HIT Standards CommitteeHIT Standards Committee

Clinical Operations Workgroup, Vocabulary Task Force (VTF)Update on Vocabulary For Stage 2Update on Vocabulary For Stage 2

Jamie Ferguson, Kaiser Permanente

Betsy Humphreys, National Library of Medicine

22 June 2011

2

Current VTF Priorities & Process

• ONC Requested Vocabulary Standards for Stage II/III– Medications for e-prescribing and medication allergies– Lab tests for results reporting and test orders– Problems for problem list documentation– Standards required to specify quality measures

• Process:– Assess/Revise as necessary Previous HITSC Vocabulary

Recommendations for key EHR segments– Series of teleconference meetings, next 6/24– Work with Clinical Quality WG on Vocabulary

Recommendations to support Quality Measures• 1st joint CQWG-VTF meeting 6/20; another 6/29?

General Issues

• Can an EHR certification requirement precede a meaningful use requirement in order to facilitate adoption? (Discussed in HITSC meeting 5/18/11)

• How will an EHR’s use of vocabulary standards be tested and certified? – VTF has scheduled presentation/discussion with NIST (6/24)

• Requirements for subsets used in certification testing could differ from those used to facilitate adoption/use.

• EHR products must be able to accommodate (i.e., not reject) any valid value from a required standard vocabulary.

3

Recent relevant developments

• May 31 – LOINC Top 2000+ Lab Observations and Mapper's Guide released

• June 6 – RxNorm Prescribable Drugs subset (1st draft) released

• May 26 – IHTSDO and Global Medical Device Nomenclature (GMDN) in formal negotiation re: inclusion of GMDN content in SNOMED CT

4

Allergens & Allergic Reactions

• Quality Measures require: – medication allergies, non-medication allergens, severity of reaction

• Medications/active ingredients - RxNorm (specific named components)

• Vaccinations– Still under discussion: CVX/MVX, RxNorm

• Inactive ingredients, non-medication allergens– Still under discussion: UNII, SNOMED CT

– Recent (5/24) recommendations from NCPDP re: allergies suggest incorporation in RxNorm

• Severity of reaction - SNOMED CT• Reaction itself – SNOMED CT

5

Medical Devices

• For initial (limited) quality measure requirements: SNOMED CT

• VTF to monitor developments and make later recommendation re: more detailed device terminology (GMDN, UMDNS)

6

For Action by VTF (after joint CQWG-VTF meeting 6/20)

• Patient characteristics• Conditions/Diagnoses/Problems• Non-laboratory Diagnostic Studies • Face-to-face, telemedicine, other communications

(e.g., mail, e-mail)– ?? Requirements for terminology vs other EHR attributes

For Joint CQWG-VTF discussion (6/29?)• Experience, Family History, Functional Status, Health

Record Component, Lab Test Orders, Interventions, Physical Exam, Preferences, Symptoms/Adverse Effects, System Resources

7