PHIN VADS Webinar Series Part 3 – Universal Authoring Framework (UAF)

1. PHIN VADS Webinar Series Part 3 – Universal Authoring Framework (UAF) December 3rd , 2010

2. Agenda • Vocabulary Governance / Standards • Universal Authoring Framework Overview • Demonstration • Q&A 2010 Webinar Series

3. Vocabulary Definitions & Examples

4. Code System – SDO Vocabulary

5. Code System Concept Metadata Synonyms Legacy SNOMED concept code Relationship 2010 Webinar Series

6. Value Set 2010 Webinar Series

7. Value Set Concept 2010 Webinar Series

8. Vocabulary View (Messaging Guides) “Vocabulary View” refers to a collection of value sets associated with a HL7 messaging guide or CDA. View is also versioned and can be downloaded as a zip file. View can also be accessed using web services. 2010 Webinar Series

9. Vocabulary View Metadata 2010 Webinar Series

10. Vocabulary Group 2010 Webinar Series

11. Vocabulary Group Metadata “Vocabulary Groups” includes only the latest version of a value set 2010 Webinar Series

12. Vocabulary Object Identifiers (OID) Vocabulary OID Management & Publishing 2010 Webinar Series

13. Code System Concept – Standards overlap & Usage Context Retired SNOMED Concepts 2010 Webinar Series

14. Standards adopted by PHIN VADS • White House E-Gov Consolidated Health Informatics (CHI): • Domain recommendations provided guidance regarding the selection of code system. Health Information Technology Standards Panel (HITSP): C80:Clinical Document and Message Terminology Component defines the vocabulary (value sets) for all the HITSP interoperability Specifications (IS). Meaningful Use (MU): The Office of National Coordinator (ONC) for Health Information Technology - Standards and Certification Criteria for Electronic Health Records ISO 11179 Metadata and HL7 Common Terminology Services (CTS) HL7 Vocabulary Technical Committee

15. PHIN VADS Users • CDC programs • State and local health departments • HL7 Messaging Guide – Value set implementers • Epidemiologists • Healthcare Providers including labs and hospitals • Value set and quality measure developers • Standard Development Organization (SDO) – for SDO issues. • Standard harmonization and recommendations workgroups, Community of Practice (CRSWg, VMCoP, LMCoP) • EMR and public health application vendors • Public health applications (EpiInfo, PHIN MSS, PHIN MQF) 2010 Webinar Series

16. CDC Vocabulary & Messaging Governance Panel • CDC Vocabulary & Messaging Team • CDC Common Data Store Team (Data Storage) • Data Message Brokering team (Routing and Translation) • NNDSS team (Data Analysis) • CDC programs & Divisions including CDC NCHS (Content) • State Public Health Dept (Implementation issues) • SDO SME Rep (only to discuss SDO issues) • CDC Partners (APHL, PHDSC, etc..) • UMLS – to discuss about SDO issues (LOINC, SNOMED, etc..) • Other Federal Agencies (USHIK, VA, NCI, FDA, EPA, NLM, DoD) to discuss about collaboration. 2010 Webinar Series

17. Functions of CDC Vocabulary & Messaging Governance Panel • Content publishing schedule & prioritization issues • SDO standards related issues • Selection of a standard for value set • Users access to VADS value set authoring tool (UAF) • Implementation issues related to Vocabulary & Messaging • PHIN VADS application enhancements and its priority 2010 Webinar Series

18. Public Health Meaningful Use Measures Vocabulary • Vocabulary & Messaging Community of Practice (VMCoP) webinars related to Meaningful Use (stage 1) can be found at VMCoP online forum (phConnect): 1) Syndromic Surveillance (October 28th 2010) 2) Electronic Laboratory Reporting (September 21st, 2010) 3) Immunization (August 17th , 2010) • PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary: • MU Stage 1- Immunization HL7 2.5.1 IG Vocabulary • MU Stage 1- ELR HL7 2.5.1 IG Vocabulary • MU Stage 1 – Value sets related to Syndromic Surveillance are available in PHIN VADS and the vocabulary view would be created in Dec 2010 2010 Webinar Series

