hit standards committee clinical quality workgroup and vocabulary task force

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HIT Standards Committee Clinical Quality Workgroup and Vocabulary Task Force. Wednesday, August 17, 2011 Jim Walker and Jamie Ferguson, Chairs Karen Kmetik and Betsy Humphreys, Co-Chairs. 1. Vocabulary Task Force. Chair : Jamie FergusonKaiser Permanente - PowerPoint PPT Presentation


  • HIT Standards CommitteeClinical Quality Workgroup and Vocabulary Task ForceWednesday, August 17, 2011

    Jim Walker and Jamie Ferguson, ChairsKaren Kmetik and Betsy Humphreys, Co-Chairs*

  • Vocabulary Task ForceChair: Jamie FergusonKaiser PermanenteCo-Chair:Betsy HumphreysNational Library of MedicineMembersDonald BechtelAccredited Standards Organization X12 Lisa CarnehanNIST Christopher ChuteMayo Clinic Bob DolinHL7 Floyd EisenbergNational Quality Forum Patricia GreimVeterans Affairs John HalamkaHarvard Medical School Stan HuffIntermountain Healthcare John KlimekNCPDP Clem McDonaldNational Library of Medicine Stuart NelsonNational Library of Medicine Marc OverhageRegenstrief Institute Marjorie RallinsAmerican Medical Association Dan VreemanRegenstrief Institute Jim WalkerGeisinger Andrew WiesenthalIHTSDO (SNOMED)Federal Ex OfficioChris BrancatoHHS/ONCGreg DowningHHSDoug FridsmaHHS/ONC Marjorie GreenbergHHS/CDCAmy GruberCMS


  • Clinical Quality Measures WorkgroupChair: Jim WalkerGeisinger Health SystemCo-Chair:Karen KmetikAmerican Medical AssociationMembersDavid BakerNorthwestern UniversityAnne CastroBlueCross BlueShield of South CarolinaChristopher ChuteMayo ClinicJohn DerrGolden Living, LLCBob DolinHL7Floyd EisenbergNQFRosemary KennedyThomas Jefferson UniversityDavid LanskyPacific Business Group on HealthGene NelsonDartmouth UniversityEva PowellNational PartnershipPhilip RennerKaiser PermanenteDanny RosenthalInova Health SystemJoachim RoskiBrookings InstitutionFederal Ex OfficioJon White, AHRQAneel Advani, Indian Health Service, HHSPatrice Holtz, CMS, HHSTBD, CDC, HHS*

  • Project ScopeAssign minimum necessary vocabulary standards to the fundamental concepts in the NQFs Quality Data Model v3.0 (QDM) to enable effective expression of quality measures and interoperable electronic health record data elements


  • Foundation Concepts1. Measures Development Limit code sets used for measures.Use of the code set may be limited to partial depth (e.g., a subset of ISO 639-2 for preferred language).Future purpose-specific subsets of code sets will be needed. 2. HIT CertificationCertified HIT shall be able to process all legal codes in the code set for a given concept (e.g., Adverse Effect).3. Meaningful Use (reimbursable)Only code sets required in HIT certification shall be required for Meaningful Use reimbursement.4. Interim Transition PlansEnd state targets are recommended for measure purposes. Some transition plans will be needed, are yet to be developed and will be presented to HITSC (more on this later)*

  • Recommended Code SetsAdverse Drug Effect (allergy or non-allergy)RxNorm for Medications (inactive ingredients to be added)SNOMED CT for non-medication substances SNOMED-CT for Adverse Effect*

  • Recommended Code SetsPatient CharacteristicsISO 639-2 for the patients Preferred LanguageCDC PHIN-VADS (HL7) for Administrative Gender CDC PHIN-VADS Race and EthnicityLOINC for assessment instruments (including tobacco use)SNOMED-CT for appropriate responses to instruments (including patient preferences and behaviors)Socio-economic Status - referred to CMS for clarification of request (in the absence of widely accepted typologies)Payer Typology of the Public Health Data Standards Consortium *

  • Recommended Code SetsCommunicationSNOMED-CTCondition/Diagnosis/Problem (active and inactive)SNOMED-CTDeviceSNOMED-CTNon-laboratory Diagnostic Study LOINC for specific study nameSNOMED-CT for appropriate findingsUCUM for specific units of measureEncounterPatient-Professional Interaction (not limited to billable events)SNOMED-CT*

  • [Patient] ExperienceLOINC for assessment instrumentsSNOMED-CT for appropriate responsesFamily HistoryLOINC for assessment instrumentsSNOMED-CT for appropriate responsesFunctional statusICF (International Classification of Functioning, Disability, and Health) for categories of function LOINC for assessment toolsSNOMED-CT for appropriate responses*Recommended Code Sets

  • Health Record Components (element of a health IT application)LOINC for naming of the components and their relationshipsHL7 for messaging among systemsIntervention (forms one end of a spectrum with Procedures)LOINC for interactions that produce an assessment or measurable resultsSNOMED-CT for appropriate results and interventions that do not produce measurable results (e.g., counseling)Adverse Effect other than Allergy (intolerance)RxNorm for medications and inert ingredientsSNOMED-CT for Non-medication substancesSNOMED-CT for Adverse effects*Recommended Code Sets

  • Laboratory testsLOINC for test name and its resultsSNOMED-CT for appropriate resultsUCUM for units of MeasureMedication (including vaccines)RxNorm for medicationsCVX for vaccinations as standard vocabulary (in some contexts vaccinations are treated as medications, in others they are treated separately)Physical ExamLOINC for assessment instrumentSNOMED-CT for appropriate responses*Recommended Code Sets

  • [Patient] PreferenceLOINC for assessment instrumentsSNOMED-CT for appropriate responsesProcedureSNOMED-CTRisk EvaluationLOINC for evaluation instrumentsSNOMED-CT for appropriate responsesSubstanceSNOMED-CT*Recommended Code Sets

  • SymptomSNOMED-CTSystem resourcesLOINC for staffing resourcesHL7 for EHR functionsSNOMED-CT for equipment TransferSNOMED-CT

    *Recommended Code Sets

  • ActionAccept the recommended code sets for QDM concepts*

  • Next StepsTransition Plans to be presented at September 28th HITSC meeting, will address:

    Interim use of code sets currently employed in quality measures6 concepts have code sets required in MU Stage 1 (3 of these would change with recommended sets e.g., using ICD, CPT, HCPCS)

    Transition time required for:Testing of recommended code setsMeasure developers to incorporate new recommendations into exiting, retooled, and de novo measuresIncorporation into certification criteria*

    Betsy, I thought we were going to recommend RxNorm for non-medication substances.**


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