Emergence of Health Information Technology Motivates the Evolution of CPT^®

Background

Health Information Technology (HIT) has been in the national spotlight since the Health Information Portability and Accountability Act (HIPAA) was enacted in 1996. HIPAA-mandated efforts initially involved the establishment of standards for electronic transactions, as well as standards for the security and privacy of health data. Current Procedural Terminology^® (CPT), which is owned and copyrighted by the American Medical Association (AMA), was identified as an important standard for HIPAA transactions. As a result, it was designated as the national code set for physician and other health care professional services.

Since the advent of HIPAA, HIT efforts have shifted in focus to building a national health information network with emphasis on patient safety and electronic health records. The envisioned health information infrastructure requires the use of uniform health information standards (both clinical and administrative) that are interoperable. Such interoperability requires that clinical and administrative code sets (such as SNOMED CT^® and CPT respectively), be incorporated into EHR systems and mapped to allow information sharing.¹

In its capacity as the HIPAA standard for procedures, CPT is primarily used for payment and administrative purposes. The reimbursement and administrative focus, while recognized as essential, has limited functionality in EHR systems unless it is linked to clinical data. Furthermore, the current flat file format of CPT, although ideal for developing printed material, is of limited use in developing healthcare software applications, mapping to other code sets, and supporting HIT initiatives.

Development of CPT Data Model

In an effort to meet the evolving needs of HIT, the existing CPT data file is undergoing significant enhancement and revision. The American Medical Association, in collaboration with Apelon, Inc., is developing a new CPT data model that facilitates interoperability. The new data model includes explicit hierarchical (vertical) relationships between CPT concepts. Its structure is based on the mathematical formalism of description logic, which allows automated classification of concepts within the hierarchy. Additional features that are intended to support emerging needs for standard terminology in EHR systems include structured descriptors and computer-readable attributes for CPT codes. Moreover, the new data model introduces horizontal relationships between CPT concepts and reference concepts. Examples of reference concepts include anatomy, devices, and clinical methods (such as excision or insertion). Together, the explicit vertical hierarchies and horizontal relationships facilitate a multi-hierarchical approach to CPT coding where users can search for CPT concepts within the CPT hierarchy itself or by traversing the horizontal relationships and reference concepts. The hierarchical structure and reference concepts will also assist with mapping to other terminologies and code sets.

Information in the data model will exist in flat relational files (ASCII) or as an XML file with an appropriate document type definition. The data model formats will be technologically independent of computer platforms, as required under the guiding principles for HIPAA standards (Federal Register, August 17, 2000, Final Rule on Health Information Reform: Standards for Electronic Transactions, p. 50332-50333).

In summary, the structure of the new CPT data model will promote the development of electronic healthcare applications, provide greater interoperability of with a variety of code sets, and support a variety of emerging HIT initiatives.