1. Meaningful Use 2014 New Setup Options
Universal Identifiers
HIS Mapping
SNOMED CT
LOINC Dictionary
And Specimens
Roger Hearn
Ask how many people are in the process of upgrading to 2014 Edition EHR certified Lab or 4.5?
Attended other seminar on MU new Fields?

2. What is Meaningful Use and Why?
MU is about the certification of Healthcare Information Systems that conform to set standards.
MU is about applying these Certified Systems in healthcare to achieve:
Interoperability
Improved Care and Outcomes
Enhanced Public Health Systems and Medical Research Data
And eventually cost savings
MU is about using Standards such as HL structured messages, standard tables, as we will see in HIS Mapping SNOMED codes and LOINCs so everyone is speaking the same language.
MU is about moving doctors and hospital out of the paper age into the 21st century
MU is about Interoperability so that divergent systems can talk to one another.
MU is about Public Health agencies that can track infectious outbreaks in real time and act proactively
MU is about building a database of diseases and conditions to accelerate medical research breakthroughs.

3. Today’s 3 Objectives
Remove any mystery regarding the new Setup Options.
Get comfortable with how and when they are used.
Jump into “as complex as it gets” and perhaps find out it’s not so bad.
Number 1 is all ready achieved by looking at this screenshot from our Setup.
Outline each one:
Simplify this right at the get go. First 2 are true “Setup’s” others are really just dictionaries.
Dictionaries or Tables where system goes when given a code to get the dictionary ID, version and code description to be sent with messages outbound. There are no edit options, they are read only.

4. New MU Setup Options are in one Window with Four Tabs

5. Universal Identifiers (UID’s) also known as “OIDS”
They provide unique universal identities to people, places and things
The ID is a string of numbers and decimals issued by official Registries, for example SoftLab’s “ISO” UID is
Used to uniquely identify
MRN’S and Order numbers,
Codes for Doctors and Clinics
IT Systems, software and messages
These numbers are a unique root identifier requested by organizations who then assign further
Branches to this root as required within their organization.

6. Common OID or UID Registries
Authorized agents that assign UID’s
HL7
ISO (International Standards Org)
IANA (supplies internet IP addresses)
NIST (National Institute of Standards and Technology)
CLIA numbers can be used for Labs
NPI for Doctors
SO your computer IP address is an OID

7. Vendor-provided UID’s
Software Vendor ………………SCC
Sending Application ………………SCC
Receiving Application ………………EHR
MRN Assigning Authority ……………EHR
Order Numbers (Placer/Filler)…… SCC, EHR
EHR in this case would be your Facility’s HIS such as Epic

8. Client Supplied UID’s Sending Facility Receiving Facility
MRN Assigning Facility
Contact Organization code Assigning Authority
Ordering Facility code Assigning Authority
User ID (result interpreter) Assigning Authority
Performing Organization code Assigning Authority
Doctor code Assigning Facility
Doctor code Assigning Authority
From a SCC standpoint these Identifiers are not required, but we must provide the capacity.
Your own MU attestation and internal directives should guide you.

9. Adding a new Universal ID for the Medical Records Number
Besides the long number punctuated with periods, the system sends and receives the Namespace ID and the UID Type, which is the Registering organization.

10. UID data is entered for the EHR system issuing the MRNs
(Repeat fields being entered)

11. The Record is Saved…
Note: MRN assigning authority may be sent through an ADT message or generated from Clinic setup.

12. SNUGINCONLINE.ORG
For a comprehensive document that explains OID’s (Universal Identifiers) and their application in and HL HIS and ELR interfaces for 2014 Certified Versions
Two separate docs one for and one for The profile message structure for 4.5 is slightly different and did not requires that we build such a vigorous structure for UID’s. In other words fewer places in software and message that they may be needed.

13. HIS MAPPING
HIS Mapping stores universally accepted tables of terms for such things as Ethnicity, Relationships and Specimen Types and converts your internal name or code to its corresponding universal name and code. Along with these codes the system sends the table ID and description.
We will return to HIS Mapping later to delve into deeper detail.

