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Query Health Concept-to-Codes (C2C) SWG Meeting #9. February 7, 2012. Today’s Agenda . Proposed Timeline . Meeting times extended from 2:30-4:00pm. TODAY. Presentation S&I Repository . Presentation RELMA (LOINC) 3M NY Presbyterian Hospital Vocab Team. Presentation AHIMA

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Presentation Transcript
proposed timeline
Proposed Timeline

Meeting times extended from 2:30-4:00pm

TODAY

  • Presentation
  • S&I Repository
  • Presentation
  • RELMA (LOINC)
  • 3M
  • NY Presbyterian Hospital Vocab Team
  • Presentation
  • AHIMA
  • LexEVS and CTS2
  • Jacob Reider - ONC
  • Tasks
  • Introductions
  • Scope
  • Proposed Approach
  • Identify SME and presentation timeline for next few meetings
  • Presentation
  • hQuery
  • i2b2
  • Presentation
  • I2b2 (Cont.)
  • Intermountain Health
  • DOQS (Data Warehousing / Mapping)
  • Tasks
  • Discussion of presentation summaries and extraction of key themes
  • Presentation
  • DOQS (Data Warehousing / Mapping) Cont.
  • PopMedNet
  • NLM
  • Presentation
  • Ibeza
  • CDISC SHARE
  • Presentation
  • NQF –Value Set presentation
  • Begin Overview of Next steps
  • Overview of Constrains and Criteria

Coordinate offline activities to summarize approaches and develop draft deliverable from presentations

overview of onc hit standards committee vocabulary recommendations

Overview of ONC HIT Standards Committee Vocabulary Recommendations

Marjorie Rallins, DPM, Director, Specifications, Standards & Informatics, AMA, Physician Consortium for Performance Improvement

Floyd Eisenberg, MD Senior Vice President, Health IT, National Quality Forum

outline
Outline
  • Background & Mission
  • Scope
  • Definitions
  • Recommendations
  • Examples
  • Challenges & Discussion
background mission
Background & Mission
  • Plethora of vocabulary standards
  • HITSC focused on parsimony
  • Clinical Quality and Vocabulary WG Mission – Evaluate and recommend a minimum set of vocabulary standards that apply to the fundamental concepts in Quality Data Model v.3 (QDM)
scope
Scope
  • Scope:
    • Reporting of clinical-quality measures
    • Facilitate standardized information exchange
  • Out of Scope:
    • Intra-organization information management
    • Reporting to other external entities
desiderata for standard vocabularies
Desiderata for Standard Vocabularies
  • Circa 1998, JJ Cimino MD, described desiderata for the design of a healthcare vocabulary;
  • Seminal work
  • http://www.ncbi.nlm.nih.gov/pubmed/9865037
  • Desiderata contributed to WG considerations
desiderata
Content (comprehensive strategy to address gaps)

Unique identifier

Polyhierarchy

Formal definitions

(semantic network)

Reject NEC, NOS

Evolve gracefully

Concept orientation

Concept permanence (no deletions; provide history)

Multiple levels of granularity/detail

Consistency in meaning along the heirarchy

Desiderata
desiderata for standard vocabularies1
Desiderata for Standard Vocabularies
  • Interdisciplinary relevance
  • Minimum necessary Maturity
    • Logical (hierarchical data model vs. flat structure)
    • Technical (eg meaningless identifiers)
desiderata for standard vocabularies2
Desiderata for Standard Vocabularies
  • Maximum expected useful Life Expectancy
    • Quality of current and ongoing duration
  • Maximum ability to accommodate Innovation
  • Serves the maximum number of needs, eg:
    • Intra-organizational clinical and administrative needs
    • Quality reporting
    • Reporting to public health agencies
    • Safety reporting
transition vocabularies rationale
Transition Vocabularies -Rationale
  • Requiring the immediate, exclusive use of some standard vocabularies might be so burdensome as to compromise clinical-quality measure (CQM) reporting.
  • Identify acceptable transition vocabularies for specific data categories of the Quality Data Model (QDM)—to support CQM reporting.
  • Scope: Recommendations for transition vocabularies do not apply beyond the domain of CQM reporting.
vocabulary summary
Recommended

