HIT Standards CommitteeHIT Standards CommitteeClinical Operations Workgroup

Update on Vocabulary Task Force

Jamie FergusonJamie FergusonKaiser Permanente

Betsy HumphreysBetsy HumphreysNational Library of Medicine

December 18, 2009

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Vocabulary Task Force

• Kick-offThe Vocabulary TF held its first meeting 11/19/2009 to begin consideration of the gaps and issues identified by the HIT Standards Committee.

• Task Force Charge:Identify gaps, issues and needs for clinical and administrative vocabulary solutions within the scope of the HIT Standards Committee. Develop recommendations to ONC for methods, actions, standards and/or programs to mitigate, manage or solve these vocabulary concerns.

• Task Force Scope:Vocabulary needed for Meaningful Use and other purposes under ARRA within the scope of the Standards Committee.

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Vocabulary Task Force Membership

Chair Jamie Ferguson Kaiser PermanenteCo-Chair Betsy Humphreys National Library of Medicine

Members• Clem McDonald National Library of Medicine• John Halamka Harvard Medical School• Stan Huff Intermountain Healthcare• Christopher Chute Mayo Clinic• Marc Overhage Regenstrief Institute• Dan Vreeman Regenstrief Institute• Andy Wiesenthal IHTSDO• Stuart Nelson RxNorm/NLM• John Klimek NCPDP• Floyd Eisenberg National Quality Forum• Amy Gruber CMS• Donald Bechtel ASC X12• Patricia Greim Veterans Affairs• Jim Walker Geisinger• Greg Downing HHS• Doug Fridsma HHS/ONC• Chris Brancato HHS/ONC• Bob Dolin HL7

ONC• Jodi Daniel• Carol Bean

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Input from Standards Committee

• Implementation Workgroup– Create publicly available vocabularies and code sets– Ensure they are easily accessible with straightforward updates– Noted licensing issues, e.g., for CPT and medication cross-

maps

• Clinical Operations Workgroup– Noted gaps in cross-maps, subsets and value sets– Noted gaps in governance, management and maintenance– Noted gaps in value set binding to content exchange standards

• Quality Workgroup– Noted needs for value set determination and processes– Coordination with quality measure stewards

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Vocabulary Process Gaps & Issues for Task Force

• Governance: requirements and recommendations

• Infrastructure: requirements and recommendations

• Licensing: requirements and recommendations

• Education/communications: requirements and recommendations

• Specific value set and subset processes– Requirements determination and definition process for value sets– Coordination of releases, e.g. RxNorm and SPL– Dissemination and publication of value sets– Maintenance of value sets

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Vocabulary Standards Gaps & Issues for Task Force

• Cross-maps• SNOMED CT frequently used to ICD and CPT

• RxNorm and proprietary medication codesets

• Testing and Implementation guidance• UCUM, RxNorm

• Tooling for implementers• SNOMED CT

• Subsets and value sets• SNOMED CT, LOINC, RxNorm

• Binding value sets to content exchange standards• CDA

• Regulatory• FDA requirements for UCUM in devices and labs

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Task Force Approach and Priorities

Goals and guidelines for discussion:• TF Approach should include public input and invited expert

testimony• TF Approach should result in recommendations to ONC on

identified gaps and issues• TF Approach should address all identified issues in 2010

Group discussion to identify TF approach alternatives

Group discussion to identify priorities and immediate next steps

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Schedule and Structure of Task Force Meetings

• Monthly meetings proposed, the day before each meeting of the HIT Standards Committee– In-person in Washington DC with teleconference capability

• Likely meeting structure– Background Paper – with Issues, Questions to be addressed

• One vocabulary process topic, plus,

• One vocabulary standards gap or issue

– Invited testimony as appropriate– Workgroup discussion– At least one task force phone call between meetings