The Consolidated Health Informatics (CHI) began as an eGov initiative that establishes a portfolio of existing health information interoperability standards (health vocabulary and messaging) enabling all agencies in the federal health enterprise to "speak the same language" based on common enterprise-wide business and information technology architectures. CHI is currently managed under the Office of the National Coordinator (ONC) for Health Informational Technology's Federal Health Architecture (FHA) Program Management Office.

Through the CHI governance process, all federal agencies will incorporate the adopted standards into their individual agency health data enterprise architecture used to build all new systems or modify existing ones.

As good business partners, federal agencies working through CHI will openly share information on the CHI standards portfolio as it is assembled. At the same time, private sector consortiums seeking standards solutions are sharing their information with CHI.

CHI standards will work in conjunction with the Health Insurance Portability and Accountability Act (HIPAA) transactions, code sets, security and privacy provisions.

The United States Health Information Knowledgebase (USHIK) provides a focal point for access to the CHI designated standards. Where the designation of the standards is to the data element level, the data element specifications are provided in an ISO/IEC 11179 format. Where the designation of the standards is not provided to the data element level, a hyperlink to where additional information is available is provided. Within USHIK, the CHI Model provides an overview of the standards as well as a drill down capability to more detail information and to data elements standards.

Note: Usability gaps and follow on work are identified in the individual CHI Standards Adoption Recommendation reports.

The following links are to sites that provide CHI information or to organizations that provide standards from which CHI standards are designated. Broad descriptions of the standards are provided. The individual CHI Standards Adoption Recommendation reports provide specifics on the portions of these standards that CHI is using.

Office of the National Coordinator for Health Information Technology (ONC)
url:  http://www.hhs.gov/healthit/chi.html; http://www.hhs.gov/fedhealtharch/index.jsp; http://www.hhs.gov/healthit/chiinitiative.html
CHI is an integral element of the Federal Health Architecture (FHA) Program that is in the Office of the National Coordinator for Health Information Technology.

National Library of Medicine (NLM) Unified Medical Language System® (UMLS®)
url: http://www.nlm.nih.gov/research/umls/
For CHI, the UMLS will be the repository of all CHI designated standards including cross-references to other healthcare terminologies. The development and cross-referencing is on-going work at the National Library of Medicine. From this site you can download the UMLS Metathesaurus®, including the College of American Pathologists Systematized Nomenclature of Medicine Clinical Terms® (SNOMED CT®) core content.

National Committee on Vital and Health Statistics
url:  http://www.ncvhs.hhs.gov/
The National Committee on Vital and Health Statistics is the Public Advisory Body to the Secretary of Health and Human Services. CHI conducts outreach to the private sector through the National Committee on Vital and Health Statistics; records and schedules are available at this site.

National Electrical Manufacturers Association (NEMA) - Digital Imaging and Communications in Medicine® (DICOM®)
url:  http://medical.nema.org
The DICOM® standard addresses the exchange of digital information between medical imaging equipment and other systems.

Institute of Electrical and Electronics Engineers 1073 (IEEE™1073)
url:  http://www.ieee1073.org
The IEEE™1073 series of standards communicate patient data from medical devices typically found in acute- and chronic-care environments (e.g., patient monitors, ventilators, infusion pumps, etc.).

National Council for Prescription Drug Programs (NCDCP)
url:  http://www.ncpdp.org
National Council for Prescription Drug Programs (NCDCP) standards for ordering drugs from retail pharmacies to standardize information between health care providers and the pharmacies. These standards already have been adopted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and ensure that parts of the three federal departments that aren't covered by HIPAA will also use the same standards.

Health Level Seven® (HL7®)
url:  http://www.hl7.org
The Health Level Seven® (HL7®) messaging standards ensure that each federal agency can share information that will improve coordinated care for patients such as entries of orders, scheduling appointments and tests and better coordination of the admittance, discharge and transfer of patients.

Regenstrief Institute, Inc. - Laboratory Logical Observation Identifiers Names and Codes® (LOINC®)
url:  http://www.loinc.org/
The LOINC® standard is a response to the demand for electronic movement of clinical data from laboratories that produce the data to hospitals, physician's offices, and payers who use the data for clinical care and management purposes.

College of American Pathologists Systematized Nomenclature of Medicine, Clinical Terms® (SNOMED CT®)
url:  http://www.snomed.org/
The College of American Pathologists Systematized Nomenclature of Medicine, Clinical Terms® (SNOMED CT®) for laboratory result contents, non-laboratory interventions and procedures, anatomy, diagnosis and problems, and nursing. HHS is making SNOMED CT® content available for use in the U.S. at no charge to users (see NLM above).

Human Genome Organization (HUGO)
url:  http://www.hugo-international.org/
The Human Gene Nomenclature (HUGN) for exchanging information regarding the role of genes in biomedical research in the federal health sector.

Environmental Protection Agency (EPA) - Substance Registry System
url:  http://www.epa.gov/srs/
The Substance Registry System (SRS) is the Environmental Protection Agency's (EPA) central system for information about regulated and monitored substances. The system provides a common basis for identification of chemicals, biological organisms, and other substances listed in EPA regulations and data systems, as well as substances of interest from other sources, such as publications.

