PHIN VADS Webinar SeriesPart 1 - Content & Application Overview

November 30, 2010

• Vocabulary Basics• PHIN VADS Purpose and Benefits• PHIN VADS

– Content– Web Application– Web Services– Value Sets Authoring Tool

• Demo• Q&A

Agenda

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CDC Interoperability Tools (Case Notification)

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Vocabulary Definitions & Examples

Code System Defined As:A collection of codes with its descriptions.

Example:SNOMED-CT,

ICD-9

Terminology, Vocabulary, Thesaurus, Taxonomy

“AKA”

Value Set Defined As:A collection of concepts created for a specific purpose such as in response to a question.

Example:A subset of microorganisms related to “Influenza” from

SNOMED-CT

Answer Lists, Permissible Values, Pick List, Code Set

“AKA”

Concept Defined As:Represents a single idea such as the name of a microorganism.

Example: Influenza A Virus

Vocabulary View (Messaging Guides)

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“Vocabulary View” refers to a collection of value sets associated with a HL7 messaging guide or CDA. View is also versioned and can be downloaded as a zip file. View can also be accessed using web services.

Vocabulary View Metadata

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Vocabulary Group

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Vocabulary Group Metadata

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“Vocabulary Groups” includes only the latest version of a value set“Vocabulary Groups” includes only the latest version of a value set

Vocabulary Object Identifiers (OID)

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OID Registry

Code System Concept – Standards overlap & Usage Context

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Retired SNOMED Concepts

White House E-Gov Consolidated Health Informatics (CHI):

• Domain recommendations provided guidance regarding the selection of code system.

Health Information Technology Standards Panel (HITSP): C80: Clinical Document and Message Terminology Component defines the vocabulary (value sets) for all the HITSP interoperability Specifications (IS).

HL7 Vocabulary Technical Committee

Meaningful Use (MU): The Office of National Coordinator (ONC) for Health Information Technology - Standards and Certification Criteria for Electronic Health Records

Standards adopted by PHIN VADS

ISO 11179 Metadata and HL7 Common Terminology Services (CTS)

Public Health Vocabulary & Messaging Community of Practice (VMCoP)

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VMCoP Website Link

Meaningful Use

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Standards & Certification Criteria Interim Final Rule: Revisions to Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology [PDF - 62 KB]

Final Rule on Meaningful Use [PDF - 13.9 MB]

• Meaningful Use Resources Website

Vocabulary & Messaging Community of Practice (VMCoP) webinars related to Meaningful Use (stage 1) can be found at VMCoP online forum (phConnect):

1) Syndromic Surveillance (October 28th 2010)2) Electronic Laboratory Reporting (September 21st, 2010)3) Immunization (August 17th , 2010)

PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary:

a) MU Stage 1- Immunization HL7 2.5.1 IG Vocabularyb) MU Stage 1- ELR HL7 2.5.1 IG Vocabularyc) MU Stage 1 – Value sets related to Syndromic Surveillance are

available in PHIN VADS and the vocabulary view would be created in Dec 2010

Public Health Meaningful Use Measures Vocabulary

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Federal Health IT (HIT) Vocabulary Task Force (VTF)

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Website Link

• Standard Development Organization (SDO) vocabulary tools can be used for browsing and searching the code system concepts as well as mapping of local vocabulary.1) LOINC – RELMA , Web search2) SNOMED CT–

National Library of Medicine (NLM) list of SNOMED browsers , NLM SNOMED CT browser, Virginia Tech SNOMED browser

3) RxNorm – RxNav from NLM4) HL7 Tools & vocabulary resources5) ICD-9 CM & ICF –

CDC National Center for Health Statistics (NCHS) and WHO6) Demographics (Geocodes) – USGS GNIS

SDO Vocabulary Tools

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• NLM Unified Medical Language System (UMLS)– SDO vocabulary (RxNorm, SNOMED), mapping between standards, Metamorphosys, UTS, etc..

• Centers for Disease Control & Prevention (PHIN VADS)– Public health & clinical care value sets, HL7 Messaging IG value sets distribution, web services, ..

• National Cancer Institute (NCI) – Enterprise Vocabulary Services (EVS)– Cancer domain, NCI Metathesaurus, FDA vocabulary (SPL, UNII), Gene (HUGO, GO), etc..

