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Maureen M. Madden Value Set Authority Center Coordinator National Library of Medicine, National Institutes of Health U.S. Department of Health and Human Services 2 A list of codes and their terms derived from standard vocabularies and used to define clinical concepts (like diabetes, blood-sugar lab tests, smoking cessation, antibiotic prescriptions) to support effective and interoperable health information exchange. 3 Name: Acute Pharyngitis Code 1532007 195655000 195656004 195657008 195658003 195659006 195660001 195662009 232399005 232400003 363746003 Standard Vocabulary: SNOMED CT Description Viral pharyngitis (disorder) Acute gangrenous pharyngitis (disorder) Acute phlegmonous pharyngitis (disorder) Acute ulcerative pharyngitis (disorder) Acute bacterial pharyngitis (disorder) Acute pneumococcal pharyngitis (disorder) Acute staphylococcal pharyngitis (disorder) Acute viral pharyngitis (disorder) Acute herpes simplex pharyngitis (disorder) Acute herpes zoster pharyngitis (disorder) Acute pharyngitis (disorder) 4 Name: Antibiotic Medications for Pharyngitis Code 1013659 1013662 1013665 1043022 1043027 1043030 105152 105170 105171 108449 Standard Vocabulary: RxNorm Description 24 HR Minocycline 105 MG Extended Release Tablet 24 HR Minocycline 55 MG Extended Release Tablet 24 HR Minocycline 80 MG Extended Release Tablet Cefixime 100 MG Chewable Tablet Cefixime 150 MG Chewable Tablet Cefixime 200 MG Chewable Tablet Amoxicillin 60 MG/ML Oral Suspension Cefadroxil 25 MG/ML Oral Suspension Cefadroxil 100 MG/ML Oral Suspension Trimethoprim 10 MG/ML Oral Suspension 5 Value sets previously created manually in subject matter expert silos with minimal code validation Centers for Medicare & Medicaid Services (CMS) urgent need to move clinical quality measures and value sets from paper to electronic format 2012: Health IT Standards Committee recommends NLM as single, central authority for value sets 6 NLM staff neither create nor govern the content of the value sets. NLM VSAC tools validate the codes within value sets and hold the value sets in a searchable public repository. VSAC implements most recent terminology updates and provides these for the value set authoring community. NLM staff conducts frequent stakeholder engagement to know emergent needs and to respond with effective tooling. 7 Federal Agency Programs Standards Development Organizations (HL7) Medical Specialty Organizations Research Groups Local Health Providers and Hospitals Public Health Agencies 8 American Academy of Neurology American Nurses Association American Society of Clinical Oncology Austin Regional Clinic Centers for Medicare and Medicaid Services (67% of VSAC value sets) Children's Hospital of Philadelphia Emergency Care Research Institute Federal Health Interoperability Modeling and Standards Minnesota Community Measurement National Minority Quality Forum Pharmacy e-Health Information Technology Collaborative Council of State and Territorial Epidemiologists Vanderbilt University Electronic Medical Record and Genomics Network 9 Clinical Quality Measurement (67%) Clinical Data Registries Computable Clinical Phenotyping from EHRs Public Health Reporting Electronic Lab Reporting EHR Structured Documents (C-CDA) Reportable Conditions Alerts (RCKMS) National and International EHR Patient Summary Exchange 10 “As medical specialty societies develop new measures using standardized coding systems, they should strongly consider using the VSAC as a source for distributing and standardizing these specifications.”2 2CMSS Primer for the Development and Maturation of Specialty Society Clinical Data Registries January 2016 11 CMS creates the majority of current value sets as data elements for Clinical Quality Measures, per HITECH Meaningful Use Program. 12 13 14 Example API Call and Resulting XML Use Case Retrieve all value sets and metadata for CMS eMeasure ID CMS100v3 API Code GET https://vsac.nlm.nih.gov/vsac/svs/RetrieveMultipleValueSets?tagName=CMS eMeasure ID &tagValue=CMS100v3&ticket=ST-20430-X0nKrEe0fYel07mqtKMs-cas Resulting XML …truncated 15 16 17 18 (not shown: 23 code systems from HL7) 19 20 21 VSAC stakeholders need tooling that supports interactive and centralized collaboration among VSAC authors and collaborators, as well as notification of changes. 22 VSAC Collaboration provides a central content management site for teams to: • Share threaded discussions about value sets • View posted value set expansions • Organize value sets by team’s workflow • Receive VSAC Collaboration activity emails 23 24 CDC: Zika Virus CDC is leveraging NLM terminology expertise and value set code validation tools and the VSAC Collaboration Tool to support CDC and subject matter expert collaboration on Zika value sets that will support interoperable electronic exchange of clinical and epidemiological information. RCKMS: Reportable Conditions Division of Council of State and Territorial Epidemiologists (CSTE) who partner with CDC. Using Value Set Authoring and Collaboration Tools to electronically develop all 80 reportable disease conditions in support of a notifiable public health disease alert system under development by CSTE. 25 Logical Value Set Definitions Terminology Validation Fast Healthcare Interoperability Resources (FHIR) for Value Set Query and Exchange 26 27 28 1. Winnenburg R, Bodenreider O. Issues in creating and maintaining value sets for clinical quality measures. AMIA Annu Symp Proc 2012:988-996. 2. CMSS Primer for the Development and Maturation of Specialty Society Clinical Data Registries (V.1) January 2016 3. Khatipov E, Madden M, Chiang P, Chuang P, Nguyen D, D’Souza I, Winnenburg R, Bodenreider O, Skapik J, McClure R, Emrick S. Creating, maintaining and publishing value sets in the VSAC. [poster] AMIA Annu Symp Proc 2014:1459. 29 National Library of Medicine Aleksandr Aliyev Soheil Alemansour Vivian Auld Pishing Chiang Philip Chuang Andrea Demsey Steve Emrick Andrew Gurung Stanley Jia Rama Khanal Mikyung Lee Maureen Madden Duc Nguyen Rob McClure, M.D. -- NLM and ONC Terminology and Standards Consultant Centers for Medicare and Medicaid Services Office of the National Coordinator for Health Information Technology 30 31 93 Measures -mandated by CMS electronic health record incentives program 8-10 Value Sets per Measure (average) -data elements that define patient populations Example Measure Titles: -Appropriate Testing for Children with Pharyngitis -Controlling High Blood Pressure -Thrombolytic Therapy -Exclusive Breast Milk Feeding 32 CLINICAL QUALITY MEASURE (implementation) Hemoglobin A1c Test for Pediatric Patients List of LOINC codes Tests for HbA1c Numerator: # diabetic patients [age 5-17] tested for HbA1c Denominator: # diabetic patients [age 5-17] Data Element Type 1 or Type 2 diabetes [Excludes gestational diabetes] Requires date of birth List of SNOMED CT or ICD-10-CM codes 33