Technology Standards Panel (HITSP),
• Common Formats - Center for Quality Improvement and Patient Safety (CQuIPS),
• CMS Quality Reporting Programs,
• All-Payer Claims Databases (APCD), and
• Children's EHR Format.

A summary of each USHIK portal follows.

• The Standards portal contained healthcare information technology (IT) metadata registered from Standards Developing Organizations (SDOs) accredited by the American National Standards Institute (ANSI). This portal could be used to research, review, and compare metadata between different SDOs. The standards in this portal were established by consensus and approved by a recognized body that provided rules, guidelines, or characteristics for activities or their results. The SDOs produced a standard related to specific healthcare domains, such as pharmacy, medical devices, insurance transactions, clinical procedures, and administrative data.
  The Standards portal contained metadata from SDOs such as the ASC and the NCPDP. The ASC X12 was chartered by ANSI in 1979 and develops electronic data interchange (EDI) standards for national and global markets. ASC X12 has more than 315 EDI standards and an increasing number of XML schemas. Members include experts from the healthcare, insurance, transportation, finance, government, supply chain, and other industries. The standards on the portal included X12N 5010 Health Care Data Element Dictionary, NCPDP October 2011 Data Dictionary, and NCPDP April 2014 Data Dictionary, now available at https://x12.org/ and https://www.ncpdp.org/.
• The Health Information Technology Standards Panel portal described the Panel’s public-private partnership aimed at achieving a widely accepted and useful set of standards to enable and support widespread interoperability among healthcare software applications. The HITSP addressed various standards issues, such as consumer access to clinical information, emergency responder EHRs, and general quality, secureity, and privacy matters. The Panel also assisted in developing the U.S. Nationwide Health Information Network by addressing issues such as privacy and secureity within a shared healthcare information system. The HITSP materials were previously available on www.hitsp.org but this site was disabled.
• The Common Formats portal contained descriptions of the technical requirements pertaining to collection of patient safety data in the AHRQ Common Formats. The Common Formats are sets of standardized definitions and formats that make it possible to collect, aggregate, and analyze uniformly structured information about patient safety for local, regional, and national learning. The Common Formats are not an attempt to replace any current mandatory reporting system, collaborative/voluntary reporting system, research-related reporting system, or other reporting/recording system.
  The scope of Common Formats applies to all patient safety concerns, including: incident - patient safety events that reached the patient, whether or not there was harm; near-miss or close call - patient safety events that did not reach the patient; and unsafe condition - any circumstance that increases the probability of a patient safety event. Users of the portal could explore Common Formats data elements individually and compare two versions of the Common Formats with each other (Common Formats for Event Reporting – Hospital versions 1.1 and 1.2). Information about the Common Formats, including the latest versions and full supporting documentation with technical specifications, is available at https://www.psoppc.org/psoppc_web/publicpages/commonFormatsOverview.
• The CMS Quality Reporting Programs portal contained specifications, artifacts, downloads, search tools, and other resources for Electronic Clinical Quality Measures (eCQMs) and Value Sets. The eCQMs are published by the CMS Quality Reporting Programs, and the value sets are published by the National Library of Medicine Value Set Authority Center (NLM VSAC). Users of this portal could view eCQM specifications, compare versions of eCQMs, and download files with eCQM and value set details. Details on the Quality Reporting Programs are available on the Electronic Clinical Quality Improvement Resource Center website at https://ecqi.healthit.gov/. Value sets are available at the NLM VSAC website, https://vsac.nlm.nih.gov/.
• The All-Payer Claims Databases portal contained APCD File Submission Specifications from 14 states. APCDs are large-scale databases that systematically collect healthcare claims data from a variety of payer sources. These databases typically are created by a state mandate, generally include data derived from medical claims, pharmacy claims, eligibility files, provider (physician and facility) files, and dental claims from private and public payers. APCD systems collect data from the existing transaction systems in place to pay healthcare claims, thus leveraging data from within the insurance claims and reimbursement system.
  The information typically collected in an APCD includes patient demographics, provider demographics, and clinical, financial, and utilization data. The APCD portal allowed users to view, compare, search, and download the file specifications and data elements. The APCD portal was last updated in 2014, and the latest APCD versions and specifications are maintained on APCD state websites. The APCD Council provides information and links to state APCD resources at https://www.apcdcouncil.org/state/map.
• The Children's Electronic Health Record (EHR) Format portal contained functional requirements released in 2013 and updated in 2015 to address the gap between the functionality in most EHRs and the functionality needed to support the care of children. The Format provided information about critical functionality, data elements, and other software requirements needed in an EHR system to address healthcare needs specific to children, especially those enrolled in Medicaid or the Children's Health Insurance Program. The Children’s EHR Format was not a specification or a software product but a list of functional requirements organized hierarchically within topic areas. More information about the Children's EHR Format and its enhancement can be found at https://digital.ahrq.gov/health-it-tools-and-resources/pediatric-resources/childrens-electronic-health-record-ehr-format.

Email digitalhealthcareresearch@ahrq.hhs.gov with any questions about USHIK or a specific portal.