• Environment Protection Agency (EPA) – Substance Registry System (SRS)– Substance (Chemical, Physical, Biological), Map to CAS #, vocabulary (Air, Water, Soil), etc…

• Agency for Healthcare Research & Quality – United States Health Information Knowledgebase (USHIK)

– Metadata registry of healthcare data elements and information models of SDOs, HITSP, …

• Mayo Clinic - LexGrid , LexBig, LexWiki – Distributed network of terminologies and ontologies using std. tools, web services (HL7 CTS), …

• Washington Publishing Company (WPC) – Taxonomy browser & file server – Code lists supporting administrative data – X12, NUCC, HIPAA, etc…

• Commercial Terminology Distribution (Vendors)

Vocabulary Distribution Portals

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• In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within the PHIN and NHIN.

• Provides all the vocabulary metadata needed for HL7 messaging.• Promotes sharing and reusing of the value sets.• Hosts multiple versions of value sets that allow implementers to have access to

the current, past and the future versions of value sets and value set collections• Provides web services (API) that allows HL7 interface engines, medical and public

health applications to obtain the value sets as well as validate the vocabulary present in HL7 messages.

• Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards.

• PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov • CDC Vocabulary and Messaging team manages the PHIN VADS.

What is PHIN VADS?

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• Distributes the value sets associated with the public health HL7 messaging (V2.x, V3) & CDA implementation guides.

• CDC as SDO maintains and distributes the code system such as Vaccine names (CVX), Vaccine manufacturers (MVX), Race & Ethnicity, Healthcare Service Locations and Nationally Notifiable Disease/Conditions (NND) using VADS.

• Facilitates the routing and filtering of HL7 messages and can be easily integrated with any medical or public health applications using VADS web services (API)

• Develops & distributes HL7 messaging value sets associated with:1) Electronic Laboratory Reporting (ELR)*2) Immunization*3) Syndromic Surveillance*4) Public Health Case Reporting5) Public Health Case Notification (infectious & non-infectious)6) NHSN Healthcare Associated Infections (HAI)7) Cancer Registry (Anatomic Pathology Reports)

8) Clinical Quality Measures reportable to public health* (e.g. Diabetes control)* Meaningful Use Stage 1 measure

Purpose and Usage of VADS

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o CDC programso State and local health departmentso HL7 Messaging Guide – Value set implementerso Epidemiologistso Healthcare Providers including labs and hospitalso Value set and quality measure developers o Standard Development Organization (SDO)o Standard harmonization and recommendations workgroups o Researcherso EMR and public health application vendorso Public health applications (EpiInfo, PHIN MSS, PHIN MQF)

PHIN VADS users

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• Currently, PHIN VADS has 592 value sets supporting 60 HL7 and CDA message implementation guides. The PHIN VADS hosts both the intrinsic and extrinsic value sets.

• PHIN VADS also hosts 149 SDO code systems that are used by HL7 messaging value sets. Many of the code systems (~ 120) belong to HL7 v2.x or V3.

• PHIN VADS updates the value sets often based upon SDO code system updates.

• PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary:

a) MU Stage 1- Immunization HL7 2.5.1 IG Vocabularyb) MU Stage 1- ELR HL7 2.5.1 IG Vocabularyc) MU Stage 1 – Value sets related to Syndromic Surveillance

PHIN VADS Content

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• PHIN VADS can be accessed using one of the following methods:1) PHIN VADS Web Browser.2) PHIN VADS Web Service – System to System

exchange of vocabulary data.3) PHIN VADS Lite – Local instance of VADS web

services and database4) PHIN VADS Custom Downloader (using web

services)

PHIN VADS Content Access

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• PHIN VADS web browser is the most commonly used method for browsing, searching and downloading the public health value sets.

• PHIN VADS web site – http://phinvads.cdc.gov • Users have an option to download PHIN VADS value sets using

Microsoft Excel or tab-delimited text format. PHIN VADS web user interface is complaint with web accessibility section 508.

• PHIN VADS allows the users to bookmark the value sets, code systems, concepts, vocabulary views and groups. PHIN VADS vocabulary view bookmarks are usually included in the HL7 message implementation guide that allows the implementers to access the messaging vocabulary associated with implementation guide easily.

• Browser compatibilityo Internet Explorer 7 and aboveo FireFox version 3.0 and above

PHIN VADS Web User Interface

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Web Browser VADS WebApplication VADS Web

Services

•The PHIN VADS web application is built upon the PHIN VADS web services.

