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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
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Standard Vocabularies in Health CareA Presentation Prepared for
The Collaborative Expedition Workshop
Kathy Lesh, RN, EdM, MSTechnical Manager Clinical Informatics
9 December 2004
GoalsGoals
•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
DefinitionsDefinitions
• 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
Standard vocabularyStandard vocabulary
• May be a controlled vocabulary, thesaurus or taxonomy
• Is adopted by a group • Not necessarily developed or adopted by a
Standards Development Organization
Standards Development OrganizationStandards 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
Vocabulary-related SDOsVocabulary-related SDOs
• HL7• College of American Pathologists• National Council for Prescription Drug Programs
• Hummmm, who’s missing???
Health information technology standards Health information technology standards initiativesinitiatives
• 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
Consolidated Health Initiative- CHIConsolidated 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
National Committee on Vital and Health StatisticsNational 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"
Institute of MedicineInstitute of Medicine
• Data standards for Patient Safety• Arose out of “To Error is Human: Building a Safer
Health System”
Connecting for Health/e- Health InitiativeConnecting for Health/e- Health Initiative
• Markle Foundation and Robert Wood Johnson funding
• Public-private partnership• Pushing adoption of health data standards
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
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
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
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
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
What does this mean?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
What does this mean?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
Where does one find these recommended Where does one find these recommended vocabularies?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/
Okay, now what do I do?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
Okay, now what do I do?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
The realityThe 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/
Stay tunedStay 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
KEVRIC’s capabilitiesKEVRIC’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
Highlighted Project:Highlighted Project:Prototype Ontology Development for NIAID - BISCPrototype 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.
NIAID Ontology Prototype in ProtégéNIAID Ontology Prototype in Protégé
