MDDS for Health Standard Part I

Ministry of Health & Family Welfare
Government of India
Meta Data and
Data Standards for Health Domain
Part I
Overview Report of the National Committee
(Draft)

Meta Data and
Data Standards for Health Domain
Part I
Overview Report of the National Committee
(Draft)
November 2013
Government of India

iii
The Ministry of Health & Family Welfare and the members of MDDS Committee would like to thank Indian
& International Health Informatics professionals who have provided valuable contributions towards
development of Meta Data & Data Standards.
The MDDS Committee acknowledges and thanks Mr. Sunil Bhushan, (Senior Technical Director, National
Informatics Centre), Dr. Meenakshi Mahajan, (Senior Technical Director, National Informatics Centre)
and her team for providing necessary help in standards development. The Committee would also like
to acknowledge the help and support provided by Dr. Rattan Chand Chief Director, Statistics Division
MoHFW. Help & support provided by MCTS Division and e-Gov Consulting team in MoHFW & Rajasthan
Medical Services Corporation team in Jaipur needs to be acknowledged. A big acknowledgement goes to
Dr. B.K. Murti, Mr. Praveen Srivastava and C-DAC team for verifying & reviewing the standards.
The MDDS Committee acknowledges, the secretariat role played by National Health Systems Resource
Centre (NHSRC) for the MDDS Committee. The intensive efforts & work contributed by two partner
agencies “Taurus Glocal Consulting” & “United Health Group” and the considerable expertise they brought
to this work is greatly appreciated and acknowledged. The committee also appreciates the technical
support received from International Health Informatics Experts Prof. Sundeep Sahay & Mr. Bob Jolliffe.
The full time professional team that worked for this secretariat are: NHSRC- Dr. Amit Mishra, Taurus
Glocal Consulting -Dr. Pankaj Gupta, Mr. Krishan Bhardwaj, Dr. Savita Gupta and Ms. Anjali Nanda, United
Health Group- Mr. Ranjan Prasad, Dr. Lokesh Gupta, Mr. J. P. Pattanaik and Ms. Akanksha.
Manoj Jhalani
Chairperson
Committee on Meta Data & Data Standards in Health Domain
New Delhi
Acknowledgement

v
HealthDomainMetaData&DataStandards
TermsofReferenceoftheDomainHealthCommittee
Terms of Reference
To identify generic data elements in the
health domain, which are common across
e-Governance applications within the domain
as well as other domains involved in providing
sectoral services delivery under e-governance.
To study the global standards for standardising
the metadata of identified generic data
elements for adoption as Indian standards.
To develop own standards / extension of global
standards in Indian context, wherever required,
around policy on open standards, and in synergy
Health Domain MDDS Committee Members
Shri Manoj Jhalani, Joint Secretary (Policy) MoHFW Chairperson
State IT Secretary or any nominated senior officer from States of Andhra Pradesh,
Bihar & Maharashtra
Member
Shri P C Cyriac, Deputy Director General (Stats), MoHFW Member
Dr. Himanshu Bhushan, Deputy Commissioner (MH) MoHFW Member
Shri Vishwajeet Ringe, Senior Technical Director, NIC Member Secretary
Shri Sunil Kumar, Senior Technical Director, NIC Member
Ms. Gayatri Mishra, Director MoHFW Member
Representative of Planning Commission Member
Shri Vishwadeep Srivastava, Senior Consultant, NeGD, DietY Member
Dr. Meenakshi Mahajan, Technical Director, eGSD(NIC) Member
NIC State Informatics Officer from State of Gujarat/ Karnataka/ Chhattisgarh Member
Dr. Karnick, CSE Department, IIT Kanpur Member
Dr. S. B. Bhattacharya, Head, Health Informatics, Tata Consultancy Services Member
Shri Gaur Sunder, Group Coordinator in-charge, Medical Informatics R&D Group at
C-DAC
Member
Shri Vishal Mane, Senior Research Scientist, Media Lab Asia Member
ED NHSRC Member
Shri Shiban Ganju, Volunteer Member
with other domain committees by following
Institutional Mechanism for formulation of
Domain specific MDDS formulation published
by DietY.
Create and maintain repository of metadata of
standardised generic standards, and include
the same in central repository by having liaison
with e-Gov standards Div, NIC.
Ensure enforcement of standards in the
applications being developed in health domain
at central/ state Government level.
To advise for identification of suitable test suits
for conformance testing of the implementation.
Terms of Reference of the
Domain Health Committee

vii
HealthDomainMetaData&DataStandards
ExecutiveSummary
The “Metadata and Data Standards” initiative
taken by the Ministry of Communication and
Technologies under National e-Governance
Plan (NeGP), aims to promote the growth of
e-Governance within the country by establishing
interoperability across e-Governance applications
for seamless sharing of data and services. Under
the MDDS initiative domain specific committees
have been constituted in priority areas.*
The Health Domain MDDS Committee is one such
initiative, constituted on Sept 2012, under the
chairmanship of Joint Secretary (Policy) with the
senior technical officer of NIC as its member-
secretary. The secretariat is located in the
National Health System Resource Centre (NHSRC),
entrusted with the task of extensive stakeholder
consultations and recruiting appropriate technical
agencies to support this work. The process
included a study of existing systems and their
interoperability issues and a study of global data
and interoperability standards.
As the National Health Mission in the 12th
Plan
period moves towards the goal of Universal Health
Coverage, one of the key challenges is to provide
the information architecture for the increasingly
large and growing complexity of information needs
of service users, healthcare providers, of hospital
and health managers and for e-governance.
Establishing nationwide metadata, data standards
and interoperability standards is one of the key
steps in the endeavour to better manage this
complexity. The Meta Data and Data Standards
are developed following the guidelines set by the
DietY #,!
, and are organised in four parts:
Part I: The Overview
Part II: Data Elements: Quick Reference
Part III: Code Directory: Quick Reference; Sample
Values and Meta Data:
Part IV: Data Elements Meta Data
The first of these parts is this publication, whereas
the other three parts are made available only as
soft copy format- in CD with this publication and
on the MOHFW, NRHM and NHSRC websites.
Part I details the structure and design of the
MDDS standards. It explains how based on
semantic theory, the principles of design were
established (see figure 1 and 2). This is essential
for ordering different words and their varying
interpretations and usage into a logically
consistent set of data elements and their
attributes with a code value for each, such that
these data standards can be readily accessed
and used in the development of all healthcare IT
applications and products. Recognising that in
the health domain, there would always be a need
for incremental additions and modification, this
section also describes the process by which the
standards were arrived at and the institutional
requirements for maintaining the very dynamic
nature of these standards and ensuring their
implementation across the nation.
In Part II, The Common Data Elements [CDE] provide
the common standardised vocabulary for various
participants in the health system – centre and state,
public and private, to begin sharing meaningful
information with each other in a timely manner.
Approximately 1000 data elements are identified
for the health domain and are grouped under 39
logical entities such as Patient, Examination,
Diagnosis, Mortality, Pharmacy etc. Grouping of
data elements under these entities would make
MDDS better manageable and easier to use.
Executive Summary
* https://egovstandards.gov.in/
# Operational Manual for formulation of Domain Specific Metadata and Data Standards
! Institutional Mechanism for formulation of Domain specific Metadata and Data standards

NationalCommitteeonMetaDataandDataStandardsForHealthDomain
OverviewReport
viii
In Part III, we provide a list of approximately 141
Code Directories that have been created to enforce
data standards. For example “the identification
of a facility” and the “operational status of a
facility” are two distinct data elements. But there
are over 200,000 facilities in the public sector
alone. Moreover, the functional status of each
of these facilities could correspond to following
descriptions: non functional, functional, under
repair, closed and so on... The code directory for
facility would report the “value” provided to each
facility such that it is uniquely identified and the
code directory for “facility operational status”
would tell us how to denote the operational
status so that all systems that read it make the
same meaning. Since most data elements have
multiple attributes, by combining values drawn
from different code directories with each data
element it would be possible to provide a standard
meaning and code for a universe of words and
meanings. Part III therefore indicates name of
each code directory, source of code directory
and the ownership rights for each of the code
directories. In some instances an existing code
directory is referred to, providing the source and
its ownership rights. In others the code directory
is created by the MDDS committee or would need
to be created. The metadata of each code directory
is given in the Code Directory Meta Data.
Part IV has metadata for each data element
developed under MDDS. Metadata includes the
data type and size for each data element defined
under MDDS.
In addition to the above, the document provides
annexures with sample data sets for users of the
Health Domain MDDS for drug inventories and
blood banks. The system specific integration
recommendations are also included in the
annexure.
One of the challenges that this committee
has addressed is the establishment of a set
of “identifiers”- i.e. standards for identifying
the Facility, the Medical Provider, Patient, and
all others handling healthcare data so that
information across different locations can be
exchanged easily and securely.
For identification of diseases, clinical procedures,
laboratory and diagnostic tests and therapeutic
interventions, standards referenced by MDDS
committee include ICD-10, ICD-9, SNOMED-
CT, LOINC, HL7 v2.x, HL7 v3 RIM, Canadian
Classification of Health Interventions (CCI), WHO
Morbidity and WHO Mortality list. Domain standards
currently in use in India were also referenced and
incorporated. All recommendations of the EMR
Committee report (Aug-2013) are incorporated in
Health MDDS. Existing programmes and systems
such as MCTS, IDSP, RNTCP, Drug Inventory
Distribution system of Rajasthan were also studied
to identify relevant common data elements and
metadata.
As the MDDS takes root, the government as well
as private players, and managements and care
providers would be better able to ensure the
Figure 1: Based on ISO/IEC 11179 Meta Model-I with an illustrative example relating to drug prescription
Conceptual Doman Entity
(e.g. Pharmacy Order)
Object Class
Medication Orders
Attribute
Frequency
Concept
Frequency of Medication
Data Element
Medication Frequency
Value Domain
Medication Frequency
Code Directory
List of Values
(BID, TID, QID, HS, STAT)
The MDDS Conceptual Design

ix
citizen’s health, the delivery of services, and
health expenditures and be able to more effectively
identify disease patterns and their progression in
the population. Such information would help in
controlling disease spread, manage progression,
understand public health program effectiveness
and provide valuable information to researchers
and medical community to help develop newer and
more effective treatments and assess effectiveness
of clinical pathways.
E-Governance systems for Health which are
operational today include a variety of applications
such as Mother and Child Tracking System (MCTS),
Health Management Information System (HMIS),
Hospital Information Systems (HIS), Supply
Chain Management for Drugs and Vaccines,
Integrated Disease Surveillance Project (IDSP),
Revised National Tuberculosis Program (RNTCP)
etc. There are states with over 30 distinct
operational systems. With the adoption of MDDS
and growing inter-operability the wealth of the
data generated by these existing applications
will create more meaningful and actionable
information for health care providers, allowing
more effective implementation and tracking of
health programmes.
Implementation of these standards requires a
number of institutional measures. At the apex
the nation would be moving towards establishing
a National Health Information Authority under
the leadership of the Ministry of Health and
Family Welfare. This Authority would be charged
with the management, promotion, adoption and
compliance with these standards. It would also
ensure that the standards are constantly updated
thus keeping them current and relevant. The
processes required for the adoption of the MDDS
would begin in parallel, and not wait the formal
constitution of the authority. This would include
dissemination of the standards, a helpline,
reference and capacity building service that would
facilitate adoption of the MDDS by developers,
linking central financing to adoption of these
standards, building organizational capacity for
testing and certification of compliance and
provide support to upgrade existing systems to
be MDDS compliant.
Though MDDS is an essential pre-condition of inter-
operability it is not sufficient. Interoperability
requires solutions at the semantic level, at the
technical level and at the institutional level.
MDDS solves the problems at the semantic level,
but has only a limited contribution to the other
two levels.
Inter-operability at the technical level would
require specific solutions. While point to point
solutions and broker systems could have immediate
but limited contributions to make, in the long term
a public gateway (Health Information Exchange)
built on MDDS principles would be desirable. This
would accelerate adoption of MDDS by public and
private health programmes and systems, Health
Information Exchange (HIE) would allow health
systems, that may be spread across public or
private sector or across different geographies, to
interact with each other through this exchange,
while ensuring that every system that interacts
with HIE uses defined data standards.
Inter-operability at the institutional level
would require a dialogue between public health
organizations, to understand information needs,
as well as barriers to better quality and use of
information. Much of this relates to terms of
collection and recording of information, the
patterns of flow and aggregation and contexts of
use of information rather to either semantic or
technical considerations. Solving the semantic
and technical barriers brings inter-operability
much closer, but there would be still challenges
to face. The MDDS publication is thus the first
step of a long journey, not its destination.
HealthDomainMetaDataDataStandards
ExecutiveSummary

