Post on 22-Feb-2016
description
Query Health Concept-to-Codes (C2C) SWGMeeting #9
February 7, 2012
1
Today’s Agenda
Topic Time Allotted
• Review of Timeline 2:30 – 2:35 pm
• Presentation by Floyd Eisenberg on Value Sets (NQF) 2:35 - 3:15 pm
• Review of Scope – Current Focus and Next Steps• Revisiting Concept Mapping Overview (from initial Kick-Off)• Reviewing Summaries and Extracting Key Themes
3:15 – 3:55 pm
2
Proposed Timeline TODAY
Coordinate offline activities to summarize approaches and develop draft deliverable from presentations
Meeting 2 – Dec 13
Meeting 3 – Dec 20
Meeting 4 – Jan 03
Meeting 5 – Jan 10
Meeting 6 – Jan 17
Meeting 7 –Jan 24
Meeting 8 – Jan 31
Meeting 9 –Feb 7
Meeting 10 – Feb 14
Presentation •NQF –Value Set presentation
•Begin Overview of Next steps
•Overview of Constrains and Criteria
Presentation•I2b2 (Cont.)•Intermountain Health•DOQS (Data Warehousing / Mapping)
Meeting times extended from 2:30-4:00pm
Presentation•hQuery •i2b2
Presentation•DOQS (Data Warehousing / Mapping) Cont.•PopMedNet•NLM
Presentation•Ibeza•CDISC SHARE
Tasks •Discussion of presentation summaries and extraction of key themes
Presentation•RELMA (LOINC)•3M•NY Presbyterian Hospital Vocab Team
Presentation•AHIMA•LexEVS and CTS2•Jacob Reider - ONC
Presentation•S&I Repository
3
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
4
Outline Background & Mission Scope Definitions Recommendations Examples Challenges & Discussion
5
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)
6
Scope Scope:
Reporting of clinical-quality measures Facilitate standardized information exchange
Out of Scope: Intra-organization information management Reporting to other external entities
7
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
8
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
9
Desiderata for Standard Vocabularies Interdisciplinary relevance Minimum necessary Maturity
Logical (hierarchical data model vs. flat structure)
Technical (eg meaningless identifiers)
10
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
11
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.
12
Vocabulary SummaryRecommended SNOMED CT LOINC RxNorm ICF UCUM CVX
CDC PHIN VADS (HL7)ISO 639PHDC Payor Typology
Transition ICD-9-CM ICD-10-CM ICD-10-PCS Current Procedural Terminology, CPT®
HCPCS
13
Vocabulary SummaryRecommended SNOMED CT LOINC RxNorm ICF UCUM CVX
CDC PHIN VADS (HL7)ISO 639PHDC Payor Typology
Transition ICD-9-CM ICD-10-CM ICD-10-PCS Current Procedural Terminology, CPT®
HCPCS
14
Definitions: SNOMED CTSystematized Nomenclature of MedicineClinical Terms®
> 310,000 active concepts> 790,000 active descriptions or names & synonyms> 920,000 relationships-Released semi-annually in Jan & July-Developed & maintained by clinicians
A comprehensive clinical terminology developed by the College of American Pathologists (CAP); now owned and maintained by International Health Terminology Standards Development Organization;
15
Definitions: SNOMED CT 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….
16
Definitions: SNOMED CT Incorporated into healthcare
applications
Manual lookup and coding Transparent to the user
17
Definitions: LOINCLogical Observation Identifiers Names and Codes®
A universal code system that facilitates exchange, pooling and processing of results;
Laboratory LOINC – Lab results and observationsClinical LOINC – Clinical results and observations
Name partitioned into segments to coordinate with messaging standards
Developed and maintained by the Regenstrief Institute
18
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.19
Definitions: LOINC
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.