HIPAA, the Health Insurance Portability and Accountability Act of 1996
url:  https://www.cms.gov/hipaageninfo/downloads/hipaalaw.pdf
The Billing/Financial standards are used to implement electronic exchange of health related information needed to perform billing/administrative functions in the Federal health care enterprise.

Federal Drug Terminologies
Medications
The scope of the medications is to focus upon the identification of terminology and standards necessary for clinical support and decision making, resulting in recommendations for adoption of terminology, code sets and other interoperability standards for drug product information.

• Active Ingredients
  url:  http://www.fda.gov/cder/ndc/database/default.htm
  An active ingredient is a substance responsible for the effects of a medication. The Food and Drug Administration (FDA) establishes names for active ingredient and FDA Unique Ingredient Identifier (UNII) codes. The CHI standard is the FDA established names and the UNII codes. These are free from FDA and will also be available from the National Library of Medicine (NLM). The FDA provides online searching of the National Drug Code Directory.
   
• Clinical Drugs
  url:  http://www.nlm.nih.gov/research/umls
  url:  http://mor.nlm.nih.gov/download/rxnav/
  A "clinical drug" is a name for a pharmaceutical preparation consisting of its component(s), defined as active ingredients and their strength, together with the dose form of the drug as given to the patient. The CHI Medications sub-group has identified the Semantic Clinical Drug (SCD) of RxNorm, a portion of the Unified Medical Language System (UMLS), as the CHI standard for clinical drug nomenclature. The National Library of Medicine (NLM) has primary responsibility for the RxNorm terminology. The RxNorm terminology is a public domain system. The RxNorm is distributed via UMLS without restriction. (See http://www.nlm.nih.gov/research/umls/ for more information.). The National Library of Medicine�s RxNav is a java-based browser for the RxNorm. For more information about RxNav see http://mor.nlm.nih.gov/download/rxnav/ .
   
• Drug Classifications
  url:  http://www.fda.gov/cder/
  This standard is the hierarchical structures to categorize each medication, such as: mechanism of action, physiologic effects, intended therapeutic use, chemical structures, pharmacological properties, and FDA approved indications. CHI recommends the use of NDF-RT classification schemes for mechanism of action and physiologic effect when possible to avoid redundancy and promote interoperability in these areas. There are many classification needs will not be met by the partial recommendation. CHI will revisit this topic in the future.
   
• Drug Product
  url:  http://www.fda.gov/cder/ndc/index.htm
  This standard enables the federal health care sector to share information regarding drug products. A drug product is one or more finished dosage forms, each of which contain one or more ingredients. The CHI drug product standard is the Food and Drug Administration�s (FDA) National Drug Code (NDC) Product Name/Code. The NDC list of products and their codes is freely available electronically from the FDA without a licensing agreement at http://www.fda.gov/cder/ndc/index.htm .
   
• Manufactured Dosage Form
  url:  http://www.fda.gov/ICECI/Inspections/InspectionGuides/ucm074927.htm
  This standard enables the federal health care sector to share information regarding drug dosage forms. A manufactured dosage form is the way of identifying the drug in its physical form. The CHI Manufactured Dosage Form standard is the FDA/ Center for Drug Evaluation and Research (CDER) Data Standards Manual. All dosage form terms are readily available through the FDA�s website, and are in the public domain via the FDA�s CDER�s website at: http://www.fda.gov/cder/dsm/DRG/drg00201.htm.
   
• Package
  url:  http://www.fda.gov/cder/dsm/drg/Drg00907.htm
  This standard enables the federal health care sector to share information regarding drug packages. A drug package is, generally, any container or wrapping in which any drug is enclosed for use in the delivery or display of such commodities to retail purchasers. If no package is used, the container shall be deemed to be the package. The CHI standard is the package name/code as defined in the Food and Drug Administration (FDA)/Center for Drug Evaluation and Research (CDER) Data Standards Manual. The FDA has regulatory authority over drug package data. It is in widespread use by the Food and Drug Administration (FDA) and is distributed with the National Drug Code. All package terms are readily available through the FDA�s website (http://www.fda.gov/cder/dsm/drg/Drg00907.htm), and are in the public domain.
   
• Structured Product Label
  url:  http://www.loinc.org
  The Structured Product Labeling specification purpose is to facilitate the submission, review, storage, dissemination, and access to product labeling information. The CHI Structured Product Labeling (SPL) Sections standard is the LOINC Clinical SPL section terminology. The terminology for product labeling sections referenced in the SPL is maintained within LOINC Clinical. The full LOINC database and RELMA -- a program for searching and viewing the LOINC� database and mapping local files to LOINC are available at no cost from http://www.loinc.org/ (see LOINC above).
   

National Institute of Standards and Technology (NIST) - Healthcare Standards Landscape Project
url:  http://www.itl.nist.gov/div897/docs/hc_roadmap.html
The purpose of Healthcare Standards Landscape project is to design and demonstrate a Web-based framework for building and maintaining a repository of information on relevant Healthcare standards, initiatives, and organizations, that enable developers and stakeholders to readily obtain needed information that can improve standards development, coordination, and the realization of more compatible standards and tools.

Last Updated 20 July, 2005