xi
NotetotheReader
The Common Data Element is meant for the use
of Healthcare-IT Professionals involved in design,
upgrade, re-engineering or interoperability of
Healthcare-IT applications. Though Healthcare
terminology much of which is derived from Greek
and Latin, is largely limited to code directories.
Some key words could have a different meaning
in general English as compared to its use in
Healthcare Informatics. For Example- The keyword
‘Provider’ has a specific meaning in healthcare
i.e. Service Provider e.g. Physician, Dentist,
Nurse etc.; whereas the word provider in English
can mean anything e.g. main bread winner or
provider of a family. Therefore non-Healthcare-IT
professional while reviewing this list of Common
Note to the Reader
Data Elements, would find it advisable to refer to
a standard Medical Dictionary e.g. Steadman’s or
keep a Healthcare-IT professional handy. We also
provide a Glossary of terms for the uninitiated
audience.
The Meta Data Data Standards published by
DietY titled as ‘Metadata and Data Standards –
Demographic (Person Identification and Land
Region Codification)* V1.1, Nov 2011’ is referred
by Health Domain for demography and other
related data elements. Users are suggested to
read Health Domain Meta Data Data Standards
in addition to the above mentioned publication
by DieTY.
* https://egovstandards.gov.in/sites/default/files/Published_Standards/Metadata%20and%20Data%20Standards/
MDDS_Demographic_Ver_1.1.pdf

Introduction
xiii
Acknowledgement iii
Terms of Reference of the Domain Health Committee v
Executive Summary vii
Note to the Reader xi
Section-I: Introduction 1
What is Common Data Element? 1
Why is Common Data Element Required? 2
Conceptual Design Principles 2
Section-II: Principles of Design 5
Structure of the MDDS Standard 5
Identifiers 5
Common Data Element Entities 9
Section-III: Standards Rollout 13
Data Sets 13
Standards Adoption for Historical Systems 13
Prospective Applications– Drug Distribution Network 14
Institutional Framework 14
Section-IV: Interoperability Solution 15
Different Models for Interoperability 15
Recommended Model:
Health Information Exchange 15
Benefits of Health Information Exchange 17
Section-V: Institutional Framework 19
The Need 19
The Mandate 19
Governance 20
Organisation Structure Processes 20
Knowledge Resources 23
Section-VI: Concluding Remarks 25
Glossary 27
References 35
Contents
xiii
Contents

Introduction
1
The Metadata and Data Standards (MDDS) is an
initiative taken by Ministry of Communication and
Technologies under National e-Governance Plan
(NeGP). The intent was to promote the growth of
e-Governance within the country by establishing
interoperability across e-Governance applications
for seamless sharing of data and services. Under
the MDDS initiative domain specific committees
have been constituted in priority areas.* The
Health Domain MDDS Committee was one such
initiative, which was constituted on Sept 2012,
under the chairmanship of Joint Secretary
(Policy) in pursuance of communication received
from Secretary, Ministry of Communication and
Technology, DietY.
Post formation, the Committee had initial
orientation meetings on Metadata and Data
Standards development for health domain. After
initial discussions, National Health System
Resource Centre (NHSRC) was constituted as
secretariat for the committee. To help develop Meta
Data Data Standards, two agencies were brought
on-board following a proper selection process
based on their merit on Health informatics. The
due diligence was thoroughly done to study the
landscape of existing health domain by involving
all relevant stakeholders and knowledge partners
including Program Officers and System Managers
of Central and State Health IT Systems. As part
of terms of reference, a thorough study of global
data and interoperability standards were taken
into account.
Initially generic data elements were extracted from
the existing health IT systems. However these
existing systems were geared towards addressing
specific program requirements which was falling
short to address the vast scope of health domain.
The other challenge was that data elements of
SECTION: 1
* https://egovstandards.gov.in/
Introduction
these systems were not aligned with global data
standards. Efforts were made to adopt and modify
global standards in such a way that these existing
applications could easily be upgraded to MDDS
standards.
The exercise yielded to approximate 1000 data
elements which were regrouped and formatted
into 39 entities for better assimilation and
presentation. These data elements will serve as the
common minimum data elements for development
of IT applications for various sub domains of health
care. This is intended to facilitate interoperability
among various applications.
What is Common Data Element?
The Health Domain MDDS Committee provides a
list of data elements that will serve as the common
data elements [CDE] for any new application
being built in health domain. CDE is enough to
provide most of the universe of data elements for
any new healthcare application to be built. This
means – the new applications must have relevant
data elements from CDE built-into it though they
may have more data elements, above and beyond
the CDE, for their local needs. CDE will then help
standardise any new IT Application being built in
the health domain.
Due to the inherent complexity of Health domain
- It is difficult to create minimum set of data
elements that every sub-domain must adhere.
Each sub-domain’s minimum data element may
not be completely applicable to other sub-
domain – meaning ‘My minimum need not be
your minimum’. For example the Lab Order data
elements required at primary care setting will be
far less than the Lab Order data elements required
at secondary care and tertiary care settings.

OverviewReport
2
Though the attempt is to be universal, healthcare
is so vast that some specific data elements on the
fringes may have been left out inadvertently. We
cannot pre-empt and include everything that is out
there and create space for it in CDE. Therefore we
have to assume that the usage of CDE will throw
up new requirements that will give inputs to the
Health Domain MDDS Committee and help CDE to
enhance, enrich and mature over time. When new
applications do not find the relevant data element
or values for their use, they will have to use ‘Free
Text’ data element or ‘Other’ Value from the code
directory or value list. Though the usage of ‘Free
Text’ data element or ‘Other’ Values will have to
be discouraged in principle; however this usage of
‘Free Text’ data element or ‘Other’ Values has to be
regularly monitored by the Health Domain MDDS
Committee and used as valuable feedback for the
next versions of the CDE.
Therefore CDE is intended to be a living document
and a designated Health Domain MDDS Committee
will have the authority to add any new data
elements, values or code directories that were left
out at this stage or that may emerge as a result of
natural evolution of the healthcare domain.
Why is Common Data Element Required?
Organizations often want to exchange data quickly
and precisely between computer systems.
The need for the CDE arose because most of the
Healthcare-IT applications are being developed
without any standards by different agencies and
vendors in public and private sector in India. Each
application is developed for standalone use without
much attention to semantic interoperability. Later
when the thought of interoperability emerges –
it becomes difficult to connect the systems and
make them talk to each other because they were
never designed for that purpose. Even if technical
and organizational interoperability is done the
semantic interoperability may remain a challenge.
For example – all applications must have the same
Facility Master. When Application A sends the ANC
data for Facility 123, the receiving Application
B should understand ANC and uniquely identify
Facility 123. Another example is if a hospital
application sends the insurance reimbursement bill
to insurance company/government, the recipient
application should be able to understand and re-
present the same meaning of bill information.
Conceptual Design Principles
The holy grail of Healthcare is the Provider –
Patient relationship. The entire common data
elements have been designed by keeping the
Provider – Patient relationship in mind rather
than either entity as the centre. The CDE has been
designed based on the standard ISO/IEC 11179.
This standard is a result of the following principles
of semantic theory, combined with basic principles
of data modelling.
Conceptual Domain: The first principle from
semantic theory is the thesaurus type relation
between wider and more specific concepts;
For Example- the wider concept ‘Order’ has a
relationship with similar more specific concept
Pharmacy Order and Immunization Order.
Therefore the CDE has created Pharmacy Order
and Immunization Order entity.

Concept: The second principle from semantic
theory is the relation between a concept and its
representation. Different synonyms or closely
related keywords can convey the same concept.
For Example – The number of times the drug/
medication has to be taken at what interval is
a concept. ‘Frequency of Drug’ and ‘Frequency
of Medication’ are different representations of
the same concept.
Data Element: The basic principle of data
modelling is the combination of an Object class
and an Attribute to form a more specific ‘data
element concept’. For example- the abstract
concept ‘Frequency of Medication’ is combined
with the object class ‘Medication Order’ and
is associated with Attribute ‘Frequency’ to
form the data element concept ‘Medication
Frequency’. The standard must select the most
appropriate keyword as the representation of
the concept. In the above case the
l Object: is ‘Medication Order’ and,
l Attribute: is ‘Frequency’
Value Domain: A value domain is the
permitted range of values for a concept. If
the data element concept has a single value
then it will remain as a single data element.
If it has a limited set of values attached to
it then it will have a value list. If the data
element has a long list of values that are liable
to change or be modified due to the business

Introduction
3
needs of the health domain then it is advisable
to create a Code Directory for those values. For
Example- For data element concept ‘Medication
Frequency’ the related Code Directory will have
values: BID, TID, QID, HS, SOS, and Stat.
There are other approaches to represent values
in use by other countries. In Australia Meteor
e.g. the different possible values of a data
element concept are described as many related
data elements. However Health Domain MDDS
Committee has consciously pushed the complexity
of healthcare into value lists and code directories.
The Committee believes that, this is a logically
more mature approach. Two more examples are
given here to help users understand this concept.
Example of Conceptual Design
Example Depicting the concept Health
Condition, Chickungunea.
Depicting the concept, Facility
Operational Status.
Data Element Health Condition Code Facility Operational Status
Object Health Condition (Chickungunea) Facility (Sub Centre)
Attribute Code (ICD-10 Code) Operational Status
Value Domain ICD-10 Code value for Chickungunea
(A92.0)
Operational Status Value List (Functional)
Data Element
Concept
Data Element
Representational
Level
Conceptual
Level
Conceptual
Domain
Value
Domain
Figure 2: ISO/IEC 11179 Meta Model-II
1:n
n:1
n:1
1:n
The CDE acts as the super set for the most of
the sub domains in healthcare. The CDE has been
designed to cover all aspects of Healthcare starting
from OPD, Inpatient, Community Care, Emergency
Care, Program Management to Health Finance. This
is across- 1) Direct Care of the patient where the
provider is providing the service directly to the
patient and 2) Supporting Services to help the
healthcare provider in providing the healthcare
services. The details of each CDE entity have been
covered in Section II.
Many of these data elements have been drawn
from standards such as –
Continuity of care document [CCD]: CCD was
developed by HL7 for portability of medical
records.
HL7 v2.x: String based standard for
interoperability of Healthcare data, developed
by HL7.org and adopted widely across the
globe.
HL7 v3 RIM: XML based standard for
interoperability of Healthcare data, developed
by HL7.org and adopted widely across the
globe.
EMR Committee Report: Completely in
agreement with EMR committee report.

