HIT Standards CommitteeHIT Standards Committee
Clinical Operations Workgroup, Vocabulary Task ForceUpdate on Vocabulary For Stage 2Update on Vocabulary For Stage 2
Jamie Ferguson, Kaiser Permanente
Betsy Humphreys, National Library of Medicine
18 May, 2011
2
Vocabulary Task Force – Current Priority
• ONC Requested Vocabulary Standards for Stage II/III– Medications for e-prescribing and medication allergies– Lab tests for results reporting and test orders– Problems for problem list documentation
• Assess Previous HITSC Vocabulary Recommendations– Whether Recommendation still valid– Readiness of Vocabulary and supporting technology– Feasibility of Industry-wide Implementation by 2013/2015
• General question: Can an EHR certification requirement precede precede a meaningful use requirement in order to facilitate adoption?
3
Medications for e-prescribing (1 of 2)
• RxNorm– RxNorm vocabulary is ready for adoption
• Coverage for prescription drugs nearly complete (CMS/Rand study)
• Distribution now includes NDF-RT
• Upcoming enhancements will aid implementers/data entry
– June 1st draft subset of approximation of prescription drugs currently marketed in US
» Will seek sources of data on frequently prescribed non-prescription drugs so these can be added
– Sept. 11 inclusion of RxTerms view, will allow grouping by general dose forms (e.g., Oral) in RxNorm
– Task Force Recommendation: Include four key elements of RxNorm in eRx (aligns with NCPDP recommendation):
• Semantic Clinical Drug (SCD); Semantic Branded Drug (SBD)
• Generic Package (GPCK); Branded Package (BPCK)
4
Medications for e-prescribing (2 of 2)
• Task Force Still Developing Recommendation on Timing and Industry Readiness for RxNorm– NCPDP members – expecting it and working toward it– Drug information providers – expecting it, mapping done or mostly done– Surescripts – getting ready to accept it, per recent conversation– Need more information on readiness of stakeholders:
• EHR vendors• Medium and Large provider organizations • Other relevant stakeholders
• Current use of “Proxy” NDCs very undesirable• Addition of frequently prescribed OTC meds needed• NLM RxNorm eRx subset – piloting, evaluation?
5
Medication Allergies
• Task Force Recommendations Under Development, Discussions To Date:
• RxNorm– Specific components: Ingredient (active), SCD, SBD,
GPCK, BPCK
• UNII– Inactive ingredients used in medications
6
Lab Results and Orders
• Task Force Will Consider Lab Recommendations Next After Medications
• LOINC recommended previously for results– Recommendations also included SNOMED CT e.g. organisms
• Lab Order vocabulary will require significant input, analysis and coordination– Coordination w/ future standardization of order messaging – Clarification of objectives is needed:
• Standardized messaging representation of current mixed codes
• vs. Standard order codes
– Key issue for lab orders: Industry migration to unique test orders
7
Problem List
• Task Force To Review And Develop Problem List Recommendations After Lab Recommendations
• Previous HITSC Recommendations for Problem List– SNOMED CT or ICD-9 for Stage 1– SNOMED CT or ICD-10 for Stage 2 (timing per HIPAA)– SNOMED CT alone for Stage 3
• Key Issue For Problem List Subsets: – Problem List For Problems (e.g. Findings and Disorders) – vs. Problem List As A Catch-All (e.g. Procedures, Medications,
Other Orders, Regimes/ Therapies, Etc.)