What is my patient’shemoglobin level?718-7:Hemoglobin:MCnc:Pt:Bld:Qn
How fast does mypatient usually walk?41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculate2
LAB LOINC
Clinical LOINC
Answers in SNOMED CT:165447008 mean corpuscular hemoglobin concentration (MCHC) - low (finding)16526500 walks 30-59 meters in 1 minute (finding)
20
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
21
Definitions: CVX, ICF, PHDC, PHIN VADS
CVX
CVX/V- The CVX code is a numeric string, which identifies the type of vaccine product used. Included in the CDC’s national Center for Immunization and Respiratory Diseases (NCIRD)
ICFICF-International Classification of Functioning, Disability, and Health is a classification of the health components of functioning and disability. (Under consideration for revision by IHTSDO/NLM)
PHDC Payor Typology
Payor Typology is a standard that allows consistent reporting of payor data to public health agencies for health care services and research
PHIN-VADS CDC Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS) that supports the standards based vocabularies of the PHIN to promote semantic operability and exchange of consistent information. 22
Definitions, ISO, UCUM
ISO 639 ISO 639 represents names of languages
UCUMThe Unified Code for Units of Measure include all units of measures used in international science, engineering, and business. The purpose is to facilitate unambiguous electronic communication of quantities together with their units.
23
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.aspx24
RecommendationVocabulary Concept QDM Category
SNOMED CT
Allergies Adverse Effect: Allergy
Non-allergic adverse effects, eg intolerance Adverse Effect: Non-allergy
Non-medication Substances eg, latex Substance
Artifacts of communication, eg, med list; clinical summary
Communication*
25
RecommendationVocabulary Concept QDM Category
SNOMED CT
Disorders, diseases, conditions, problems Condition, Diagnosis,
Problem
Symptoms, eg nausea, vomiting, pain (reported by the patient)
Symptom
Any patient provider interaction, eg phone calls, etc; regardless of reimbursement status
Encounter
Instruments, hardware Device
26
RecommendationVocabulary Concept QDM Category
SNOMED CT
Results and findings for laboratory results, diagnostic studies, physical exam,
Physical Exam
Laboratory Test
Diagnostic Study (non-laboratory)
Procedures – surgical, physical manipulation
Results and findings for procedures
Procedure
27
RecommendationVocabulary Concept QDM Category
SNOMED CT
Excepted answers to patient characteristics, experience, preference, risk evaluation, family history, functional status eg answers to assessment instruments, eg patient has a caregiver,
Characteristics
Experience
Preference
Risk Evaluation
Family History
Functional Status
28
RecommendationVocabulary Concept QDM Category
SNOMED CTAvailable medical equipment System Resources
settings (eg home, SNF) that a patient is released to or receive from; concepts support care coordination
Transfer
29
RecommendationVocabulary Concept QDM Category
LOINC Assessment instrumentsAssessment questions
Characteristics
Experience
Preference
Risk Evaluation
Family History
Functional Status
30
RecommendationVocabulary Concept QDM Category
LOINCLaboratory test and Diagnostic study names
Laboratory Test
Diagnostic Study
Staffing Resources eg nursing units System Resources
31
RecommendationVocabulary Concept QDM Category
RxNorm
Medications that cause allergies Adverse Effect: Allergy
Medications and inert ingredients associated with non-allergic adverse effects eg intolerance Adverse Effect: Non-allergy
Medications administered (excluding vaccines) Medication
CVX Vaccines administered Medication
32
RecommendationVocabulary Concept QDM Category
ICF* Categories of function Functional Status
UCUM Units of measureDiagnostic Study
Laboratory Test
33
RecommendationVocabulary Concept QDM Category
HL7
Administrative Gender, Race & Ethnicity, DOB (CDC PHIN-VADS)
Characteristic
Messaging among systemsHealth Record Artifact
EHR capabilities and function, eg e-prescribing System Resource
ISO 639 Preferred languageCharacteristic
Payor topology Payor Characteristic
34
Transition VocabulariesVocabulary Concepts Final Date*
ICD-9 CM Diagnoses condition, diagnosis, problem, family history--
Not usable for services provided after 10/1/2013.
