1. Standard Vocabularies in Health Care A Presentation Prepared for The Collaborative Expedition Workshop Kathy Lesh, RN, EdM, MS Technical 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