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What are the top 8 healthcare data and coding standards?

Data standards are the secret sauce that allow information to flow from one provider to another and enable providers to bill for specific procedures.

By
  • Brian T. Horowitz
Published: 09 Jun 2025

As the healthcare industry continues to share more health information, developing and upholding data standards are essential to improving interoperability and ensuring regulatory compliance.

"Health data should be more consistent across programs, payers, and other data holders; users should not be comparing 'apples to oranges' when using data from different sources," according to the website for the Office of the Assistant Secretary for Planning and Evaluation within the Department of Health and Human Services.

The agency lays out several other principles as it aims to make health data more valuable across multiple stakeholders, from greater collaboration among the public and private sectors to maintaining privacy and security.

While data standards at HHS are voluntary, they have significant benefits, including helping providers make more informed decisions about patient care and supporting the social determinants of health to avoid bias and promote health equity. From an operational perspective, they also have coding standards that allow health systems to process claims and receive reimbursement.

Some data standards enable interoperability such as Fast Healthcare Interoperability Resources while others like ICD-10 are for billing, said Shannon Germain Farraher, a senior analyst at Forrester.

Training is critical for clinicians to understand the different coding standards, Germain Farraher noted. Without proper training, healthcare organizations may "undercode" and fail to get the reimbursement they're entitled to, she said. Healthcare organizations also "overcode" to get higher reimbursement, and billing inappropriately could be viewed as fraud.

"I'm not even sure that a lot of clinicians know that there are codes for certain things, and I think that's a major problem, especially from a revenue perspective," Germain Farraher says.

Providers, for example, might bill for ordinary high blood pressure when a more serious hypertensive episode is happening that requires greater treatment, Germain Farraher said.

"It needs more physician time and all of that stuff is not being captured, so you can see how that results in lost revenue," she said.

Here's a look at eight of the top data exchange and coding standards in healthcare that providers need to know.

HL7

The nonprofit standards organization Health Level Seven International created the HL7 standards in 1987 for the transfer, integration, storage and retrieval of electronic health information. With so many different tech systems and applications across health organizations, these standards help define guidelines and methodologies to more consistently and efficiently exchange data.

With EHRs, for example, the HL7 standards include functional models and profiles to help ensure that different systems can understand the information being shared. 

The HL7 received accreditation from the American National Standards Institute in 1994. 

FHIR

Fast Healthcare Interoperability Resources is a popular open-source data standard for health data exchange.

Although HL7 standards were the created first, "FHIR is newer, more flexible and leverages more modern web technologies and APIs," Germain Farraher said. It's a "step forward in interoperability."

According to the nonprofit HL7, FHIR standards were created to adapt to emerging approaches to interoperability and streamline implementation. While it can be used on its own, it's typically applied in conjunction with existing standards.

Germain Farraher also noted FHIR is required to leverage other data standards such as DICOM.

ICD-10

The International Classification of Diseases are codes that help standardize how providers classify and report diagnoses, symptoms and procedures and are critical to processing claims and receiving proper reimbursements. The codes are also used for research to study healthcare patterns and trends. 

There are thousands of codes, with more added or revised each year. In April, the Centers for Medicare and Medicaid Services implemented 50 new procedure codes for ICD-10, referencing very specific medical procedures such as "introduction of other therapeutic substance into joints, open approach" or "transplantation of larynx, syngeneic, open approach."

Although the World Health Organization released ICD-11 in 2022, it’s not yet fully implemented in the United States.

CCD

A Continuity of Care Document provides an overview of a patient's health record when one provider shares it with another. A CCD specification is a combination of a standard from two organizations: ASTM International and HL7. It uses extensible markup language to present medical data in a consistent, tagged format. Under HIPAA, health providers can exchange protected health information within a CCD to ensure continuity of care without seeking patient consent or authorization.

CPT

Current Procedural Terminology is a uniform language from the American Medical Association for coding medical services and procedures, which increases the accuracy and efficiency of billing through streamlined reporting. It is outlined in HIPAA and is a national standard in the U.S.

DICOM

The Digital Imaging and Communications in Medicine is the international standard that lays out the protocol for sharing, formatting, managing, storing, printing and displaying medical images and image-related information. With billions of DICOM images, the standard is key to ensuring technologies across health systems can be shared efficiently and accurately.

LOINC

A standard from the Indianapolis-based Regenstrief Institute, Logical Observation Identifiers Names and Codes is a set of common terminology for lab results and clinical observations. It allows healthcare providers, government agencies, reference labs and insurance providers, as well as software and device manufacturers to easily identify and transfer data.

SNOMED CT

SNOMED CT is a multilingual healthcare terminology for healthcare professionals from the SNOWMED International, a nonprofit focused on determining the top global standards for health terminologies.

"SNOWMED codes can be mapped to other coding systems like ICD-10 and CPT codes," Germain Farraher says.

More than 80 countries use SNOWMED CT, and the standard is maintained by the International Health Terminology Standards Development Organization.

Software vendors can help with coding, but physicians should be the only ones responsible for accessing EHRs, according to Germain Farraher.

Health systems, tech buyers and IT teams should have a solid understanding of standards such as HL7 and FHIR and carefully vet vendors to ensure they meet all criteria for data exchange, Germain Farraher said.

Brian T. Horowitz started covering health IT news in 2010 and the tech beat overall in 1996.

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