ICD-9 CM Procedures Inpatient Encounter; Intervention; Procedure
Not usable for services provided after 10/1/2013.
ICD-10 CM condition, diagnosis, problem, family history;
One year after MU-3 is effective
ICD-10 PCS Inpatient Encounter; Intervention; Procedure
One year after MU-3 is effective
*Final Date, relevant for reporting of quality measure results only. Not relevant for other purposes, eg, claims reporting. 35
Transition VocabulariesVocabulary Concepts Final Date*
CPT Encounter; Intervention; Procedure
One year after MU-3 is effective
HCPCS Communication, Non-lab diagnostic study, Encounter, Intervention, Procedure)
One year after MU-3 is effective
*Final Date, relevant for reporting of quality measure results only. Not relevant for other purposes, eg, claims reporting.. 36
ExamplesDemonstrate 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
37
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
38
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
39
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
Concept/Data Element
QDM Category Vocabulary
Peripheral Vascular Disease Condition/Diagnosis/Problem SNOMED CT (disorder hierarchy)Transition VocabICD 9 CMICD10
Neuropathy Symptoms Symptom SNOMED CT (findings hierarchy)
Assessment of Foot Sensation
Risk Evaluation LOINC(Clinical LOINC)No transition vocabularies*
Foot Sensation Assessment Findings
Physical Exam SNOMED CT (findings hierarchy)No transition vocabularies*
40
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
41
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
42
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
Concept/Data Element
QDM Category Vocabulary
Peripheral Vascular Disease Condition/Diagnosis/Problem SNOMED CT (disorder hierarchy)
Transition VocabICD 9 CMICD10
Foot Ulcer Condition/Diagnosis/Problem SNOMED CT (disorder hierarchy)
Transition VocabICD 9 CMICD10
Culture Laboratory Test LOINC(Lab LOINC)No transition vocabularies*
Sensitivity Laboratory Test LOINC(Lab LOINC)No transition vocabularies*
Third Generation Cephalosporin
Medication RxNorm(cui for the SCD) No transition vocabularies*
43
Challenges Gaps in terminology, eg LOINC,
SNOMED CT Transition recommendations,
adoption, traction rather than gaps
44
Current SWG Tasksand
Next Steps
45
Next Steps*
Current Focus and Next StepsCurrent SWG Focus
Standards
Tools
Distributed Query Networks
C2C Output Summary of Various Approaches taken by Organizations Identification of Key Themes and Industry Best Practices
List of Constraints to analyze Best Practices for QH within the Technical framework
Identify and assign Value Sets for a core set of data elements within the Harmonized QH CEDD as part of the Cross Walk
Align Proposed Technical Expression with Existing Value Set(s) and Vocabulary Task Force Recommendations
Identify standardized approach to store and access Value Set(s)
Dec
2011
– Fe
brua
ry 2
012
Feb
2012
- TB
D
Conduct Environmental Scan
Develop Technical Expression of C2C Technical Expression of C2C Approach as it Aligns with the Reference Implementation
Identified Value Set Representations for core set of Data Element in the CEDD
Selection of Existing Value Set in Alignment with the QH CEDD
Reference implementation Guidance for QH
Harmonized CEDD and Selected Value Set
Technical Expression of C2C Approach
Value Set Representation
C2C Output / Recommendation
Suggested Inputs Suggested Outputs
Clinical CEDD
Technical
Technical
C2C / Technical
Task Team
46
Value Sets
* Steps are not in sequential order
Criteria and Constraints
1. 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 .2. Utilize NQF as starter Value Sets per Jacob Reider’s recommendation
– Additional Value Sets can be identified and included as needed3. 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 set4. Potential mechanisms to import Value Sets as part of the Reference Implementation
should be identified (ex. - Excel or another format?)5. Each participating organization within the query network should consider operational
best practices for ongoing updates and maintenance of Value Set6. Value Set Owners are expected to perform ongoing maintenance of Value Sets
47