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HIT Standards Committee. Clinical Operations Workgroup, Vocabulary Task Force Update on Vocabulary For Stage 2 Jamie Ferguson, Kaiser Permanente Betsy Humphreys, National Library of Medicine 18 May, 2011. Vocabulary Task Force – Current Priority.
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HIT Standards Committee Clinical Operations Workgroup, Vocabulary Task Force Update on Vocabulary For Stage 2 Jamie Ferguson, Kaiser Permanente Betsy Humphreys, National Library of Medicine 18 May, 2011
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 a meaningful use requirement in order to facilitate adoption?
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)
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?
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
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
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.)
