1. V ocabulary Subsets and Value Sets NCPDP Response Feb 23, 2010 HIT Standards Committee (HITSC) Task Force on Vocabulary

2. Who is NCPDP?  NCPDP is an American National Standards Institute (“ANSI”) accredited standards development organization (“SDO”)  NCPDP provides a forum and marketplace for a diverse membership focused on healthcare and pharmacy business solutions  NCPDP is a member-driven organization that has been named in various government regulations and policies (including HIPAA and Medicare Modernization Act)

3. Membership Representation Producer/Provider –Client service oriented sector –Includes Pharmacies, Pharmacists, and Manufacturers Payer/Processor –Financial oriented sector –Includes HMO’s, PBM’s, Government Payers, Health Insurers Vendors and General Interest –The link between Producer/Provider & Payer/Processor –Includes Drug Wholesalers, Consultants, Clinical Programs and Software and Hardware Vendors

4. 1) Who should determine subsets and/or value sets that are needed? Industry Driven Enhancements business driven Open collaborative environment Currently much confusion –Example: drug concept would come from RxNorm, the strength from one vocabulary, the route of administration from yet another vocabulary

5. 2) Who should produce subsets and/or value sets? Owner/operator responsible Timely Quick access / possible common site

6. 3) Who should review and approve subsets and/or value sets? Industry input Rule based

7. 4) How should subsets and/or value sets be described, i.e., what is the minimum set of metadata needed? Clearly established Examples that meet criteria Possible metadata for value/subsets: –subset name and identifier –version or revision identifier –access information (e.g., where can the [updated] subset/value set be found and retrieved), –update frequency –source information set(s) with version/revision –source information set owner/maintainer(s) –subset/value set definition authority

8. 5) In what format(s) and via what mechanisms should subsets and/or value sets be distributed? Both distributed in consistent manner CSV, Excel, tab delimited text are popular choices

9. 6) How and how frequently should subsets and/or value sets be updated, and how should updates be coordinated? Timely If possible, prior to industry need Both value sets and subsets same schedule for consistency Possible schedules Customer support for questions/comments

10. 7) What support services would promote and facilitate their use? Educational information on the use of the products Distribution schedules reflecting industry needs Published production distribution schedules Ease of access to obtaining products Customer support to handle general industry inquiries timely Account management functions for the timely support of technical and business users (e.g. SDOs, drug knowledgebase entities, corporate headquarters, large provider groups, vendors, etc) Ease of access to request enhancements or modifications to the sets Escalation procedures for emergency needs (what to do if a value is not available)

11. 8) What best practices/lessons learned have you learned, or what problems have you learned to avoid, regarding vocabulary subset and value set creation, maintenance, dissemination, and support services? Terminology Organizations best source Industry buy-in Best example is NCPDP External Code Set / Updates quarterly Driven by industry needs Timely

12. 9) Do you have other advice or comments on convenience subsets and/or value sets and their relationship to meaningful use? Unclear yet pharmacies role Industry requesting caution and experience for vocabs listed

13. 10) What must the federal government do or not do with regard to the above, and/or what role should the federal government play? Provide clear guidance Gap between terminologist, message exchange and implementer Alphabet soup! Possible diagram for implementers

14. Thank You