•When using the PHIN VADS application, the web services are used indirectly.

•These web services are public and built upon open standards (HL7 CTS2 , IHE SVS).

PHIN VADS Web Services: System-to-System Exchange of vocabulary data

PHIN VADS Web Services

VADS Web Services

Custom Program

•Custom programs, applications, or data extraction scripts can be written to directly use PHIN VADS Web Services.

•The PHIN VADS technical team is available to assist you.

•Sample code and a detailed API are available in the PHIN VADS Developer’s Toolkit - http://phinvads.cdc.gov/vads/developersGuide.action

PHIN VADS Application Integration & Web Services Overview

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Webinar Invitation link

• Allows any individual or organization to implement a local instance of the VADS service and database.

• The VADS Lite deployment is available for Oracle and Microsoft SQL Server.

• VADS Lite is not deployed with a User Interface• The deployment model requires the users to download, install,

and maintain a local installation on their hardware. Vocabulary Server with Application Programming Interface (API) may allow the vendors or implementers to integrate the vocabulary server with their application. – E.g. NEDSS Messaging Subscription Service application includes PHIN

VADS vocabulary server and Orion Rhapsody that will help validate HL7 messages and assist mapping between local and standard terminology.

PHIN VADS Lite

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• PHIN VADS custom downloader can be used like a shopping cart for downloading the VADS content.

• Useful tool especially for generating custom reports and queries from PHIN VADS database.

• Can be easily executed by non-technical people (Epidemiologist, Clinicians, Quality Measure Developers, Value set creators, etc..)

• Allows to download several value sets into a single file. This helps the implementers to import value set collections into a database.

• Uses VADS web services to query the VADS database.• Value set and quality developers can use this tool to develop the

intrinsic value sets using the hierarchical relationships from SDO vocabulary such as SNOMED.

• Download this tool from VADS online forum (phConnect)

PHIN VADS Custom Downloader

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UAF – A Distributed Terminology Development Environment• A web-based thin client distributed environment which allows for

vocabulary authoring and publishing.• Provides Versioning Capability for Vocabulary Objects.• Provides historical tracking of database updates.• Allows multiple users to author data simultaneously via the Change Event.• Allows for vocabulary updates via the web services.

Value Set Authoring – Universal Authoring Framework (UAF)

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• UAF is currently available to CDC partners, value set creator and quality measure developers who are involved in the development and management of the value sets present in PHIN VADS.

• UAF has most of the code systems suggested by Consolidated Health Informatics (CHI) for various domains.

• Allows vocabulary specialists to either enumerate the value set concepts or provide the logic for creating the intrinsic value set.

• Allows programs to select a particular version of the value set to be associated with the messaging vocabulary view.

• Allows programs to create / import code systems which include the concepts, relationships, alternate designations, and extended properties.

• Allows authoring the local code systems as well as CDC code systems that has been adopted by standards such as HL7. (E.g. CVX, MVX, Nationally Notifiable Disease).

UAF Usage

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Value Set Maintenance (Versioning)

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Change Event Model:

PHIN VADS maintains the past, current and future versions of a value set.

Provides a historical record of all changes made to an object over time.

Each change is stored as a delta from prior version to proposed version..

• Notification about VADS updateo E-mail: List Serv (VMCoP, HL7 PHER, PHIN)o VADS Online Forum o VMCoP monthly meetings

• Frequencyo Quarterlyo On-demand (e.g. Outbreak or Natural disasters)

PHIN VADS Vocabulary Updates

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Value Set Authoring Tool Webinar

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Webinar Invitation link

PHIN VADS Support - phConnect

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PHIN VADS online forum URL: http://www.phconnect.org/group/phinvads

E-mail:phinvs@cdc.gov

• Notifiable Condition Mapping Table• Data Elements (Questions) Module• Relationship Navigator• Web Services Enhancements• Collaboration with other vocabulary tools

– LexGrid, IHTSDO SNOMED Workbench, Messaging Workbench, UMLS, USGS, EPA SRS, RELMA, etc..

