HIPAA, EDI, HL7, ICD, and DataDirect

Martin visited DataDirect and learned about the new HIPAA and ICD standards.

Last week I visited Dr. Carlo "Minollo" Innocenti of Progress Software subsidiary DataDirect to talk about HIPAA 5010 electronic transactions, ICD-10 diagnostic codes, HL7 3.x, and the DataDirect Data Integration Suite. The visit came about because of my blog post the previous week about XBRL, HL7, and Altova MissonKit 2009. You may recall that I went into some detail about XBRL in that post, but deferred electronic health records to another time: basically, I wanted to hear another viewpoint.

Minollo, who is the XML technologies lead at DataDirect, gave me a nice overview of the current electronic health care records situation, and a demo of how DataDirect can solve some of the problems. According to Minollo, while DataDirect Data Integration Suite is often compared to Altova's products because of their overlap, its emphasis is different: DataDirect centers on its XQuery engine and XML converters and just happens to have an IDE called Stylus Studio to support these.

The problems that companies who want to implement the current revision of HIPAA transactions face are serious, but not insurmountable. Health plans, health care providers, and health care clearinghouses all need to conform to the HIPAA EDI standards, but it's the clearinghouses that have the biggest headaches.

What's the problem? Basically, the new standards aren't backward compatible. Specifically, the EDI-based HIPAA Version 4 release 1 (4010) is being replaced by the XML-based Version 5 release 1 (5010), and the ICD-9 International Classification of Diseases code set is being replaced by ICD-10. The mandated compliance dates are January 2012 and October 2013.

Suppose a doctor's office is producing HIPAA 4010 with ICD-9 diagnostic codes, and the patient's health plan requires HIPAA 5010 with ICD-10 diagnostic codes. If you're the clearinghouse, you have a data conversion problem.