SNOMED CT

LOINC

RxNorm

ICF

UCUM

CVX

CDC PHIN VADS (HL7)

ISO 639

PHDC Payor Typology

Transition

ICD-9-CM

ICD-10-CM

ICD-10-PCS

Current Procedural Terminology, CPT®

HCPCS

Vocabulary Summary
vocabulary summary1
Recommended

SNOMED CT

LOINC

RxNorm

ICF

UCUM

CVX

CDC PHIN VADS (HL7)

ISO 639

PHDC Payor Typology

Transition

ICD-9-CM

ICD-10-CM

ICD-10-PCS

Current Procedural Terminology, CPT®

HCPCS

Vocabulary Summary
definitions snomed ct
Definitions: SNOMED CT

Systematized Nomenclature of MedicineClinical Terms®

A comprehensive clinical terminology developed by the College of American Pathologists (CAP); now owned and maintained by International Health Terminology Standards Development Organization;

> 310,000 active concepts

> 790,000 active descriptions or names & synonyms

> 920,000 relationships

-Released semi-annually in Jan & July

-Developed & maintained by clinicians

definitions snomed ct1
Concepts

Hierarchies/Trees

Parent/child relationships

Relationships between concepts

Clinical finding (disorders and findings)

Procedure

Body structure

Substance

Organism

Qualifier value

Situation with explicit context

Physical object (devices)

Observable entity

Staging and scales

Several others….

Definitions: SNOMED CT
definitions snomed ct2
Definitions: SNOMED CT
  • Incorporated into healthcare applications
  • Manual lookup and coding
  • Transparent to the user
definitions loinc
Definitions: LOINC

Logical Observation Identifiers Names and Codes®

A universal code system that facilitates exchange, pooling and processing of results;

Laboratory LOINC – Lab results and observations

Clinical LOINC – Clinical results and observations

Name partitioned into segments to coordinate with messaging standards

Developed and maintained by the Regenstrief Institute

definitions loinc1
Definitions: LOINC

If an observation is a question and the

observation value is an answer…

LOINC provides codes for

questions

Other terminologies provide codes for

answers1

1https://loinc.org/slideshows/lab-loinc-tutorial/files/loinc-overview-and-introduction-current.pdf/index_

html?portal_status_message=Welcome%21+You+are+now+logged+in.

definitions loinc2
Definitions: LOINC

What is my patient’s

hemoglobin level?

718-7:Hemoglobin:MCnc:Pt:Bld:Qn

LAB LOINC

How fast does my

patient usually walk?

41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculate2

Clinical LOINC

Answers in SNOMED CT:

165447008 mean corpuscular hemoglobin concentration (MCHC) - low (finding)

16526500walks 30-59 meters in 1 minute (finding)

2https://loinc.org/slideshows/lab-loinc-tutorial/files/loinc-overview-and-introduction-current.pdf/index_

html?portal_status_message=Welcome%21+You+are+now+logged+in.

definitions rxnorm
Definitions: RxNorm

RxNorm:

A standardized nomenclature that provides names and identifiers for clinical drugs

Scope: Clinical drugs: administered to patients for therapeutic or diagnostic intent; eg Injectable solution vs Powder for dilution

Purpose: Allow various systems using different drug nomenclatures to share data efficiently at the appropriate level of abstraction

Produced by the National Library of Medicine (NLM).

Semantic Clinical Drug (SCD CUI) for reporting performance measures

definition quality data model
Definition: Quality Data Model
  • The Quality Data Model (QDM) is an “information model” that clearly defines concepts used in quality measures and clinical care and is intended to enable automation of electronic health record (EHR) use. It provides a way to describe clinical concepts in a standardized format so individuals (i.e., providers, researchers, measure developers) monitoring clinical performance and outcomes can clearly and concisely communicate necessary information.
  • The QDM describes information so that EHR and other clinical electronic system vendors can consistently interpret and easily locate the data required 1

1http://www.qualityforum.org/Projects/h/QDS_Model/Quality_Data_Model.aspx

transition vocabularies
Transition Vocabularies

*Final Date, relevant for reporting of quality measure results only.