Upcoming PHIN VADS Enhancements

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• IHE Profile value sets supporting IHE Connectathon 2011– Maternal & Child Health (Birth Certificate)– Cancer Reporting– Early Hearing Defects Intervention (EHDI)

• Meaningful Use Stage 1 Clinical Quality Measures that are reportable to public health

• Syndromic Surveillance HL7 IG value sets• Race & Ethnicity Questions Collection methods• RxNorm drug value sets – NHSN / NQF

VADS Content Updates (Dec 2010)

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Demonstration

Code System – SDO Vocabulary

Code System Concept Metadata

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Synonyms

Relationship

Legacy SNOMED concept code

Value Set

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Value Set Concept

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Questions

Sundak Ganesan – Lead Vocabulary Specialist Sheila Abner – Vocabulary Specialist Steve Eady – Tech Lead Prosenjit Dutta – Developer Scott Keller – Database Analyst Cathy Lester – Quality Assurance/Tester Vanessa Fernandez – Business Analyst Michael Pray – Project Manager Mark Winarsky & Gautam Kesarinath

– CDC FTE Program Managers Nikolay Lipskiy – CDC FTE lead for SDO standards

Acknowledgments

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Appendix

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• Resources1. PHIN VADS Help – FAQ and Glossary2. HL7 Vocabulary TC

- Good Vocabulary Practice Guide (May 2000)- Core principles and properties of V3 (Sept 2010

Ballot)- HL7 OID Registry

3. Federal Health IT - Vocabulary Task Force4. Health Information Technology Standards Panel

(HITSP) – C80 Messaging Terminology

Vocabulary Basics - Resources

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HIT VTF Testimony (Sept 1st and 2nd 2010)- One Stop Shopping Theme

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Meeting Audio for September 1, 2010 [MP3 - 34.3 MB]

Meeting Transcript for September 1, 2010 [PDF - 508 KB]

Meeting Audio for September 2, 2010 [MP3 - 18.1 MB]

Meeting Transcript for September 2, 2010 [PDF - 287 KB]

Web site links

VTF Testimony (March 23rd 2010)- Governance of Value Sets (Govt. Agencies)

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Meeting Audio [MP3 - 47 MB]

Meeting Transcript [PDF - 566 KB]

Web site links

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VTF Testimony (February 23rd 2010)- Governance of Value Sets (Vendors & SDO)

Meeting Audio [MP3 - 30 MB]

Meeting Transcript [PDF - 490 KB]

Web site links

PHIN VADS Framework

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OID Request

CDC is plan on publishing all the vocabulary OID’s in HL7 OID registry.

• Allows locking of a subset of the data model to be edited.• Change Control Model provides a mechanism for governance

of edits to VADS data.• Organizes edits to subsets of the data structure, such as Code

System, Value Set, Vocabulary Views, etc.• Edits to VADS are checked against business rules, then applied

as a group to the actual tables• Completed edits are moved via XML as a Change Control

Package to the Review and Production environments. • Each change control package contains the original vocabulary

item as well as its changes. This can be used for reports later.• The Change Control Package provides an audit trail.

PHIN VADS Change Control Model

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• Collaborating with the stakeholders, Standard Development Organizations (SDO), Community of Practice and implementers during the process of developing messaging guide and value sets helps in the adoption of standard vocabulary.

• Most of the HL7 implementation guides require at least 25 to 30 value sets that were developed from various coding systems. CDC programs and implementers found it easier to download a specific version of the value set or vocabulary view from such single for PH location as PHIN VADS.

• PHIN VADS value set download includes all the metadata that are needed for implementing HL7 message coded data types (CE, CWE) which makes it easier for implementing the value set concepts in HL7 message or CDA.

• Implementers and CDC programs can access the previous, current and future versions of value sets and vocabulary views from PHIN VADS as they become available. This makes it easier for implementers to implement a particular release of the HL7 messaging or CDA implementation guide.

Lessons learned in the management of value sets

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• The biggest challenge in creating value sets is the timeliness of getting the new standard vocabulary concepts from SDO.

• An e-mail notification process is not an optimal solution for notifying implementers about the updates in a timely manner. We believe that a subscription mechanism (e.g. RSS Feeds) would work better for getting updates to vocabulary views or value sets.

• Many implementers have not adopted the SNOMED numeric codes. They are still using the SNOMED alphanumeric codes. PHIN VADS include the value set concepts with the preferred concept codes as well as the alternate codes which allows the implementers to map their local vocabulary to standard vocabulary.

Value set management issues

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