Standard Vocabularies in Health Care A Presentation Prepared for

1. Standard Vocabularies in Health Care A Presentation Prepared for The Collaborative Expedition Workshop Kathy Lesh, RN, EdM, MSTechnical Manager Clinical Informatics 9 December 2004

2. Goals • Introduce to current vocabulary standards initiatives in the US • Provide a basic overview of vocabularies recommended as standards • Provide some ideas as to where these initiatives are going • Feel free to ask questions • Email me if you would like a copy of this presentation

3. Definitions • Vocabulary – words used in a language • Terminology – used as synonym to vocabulary • Controlled vocabulary - a standard system of terminology used for coding, classifying or otherwise uniquely identifying data and information • Thesaurus – a controlled vocabulary arranged in a known order (ANSI/NISO Z39.19) • Taxonomy – a hierarchical classification of things using the “is_a” relationship

4. Standard vocabulary • May be a controlled vocabulary, thesaurus or taxonomy • Is adopted by a group • Not necessarily developed or adopted by a Standards Development Organization

5. Standards Development Organization • ANSI • ANSI administers and coordinates the U.S. voluntary standardization and conformity assessment system • ANSI HISB • Standards Council of Canada • ISO TC 215 Workgroup 3 - Health concept representation • ISO/TS 17117:2002 Controlled health terminology -- Structure and high-level indicators • ISO 18104:2003 Integration of a reference terminology model for nursing

6. Vocabulary-related SDOs • HL7 • College of American Pathologists • National Council for Prescription Drug Programs • Hummmm, who’s missing???

7. Health information technology standards initiatives • CHI – Consolidated Health Initiative • NCVHS Patient Medical Record Information • Institute of Medicine – patient safety standards • Connecting for Health/e-Health Initiative • NHII – National Health Information Infrastructure

8. Consolidated Health Initiative- CHI • Part of e-gov initiative • Goal – to enable government agencies to share health information • Identified 24 domains • Establish a portfolio of existing clinical vocabularies and messaging standards for each of the 24 domains

9. National Committee on Vital and Health Statistics • Public advisory body to the Secretary HHS regarding health data, statistics, privacy and national health information policy • Includes Administrative Simplification provisions of HIPAA • HIPAA directed NCVHS to "study the issues related to the adoption of uniform data standards for patient medical record information and the electronic exchange of such information"

10. Institute of Medicine • Data standards for Patient Safety • Arose out of “To Error is Human: Building a Safer Health System”

11. Connecting for Health/e- Health Initiative • Markle Foundation and Robert Wood Johnson funding • Public-private partnership • Pushing adoption of health data standards

12. Recommended vocabulary standards for clinical information • SNOMED CT • Anatomy • Nursing • Diagnosis and problem lists • Laboratory result contents • Non-laboratory interventions and procedures • LOINC (Logical Observation Identifiers Names and Codes ) • Laboratory test order names • Laboratory test result names • NCBI Taxonomy • Organism names for lab test results

13. Recommended vocabulary standards for clinical information - continued • HL7 • Laboratory test result units • Text based reports structure and syntax • Anatomy qualifiers • Clinical encounters • ADT information • Provider information • Demographic information • Immunizations • NCI Thesaurus • Anatomy in research – subcellular structures

14. Recommended vocabulary standards for clinical information - continued • Human Gene Nomenclature • Gene names • EPA’s Substance Registry System • Chemicals • HIPAA transactions and code sets • Billing and financial information • ICD-9-CM • CPT/CDT • NDCs • HCPCS

15. Recommended vocabulary standards for clinical information - continued • Medications • Special populations – HL7 • Drug classification • Physiological effect and mechanism of action – NDF-RT • Clinical drug - RxNorm • Manufactured dose form and Package– FDA/CDER Standards Manual • Active ingredient - FDA Ingredient & Unique Ingredient Identifier (UNII) codes • Product - NDC • Structured product label – LOINC Structured Product Labeling

16. Recommended vocabulary standards for clinical information - continued • No recommendations have been made in several areas • Adverse events • Dosage and administration • Indications • Contraindications • Pharmacokinetics & pharmacodynamics • Disability • History and physical • Medical devices and supplies • Population health • Physiology • Proteins • Multimedia

17. What does this mean? • NCVHS has concurred with the CHI recommendations with minor exceptions • Add International Classification for Primary Care to be used with Diagnosis and Problem List • To specifically answer their task, the NCVHS recommended of “core set” of PMRI terminology standards • SNOMED CT • LOINC laboratory subset • Federal drug terminologies – RxNorm, NDF-RT and FDA

18. What does this mean? • The IOM report recommends following the CHI and NCVHS recommendations • Connecting for Health/e-Health Initiative are pushing for the adoption of the recommendations

19. Where does one find these recommended vocabularies? • National Library of Medicine Unified Medical Language System (UMLS) - http://umlsks.nlm.nih.gov/kss/servlet/Turbine/template/admin,user,KSS_login.vm • FDA - http://www.fda.gov/cder/dsm/drg/Drg00907.htm • EPA - http://www.epa.gov/srs/

20. Okay, now what do I do? • Unfortunately, these are standards are not easily used “out of the box” • Currently, there is no one place to get all the recommended vocabularies • Currently, the vocabularies are not integrated • Options: • Hire someone to extract and integrate the vocabularies to meet your needs - KEVRIC, for example • Extract and integrate the vocabularies yourself

21. Okay, now what do I do? • Fortunately, in their letters to the Secretary DHHS, the NCVHS has recommended funding for some integration activities and that the National Library of Medicine be the central repository • OOPS – that’s only for the PMRI core set, not the CHI recommendations • Another option – wait until vendors do the work then buy their product

22. The reality • These are recommendations – not mandates • HOWEVER …. • The federal government would like this to be open source • Change in HHS administration could hinder or help this effort • The Bush administration supportive • April, 2004 created a sub-Cabinet level position at DHHS • National Health Information Technology Coordinator • http://www.hhs.gov/healthit/

23. Stay tuned • We believe that public health and environmental health vocabularies will become part of the health vocabulary standards initiative • CDC is actively engaged in creating a Controlled Health Thesaurus with plans to expand into a Public Health Ontology • It will be open source

24. KEVRIC’s capabilities • Numerous vocabulary-specific projects • AHRQ-funded project with JCAHO • NIAID BISC • NCI Enterprise vocabulary system • CDC web redesign controlled health thesaurus • National Patient Safety Network • UMLS • NCHS – Verity lexicon expansion

25. Highlighted Project:Prototype Ontology Development for NIAID - BISC • Developed specifications for an immunology ontological data model and vocabulary server for NIAID - Bioinformatics Integration Support Contract. • Adopted NCI Thesaurus and customized for NIAID usage. • Merged and generalized MGED Ontology for modeling data related to experiments. • Developed and integrated an in-house immune disorder tree. • Inserted and modeled immunology-related genes. • Supported targeted applications by modeling concepts related to data elements.

26. NIAID Ontology Prototype in Protégé

27. Thank you Kathy Lesh klesh@kevric.com Paul Koch pkoch@kevric.com