19. SDO Vocabulary Tools • Standard Development Organization (SDO) vocabulary tools can be used for browsing and searching the code system concepts as well as mapping of local vocabulary. • LOINC – RELMA , Web search • SNOMED CT– National Library of Medicine (NLM) list of SNOMED browsers , NLM SNOMED CT browser, Virginia Tech SNOMED browser • RxNorm – RxNav from NLM • HL7 Tools & vocabulary resources • ICD-9 CM & ICF – CDC National Center for Health Statistics (NCHS) and WHO • Demographics (Geocodes) – USGS GNIS 2010 Webinar Series

20. Vocabulary Distribution Portals • NLM Unified Medical Language System (UMLS) • SDO vocabulary (RxNorm, SNOMED), mapping between standards, Metamorphosys, UTS, etc.. • Centers for Disease Control & Prevention (PHIN VADS) • Public health & clinical care value sets, HL7 Messaging IG value sets distribution, web services, .. • National Cancer Institute (NCI) – Enterprise Vocabulary Services (EVS) • Cancer domain, NCI Metathesaurus, FDA vocabulary (SPL, UNII), Gene (HUGO, GO), etc.. • Environment Protection Agency (EPA) – Substance Registry System (SRS) • Substance (Chemical, Physical, Biological), Map to CAS #, vocabulary (Air, Water, Soil), etc… • Agency for Healthcare Research & Quality – United States Health Information Knowledgebase (USHIK) • Metadata registry of healthcare data elements and information models of SDOs, HITSP, … • Mayo Clinic - LexGrid , LexBig, LexWiki • Distributed network of terminologies and ontologies using std. tools, web services (HL7 CTS), … • Washington Publishing Company (WPC) – Taxonomy browser & file server • Code lists supporting administrative data – X12, NUCC, HIPAA, etc… • Commercial Terminology Distribution (Vendors) 2010 Webinar Series

21. What is PHIN VADS? • In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within the PHIN and NHIN. • Provides all the vocabulary metadata needed for HL7 messaging. • Promotes sharing and reusing of the value sets. • Hosts multiple versions of value sets that allow implementers to have access to the current, past and the future versions of value sets and value set collections • Provides web services (API) that allows HL7 interface engines, medical and public health applications to obtain the value sets as well as validate the vocabulary present in HL7 messages. • Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards. • PHIN VADS can be accessed at a public web site - http://phinvads.cdc.gov • CDC Vocabulary and Messaging team manages the PHIN VADS. 2010 Webinar Series

22. Purpose and Usage of VADS • Distributes the value sets associated with the public health HL7 messaging (V2.x, V3) & CDA implementation guides. • CDC as SDO maintains and distributes the code system such as Vaccine names (CVX), Vaccine manufacturers (MVX), Race & Ethnicity, Healthcare Service Locations and Nationally Notifiable Disease/Conditions (NND) using VADS. • Facilitates the routing and filtering of HL7 messages and can be easily integrated with any medical or public health applications using VADS web services (API) • Develops & distributes HL7 messaging value sets associated with: • Electronic Laboratory Reporting (ELR)* • Immunization* • Syndromic Surveillance* • Public Health Case Reporting • Public Health Case Notification (infectious & non-infectious) • NHSN Healthcare Associated Infections (HAI) • Cancer Registry (Anatomic Pathology Reports) • Clinical Quality Measures reportable to public health* (e.g. Diabetes control)* Meaningful Use Stage 1 measure 2010 Webinar Series

23. PHIN VADS Content • Currently, PHIN VADS has 592 value sets supporting 60 HL7 and CDA message implementation guides. The PHIN VADS hosts both the intrinsic and extrinsic value sets. • PHIN VADS also hosts 149 SDO code systems that are used by HL7 messaging value sets. Many of the code systems (~ 120) belong to HL7 v2.x or V3. • PHIN VADS updates the value sets often based upon SDO code system updates. • PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary: • MU Stage 1- Immunization HL7 2.5.1 IG Vocabulary • MU Stage 1- ELR HL7 2.5.1 IG Vocabulary • MU Stage 1 – Value sets related to Syndromic Surveillance 2010 Webinar Series

24. PHIN VADS Content Access • PHIN VADS can be accessed using one of the following methods: • PHIN VADS Web Browser. • PHIN VADS Web Service – System to System exchange of vocabulary data. • PHIN VADS Lite – Local instance of VADS web services and database 2010 Webinar Series

