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.)