Not relevant for other purposes, eg, claims reporting.

transition vocabularies1
Transition Vocabularies

*Final Date, relevant for reporting of quality measure results only.

Not relevant for other purposes, eg, claims reporting..

examples
Examples

Demonstrate with examples-

  • ”Fictitious/mock” measures - used for demonstration purposes only
  • no association with guidelines, standards of care, measure steward
  • Demonstrate use of vocabularies rather than comprehensive QDM modeling and logic
measure 1
Measure 1
  • Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease, with symptoms of neuropathy, who received an assessment of foot sensation using a standardized assessment tool with findings communicated to primary care physician
measure 11
Measure 1
  • Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease, with symptoms of neuropathy who received an assessment of footsensationusing a standardized assessment tool with findings communicated to primary care physician
slide40
Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease, with symptoms of neuropathy who received an assessment of footsensationusing a standardized assessment tool with findings communicated to primary care
measure 2
Measure 2
  • Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease who have a foot ulcer and received a culture and sensitivity and were prescribed a 3rd generation cephalosporin
measure 21
Measure 2
  • Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease who have a foot ulcer and received a culture and sensitivity and were prescribed a 3rd generation cephalosporin
slide43
Percentage of patients age 18 years and older with a diagnosis of peripheral vascular disease who have a foot ulcer and received a culture and sensitivity and were prescribed a 3rd generation cephalosporin
challenges
Challenges
  • Gaps in terminology, eg LOINC, SNOMED CT
  • Transition recommendations, adoption, traction rather than gaps
current focus and next steps
Current Focus and Next Steps

Dec 2011– February 2012

Current SWG Focus

Conduct Environmental Scan

C2C Output

Summary of Various Approaches taken by Organizations

Identification of Key Themes and Industry Best Practices

Standards

Tools

Distributed Query Networks

List of Constraints to analyze Best Practices for QH

within the Technical framework

Value Sets

Next Steps*

Suggested Outputs

Suggested Inputs

Task

Team

Feb 2012 - TBD

Develop Technical Expression of C2C

C2C Output / Recommendation

Technical Expression of C2C Approach as it Aligns with the Reference Implementation

C2C / Technical

Selection of Existing Value Set in Alignment with the QH CEDD

Align Proposed Technical Expression with Existing Value Set(s) and Vocabulary Task Force Recommendations

Technical Expression of C2C Approach

Technical

Identify and assign Value Sets for a core set of data elements within the Harmonized QH CEDD as part of the Cross Walk

Harmonized CEDD and Selected Value Set

Clinical CEDD

Identified Value Set Representations for core set of DataElement in the CEDD

Reference implementation Guidance for QH

Identify standardized approach to store and access Value Set(s)

Value Set Representation

Technical

* Steps are not in sequential order

criteria and constraints
Criteria and Constraints
  • The approach must be easily implemented as part of the Technical Framework.
    • The Reference Implementation has to easily be able to use the mappings and the Value Sets .
  • Utilize NQF as starter Value Sets per Jacob Reider’s recommendation
    • Additional Value Sets can be identified and included as needed
  • Value set representation should utilize NQF and the IHE SVS
    • Integrating the Healthcare Enterprise -Sharing Value Sets (IHE SVS) Profile can be thought of as a Value Set Repository that houses Value Sets
    • IHE SVS provides a standardized, easy to use, RESTful interface to the value set
  • Potential mechanisms to import Value Sets as part of the Reference Implementation should be identified (ex. - Excel or another format?)
  • Each participating organization within the query network should consider operational best practices for ongoing updates and maintenance of Value Set
  • Value Set Owners are expected to perform ongoing maintenance of Value Sets
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