25. PHIN VADS Framework 2010 Webinar Series

26. PHIN VADS Web User Interface • PHIN VADS web browser is the most commonly used method for browsing, searching and downloading the public health value sets. • PHIN VADS web site – http://phinvads.cdc.gov • Users have an option to download PHIN VADS value sets using Microsoft Excel or tab-delimited text format. PHIN VADS web user interface is complaint with web accessibility section 508.   • PHIN VADS allows the users to bookmark the value sets, code systems, concepts, vocabulary views and groups. PHIN VADS vocabulary view bookmarks are usually included in the HL7 message implementation guide that allows the implementers to access the messaging vocabulary associated with implementation guide easily. • Browser compatibility • Internet Explorer 7 and above • FireFox version 3.0 and above 2010 Webinar Series

27. PHIN VADS Web Services: System-to-System Exchange of vocabulary data Get Value Set Get Value Set Concepts Get All Views Find Concept VADS Web Application Web Browser Validate Concept VADS Web Services • The PHIN VADS web application is built upon the PHIN VADS web services. • When using the PHIN VADS application, the web services are used indirectly. • These web services are public and built upon open standards (HL7 CTS2 , IHE SVS). • Sample code and a detailed API are available in the PHIN VADS Developer’s Toolkit - http://phinvads.cdc.gov/vads/developersGuide.action

28. PHIN VADS Lite • Allows any individual or organization to implement a local instance of the VADS service and database. • The VADS Lite deployment is available for Oracle and Microsoft SQL Server. • VADS Lite is not deployed with a User Interface • The deployment model requires the users to download, install, and maintain a local installation on their hardware. Vocabulary Server with Application Programming Interface (API) may allow the vendors or implementers to integrate the vocabulary server with their application. • E.g. NEDSS Messaging Subscription Service application includes PHIN VADS vocabulary server and Orion Rhapsody that will help validate HL7 messages and assist mapping between local and standard terminology. 2010 Webinar Series

29. Custom Downloader Example • PHIN VADS custom downloader can be used like a shopping cart for downloading the VADS content. • Useful tool especially for generating custom reports and queries from PHIN VADS database. • Can be easily executed by non-technical people (Epidemiologist, Clinicians, Quality Measure Developers, Value set creators, etc..) • Allows to download several value sets into a single file. This helps the implementers to import value set collections into a database. • Uses VADS web services to query the VADS database. • Value set and quality developers can use this tool to develop the intrinsic value sets using the hierarchical relationships from SDO vocabulary such as SNOMED. • Download this tool from VADS online forum (phConnect) 2010 Webinar Series

30. Value Set Authoring – Universal Authoring Framework (UAF) UAF – A Distributed Terminology Development Environment • A web-based thin client distributed environment which allows for vocabulary authoring and publishing. • Provides Versioning Capability for Vocabulary Objects. • Provides historical tracking of database updates. • Allows multiple users to author data simultaneously via the Change Event. • Allows for vocabulary updates via the web services.  2010 Webinar Series

31. UAF Usage • UAF is currently available to CDC partners, value set creator and quality measure developers who are involved in the development and management of the value sets present in PHIN VADS. • UAF has most of the code systems suggested by Consolidated Health Informatics (CHI) for various domains. • Allows vocabulary specialists to either enumerate the value set concepts or provide the logic for creating the intrinsic value set. • Allows programs to select a particular version of the value set to be associated with the messaging vocabulary view. • Allows programs to create / import code systems which include the concepts, relationships, alternate designations, and extended properties. • Allows authoring the local code systems as well as CDC code systems that has been adopted by standards such as HL7. (E.g. CVX, MVX, Nationally Notifiable Disease). 2010 Webinar Series

32. Value Set Maintenance (Versioning) • Change Event Model: • PHIN VADS maintains the past, current and future versions of a value set. • Provides a historical record of all changes made to an object over time. • Each change is stored as a delta from prior version to proposed version. • . 2010 Webinar Series