OverviewReport
4
Though the above said standards are our reference
point but we have extended and modified them
to apply to Indian setting. The associated Code
Directories are drawn from standards such as –
ICD-10 for Diagnosis: ICD is used to classify
diseases and other health problems recorded
on many types of health and vital records
including death certificates.
LOINC for Lab: LOINC is a universal code
system to identify laboratory and clinical
observations to facilitate exchange and storage
of clinical results or vital signs for patient care
and research
CCI for Procedures: CCI is a Canadian
national standard for classifying health care
procedures such as therapeutic, diagnostic and
psychosocial interventions. CCI is available
as open source with proper attribution to
Canada. Whereas other similar standards e.g.
CPT of US and ACHI of Australia are licence
based. In addition CPT is updated annually and
thus any standard derived from CPT will need
regular updating.
WHO Morbidity list: The noun morbidity
means “the quality of being un-healthful.” The
special tabulation list for morbidity published
in ICD-10 volume 1 consists of 298 groups
defined by their ICD-10 codes.
WHO Mortality list: The noun mortality
means “Death” The special tabulation list
for mortality published in ICD-10 volume 1
consists of groups defined by their ICD-10
codes.
WHO ICF: The International Classification of
Functioning, Disability and Health (ICF) are
used for defining functionality disability.
WHO Verbal Autopsy Standards: Is list of
standards for causes of death with mapping to
ICD-10 Codes.

PrinciplesofDesign
5
SECTION: 2
Principles of Design
Structure of the MDDS Standard
The Meta Data and Data Standards are developed
following the guidelines set by the DietY in form
of MDDS Operational Manuals2,3
. MDDS Standards
are broadly covered under five sections as given
below.
1. Data Element Quick Reference (ref: Part-II)
2. Code Directory Quick Reference (ref: Part-III)
3. Code Directory Sample Values (ref: Part-III)
4. Code Directory Meta Data (ref: Part-III)
5. Data Element Meta Data (ref: Part-IV)
Data Element Quick Reference document is the
list of all the data elements created under the
MDDS Health Domain (Part II). This list gives
brief description about the data element in
addition to the data format size it follows. The
comprehensive list of attributes of data elements
is available in the Mata Data of Data Elements
Document (Part IV). Under the quick reference
document, each data element is classified into
four categories to help identify following:
Data elements which can be used from health
domain to other domains (Prospective Generic
Across Domain (Viz.: PGAD))
Data elements which are common within health
domain (Prospective Generic Within Domain
(Viz.: PGWD)),
Data elements which are customised
from generic data elements of MDDS (Custom
(Viz.: C))
Data elements which are application specific in
health domain (Application (Viz.: A)).
As per the conceptual design of data element
(ISO/IEC 11179), each data element can have a
2 Operational Manual for formulation of Domain Specific Metadata and Data Standards
3 Institutional Mechanism for formulation of Domain specific Metadata and Data standards
single value or multiple values attached to it.
The data element which has a single value will
be complete in itself and if a data element has
a limited list of values associated with it, then
those values will be a part of value list for that
data element. However if there is a long list of
complex values for the data element, they have
been put in relevant code directories. Values in
the code directories can grow and mature with
review and modification.
Code Directory Quick Reference document is ready
reference to the code directories developed (Part
III). This indicates name of code directory, source
of code directory and the ownership rights for each
of the code directory. The metadata of each code
directory is given in the Code Directory Meta Data
(Part III). The sample value for each code directory
is also populated in the Part III. For some of the
code directories, which are highly implementation
specific, no sample values are populated and it is
expected that each implementer will populate the
values in these code directories and help MDDS
committee to enrich these code directories.
Identifiers
This effort of Health Domain MDDS Committee
includes creating an infrastructure to allow the
exchange of healthcare data at the regional, state
and national levels. To do this we must start with
the accurate identification of each person/ facility
receiving or providing healthcare services, and
also anyone accessing or using this information.
As we move away from paper-based healthcare
data that are controlled by physical access to
buildings, rooms, and files, we need to have an
infrastructure that supports strong identity and

NationalCommitteeonMetaDataandDataStandardsforHealthDomain
OverviewReport
6
security controls. The issues with establishing
identity are compounded by the fact that healthcare
data is used by many different organizations at
the regional, state, and national levels. There must
be a way to uniquely and securely authenticate
each person across the healthcare infrastructure,
whether that interaction is in person or over the
Internet.
Healthcare Identifiers are necessary to ensure
that patient related information is accessed
by right persons and individual patient records
are not duplicated across multiple systems –
“User U in role R who satisfies constraint C has
permission P”.
Currently Identity Management is a major
gap in healthcare i.e. - identification and
authentication are currently uncontrolled and
not standardized among medical systems,
locations, and organizations within the healthcare
community. There are a myriad of systems on
the market today, each with its own methods for
handling providers, health facilities and patients’
identification, and very little attention to security
and privacy controls. Many systems rely on simple
usernames and passwords to identify and control
access. Far fewer implement strong multi-factor
authentication. This leads to a condition where
one individual is identified by many identifiers
without these numbers referring to each other.
This condition impacts data exchange and usage
among various IT applications.
It is critical that a set of standards be established
for identifying the Facility, the Medical Provider,
Patient, and all others handling healthcare data
so that information across different locations can
be exchanged easily and securely.
An Identifier could be a number, image (e.g. Bar
Code or Blackberry ID), Biometrics (e.g. finger
print or retinal scan), Radio Frequency Identifier
Tag (RFID), Smart Card or a combination of
these. Considering that none of these identifier
standards exist today in Public Health space- The
Health Domain MDDS Committee proposes basic
number based identifiers. The standard can be
upgraded to include Alternate Identifiers such as
Bar Codes, RFIDs, Digital Signature etc., as the
healthcare industry matures. For now appropriate
Data Elements have been created to capture
information about these Alternate Identifiers.
With regards to the nomenclature of the Identifiers
some qualifiers were followed to maintain the
uniformity.
a) Identifiers which were drawn from established
sources were used as it is and no change is
made in their names. e.g. Unique Identification
Number (UID), PAN etc.
b) Identifiers which are proposed to be used
uniquely and uniformly across states are
termed as “Numbers” e.g. Unique Facility
Identification Number, Alternate Unique
Identification Number etc.
c) Identifiers where code directory or value list
from established source is used are termed as
‘Codes” e.g. Diagnosis Codes (ICD10 Codes),
Procedure Codes (CCI Codes) etc.
d) Identifiers which were transaction specific are
termed as “Identifiers or IDs”. E.g. Employee
ID, Document ID etc. However some of these
can come from code directory master but are
named as IDs because they are transaction
identifiers to be populated at the time of
implementation.
I. Facility Identifiers: Facility Identity
management is complex – therefore a Facility
Code Directory is created to give a structure
to it. This Facility code directory will serve
as a Master to which all the Applications will
refer. Two set of identifiers are proposed/
mandated to uniquely identify each facility-
GUID UFIN.
a) Global Unique Identifier (GUID) – This
data element is a 16-bit number, which
will be generated following a standardized
algorithm by system. An example of a GUID
in its standard form is 40e74fae-c0ab-
11dfb090-0017f2300bf5. GUID will be
used at the back-end to uniquely identify
each facility. GUID will guarantee global
uniqueness of each facility no matter
where or by whom they are generated.
All prospective systems need to follow
standard algorithm in their backend to use
GUID.
b) Unique Facility Identification Number
(UFIN)- UFIN is a 10 digit running
number given for each facility (public
private) engaged in providing some form
of health care services. UFIN will be used
at the front-end with some form of human
readability. There are two ways to do this.

PrinciplesofDesign
7
Give the facility a number with facility
related information embedded in it
(e.g. ABC-13-05-0001, where ABC
represents State, District Block
respectively and next two digits
represent year of facility formation.
Next two digits represent type of
facility and last four digits represent
the facility itself). However this
approach has certain challenges as
facilities might upgrade or facility
attributes may change due to
administrative, geographic or political
realignments.
The other way of doing it is by giving
a unique running number to each
facility without making this number
dependent on any other factor. Where
the facility related information can be
added as an attribute to the UFIN.
The Health Domain MDDS Committee has adopted
the later approach to uniquely identify each
facility.
Why two identifiers for a facility?
Each facility will be given a sequential 10 digit
integer number (UFIN) which will be used as a
unique facility identifier by all users. However the
uniqueness of these codes will be dependent on
database system which generate these numbers,
which still does not necessarily guarantees to
be always unique e.g. if the database is ported
from one Database Management System (DBMS) to
another, the unique sequential number (or auto
increment primary keys of tables) will change.
In order to avoid this problem GUID is proposed
along with UFIC.
Master Facility List (MFL): Using UFIN GUID,
a Master Facility List will be created at the centre
and put up in a public domain and this will be used
as reference by all prospective applications built
at state or national level. At the implementation
level we propose a Health Information Exchange
or Intelligent Gateway with a Facility Registry
to match facility identifiers given by various
healthcare applications.
Facility identification and associated attributes
can be categories in four major groups.
a) Facility Signature Domain: Information which
will help in identification of each facility
with its attributes is grouped under signature
domain. E.g. type, geography, address etc.
i. Type of Facility Code Directory – This will
contain code of the type of facility. E.g. 01
for Sub centre, 02 for PHC etc.
ii. Address- This includes address details of
the facility, the district, state and area
which it belongs to.
iii. Geocode - Longitude, Latitude Altitude
to identify a facility by GIS or GPRS system.
iv. Access to Facility Indicator- This will
help identify the area where this facility
is located as per the difficulty criteria set
by MoHFW which includes -Easy/Difficult
geographic area, hilly area etc.
v. Region Indicator- Indicates rural or urban
setting where the facility is located.
vi. Population Covered – This will help provide
a population based denominator to the
facility. Each facility will be mapped with
the census population of area which it
covers to. e.g. Each Health Sub Centre (HSC)
will be mapped to the villages it is serving
currently, through the Census village data-
base. Two or more HSCs which are sharing
one village will use a proportionate
population formula to get their piece of
serving population from the census village
data-base and to accommodate this Many-
to- many relationships with HSC and villages
would be required. This arrangement would
further help identification of areas covered
by the PHCs and their serving population.
In the urban areas each ward will be
mapped with Urban PHC through Many
to many relationship. Population based
catchment area would be defined for the
government facilities under public health
systems. For private and other ministry run
facilities no population catchment area
would be assigned.
The principle of defining this linkage is that
the denominator of the sub-unit aggregate
would provide the denominator for the
administrative hierarchy e.g. all sub-centres
under one PHC are linked with it.
vii. Administrative Linked Facility Type –
This will include Type of Facility Code

