1. HIT Standards Committee Clinical Quality Workgroup and Vocabulary Task Force Wednesday, July 20, 2011 Jim Walker and Jamie Ferguson, Chairs Karen Kmetik and Betsy Humphreys, Co-Chairs

2. Vocabulary Task Force Members Chair: Jamie FergusonKaiser Permanente Co-Chair:Betsy HumphreysNational Library of Medicine Members Donald BechtelAccredited Standards Organization X12 Lisa CarnehanNIST Christopher ChuteMayo Clinic Bob DolinHL7 Floyd EisenbergNational Quality Forum Patricia GreimVeterans Affairs John HalamkaHarvard Medical School Stan HuffIntermountain Healthcare John KlimekNCPDP Clem McDonaldNational Library of Medicine Stuart NelsonNational Library of Medicine Marc OverhageRegenstrief Institute Marjorie RallinsAmerican Medical Association Dan VreemanRegenstrief Institute Jim WalkerGeisinger Andrew WiesenthalIHTSDO (SNOMED) Federal Ex Officio Chris BrancatoHHS/ONCGreg DowningHHS Doug FridsmaHHS/ONC Marjorie GreenbergHHS/CDC Amy GruberCMS 2

3. Clinical Quality Workgroup Members Chair: James WalkerGeisinger Health System Co-Chair:Karen KmetikAmerican Medical Association Members David BakerNorthwestern University Anne CastroBlueCross BlueShield of South Carolina Christopher ChuteMayo Clinic John DerrGolden Living, LLC Bob DolinHL7 Floyd EisenbergNQF Rosemary KennedyThomas Jefferson University David LanskyPacific Business Group on Health Gene NelsonDartmouth University Eva PowellNational Partnership Philip RennerKaiser Permanente Danny RosenthalInova Health System Joachim RoskiBrookings Institution Federal Ex Officio Jon White, AHRQ Aneel Advani, Indian Health Service, HHS Patrice Holtz, CMS, HHS TBD, CDC, HHS 3

4. CODE SET SELECTION Joint review to assign code set(s) to the fundamental concepts in the NQF’s Quality Data Model v.3 (QDM) Preparatory Interviews –Task force and work group members –Measure developers –Other subject matter experts Three joint meetings June 20, 29, and July 15. 4

5. Identify potential problems with this set of recommendations (Final presentation is scheduled for August). Questions to be Answered by HITSC 5

6. Types of Vocabulary Recommendations 1.Measures Development 2.HIT Certification 3.Meaningful Use 6

7. 1. Measures Development a.Limit code sets used for measures. b.Use of the code set may be limited to partial depth (e.g., ISO 639-2). c.Purpose-specific sub-sets of code sets will be needed. 7

8. 2. HIT Certification a.Certified HIT shall be able to process all legal codes in the code set for a given concept (e.g., Adverse Effect). 8

9. 3. Meaningful Use (reimbursable) a.Only code sets required in HIT certification shall be required for Meaningful Use reimbursement. 9

10. Recommended Code Sets Adverse Drug Effect (allergy or non-allergy) –RxNorm for Medications (inactive ingredients to be added) –SNOMED CT for non-medication substances –SNOMED-CT for Adverse Effect 10

11. Patient Characteristics –ISO 639-2 for Preferred Language –HL7 for Administrative Gender –PHIN-VADS for Race & Ethnicity –LOINC for assessment instruments (“questions”) –SNOMED-CT for appropriate responses (“answers”), including behaviors, psychosocial resources, and tobacco use –Socio-economic Status - referred to CMS for clarification of request (in the absence of widely accepted typologies) –Payer typology – Confirming the aptness of ANSI ASC X12 and the Payer Typology with CMS. 11 Recommended Code Sets

12. Condition/Diagnosis/Problem (active and inactive) –SNOMED-CT Device –SNOMED-CT (for now) Non-laboratory diagnostic study results –LOINC for specific study name –SNOMED-CT for appropriate findings –UCUM for units Patient-Professional Interaction (“Encounter”) –SNOMED-CT Communication –SNOMED-CT 12 Recommended Code Sets

13. Patient Experience –LOINC for surveys –SNOMED-CT for appropriate responses Family History –LOINC for surveys –SNOMED-CT for appropriate responses Functional status –ICF (International Classification of Functioning, Disability, and Health) for categories of function –LOINC for assessment tools and individual functions 13 Recommended Code Sets

14. HIT Components –LOINC for components –HL7 for messaging among systems Interventions (forming one end of a spectrum with Procedures) –LOINC for interactions that produce an assessment or measurable results –SNOMED-CT—for appropriate results and interventions that do not produce measurable results (e.g., counseling) Procedures –SNOMED-CT 14 Recommended Code Sets

15. Laboratory test –LOINC for lab name and results –SNOMED-CT for appropriate results –UCUM for units of Measures Medication (including vaccines) –RxNorm Physical Exam –LOINC for component (“question”) –SNOMED-CT for appropriate observations (“answer”) 15 Recommended Code Sets

16. Patient Preferences –LOINC for surveys –SNOMED-CT for appropriate responses Risk Assessment –LOINC Symptoms –SNOMED-CT System resources –LOINC and HL7 Transfer –SNOMED-CT 16 Recommended Code Sets