14. SNOMED CT (Dictionary)
Systematized Nomenclature of Medicine – Clinical Terminology
it is available at no cost through the National Library of Medicine website.
It is the most comprehensive clinical vocabulary available and composed of ¾ of a million terms.
SNOMED-CT is expected to enhance the accuracy of patient data analysis.
It is structured into “hierarchies” – 19 of them -- These hierarchies are then broken down through a tree structure into finer branches , resulting in very specific clinical concepts (concept ID) to define a medical term such as an organism in microbiology or a specimen type in Lab. System uses and sends the Concept ID, not the SNOMED code.
This table is used to find the matching Concept ID and sends the concept ID description and dictionary name and version present.

15. LOINC Dictionary Logical Observation Identifiers of Names And Codes
Composed of only 60,000 terms for clinical observations such as lab tests. Only 3800 are commonly used.
Its purpose is to standardize test codes for patient care, management and research.
Also free from LOINC.org. New terms are added every June and Dec, but codes and names are never changed.
(Show next slide where loincs are found in test setup)
Within its name it communicates the analyte, measure type, sample type, any timing or duration, and whether it is quant/qual/etc.

16. LOINCS are added in Test Setup
The system will take the LOINC associated with the scc test ID, find it in the LOINC dictionary and send the LOINC with its associated name and the dictionary version.

17. Returning to HIS Mapping courtesy of MU New Specimen functionality
(Ask how many people are using Settings and Definitions?)
These drop down choices found in fields such as race, sex, species are defined in S&D. So they can be edited by users vs previous “help files”
These drop down values are also known as internal or local codes. HIS Mapping will translate these local codes to MU acceptable universal codes. Let’s use Specimen type as an example to explore some new MU functionality and follow it from specimens in Order Entry and back to HIS Mapping.

18. OE > Specimen Tab > Collect Info button opens a NEW window with many new MU required Specimen attributes
Remember you are not compelled to fill or even use these fields, but we were required to make them available.
For our example lets use the internal code of CAPF, which is filter paper used to collect blood from a baby’s heel stick. For purposes of this example, lets say for our HIS system we use the standard HL7 table for specimen types. But our state public health department requires the concept ID’s from SNOMED. Our certified ELR interface is used to automatically send qualifying results to the reporting agencies.

19. Adding the CAPF internal code to HIS Mapping for ELR
Selecting the Category “Specimen Type”.
And the
SCT (SNOMED) “Coding System”
For the
ELR Interface
And then Clicking Edit...
As an example, lets say that for you’re HIS system you send specimen types using local codes such as red tops

20. Adding the external concept ID for the specimen type “CAPF”.
Clicking on the green “+” sign opens a new window for adding new codes.
A drop downs exist for Coding System and Version.
We are adding our Internal or Local code and the external Code which is a SNOMED Concept Code, expected by the Public Health Department.

21. The Translation for CAPF to expected SNOMED ID is complete.

22. Additional MU Setup Time permitting…
MU Specimen Attributes
Setup for Specimen Attributes
4.0 vs. 4.5 Specimen Attributes
Lets take sometime to review the new MU functionality for specimens because this is so new, different and probably the most complex new addition to SoftLab,

23. Revisiting MU 4.0 OE Specimen Window. Note #’s 1, 2, 3, 4
(Describe the button location in OE, specimen tab and 10 drop downs in the specimen window.)
(Again mention not required to fill these fields, we must provide them)

24. Values can be defaulted in from Specimen Tube Type Setup
(Explain defaulted in)
Remember Settings and Definitions are where these drop downs are defined.
(#4 is collection method)

25. MU 4.5 OE Specimen Window Note numbers 1, 2, 3 same as 4.0
But because Collection Method all ready existed as “Draw Type” (#4) DT it is located here.

26. MU 4.0 the four attributes come from Specimen Tube Type Setup

27. But in MU 4.5 these same Specimen Attributes are defined in Test Setup. Note 1, 2, 3 circled below.
Found in Test Setup under the Specimen tab

28. And finally #4 “Draw Type” aka “Collection Method” in MU 4
And finally #4 “Draw Type” aka “Collection Method” in MU 4.5 comes from Container Setup
And that completes are review of specimens, the new options in Setup… Universal Identifiers, HIS Mapping and the SNOMED and LOINC dictionaries. And also concludes my presentation.

29. MU means different things to different people…
Here we see Dr. Jones using the hospitals Ipad to update his Facebook status.