R380-70. Standards for Electronic Exchange of Clinical Health Information, R380. Health, Administration, Utah Administrative Code

Utah Administrative Code (Current through November 1, 2019)

R380-70. Standards for Electronic Exchange of Clinical Health Information

R380-70-1. Purpose and Authority

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This rule governs electronic information exchanges between health care providers, laboratories, and third party payers. It is authorized by Sections 26-1-30 and 26-1-37.

R380-70-2. Definitions

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The terms defined in Utah Code 26-1-37 apply to this rule and the standards adopted by this rule. In addition, the following terms apply to this rule and the standards adopted by this rule:

(1) "Clinical health information" means data gathered on patients regarding episodes of clinical health care.

(2) "Clinical laboratory" means a laboratory that performs laboratory testing on humans (except research) in the U.S.

(3) "Health care provider" has the same meaning as used in Utah Code Section 26-1-37 and includes an entity, such as a clinic, employer, or other business arrangement, where an individual licensed under Title 58, Occupations and Professions, provides health care.

R380-70-3. Terms Used in Standards

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Some terms used in this rule and the standards adopted by this rule are nationally recognized terms within the clinical data exchange community. The following are provided as an aid to the reader:

(1) Health care information codes

(a) "ASA Codes" are the codes contained in the ASA Relative Value Guide developed and maintained by the American Society of Anesthesiologists to describe anesthesia services and related modifiers.

(b) "CDT Codes" are the Current Dental Terminology prescribed by the American Dental Association.

(d) "HCPCS" are CMS's Common Procedure Coding System, a coding system that describes products, supplies, procedures and health professional services and includes, the American Medical Association's Current Procedural Terminology codes, alphanumeric codes, and related modifiers. HCPCS codes are:

(i) "HCPCS Level I Codes" are the CPT codes and modifiers for professional services and procedures.

(ii) "HCPCS Level II Codes" are national alphanumeric codes and modifiers for health care products and supplies, and codes for professional services not included in the AMA's CPT codes.

(e) "ICD-CM Codes" are the diagnosis and procedure codes in the International Classification of Diseases, clinical modifications published by the U.S. Department of Health and Human Services.

(f) "LOINC" means Logical Observation Identifiers Names and Codes. It is a set of universal codes and names to identify laboratory and other clinical observations developed by the Regenstrief Institute.

(g) "NDC" means the National Drug Codes of the Food and Drug Administration.

(h) "SNOMED" means Systematized Nomenclature of Medicine maintained and distributed by the International Health Terminology Standards Development Organisation. It is a systematically organized computer processable collection of medical terminology.

(2) Electronic Data Interchange Standards

(a) "ASC X12N" are standard formats developed by the Accredited Standards Committee X12N Insurance Subcommittee of the American National Standards Institute and the ASC X12N implementation guides either as promulgated or as modified by another federally registered SDO;

(b) "HL7" are electronic data interchange standard formats developed by Health Level 7, which is a standards development organization accredited by the American National Standards Institute. The HL7 standard is usually modified into specific implementation guides by a separate standards development organization;

(c) "NCPDP" are standard formats for the transfer of data to and from the pharmacy services sector of the healthcare industry. It is developed by the National Council on Prescription Drug Program, which is a standards development organization accredited by the American National Standards Institute.

R380-70-4. Electronic Exchange Requirements

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(1) A health care provider or third party payer that exchanges information electronically with another health care provider or third party payer must comply with the provisions of this rule.

(2) A person required to report information to the Utah Department of Health and that submits its report electronically shall submit the report in accordance with the provisions of this rule.

(3) A health care provider or third party payer may reject electronically transmitted clinical information if it is not transmitted in accordance with this rule.

R380-70-5. Exemptions

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(1) This rule does not govern the exchange of information that is not conducted electronically or for which no standard has been established in this rule.

(2) This rule does not apply to the exchange of clinical health information among affiliates, as provided in 26-1-37, within a health care system.

(3) Nothing in this rule requires a health care provider or third party payer to use a specific telecommunications network for the exchange of clinical health information.

R380-70-6. Electronic Data Interchange Standards

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Standards incorporated by reference in this rule are available for public inspection at the department during normal business hours or at http://health.utah.gov/phi/index.php?formname=laws.

(1) A health care provider, a clinical laboratory, or third-party payer that electronically exchanges clinical health information with another health care provider, a clinical laboratory, or third-party payer must comply with the following Utah Health Information Network standards-:

(a) Discharge Summary v2.0, March 4, 2009;

(b) History and Physical v2.0, March 4, 2009;

(d) Operative Report v2.0, June 15, 2009;

(e) Clinical Acknowledgement and Error Status v2.0, June 15, 2009;

(f) Laboratory Test Result Identifiers v2.0, September 5.2009;

(g) Clinical Laboratory Results v2.0, September 30, 2009;

(h) Radiology Report v2.0, June 21, 2010, which are incorporated by references.

R380-70-7. Standards Recommendations

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A party that recommends standards to the Department, shall seek guidance and work with national standard setting entities, such as the American National Standards Institute ASC X12, Health Level 7, and the National Council on Prescription Drug Program, that deal with the particular subject matter.