OverviewReport
8
with which this facility is linked for the
administrative purposes. This relationship
will help identify administrative hierarchy
among facilities.
viii. Operational Status- This will indicate
functioning status of the facility whether
facility is functional or inactive.
ix. Referral facility – This provides details of
the facility Type linked for referral. There
can be multiple facilities to which a facility
may refer their patients. However this data
element will define only referral facility
linkage and during implementation many
facilities can be linked for referral.
x. Code Directory Ownership Authority
Type: This data element and related code
directories together will indicate the
ownership status for the facility. A facility
can be owned by individual, public, private
or combination of these. There can be
multiple type of ownership within public
private. All these combinations can be
addressed by using this data element.
b) Facility Services Domain: Each facility in
India provides a set of services as mandated
by the respective administration. In addition
set of facilities also provide services from
alternate system of medicine. E.g. Ayurvedic,
Homeopathy etc. For Allopathic system of
medicine list of services will come from LOINC
CCI. However in the case of alternate system
only name of system of medicine would be
applicable as the standard list of services
from alternate system of medicine are not
available.
i. Code Directory Facility System of Medicine
Type: This will indicate which type of
medicine system related services are
provided from this facility. There is more
than one system of medicine in our
country. Services of more than one system
of medicine are also provided from one
facility and this data element will help
define these combinations.
ii. Code Directory Facility Services Master:
Indicates the services rendered by the
facility- This gives the detailed list of
services that a facility can provide. Any
facility can select list of services that it
can provide from this code directory.
c) Facility Human Resource Domain: Code
directory Facility Human Resources Type
Master: Indicates the number of human
resources available with the facility with their
designations.
d) Facility Infrastructure Domain:
i. Facility Bed Master: This will indicate
number of beds available with facility.
ii. Facility Bed Type Master: This will indicate
the type of beds available with the facility-
sanctioned, functional and available.
II. People Identifiers: These are the identifiers
used to identify individual patients, relatives
and various providers in the health system.
a) Patient Identifiers: Currently multiple
patient identifiers are used across
applications in health care space in India.
There is also a massive program allocating
unique identification number to individuals
i.e. Aadhar Number. Aadhar number is
12 digit integer allocated by Unique
Identification Authority of India (UIDAI).
The Health Domain MDDS Committee
proposes to use Aadhar Number as unique
patient identifier. However in case patient
does not have Aadhar Number a provision
has been made for the use of Alternate ID,
issued by any other competent authority
e.g. Election ID, Driving License ID, Ration
Card ID, PAN Card ID, BPL ID etc. Provision
has also been made to identify unknown
persons/dead bodies coming to emergency
hospital wards in case of emergency or
Mass Casualty Incident (MCI) e.g. John Doe
and Jane Doe (widely used placeholder for
unidentified persons in emergency).
b) Provider Identifiers: Each provider would
be given a unique identifier and for this
purpose individual registration number
from respective registration councils
would be used. E.g. for Allopathic Doctors
registration number given by MCI, for
Ayurvedic Physicians registration number
from Central Council of Indian Medicine,
and for Nurses registration number given
by Nursing council. Those providers who
do not have any registration authority (i.e.
physiotherapist, paramedic workers, and

PrinciplesofDesign
9
community health volunteers) - individual
person UID or alternate UID would be
used for this purpose. Later on when a
competent registration authority is put in
place the number can be captured just like
other Providers after appropriate values in
relevant code directory has been updated.
c) Other People Identifiers – e.g. Identifiers
for Patients relative and next of kin.
III. Disease Identifiers: Each procedure and
service is uniquely identified by a standard
code.
i. Diagnosis Identifiers: e.g. ICD10 codes for
diseases
ii. Procedure Identifiers: e.g. CCI codes for
procedures
iii. Output Identifiers: e.g. WHO Morbidity
and Mortality list based on ICD10 codes,
and WHO ICF codes for functionality and
disability.
IV. Clinical Event Identifiers: This indicates
Document Registry to match Encounter and
Episode identifiers given by various healthcare
applications.
a) Encounter Identifiers - Every time the
patient meets a provider it is documented
as an Encounter with a new Encounter
ID. Encounter identifiers would apply to
clinical, lab, radiology encounters. Physical
examination done by the Helth Service
Provider is considered as an Encounter
and documented as clinical notes with a
specific Encounter Identifier.
b) Episode Identifiers – A group of closely
related encounters for the same patient
will get an Episode ID.
V. Drug and Inventory Identifiers: Each drug
whether generic or brand is given a unique
identifier. For generic names– drug list from
National Formulary of India (NFI) is used as the
code directory. For brand names – the brand
name code directory structure has been defined
but it is left to the application to take the code
directory values from appropriate source e.g.
MIMS or CIMS.
Item Identifiers: As discussed above,
all items - consumables, semi-durables,
durables and equipment will also be given
unique identifiers in the code directories.
VI. Lab identifiers: For laboratory procedures
LOINC codes are proposed for use as identifiers.
VII. RadiologyIdentifiers:ForRadiologyDiagnostic
and Radiology Interventional procedures - the
identifiers will be taken from CCI.
VIII. Financial Identifiers
Source of Payment Identifiers e.g.
Insurance Provider Identifier.
Billing Identifiers: Identifiers for services,
procedures and medications billing.
IX. Other identifiers- For identifying each entity
or event separately a unique ID is proposed
i.e. Medical Registration board ID, ambulance
service providers ID, ambulances ID, hospital
departments ID etc.
Common Data Element Entities
Health Domain is very vast and to make it more
readable, Health Domain MDDS Committee has
created 39 logical grouping of data elements named
as entities. For example emergency patient rescue
related data elements were bundled together in
Ambulance entity and emergency hospital care
related data elements were bundled together in
Emergency entity.
Entities were created to help users to locate their
data elements from the entire list. However this
grouping should not be confused with data sets. Data
sets are list of data elements required for certain
program or application to function and should be
created choosing relevant data elements from various
entities e.g. Diabetes Data Set, Family Planning
Data Set, Inpatient Care Data Set. This grouping
does not act as a binding to further development,
regrouping or change in the Common Data Element
list. Description of each entity is given below.

OverviewReport
10
Table-1: Description of Entities
SN Entity Description*
1 Generic Generic Entity contains data elements which can be applicable to various
applications used in health domain. E.g. Time
2 Person Person is an individual with certain attributes associated with it. These relates
to identity management of an individual in health care. E.g. Alternate Unique
Identification Number(UID)
3 Patient A patient is any recipient of health care services. This entity list patient
attributes as data elements. E.g. Patient Age
4 Employee An Employee is a person who is hired to provide health care services to a
health delivery organisation in exchange for compensation under the ambit of a
contract. Human Resource Management Related data elements are grouped under
this entity. E.g. Employment Status, Employment Type.
5 Provider A health care provider is any individual that provides preventive, curative,
promotional or rehabilitative health care services to individuals, families or
communities. Under this entity Individual health service provider related data
elements are grouped together. E.g. Unique Individual Health Care Provider ID
6 Source of
Payment
Source of Payment in healthcare indicates who is paying for the services given to
the patient. This can be out of pocket by patient, insurance (public, private) or
provisioned through government budget, government reimbursement. Relevant
data elements are grouped under this entity. E.g. Insurance Policy Type.
7 Bill A bill is a commercial document issued by a seller to a buyer, indicating the
products, quantities, and agreed prices for products or services the seller has
provided to the buyer. This entity contains list of data elements which are
related to billing for hospital purposes and for insurance purposes. E.g. Bill ID,
Bill Type.
8 Facility Any institution which is engaged in the delivery of health care services to the
individuals, families or communities. This entity contains list of data elements
which are related to health facility identification. E.g. Unique Facility ID, Facility
Type Code.
9 Episode Any health condition for which an individual is provided care by a health service
provider for a certain period of time is considered as episode of care. E.g.
Episode ID
10 Encounter A patient encounter is a record of a patient’s arrival in the health facility for any
form of diagnostic and/or therapeutic event. This indicates interaction between
a patient and health service provider irrespective of place of interaction for the
purpose of diagnosis, care treatment. An episode can contain multiple related
encounters. E.g. Encounter ID, Encounter Type.
11 Advance
Directives
An advance health care directive is a set of written instructions that a person
gives that specify what actions should be taken for their health, if they are no
longer able to make decisions due to illness or incapacity. E.g. Advance Directive
Type
12 ADT ADT refers to Admission, Discharge Transfer of a patient in a health facility.
E.g. Admission Date, Admission Type
13 Emergency Emergency care relates to the inpatient emergency care provided to the patient
reaching to the emergency department of the health facility. E.g. Patient Status,
Ambulatory Status
* http://en.wikipedia.org

PrinciplesofDesign
11
14 Outreach Outreach is an activity of providing services to populations who might not
otherwise have access to those services. A key component of outreach is that
the groups providing it are not stationary, but mobile; in other words they are
meeting those in need of outreach services at the locations where those in need
are. E.g. Outreach Service Provider, Outreach Service Type etc.
15 Disaster
Response
Disaster response is the health care response to the disaster and consist data
elements which are part of rescue, first aid, triage, transport to the facility and
deceased management. E.g. Mass Casualty Incident Type.
16 Examination Medical examination or clinical examination is the process by which a medical
professional investigates the body of a patient for signs and symptoms of disease.
Patient examination related data elements are grouped under this entity. E.g.
Examination Type etc.
17 Vital Signs Vital signs are measures of various physiological statistics, often taken by
health professionals, in order to assess the most basic body functions. i.e. Body
Temperature, Blood Pressure. Relevant Data Elements are covered under this
entity. E.g. Vital Sign Result Status
18 Allergy An allergy is a hypersensitivity disorder of the immune system. Allergic reactions
occur when a person’s immune system reacts to normally harmless substances
in the environment. A substance that causes a reaction is called an allergen.
Relevant Data Elements are grouped under this entity. E.g. Adverse Event Type.
19 Clinical Notes Clinical Note is documentation of patient conditions, by medical service provider
- which helps to reach diagnosis, acts as communication between two providers
for medical care and also acts as historical reference document in patient case
file. E.g. treatment summary, discharge notes etc
20 Diagnosis Diagnosis is the process of reaching to a conclusion by determining which
disease or condition is affecting human health. Health Conditions (Diseases)
related data elements are placed under this entity. E.g. Health Condition Type
21 Lab Lab entity covers data elements related for ordering laboratory services. E.g. Lab
Order Code
22 Radiology Radiology entity covers data elements related for ordering Radiology services.
E.g. Radiology Procedure Code
23 Pharmacy Pharmacy entity covers data elements related for ordering Pharmacy services.
E.g. Medication Frequency, Dose
24 Immunisation
Order
Orders are indication for execution of certain tasks related to patient care,
medication administration, disease prevention etc. Immunisation Order
Entity covers data elements related for ordering Immunisation services. E.g.
Immunization Administered Date, Immunisation product code
25 Clinical Order Clinical Order Entity covers data elements related for Clinical Orders. E.g. Order
to admit date
26 Procedure A medical procedure is a course of action intended to achieve a result in the
care of person with health problems. In this entity health care procedure related
data elements are listed. E.g. Procedure Code, Procedure Type

OverviewReport
12
27 Blood Bank A blood bank is a bank of blood or blood components, gathered as a result
of blood donation or collection, stored and preserved for later use in blood
transfusion. The term “blood bank” typically refers to a division of a hospital
where the storage of blood product occurs and where proper testing is performed.
However, it sometimes refers to a collection center, and indeed some hospitals
also perform collection. Relevant data elements are grouped under this entity.
E.g. Blood Bank ID, Blood Group.
28 Nursing Nursing care is the care of individuals, families, and communities so they
may attain, maintain, or recover optimal health and quality of life. In-patient
nursing care related data elements are grouped under this entity. E.g. Bed Side
Procedure Indicator
29 OT Operation Theatre is a facility within a hospital where surgical operations are
carried out in a sterile environment. Relevant data elements are grouped under
this section. E.g. Anaesthesia Type, Procedure Priority
30 CSSD Central Sterile Supply Department (CSSD) is essential department in the hospital
and supports sterile supply, processing, distribution for various departments
especially Operation Theatre. Relevant data elements such as Sterilization Test
ID are grouped under this section.
31 Inventory Inventory management is primarily about managing supplies and stocks that
are required at different locations within a facility or within many locations
of a supply network. This entity includes data elements required for inventory
management for drug and non drug items in health facilities. E.g. Drug ID,
Supplier Name etc.
32 Remission Remission is a condition of being healthy after an episode of disease. Relevant
data elements are grouped under this entity. E.g. Remission Type.
33 Complications Complication is an unfavourable evolution of a disease or a health condition or a
therapy. Relevant Data Elements are grouped under this entity. E.g. Complication
Code
34 Relapse Relapse is recurrence of past disease or condition. Relevant data elements are
grouped under this entity. E.g. Relapse Type
35 Morbidity Morbidity is a diseased state, or poor health due to any cause in a person or in a
population. Relevant data elements are grouped under this entity. E.g. Morbidity
Code
36 Disability Disability is the consequence of an impairment that may be physical, cognitive,
mental, sensory, emotional, developmental, or some combination of these.
Relevant data elements are grouped under this entity. E.g. Disability Code.
37 Mortality Mortality refers to the death of an individual or incidence of Death in a
population. Relevant data elements are grouped under this entity. E.g. Mortality
Code.
38 Ambulance An ambulance is a vehicle for transportation of sick or injured people to, from or
between places of treatment for an illness or injury and in some instances will
also provide out of hospital medical care to the patient. Relevant data elements
are grouped under this entity. E.g. Ambulance ID, Ambulance Distance Covered,
Ambulance en route event.
39 Indicator Indicator entity is created as placeholder for the aggregate data elements and
for reporting from population-based indicators. E.g. Infant Mortality Rate etc.

