Transcript Standard Vocabularies in Health Care

Standard Vocabularies in Health Care
A Presentation Prepared for
The Collaborative Expedition Workshop
Kathy Lesh, RN, EdM, MS
Technical Manager
Clinical Informatics
9 December 2004
Goals
•Introduce to current vocabulary standards initiatives in the US
•Provide a basic overview of vocabularies recommended as
standards
•Provide some ideas as to where these initiatives are going
•Feel free to ask questions
•Email me if you would like a copy of this presentation
Definitions
• Vocabulary – words used in a language
• Terminology – used as synonym to vocabulary
• Controlled vocabulary - a standard system of terminology
used for coding, classifying or otherwise uniquely identifying
data and information
• Thesaurus – a controlled vocabulary arranged in a known
order (ANSI/NISO Z39.19)
• Taxonomy – a hierarchical classification of things using the
“is_a” relationship
Standard vocabulary
• May be a controlled vocabulary, thesaurus or taxonomy
• Is adopted by a group
• Not necessarily developed or adopted by a Standards
Development Organization
Standards Development Organization
• ANSI
– ANSI administers and coordinates the U.S. voluntary standardization
and conformity assessment system
– ANSI HISB
• Standards Council of Canada
• ISO TC 215 Workgroup 3 - Health concept representation
– ISO/TS 17117:2002 Controlled health terminology -- Structure and
high-level indicators
– ISO 18104:2003 Integration of a reference terminology model for
nursing
Vocabulary-related SDOs
• HL7
• College of American Pathologists
• National Council for Prescription Drug Programs
• Hummmm, who’s missing???
Health information technology standards
initiatives
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CHI – Consolidated Health Initiative
NCVHS Patient Medical Record Information
Institute of Medicine – patient safety standards
Connecting for Health/e-Health Initiative
NHII – National Health Information Infrastructure
Consolidated Health Initiative- CHI
• Part of e-gov initiative
• Goal – to enable government agencies to share health
information
• Identified 24 domains
• Establish a portfolio of existing clinical vocabularies and
messaging standards for each of the 24 domains
National Committee on Vital and Health Statistics
• Public advisory body to the Secretary HHS regarding health
data, statistics, privacy and national health information policy
– Includes Administrative Simplification provisions of HIPAA
• HIPAA directed NCVHS to "study the issues related to the
adoption of uniform data standards for patient medical record
information and the electronic exchange of such information"
Institute of Medicine
• Data standards for Patient Safety
• Arose out of “To Error is Human: Building a Safer Health
System”
Connecting for Health/e- Health Initiative
• Markle Foundation and Robert Wood Johnson funding
• Public-private partnership
• Pushing adoption of health data standards
Recommended vocabulary standards for clinical
information
• SNOMED CT
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Anatomy
Nursing
Diagnosis and problem lists
Laboratory result contents
Non-laboratory interventions and procedures
• LOINC (Logical Observation Identifiers Names and Codes )
– Laboratory test order names
– Laboratory test result names
• NCBI Taxonomy
– Organism names for lab test results
Recommended vocabulary standards for clinical
information - continued
•HL7
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Laboratory test result units
Text based reports structure and syntax
Anatomy qualifiers
Clinical encounters
• ADT information
• Provider information
– Demographic information
– Immunizations
•NCI Thesaurus
– Anatomy in research – subcellular structures
Recommended vocabulary standards for clinical
information - continued
•Human Gene Nomenclature
– Gene names
•EPA’s Substance Registry System
– Chemicals
•HIPAA transactions and code sets
– Billing and financial information
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ICD-9-CM
CPT/CDT
NDCs
HCPCS
Recommended vocabulary standards for
clinical information - continued
•Medications
– Special populations – HL7
– Drug classification
• Physiological effect and mechanism of action – NDF-RT
– Clinical drug - RxNorm
– Manufactured dose form and Package– FDA/CDER Standards Manual
– Active ingredient - FDA Ingredient & Unique Ingredient Identifier
(UNII) codes
– Product - NDC
– Structured product label – LOINC Structured Product Labeling
Recommended vocabulary standards for clinical
information - continued
• No recommendations have been made in several areas
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Adverse events
Dosage and administration
Indications
Contraindications
Pharmacokinetics & pharmacodynamics
Disability
History and physical
Medical devices and supplies
Population health
Physiology
Proteins
Multimedia
What does this mean?
•NCVHS has concurred with the CHI recommendations with
minor exceptions
– Add International Classification for Primary Care to be used with
Diagnosis and Problem List
•To specifically answer their task, the NCVHS recommended of
“core set” of PMRI terminology standards
– SNOMED CT
– LOINC laboratory subset
– Federal drug terminologies – RxNorm, NDF-RT and FDA
What does this mean?
•The IOM report recommends following the CHI and NCVHS
recommendations
•Connecting for Health/e-Health Initiative are pushing for the
adoption of the recommendations
Where does one find these recommended
vocabularies?
• National Library of Medicine Unified Medical Language
System (UMLS) http://umlsks.nlm.nih.gov/kss/servlet/Turbine/template/admin,
user,KSS_login.vm
• FDA - http://www.fda.gov/cder/dsm/drg/Drg00907.htm
• EPA - http://www.epa.gov/srs/
Okay, now what do I do?
•Unfortunately, these are standards are not easily used “out of
the box”
•Currently, there is no one place to get all the recommended
vocabularies
•Currently, the vocabularies are not integrated
•Options:
– Hire someone to extract and integrate the vocabularies to meet your
needs - KEVRIC, for example
– Extract and integrate the vocabularies yourself
Okay, now what do I do?
•Fortunately, in their letters to the Secretary DHHS, the NCVHS
has recommended funding for some integration activities and that
the National Library of Medicine be the central repository
•OOPS – that’s only for the PMRI core set, not the CHI
recommendations
•Another option – wait until vendors do the work then buy their
product
The reality
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These are recommendations – not mandates
HOWEVER ….
The federal government would like this to be open source
Change in HHS administration could hinder or help this effort
The Bush administration supportive
– April, 2004 created a sub-Cabinet level position at DHHS
– National Health Information Technology Coordinator
– http://www.hhs.gov/healthit/
Stay tuned
•We believe that public health and environmental health
vocabularies will become part of the health vocabulary standards
initiative
•CDC is actively engaged in creating a Controlled Health
Thesaurus with plans to expand into a Public Health Ontology
– It will be open source
KEVRIC’s capabilities
•Numerous vocabulary-specific projects
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AHRQ-funded project with JCAHO
NIAID BISC
NCI Enterprise vocabulary system
CDC web redesign controlled health thesaurus
National Patient Safety Network
UMLS
NCHS – Verity lexicon expansion
Highlighted Project:
Prototype Ontology Development for NIAID - BISC
• Developed specifications for an immunology
ontological data model and vocabulary server for
NIAID - Bioinformatics Integration Support Contract.
• Adopted NCI Thesaurus and customized for NIAID
usage.
• Merged and generalized MGED Ontology for
modeling data related to experiments.
• Developed and integrated an in-house immune
disorder tree.
• Inserted and modeled immunology-related genes.
• Supported targeted applications by modeling concepts
related to data elements.
NIAID Ontology Prototype in Protégé
Thank you
Kathy Lesh
[email protected]
Paul Koch
[email protected]