Transcript Value Set Authority Center

Maureen M. Madden
Value Set Authority Center Coordinator
National Library of Medicine, National Institutes of Health
U.S. Department of Health and Human Services
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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.
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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)
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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
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 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
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
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.
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 Federal Agency Programs
 Standards Development Organizations (HL7)
 Medical Specialty Organizations
 Research Groups
 Local Health Providers and Hospitals
 Public Health Agencies
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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
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 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
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“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
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 CMS creates the majority of current value sets as data
elements for Clinical Quality Measures, per HITECH
Meaningful Use Program.
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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
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(not shown: 23 code systems from HL7)
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VSAC stakeholders need tooling that supports
interactive and centralized collaboration among VSAC
authors and collaborators, as well as notification of
changes.
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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
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 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.
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 Logical Value Set Definitions
 Terminology Validation
 Fast Healthcare Interoperability Resources (FHIR)
for Value Set Query and Exchange
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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.
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
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

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 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
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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
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