StandardsRollout
13
StandardsRollout
Data Sets
Data sets are list of data elements required for
certain program or application to function and
should be created by choosing relevant data
elements from various entities. Each sub-domain,
e.g. Disease Control Program, will not require all
of the CDE therefore they must create its own
minimum data sets from the CDE. The details of
few sample data sets are given in the Annexure
e.g. Drug Inventory, Blood Bank, School Health
Program Data Set etc.
Due to the inherent complexity of Health domain,
it is difficult to create a minimum data set that
every sub-domain must adhere - Meaning ‘My
minimum need not be your minimum’. The CDE
therefore acts as the super set for the most of the
sub domains in Healthcare.
Standards Adoption for Historical Systems
Adoption of the Standards will vary by organisation
and IT system. Some organisations will be early
movers owing to their leadership and HR capacity
to adopt the standard and undergo a rapid
transformation, whereas others will lag behind,
and then there will be few those may completely
resist the change.
Historical Applications: Some of the resistance
to change will be genuinely rooted in necessity
to keep the past data and maintain the current
operations. The leadership has to make a hard
decision about the duration of status-quo pending
an imminent upgrade. For such necessities point-
to-point integration maybe considered in the
interim e.g. MCTS-HMIS.
Upgraded Systems: For this systems will have
to map their data elements to the CDE so that
they can send the data in a standard format
for interoperability. Slow movers will update/
Standards Rollout
upgrade the systems as per the standard wherever
necessary e.g. non-compliant data elements, non-
compliant modules, and periodicity of reporting,
facility masters, and other masters. They have to
fulfil the gaps between their data elements and
related master, and those required as per MDDS
CDE and Code Directories. Meanwhile the paper
based records have to change their formats to
match with upgraded systems and build capacity
to feed patient data aggregate data to upgraded
systems.
For Example – MCTS has data elements such as Hb
7 and Hb 7; Whereas CDE has data elements
such as Result Type, Result Status, Result Value
and Result Reference Range. Over time MCTS will
have to upgrade such that it can accept data
inputs as per MDDS standard, aggregate it and
convert it into outputs such as HB 7 HB
7 without having entry of this as separate data
elements. Institutional capacity will have to be
built to support this change. Another Example –
Peripheral paper based records will have to change
their formats as per MDDS to feed IDSP.
Clean Slate Systems: New systems to be built
on MDDS standards. These systems will be fully
geared for Interoperability with all applications
built on MDDS standard. Though they will also go
through a maturation cycle to completely comply
to the standard and in many ways may help the
MDDS Health domain standard to grow. Meanwhile
as paper based recording shifts to e-recording
based on MDDS standards, it would be able to
feed patient data aggregate data to clean slate
systems.
Given such a context, a Health Information
Exchange using an Intelligent Gateway is a
preferred interoperability solution for an imperfect
world of healthcare including, where historical,
upgraded and clean slate applications, would all
continue and converge.
SECTION: 3

OverviewReport
14
Table-2: Standards Roll-out across Systems
Enabling provider for
Quality of care
Reporting Aggregate Data Recording Systems
Historical
Systems
MCTS can function as is. HMIS can take inputs from
MCTS in the interim.
Paper based records fed
into MCTS at block level.
Upgraded
Systems
Modify Data Elements
and Masters as per MDDS
standard. E.g. MCTS
upgraded as per CDE.
Technical workarounds for
integration.
HMIS can take inputs from
Upgraded MCTS in the
interim.
All entries are granular to
patient level aggregate
data. Build capacity to
feed patient data.
Clean Slate
Systems
Fully geared for
Interoperability with all
applications built on MDDS
standard.
Create logical Aggregate
Data Elements [MIS] from
common data elements.
Recording of data in
EHR format. Automate
aggregation as per local
reporting requirements
Prospective Applications – Drug
Distribution Network
Given the diversity of India, historical and clean
state applications will coexist at any point of time
since the existing applications cannot be retired
overnight. For Example – TN and Delhi states have
their own Drug Inventory and Distribution systems
and over a course of time, they have familiarized
themselves with the operation and usage of the
system; Whereas Rajasthan, Maharashtra and
Punjab are adopting the e-Aushadhi system
being developed by C-DAC. Also each of these
e-Aushadhi implementations has a different code
base owing to extreme differences in masters
e.g. organisation hierarchy, drug procurement
and distribution processes and implementation
methodology. Even if C-DAC upgrades e-Aushadhi
to MDDS standards, there are other disparate drug
inventory systems (e.g. systems functional in
Tamil Nadu West Bengal etc.) which may not be
able to completely interoperate e-Aushadhi.
To make these disparate systems interoperable,
following three options can be explored:
Point-to-point, Broker based, and Exchange based
patterns.
However, point to point will be expensive to
maintain, broker systems may not be able to
lookup a registry to locate the source of data. This
requires to setup a centralised data warehouse
model for reporting, which is a costly proposition
in terms of maintainability and feasibility.
Exchange based pattern can be achieved by
introducing an intelligent gateway to define
concept, code mapping and transformations at
dynamic run time for all historical applications
and clean slate applications. This will lead to
feasible interoperable solution.
Institutional Framework
For implementing Meta Data Data Standards some
institutional mechanism needs to be put in place
which will ensure participation from stakeholders
and partners. There are various mechanism which
can enable standards roll-out in prospective and
existing systems. Standard’s institution role and
framework are described in section V.

15
SECTION: 4
InteroperabilitySolution
Different Models for Interoperability
There could be numerous ways of integrating
disparate applications; however the approaches
are logically grouped into the following main
categories of application integration. Each one
has its own pros and cons-
a) Point-to-point model: This approach by design
is too expensive to write and maintain because
the resultant solution could end up with a
spaghetti of approximately (X)n
point-to-point
connections for 35 States and UTs.
b) Broker Model: This model has some know
inherent design challenges e.g. generating a
report on demand from a broker based model is
not possible. The broker may not have a Registry
lookup access to locate the source of the data.
The solution may not know the location of
data and cannot discover all applications. For
Example - If drug distribution related data is
spread across three e-Aushadhi applications,
the Non Intelligent Broker will have challenges
to access the data from these three systems.
This challenge can be resolved if the logic of
integration and data retrieval for all three
applications is defined in the Broker in advance
during the design phase. The data need and
integrating logic are not static in nature in the
given context so this design will always have a
maintainability and feasibility issue.
In the broker based system the only option is
to have a centralised data warehouse model for
reporting. Given the size [~1.2 Billion] of India’s
population and the daily transactions e.g. drug
distribution is sure to become a bottleneck for
any centralised data warehouse model and will
push it above and beyond its limit.
c) Health Information Exchange Model: The concept
of intelligent broker and Registry architecture
pattern appears to be better suited in the given
Interoperability Solution
context. This approach allows to dynamically
locate the data records and the application
locations. This will allow applications to serve
requested data in a more optimal way. Also, this
model allows connecting throughout an array
of heterogeneous applications removing the
need for complex point-to-point connectivity.
RecommendedModel:HealthInformation
Exchange
In a long run all public and private Health IT systems
have to converge to a Health Information Exchange
to realize the objective of Universal Health Coverage
as laid down in 12th Five Year Plan.
This model addresses MDDS standards to ensure
semantic interoperability across all applications,
their data storage, privacy, security, integration,
data retrieval, analysis and information usage.
This model envisages the creation of local,
regional and state Health Information Exchanges
[HIE] that feed the National Health Information
Network [NHIN]. A centralised Health Information
Exchange [HIE] has to emerge for every state that
will be used for exchanging health information.
All public and private Health IT applications will
be integrated with the HIE exchange following a
decentralized model leaving their respective data
repositories intact within application data centres/
premises and applications exchanging their data
using constellation of intelligent gateways and
centralized registries.
The HIE will have a data warehouse to analyse
the consolidated public health data. A federated
structure should be adopted where the data is
pulled on-demand. Central data repository model is
not a suggested route as it becomes unwieldy and
too expensive over a period of time. By design, the
HIE pulls up only a part of data that is required
for consolidated data analysis or health record
portability. The patient registry will have entries

OverviewReport
16
for the diseases being tracked and will also cater
to population migrations where the portability of
patient-based health record is important.
The HIE will support the centralized Metadata
registry and register the standard Metadata
specifications for all Health domain concepts. The
data from Different integrating applications will
be transformed to these standard concepts based
on Metadata registry lookups inside the intelligent
gateways before passing the data to the requesting
application. Intelligent Gateway will have the
built in logic to discover the applications which
will provide the requested data based on the type
of request generated from a requesting application
or person. The gateway will be able to locate the
records from different application repositories,
apply dynamic transformations, codes and concept
translations, data aggregation logic, based on the
predefined rules in the Intelligent Gateway.
The HIE model will specify data analytics framework
so that it can be flexible and capable of catering
to local, District, State and National analysis and
reporting requirements. This includes:
a) National Data Warehouse – Define a National
level data warehouse in the NHIN to analyse
the consolidated data and produce indicator
based reports from source systems.
b) Local Data Analytics -Define a local data
mart in every State HIE. The exchange should
provide online analytical processing [OLAP]
for the users at all levels to generate their
own reports needed for local action. The users
should be able to save the report format and
define the frequency at which the reports
should be populated with data. This will
significantly enhance acceptability, usability
and adoption.
Figure 3: State Health Information Exchange [HIE]- Conceptual Architecture
Births and
Deaths
Service
Delivery data
from HMIS
National
Disease/
Program
Monitoring
Disease
Surveillance
Epidemiology
GIS
Nutrition
Surveillance
Emergency
Response
Support
Public
Information
HR and
Financial
Management
Hospital
Information
Systems
Regulatory
Support
State Health
Information
Exchange
Medical
Education and
Research