33. UAF Security & Role 2010 Webinar Series

34. UAF Security & Role 2010 Webinar Series

35. How to request UAF access? • Request access along with access level desired by sending an email to the CDC Vocabulary & Messaging team at phinvs@cdc.gov. • Please note that desired access level cannot be guaranteed for the user. Vocabulary & Messaging Governance Panel will carefully analyze each request to determine level of access • Once approved, user will be sent instructions to complete formalities to have a SAMS account created • An id will also be created for the user in the UAF application • Once SAMS account is created and approved for the user, they will be notified by email. The user will also be notified of the appropriate access level approved for them by the CDC Vocabulary & Messaging Governance Panel. 2010 Webinar Series

36. UAF Training & Orientation • UAF Training • Standards Selection Guidance • CDC Vocabulary & Messaging Team Support • New SDO concept request process • Communication about timeline for publishing in PHIN VADS • CDC Vocabulary & Messaging Team Governance Meetings (optional) 2010 Webinar Series

37. PHIN VADS Vocabulary Updates • Notification about VADS, UAF update • E-mail: List Serv (VMCoP, HL7 PHER, PHIN) • VADS Online Forum • VMCoP monthly meetings • Frequency • Quarterly • On-demand (e.g. Outbreak or Natural disasters) • Code System Update in UAF (LOINC, SNOMED) 2010 Webinar Series

38. PHIN VADS Support - phConnect PHIN VADS online forum URL: http://www.phconnect.org/group/phinvads E-mail: phinvs@cdc.gov 2010 Webinar Series

39. Demonstration

40. Demonstration • Code System Representation in VADS and standard selection guidance (Web site link) • OID Registry • CDC Local Coding System Usage • UAF Help Navigation • UAF Editor - Change Arboviral Value Set - Create a new value set (Flu Activity Code) - Create Code System (USDA Subject Descriptor) • UAF Publish Module

41. Questions

42. Acknowledgments • Sundak Ganesan – Lead Vocabulary Specialist • Sheila Abner – Vocabulary Specialist • Steve Eady – Tech Lead • Prosenjit Dutta – Developer • Scott Keller – Database Analyst • Cathy Lester – Quality Assurance/Tester • Vanessa Fernandez – Business Analyst • Michael Pray – Project Manager • Mark Winarsky & Gautam Kesarinath – CDC FTE Program Managers • Nikolay Lipskiy – CDC FTE lead for SDO standards 2010 Webinar Series

43. Appendix 2010 Webinar Series

44. Vocabulary Basics - Resources • Resources • PHIN VADS Help – FAQ and Glossary • HL7 Vocabulary TC • Good Vocabulary Practice Guide (May 2000) • Core principles and properties of V3 (Sept 2010 Ballot) • HL7 OID Registry • Federal Health IT - Vocabulary Task Force • Health Information Technology Standards Panel (HITSP) – C80 Messaging Terminology 2010 Webinar Series

45. HIT VTF Testimony (Sept 1st and 2nd 2010)- One Stop Shopping Theme Web site links • Meeting Audio for September 1, 2010 [MP3 - 34.3 MB] • Meeting Transcript for September 1, 2010 [PDF - 508 KB] • Meeting Audio for September 2, 2010 [MP3 - 18.1 MB] • Meeting Transcript for September 2, 2010 [PDF - 287 KB] 2010 Webinar Series

46. VTF Testimony (March 23rd 2010)- Governance of Value Sets (Govt. Agencies) Web site links • Meeting Audio [MP3 - 47 MB] • Meeting Transcript [PDF - 566 KB] 2010 Webinar Series

47. VTF Testimony (February 23rd 2010)- Governance of Value Sets (Vendors & SDO) Web site links • Meeting Audio [MP3 - 30 MB] • Meeting Transcript [PDF - 490 KB] 2010 Webinar Series

48. CDC Interoperability Tools (Case Notification) 2010 Webinar Series

49. OID Request CDC is plan on publishing all the vocabulary OID’s in HL7 OID registry.

50. PHIN VADS Change Control Model • Allows locking of a subset of the data model to be edited. • Change Control Model provides a mechanism for governance of edits to VADS data. • Organizes edits to subsets of the data structure, such as Code System, Value Set, Vocabulary Views, etc. • Edits to VADS are checked against business rules, then applied as a group to the actual tables • Completed edits are moved via XML as a Change Control Package to the Review and Production environments. • Each change control package contains the original vocabulary item as well as its changes. This can be used for reports later. • The Change Control Package provides an audit trail. 2010 Webinar Series