17
InteroperabilitySolution
The HIE will provide the flexibility to allow inputs
in consolidated [District-wise or facility-wise] as
well as granular [patient-based] models. Based
on readiness, HIE will allow the States to decide
the mode of data entry – consolidated, facility-
wise or patient-based; as long as the published
architecture and standards for vocabulary, data,
input/output, storage, integration, hardware and
network are followed. The HIE model envisages
all public health IT systems to follow integration
based on known standards such as HL7, DICOM,
XML etc.
Registries: - The heart of the HIE is a registry
based model that has district and state level
registries about disease, facility and patient. The
registry may be indexed and searched by using
unique identifiers. The registry will have metadata
that points to the details in the source system.
The indicators derived from the state disease
registries should be rolled up to the central disease
registry for reporting. However drill down should
be available to get granular data on demand.
Benefits of Health Information Exchange
i. Historical applications can never be done
away due to their current wide-spread usage,
substantially large database, user adoption and
heavy investment. Using this model all existing
Historical and Clean state applications can be
integrated to form a unified Health Information
Exchange based on a federated data model
without any disruption or application design
changes in existing historical applications.
ii. The semantic interoperability in different
applications can be ensured using a centralized
metadata registry using HIE based intelligent
gateways having functions to register,
discover, transform, notify, query and retrieve
concepts and their meta data from centralized
metadata registry. This model has already been
successfully implemented in Canada Infoway.
iii. Integration with other domain applications is
quite easy.
iv. Lack of awareness in India towards the need
of a HIE which is apprehended by many as
a complex thing to achieve which is just a
negative perception and need to be corrected
by proper education of this model.
Figure-4: National Health Information
Network [NHIN]- Conceptual Architecture
State
Health
Information
Exchange
National
Health
Information
Network
State
Health
Information
Exchange
State
Health
Information
Exchange
State Health
Information
Exchange

OverviewReport
18
State Health Information Exchange
MoHFW
Directorates
Private Sector
State HQ
District Admin
Document
Registry
Facility
Registry
Service
Registry
Portal
Patient
Private Sector
Nutrition- NRCs
Birth Deaths
HIS, EMR
Block 2Block 1
Facilituy 1 Facilituy 1Facilituy 2 Facilituy 2Facilituy 3 Facilituy 3
Disease
Registry
Provider
Registry
Payment
Registry
Data Warehouse
Meta Data
Registry
Patient
Registry
Central
RCH
Systems-
HMIS,
MCTS
National
Disease
Programs-
Malaria,
IDSP,
NACO
State
Health
Programs
EMRI,
DHIS,
Kala Azar
Figure 5: State Health Information Exchange –Proposed Architecture

InstitutionalFramework
19
SECTION: 5
Institutional Framework
The Need
As compared to other domains, information
requirement in health domain changes more rapidly
and today’s information systems and standards
slowly becomes obsolete if not updated on a
regular basis. There has been a surge in public
health IT systems development under NRHM both
by states and centre as noted by various Common
Review Mission (CRM) reports. However each
system was developed to cater local requirements
and have followed their own standards leading to
a situation where systems were not being able
to exchange data. This adversely affects use of
information. In addition data from private sector
was not available for generation of population-
based analytics as required to assess universal
health coverage.
There is great need to make systems interoperate
at various levels for seamless flow of information,
which has been documented by various study
reports. Mission Mode Project recently has also
documented the challenges of IT silos in health
care and suggested that systems should be
able to speak to each other using standards of
interoperability. 12th
five year plan document
has also recommended health IT standards to
achieve interoperability among various systems.
In addition plan document also mentions creation
of set of indicators through which information
would be shared across systems.* All this
necessitates an institutional structure to be in
place for information sharing among various
systems and between various providers (public
private), supported by frameworks for standards
implementation, certification and management.
The institution should be Apex statutory body
in form of National Health Information Authority
(NHIA)
The nature and scope of work necessitates that
this standards management institution should be
placed halfway between IT and health domain
with participation from IT, Health Management
professionals. The leadership would be drawn from
the Ministry of Health Family Welfare.
The Mandate
The Authority shall be responsible for,
i. Maintaining the repository of standards
ii. Update and upgrade standards
iii. Ensuring compliance to standards.
iv. Facilitate adoption/ implementation
I. Managing repository of standards
Healthcare is a very diverse domain and to
address standardization, it needs a large set of
data standards. . It is an error prone and difficult
task to manage these standards manually and
would require automated management of
standards. DietY has a framework to address
this purpose and it suffices the need of health
domain as well.
II. Update Upgrade Standards
a) Documenting specific standards request:
As an iterative process the standards
management organisation has to work
closely with the state public health
departments and private health sector to
document various standards requirements
originating with new program and with
new areas as they open up.
b) Organising standards consultations:
The organisation has to arrange specific
standards consultations with participation
from various stakeholders which will
discuss and recommend updation in the
standards list.
* http://planningcommission.gov.in/plans/planrel/12thplan/pdf/12fyp_vol3.pdf

OverviewReport
20
c) Decision making: Once thorough
deliberation is done on the prospective
standards and legitimate feedbacks are
absorbed, a decision should be made on
the shape, size and form of standards.
The decision can include the timelines
and mode of releasing the standards and
guidelines for implementation.
d) Notifying the standards: All the competent
stakeholders should be dully notified using
the prevalent mode of communication by
standards organization. The standards
once notified should be available in public
space for usage.
III. Ensuring Compliance to standards
a) Certification: Prospective health IT
applications have to undergo auditing
and testing to ensure compliance with the
standards. This task should be done by a
‘Standards Auditor Group’ in which external
empanelled experts should participate
with internal consultants. If any incentive
mechanism is put in place for standards
compliance, the applications which are not
compliant can be disqualified for incentive
schemes.
b) Accreditation: Authority can accredit
different health IT systems based on
series of evaluations and audits ensuring
compliance with the standards.
c) Voluntary association: Currently private
health sector is unregulated and does not
participate in information sharing. Private
sector may voluntarily come forward
and adopt standards for recognition and
certification.
IV. Facilitate adoption/implementation:
a) Incentive Mechanism: The authority can
provide incentives for system design,
implementation and maintenance if they
comply with the MDDS standards.
b) Legislations: To ensure that systems
collaborate and participate in information
sharing and exchange, a legal support
needs to be in place in form of an ‘act’.
This ‘act’ should also indicate creation of
a National Health Information Authority
and information sharing mechanism across
providers (public private).
c) Others: Other mechanism should be
carved out in consultation with various
stakeholders.
Governance
An organisation needs to be established initially
by MoHFW, later by an ‘act’ as the apex
institution for carrying out its task as defined
in mandate. One suggestion that was discussed
that the current Health Domain MDDS Committee,
could after some changes in composition as
considered necessary, would be the National
Health Information Authority. The regular function
could be executed by constituting a secretariat,
that could be placed in one of the existing apex
public institutions or a new one created for
the same.
Organisation Structure Processes
1. Structure at Centre: The proposal that has
been mooted visualizes a central organisation
headed by Chief Executive Officer (CEO)
supported by three major professional groups-
a ‘functional group’ comprising of health
care experts with IT systems experience., a
a ‘technical group’ comprising of technical
architects with expertise in health IT and a
Figure 6: Standards Organization: Roles
Functions
l Publish
l Disseminate
l FAQs
l Help lines
l Update
l Upgrade
l Identify
gaps
l Collect
Feedback
l Testing
Certification
l Accreditation
l Compliance
l Advocacy
l Capacity
Building
l Incentive
l Legislation
MDDS Health
Domain Standard
MAINT
AIN
C
ERTIFY
MANAGE
FACI
LITATE

InstitutionalFramework
21
management group. These groups with support
of other stakeholders should collectively
form three working clusters for following
three specific purposes - policy formulation,
standards implementation and management
of standards.
2. Structure at State: In addition to the structure
at the centre a similar structure with less
number of consultants should be created at
the state level and placed in the form of ‘State
Health Information Councils.’ These councils
can be placed with the state level resource
centres or equivalent institutions.
At both centre and state one would need a
mix of consultants, some drawn on deputation
basis from government services or from
academic institutions with a minimum of 2-3
years of working contract and the rest drawn
as independent consultants with a 2-3 years of
contract. The organisation has to be supported
by budgetary allocation to meet its mandates.
3. Processes:
a. All sanction of funds from NHM/MOHFW
for development of health IT applications
and software would require compliance
with these standards as conditionality.
b. Suggestions, complaints, technical snags
will continue to emerge. These should be
sent to the chief technical officer, NIC,
who is the member- secretary of the MDDS
committee. He would then have to reply to
each of these queries within a one month
time standard. The response could include
a modification in the standards. Any
such modification in standards would be
notified on the website of MoHFW, NHSRC
and the main portal of the standards.
Figure 7: Standards Management Organisation: Organisational Structure
Technical
Group (4-5
Technical
Architect)
Functional
Group (4-5
Health IT
Professionals)
Management
Group (4-5
Health Mgmt
Professionals
Core Functions
Core Groups
Health IT Forum
State
Health
Inform
ation
Councils
Academic
Research
Institutions
International
Standards
Bodies
Certification
Group
StandardsManagement
Policy Formulation
StandardsImplementation
Na
tional Health Information Authorit
y

OverviewReport
22
List of changes made would be available
alongside standards as modified.
c. Specific proposals received to reengineer
available health IT products to confirm to
standards including those of state level
systems but not originally financed by
NRHM would be favourably considered
under NRHM. However this is to be taken
up on case to case basis but this is not to
be done for new applications.
d. The government/ MDDS committee
would accredit and rate contract suitable
testing agencies and for testing and a
third party assurance of compliance with
these standards.
e. Investment would be made in attending
all major health IT symposia and seminars
to explain and popularise standards so
that industry voluntarily adopts the
standards even solely for private purposes.
Workshops for capacity building wherever
required would also be organized.
f. All existing systems which are publicly
financed and owned by MoHFW or any
statutory body under MoHFW can request any
other system for specific information that it
Figure 8: Standard Development Process
Justification for choosing
the category from public
health space is based
on logical analysis of
conceptual domains and
relevant constraints
MDD is a pivotal
process
Build a case for
health domain
categories
Initialize
MDDS
program
Measure and
Maintain the master
data elements and
other resultant
datasets
This involves
indetification of
value domains
and populations
of code directory
Chosen category
justified for the
MDDS Health
candidate?
Processes
like Data DE
duplication,
establishing
metadata
references
between data
elements and
metadata etc..
Identify the
master Data
Elements
Choose and MDDS
representation
style
Based on MDDS
standards
template.
It is further
customized to
meet the goal
Standardize
the meta data
of master data
elements
Yes
No

PrinciplesofDesign
23
needs giving justification. The other system
would then be obliged to provide the same
in the interoperability syntax ‘indicator’.
Where necessary MDDS committee can take
initiatives to find technical partners who
can arrange integration between systems.
Such interoperability is desirable between
state financed and central financed systems
however due to lack of capacity to do so it
is not made mandatory as of now.
g. For standards development and updation,
participation of various stakeholders is
required. There needs a ‘Health IT Forum’
which can provide a platform for various
stakeholders from industry, academia
implementers to participate and provide
suggestions and feedbacks on standards.
The State organisations/councils will
document the standards requests and
forward these to NHIA and shared with
the Health IT Forum which would provide
its inputs on these requests. The final
decision on standards would be made by
NHIA.
Knowledge Resources
Vast amount of work has been globally done for the
health IT standards development by governments,
private organisation and by international NGOs.
However keeping pace with these developments
is only possible when the NHIA works closely
with these institutions through partnerships from
inception. In addition the NHIA should have
easy access to documented studies, research
publications on health IT standards. The authority
should also collaborate with the other sectors
such as insurance, IT, hospitals etc. to understand
their needs and demands.

25
SECTION: 6
ConcludingRemarks
Concluding Remarks
As the MDDS takes root, the government as
well as private players, and managements and
care providers shall be able to better ensure the
citizen’s health, the delivery of services, and
health spend, and be able to more effectively
identify disease patterns and their progression
within our population. Such information shall help
in controlling disease spread, manage progression,
understand public health program effectiveness as
well as provide valuable information to researchers
and medical community to help develop newer and
more effective treatments and assess effectiveness
of clinical pathways.
E-Governance systems for Health which are in
operation today include a variety of applications
such as Mother and Child Tracking System (MCTS),
Health Management Information System (HMIS),
Hospital Information Systems (HIS), Supply Chain
Management for Drugs and Vaccines, Integrated
Disease Surveillance Project (IDSP), Revised
National Tuberculosis Program (RNTCP) etc.
There are states with over 30 distinct systems
which are operational. With adoption of MDDS
and growing inter-operability the richness of the
data generated by these existing applications
will create more meaningful and actionable
information for health care providers, allowing
more effective implementation and tracking of
health programmes. MDDS will enable decision
makers to look across the vertical programme
silos such as RCH, Malaria, TB, HIV and help to
bring more meaningful decisions to the table with
respect to resource planning optimisation.
Multiple Disease specific applications are neither
economical nor a good implementation design.
Inter-operability between systems will make
it possible not to burden field workers with
reporting on multiple systems. Multiple systems
can grow in parallel in a decentralised manner
with each system having the flexibility to define
its own data elements, forms, workflow, reporting
frequency and report formats- but at the same
time allowing for aggregations, integration and
use of information at any level.
Though MDDS is an essential pre-condition of
inter-operability, it is not a sufficient condition.
Interoperability requires solutions at the semantic
level, at the technical level and at the institutional
level. MDDS solves the problems at the semantic
level, but has only a limited contribution to the
other two levels.
Inter-operability at the technical level would
require specific solutions. While point to point
solutions and broker systems could have immediate
but limited contributions to make, in the long term
a public gateway (Health Information Exchange)
built on MDDS principles would be desirable. This
would accelerate adoption of MDDS by public and
private health programmes and systems, Health
Information Exchange (HIE) would allow health
systems, that may be spread across public or
private sector or across different geographies, to
interact with each other through this exchange,
while ensuring that every system that interacts
with HIE uses defined data standards.
Inter-operability at the institutional level
would require a dialogue between public health
organizations, to understand the information
needs, and the barriers to better quality and
use of information- much of it relates to terms
of collection and recording of information, the
patterns of flow and aggregation and contexts of
use of information rather to either semantic or
technical considerations. The MDDS standard fills
an unmet need to provide semantic standardisation
across the Health domain and provides a framework
or interoperability. Though the implementation
and adoption will take time and there are more
steps to be taken, the effort to get there will be
worth it. The MDDS publication is thus the first
step of a long journey, not its final destination.

27
Glossary
Glossary
Terms Definitions Reference Remarks
ADT Patient Administration, also known as
Admit, Discharge and Transfer (ADT),
supports many of the core administrative
functions in healthcare such as person
and patient registration and encounter
management.
HL7 http://www.hl7.org/
implement/standards/
product_brief.
cfm?product_id=92
Adverse Event In medicine, an adverse effect is a harmful
and undesired effect resulting from a
medication or other intervention such as
surgery. An adverse effect may be termed a
“side effect”, when judged to be secondary
to a main or therapeutic effect. If it
results from an unsuitable or incorrect
dosage or procedure, this is called a
medical error and not a complication.
Wikipedia http://en.wikipedia.org/
wiki/Adverse_event
Allergy An allergy is a hypersensitivity disorder
of the immune system. Allergic reactions
occur when a person’s immune system
reacts to normally harmless substances in
the environment. Example : Dust, pollen,
certain medications like aspirin etc.
wiki/Allergy
Advance
Directives
An advance health care directive, also
known as living will, personal directive,
advance directive, or advance decision, is
a set of written instructions that a person
gives that specify what actions should be
taken for their health, if they are no longer
able to make decisions due to illness or
incapacity.
wiki/Advance_directives
Blood Bank A blood bank is a cache or bank of blood
or blood components, gathered as a
result of blood donation or collection,
stored and preserved for later use in
blood transfusion. The term “blood
bank” typically refers to a division of
a hospital where the storage of blood
product occurs and where proper testing
is performed. However, it sometimes refers
to a collection center, and indeed some
hospitals also perform collection.
wiki/Blood_bank

OverviewReport
28
Blood Donor
Registration
Blood Donor registry refers to the collection
and sharing of data about donated blood
and ineligible donors.
Online
Medical
Dictionary
http://medical-dictionary.
thefreedictionary.com/
Blood+Donation+and+Registry
Blood
transfusion
Blood transfusion is generally the process
of receiving blood products into one’s
circulation intravenously. Transfusions are
used in a variety of medical conditions to
replace lost components of the blood.
wiki/Blood_transfusion
Common Data
Element
Data Elements which are mostly needed
across sub-domains for their information
systems development are known as
Common Data Elements.

Code Directory Code Directory is group of Common
Data Elements where each data element
is indexed based on their codes. Code
Directory enhances indexing and search of
data elements.

Comorbidity Comorbidity is the simultaneous presence
of two or more medical conditions
wiki/Morbidity#Morbidity
Clinical/
Progress
Notes
Notes made by a nurse, physician, social
worker, physical therapist, and other
health care professionals that describe the
patient’s condition and the treatment given
or planned.
Online
Medical
Dictionary
progress+notes
CSSD The central sterile services department
(CSSD) is an integrated place in hospitals
and other health care facilities that
performs sterilization and other actions
on medical devices, equipment and
consumables; for subsequent use by health
workers
wiki/Central_sterile_
services_department
Disaster
Management
Disaster management is the discipline of
dealing with and avoiding both natural
and manmade disasters. It involves
preparedness, response and recovery in
order to lessen the impact of disasters
wiki/Disaster_relief
Disability Disability is the consequence of an
impairment that may be physical,
cognitive, mental, sensory, emotional,
developmental, or some combination of
these. A disability may be present from
birth, or occur during a person’s lifetime.
wiki/Disability
Data Element A data element refers to the name of
a particular event or factor that must
be counted or measured. In context of
Healthcare, a data element is a record of
health event or health related event.

29
Glossary
Data Standard Data Standards denotes to the formal
documented principles for representation,
format, definition, structuring, tagging,
transmission, manipulation, use, and
management of data.

Diagnosis Medical diagnosis refers to both the
process of attempting to determine or
identify a possible disease or disorder and
to the opinion reached by this process.
wiki/Medical_diagnosis
Donor
Screening
Potential donors are evaluated for anything
that might make their blood unsafe to
use. The screening includes testing for
diseases that can be transmitted by a
blood transfusion, including HIV and viral
hepatitis. The donor must also answer
questions about medical history and take
a short physical examination to make sure
the donation is not hazardous to his or her
health
wiki/Blood_donation
Drug Plan
Monitoring
Monitoring and administering of drug to
the patient by the nurse in accordance
to the dose, route of administration,
frequency and any other instructions as
prescribed by the physician

Direct Care The provision of services to a patient that
require some degree of interaction between
the patient and the health care provider.
Examples include assessment, performing
procedures, teaching, and implementation
of a care plan.
Online
Medical
Dictionary
direct+care
Emergency
care
Emergency medicine is a medical specialty
involving care for patients with acute
illnesses or injuries which require
immediate medical attention
wiki/Emergency_care
Facility Healthcare institutions that include
hospitals, clinics, primary care centres, and
other healthcare service delivery points.
wiki/Health_care_provider
HEENT A HEENT examination is a portion of
a physical examination; it principally
concerns the Head, Ears, Eyes, Nose and
Throat.
wiki/HEENT_examination
Identifier An identifier is a sequence of characters
or words that uniquely identify an object
within a particular context or domain.
Identifiers can be unique within the
environment of use or they can be unique
across all settings. E.g. UID, ICD Codes.

OverviewReport
30
ICD 10 ICD-10 is the 10th revision of the
International Statistical Classification of
Diseases and Related Health Problems
(ICD), a medical classification list by the
World Health Organization (WHO). It codes
for diseases, signs and symptoms, abnormal
findings, complaints, social circumstances,
and external causes of injury or diseases.
It permits the tracking of new diagnosis.
wiki/ICD-10
Immunization Immunization, or immunisation, is the
process by which an individual’s immune
system becomes fortified against an agent.
Immunization is done through various
techniques, most commonly vaccination
wiki/Immunization
LOINC Logical Observation Identifiers Names
and Codes (LOINC) is a database and
universal standard for identifying medical
laboratory observations. It was developed
and is maintained by the Regenstrief
Institute, a US non-profit medical
research organization, in 1994. LOINC was
created in response to the demand for an
electronic database for clinical care and
management.
wiki/LOINC
Mass Casualty (MCI) Any large number of casualties
produced in a relatively short period of
time, usually as the result of a single
incident such as a military aircraft
accident, hurricane, flood, earthquake, or
armed attack that exceeds local logistic
support capabilities
Wikipedia http://www.
mass+casualty
Meta Data The term metadata refers to “data about
data”. International standards apply to
metadata.
wiki/Data
Master Data These are the Data elements that are of
master nature and are going to be static in
nature for the scope of the standards.
wiki/Master_Data
Morbidity Morbidity is a diseased state, disability,
or poor health due to any cause. The term
may be used to refer to the existence of
any form of disease, or to the degree that
the health condition affects the patient
wiki/Morbidity#Morbidity
Mortality the death rate, which reflects the number
of deaths per unit of population in any
specific region, age group, disease, or
other classification
Online
Medical
Dictionary
mortality

31
Glossary
OT
Management
Operation Theatre or Operational operating
room management focuses on maximizing
operational efficiency at the facility, i.e.
to maximize the number of surgical cases
that can be done on a given day while
minimizing the required resources and
related costs
Wikipedia http://en.wikipedia.
org/wiki/
Operating_room_management
Outcome the condition of a patient at the end of
therapy or a disease process, including
the degree of wellness and the need for
continuing care, medication, support,
counselling, or education.
Online
Medical
Dictionary
outcome
Outreach
Services
Outreach is an activity of providing
services to populations who might not
otherwise have access to those services.
A key component of outreach is that the
groups providing it are not stationary, but
mobile; in other words they are meeting
those in need of outreach services at
the locations where those in need are in
addition to delivering services, outreach
has an educational role, raising the
awareness of existing services. E.g. mobile
medical unit, health camp, Village health
and nutrition day.
wiki/Outreach
Pain
Assessment
Pain assessment is an evaluation of the
reported pain and the factors that alleviate
or exacerbate it, as well as the response to
treatment of pain. Responses to pain vary
widely among individuals, depending on
many different physical and psychological
factors, such as specific diseases and
injuries and the health, pain threshold,
fear, anxiety, and cultural background of
the individual involved, as well as the way
the person expresses pain experiences
Online
Medical
Dictionary
pain+assessment
Physical
Examination
A physical examination, medical
examination, or clinical examination
(more popularly known as a check-up
or medical) is the process by which a
medical professional investigates the
body of a patient for signs of disease.
It generally follows the taking of the
medical history — an account of the
symptoms as experienced by the patient.
Together with the medical history, the
physical examination aids in determining
the correct diagnosis and devising the
treatment plan
wiki/Physical_examination

OverviewReport
32
Post op
recovery
monitoring
Keeping an eye on patients who are at
serious risk of complications, and on
more standard recovery floors in the
hospital. They are usually responsible for
changing dressings, monitoring vital signs,
looking for signs of complications, and
administering medications. The care of
an attentive surgical nurse ensures that
a patient’s recovery goes as smoothly as
possible.
wiki/Surgical_nursing
Pre-Anesthetic
checks
Evaluation of anesthesia risk of a patient
prior to administering anesthesia, which
includes review of medical history, drug/
allergy history, interview and examination
of patient.

Pre-operative
checks
In pre-operative care, a surgical nurse
helps to prepare a patient for surgery, both
physically and emotionally. Surgical nurses
may explain the procedure to the patient,
and ease fears about the upcoming surgery
and recovery. They also check the patient’s
vitals, administer medications, and help to
sterilize and mark the surgical site.
wiki/Surgical_nursing
Provider A health care provider is an individual or
an institution that provides preventive,
curative, promotional or rehabilitative
health care services in a systematic way to
individuals, families or communities.
wiki/Health_care_provider
Palliative Care Palliative care is an area of healthcare that
focuses on relieving and preventing the
suffering of patients.
wiki/Palliative
Rehabilitative
Care
Rehabilitation is a treatment or treatments
designed to facilitate the process of
recovery from injury, illness, or disease
to as normal a condition as possible. The
purpose of rehabilitation is to restore some
or all of the patient’s physical, sensory,
and mental capabilities that were lost due
to injury, illness, or disease.
Online
Medical
Dictionary
Rehabilitation
Remission Remission is the state of absence of
disease activity in patients with a chronic
illness, with the possibility of return of
disease activity
wiki/Remission
Relapse A relapse is a recurrence of a past medical
condition
wiki/Relapse
Recipient In context of blood transfusion, a recipient
is a person who receives blood from a
blood donor.

33
Glossary
RxNorm RxNorm is a name of a US-specific
terminology in medicine that contains all
medications available on US market.
wiki/RxNorm
RFID Radio-frequency identification (RFID) is the
wireless non-contact use of radio-frequency
electromagnetic fields to transfer data, for
the purposes of automatically identifying
and tracking tags attached to objects.
wiki/RFID
Sterlization Sterilization (or sterilisation) is a term
referring to any process that eliminates
(removes) or kills all forms of microbial
life, including transmissible agents (such as
fungi, bacteria, viruses, spore forms, etc.)
present on a surface, contained in a fluid,
in medication, or in a compound such as
biological culture media. Sterilization can
be achieved by applying heat, chemicals,
irradiation, high pressure, and filtration or
combinations thereof.
org/wiki/
Sterilization_(microbiology)
Supportive
Care
Supportive care interventions that help the
patient achieve comfort but do not affect
the course of a disease.
Online
Medical
Dictionary
supportive+care
Supply Chain
Management
Supply chain management (SCM) is the
management of an interconnected or
interlinked between network, channel and
node businesses involved in the provision
of product and service packages required
by the end customers in a supply chain.
Supply chain management spans the
movement and storage of raw materials,
work-in-process inventory, and finished
goods from point of origin to point of
consumption
org/wiki/
Supply_chain_management
Vital Signs Vital signs are measures of various
physiological statistics, often taken by
health professionals, in order to assess
the most basic body functions. The act of
taking vital signs normally entails recording
body temperature, pulse rate (or heart
rate), blood pressure, and respiratory rate,
but may also include other measurements.
wiki/Vital_Signs

35
References
References
1. E-Governance Standards Accessed from https://egovstandards.gov.in/ on 15th
July 2013.
2. MDDS Demographics v1.1 Accessed from https://egovstandards.gov.in/sites/default/files/Published_
Standards/Metadata%20and%20Data%20Standards/MDDS_Demographic_Ver_1.1.pdf on 11th July
2013.
3. Website of Ministry of Health Family Welfare (http://mohfw.nic.in/) Accessed on 20th
July 2013.
4. Website of National Health Systems Resource Centre (www.nhsrcindia.org) Accessed on 1st
August
2013.
5. Website of Medical Council of India (http://www.mciindia.org/) Accessed on 17th
August 2013.
6. Website of Rajasthan Medical Services Corporation (http://www.rmsc.nic.in/) Accessed on 15th
August
2013.
7. Website of IRDA. Accessed from www.irda.gov.in on 21st
September 2013.
8. Website of National Disaster Management Authority, Government of India (http://ndma.gov.in/ndma/
index.htm) Accessed on 19th
August 2013.
9. NRHM HMIS Web Portal, www.nrhm-mis.nic.in Accessed on 11August 2013.
10. NRHM Mother Child Tracking System, www.nrhm-mcts.nic.in/MCH Accessed on 18th September 2013.
11. Website of Integrated Disease Surveillance Project (IDSP), (www.idsp.nic.in/) Accessed on 9th
September
2013.
12. Strategic Information Management System, National AIDS Control Organization (www.naco-sims.nic.in)
Accessed on 12th
September 2013.
13. Master Facility List Guidelines, WHO 2012 Accessed from http://www.who.int/healthinfo/systems/
WHO_CreatingMFL_draft.pdf on 6th
August 2013.
14. Master Facility List- Implementation Guide, Division of Health Information Systems Department of
Standards and Regulatory Services Ministry of Medical Services, Kenya February 2010 http://www.
ehealth.or.ke/facilities/ Accessed on 11 August 2013.
15. HITSP Data Dictionary Component, Healthcare Information Technology Standards Panel. Jan 2010.
Accessed from http://wiki.siframework.org/file/view/HITSP_V1.0_2010_C154_-_Data_Dictionary.pdf
on 8th August 2013.
16. International Statistical Classification of Diseases and Related Health Problems 10th Revision, WHO
Accessed from http://apps.who.int/classifications/icd10/browse/2010/en on 20th
July 2013.
17. Canadian Classification of Health Interventions (CCI Codes) Accessed from http://www.cihi.ca/cihi-
ext-portal/pdf/internet/cci_vol3_2009_en on 18th
July 2013.
18. International Classification of Functioning, Disability and Health (ICF),WHO 2001, Accessed from
http://apps.who.int/classifications/icfbrowser/ on 17th
August 2013.
19. LOINC Standards Accessed from https://loinc.org/ on 11th
August 2013.
20. Website of Standards International Accessed from http://www.standardsinternational.net/ on 26th
August 2013.

OverviewReport
36
21. Public Health Guide for Emergencies, Centre for Refugee Disaster Response, John Hopkins Bloomberg
School of Public Health, Accessed from http://www.jhsph.edu/research/centers-and-institutes/center-
for-refugee-and-disaster-response/publications_tools/ publications/_CRDR_ICRC_Public_Health_
Guide_Book/Public_Health_Guide_for_Emergencies on 10th
September 2013.
22. Additional Information Specification 0001: Ambulance Service Attachment Release 2.0, Based on HL7
CDA Standard Release 1.0, with supporting LOINC® Tables, CDA Ballot, August 2003 Accessed from
http://www.hl7.org/documentcenter/public/wg/ca/AMBULANCE%20Additional%20Information%20
Specification%20(Jan%202012%20Draft%20Copy).doc 8th
September 2013.
23. Management of Dead Bodies after Disasters: A Field Manual For First Responders, Pan American Health
Organization, Washington 2006. Accessed from http://www.paho.org/disasters/ on 18th
August 2013.
24. Data Against Natural Disasters: Establishing Effective Systems for Relief, Recovery, and Reconstruction.
The World Bank, Washington DC 2008. Accessed from www.ipcc-wg2.gov/njlite_download.php?id=6686
on 8th
September 2013.
25. Impact of Public Health Emergencies on Modern Disaster Taxonomy, Planning, and Response, Frederick
M. Gregg G, Special Focus 2008 Accessed from http://www.ncbi.nlm.nih.gov/pubmed/18562943 on
9th
September 2013.
26. Special tabulation lists for mortality and morbidity, ICD-10, WHO. http://apps.who.int/classifications/
icd10/browse/2010/en on 20th
July 2013.
27. Report on Medical Certification of Cause of Death 2008, Office of The Registrar General, India,
Government of India, Accessed from http://www.censusindia.gov.in/2011-Documents/mccd_Report1/
Report%20on%20Medical%20Certification%202.pdf on 8th
August 2013.
28. NSSO -71- the List of ailments with codes and working definitions. NSSO.
29. Verbal Autopsy Standards: Ascertaining and attributing causes of death, The 2012 WHO verbal autopsy
instrument, WHO Accessed from http://www.who.int/healthinfo/statistics/verbalautopsystandards/
en/ on 23 August 2013.
30.InstitutionalMechanismforFormulationofDomainspecificMetadataandDataStandardsine-Governance,
eGSI-IM:02, Version 1.0, April 2012, Department of Electronics and Information technology Ministry of
Communications and Information Technology Government of India, Accessed from http://egovernance.
gov.in/policy/institutional-mechanism on 8th
September 2013.
31. The Signature Domain and Geographic Coordinates: A Standardized Approach for Uniquely Identifying
a Health Facility Health Facility Assessment Technical Working Group January 2007, WP-07-91, WHO.
Accessed from http://www.cpc.unc.edu/measure/publications/wp-07-91/at_download/document on
11 September 2013.
32. United States of America Food and Drug Administration (FDA) - Medication Physical Form http://
www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162038.htm Accessed on
12th
September 2013.
33. United States of America Food and Drug Administration (FDA) - Pharmaceutical Unit of Measurement
http://www.fda.gov/forindustry/datastandards/structuredproductlabeling/ucm168397.htm Accessed
on 8th
September 2013.
34. United States of America Food and Drug Administration (FDA) - Medication Package Type http://
www.fda.gov/ForIndustry/DataStandards/StructuredProductLabeling/ucm162034.htm Accessed on 3rd
September 2013.
35. United States of America Food and Drug Administration (FDA) - Route of Administration http://www.
fda.gov/Drugs/DevelopmentApprovalProcess/FormsSubmissionRequirements/ElectronicSubmissions/
DataStandardsManualmonographs/ucm071667.htm Accessed on 3rd
September 2013.
36. Rajasthan Medical Service Corporation for Equipments or Instruments http://www.rmsc.nic.in/pdf/eel.
pdf Accessed on 18th
August 2013.
37. API Textbook of Medicine Volume-I II, Ninth Edition.

37
References
38. National Formulary of India. Accessed from http://www.cdsco.nic.in/NFI_2011.pdf on 12th
September
2013.
39. Website of Canada Health Infoway Accessed from https://www.infoway-inforoute.com/ on 11th
October 2013.
40. Metadata Online Registry METeOR, Australia Accessed from http://meteor.aihw.gov.au/content/index.
phtml/itemId/181162 on 12th
October 2013.
41. Website of Society of Health Information Systems Program (http://hispindia.org/ ) Accessed on 28th
August 2013.
42. DHIS 2 Software Accessed from http://www.dhis2.org/downloads on 13th September 2013.
43. iHRIS Software Accessed from http://www.ihris.org/ on 13th September 2013.
44. National eHealth Transformation Authority, NEHTA http://www.nehta.gov.au/ Accessed on 18th
October 2013.

Ministry of Health Family Welfare
Government of India

MDDS for Health Standard Part I

More Related Content

What's hot (20)

Similar to MDDS for Health Standard Part I (20)

More from Pankaj Gupta (20)

Recently uploaded (20)

MDDS for Health Standard Part I