Demonstration for AHIMA Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS) Jannie Williams, PHIN VADS Team Lead PHIN VADS Team: Jemal Ahamed, Jennifer Puyenbroek, Cole Downing, Nihit Desai, Richard Alexander, David Merritt, Kumar Nakkerthi Demonstration for AHIMA 8/4/2016 Center for Surveillance, Epidemiology, and Laboratory Services Division of Health Informatics and Surveillance

Summary VADS Overview and High level view of architecture VADS Vocabulary Content and Message Mapping Guide Support How PHIN VADS is used VADS Publishing Process overview Demo of VADS Browser & Universal Authoring Framework Q & A

PHIN VADS Purpose A publicly available web based tool for accessing, searching, and distributing standards-based vocabularies used within PHIN to local, state and national PHIN partners. It promotes the use of standards-based vocabulary within PHIN systems to support the exchange of consistent information among Public Health Partners. Contains the coded values, code systems, and value sets used by implementation guides. PHIN VADS is the primary public health vocabulary distribution portal for the public health community. PHIN VADS is a repository for public health vocabulary and includes many standard coding systems (LOINC, SNOMED-CT, ICD-10) which are kept up to date.

PHIN VADS Currently, there are 205 code systems, 1,470 value sets and over 3.1 million value set concepts in VADS. Promotes sharing and reusing of the value sets. Hosts multiple versions of value sets which allow implementers to have access to the current, past and the future versions of value sets and value set collections Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes. This will facilitate the implementation of value sets and improve the quality of local vocabulary mapping to standards.

Universal Authoring Framework (UAF) PHIN VADS Web Application https://phinvads.cdc.gov/vads/SearchVocab.action

PHIN VADS Framework

Universal Authoring Framework (UAF) UAF – A Distributed Terminology Development Environment A web-based thin client distributed environment which allows for vocabulary authoring and publishing. Provides Versioning Capability for Vocabulary Objects. Provides historical tracking of database updates. Allows multiple users to author data simultaneously via the Change Event. Allows for vocabulary updates via the web services. 

PHIN VADS Web Services: System-to-System Exchange of vocabulary data Get Value Set Get Value Set Concepts Get All Views Find Concept VADS Web Application Web Browser Validate Concept VADS Web Services The PHIN VADS web application is built upon the PHIN VADS web services. When using the PHIN VADS application, the web services are used indirectly. These web services are public and built upon open standards (HL7 CTS2 , IHE SVS).

SDO Vocabulary Tools Standard Development Organization (SDO) vocabulary tools can be used for browsing and searching the code system concepts as well as mapping of local vocabulary. LOINC – RELMA , Web search SNOMED CT– National Library of Medicine (NLM) list of SNOMED browsers , NLM SNOMED CT browser, Virginia Tech SNOMED browser RxNorm – RxNav from NLM HL7 Tools & vocabulary resources ICD-9 CM & ICF – CDC National Center for Health Statistics (NCHS) and WHO Demographics (Geocodes) – USGS GNIS

Vocabulary Distribution Portals Centers for Disease Control & Prevention (PHIN VADS) Public health & clinical care value sets, HL7 Messaging IG value sets distribution, web services, .. NLM Value Set Authority Center (VSAC) & Unified Medical Language System (UMLS) SDO vocabulary (RxNorm, SNOMED), mapping between standards, Metamorphosys, UTS, etc. National Cancer Institute (NCI) – Enterprise Vocabulary Services (EVS) Cancer domain, NCI Metathesaurus, FDA vocabulary (SPL, UNII), Gene (HUGO, GO), etc.. Environment Protection Agency (EPA) – Substance Registry System (SRS) Substance (Chemical, Physical, Biological), Map to CAS #, vocabulary (Air, Water, Soil), etc… Agency for Healthcare Research & Quality – United States Health Information Knowledgebase (USHIK) Metadata registry of healthcare data elements and information models of SDOs, HITSP, … Mayo Clinic - LexGrid , LexBig, LexWiki Distributed network of terminologies and ontologies using std. tools, web services (HL7 CTS), … Washington Publishing Company (WPC) – Taxonomy browser & file server Code lists supporting administrative data – X12, NUCC, HIPAA, etc… Commercial Terminology Distribution (Vendors)

Why PHIN VADS? Why to use VADS over other Distribution systems? Advantages? VADS provides value set based distribution system, which can provide multiple standards under the same value set. In addition VADS has an interface easy to search and download value sets. In addition VADS has capability to store and display concept hierarchies using multiple relationship types, spanning multiple code systems VSAC – Requires a user profile, so they are able to monitor daily active users. VADS – has capability to create and display hierarchies of concepts within code systems and also connect concepts to answer lists (value sets) Message mapping Guides (MMGs) and PHIN VADS

Active Users of VADS National Notifiable Disease System (NNDSS): Vocabulary requirements for the NNDSS Message Mapping Guides (MMGs) EHR vendors: Source of truth for the vocabulary requirements of the meaningful use specifications for Public Health (Immunization Registry, Electronic Lab Reporting, Syndromic Surveillance, and Cancer Registry) Support for Ebola and Zika Reportable Condition Mapping Table (RCMT): provides mappings between reportable conditions and their associated LOINC laboratory tests and SNOMED results (uses standards suggested for the meaningful use measure “reportable lab result reporting to public health”) National Center for Health Statistics (NCHS): Value sets for their national HL7 implementation guides (CDA and 2.x) Association of Public Health Laboratories (APHL)/CDC Public Health Laboratory Interoperability Project (PHLIP): Value sets for their implementation guides National Healthcare Safety Network (NHSN): Provide OIDs Emergency Preparedness and Response (EPHAR): Data Element Repository

Updates to Code Systems VADS allow users to search, browse, and download vocabularies to create, send and receive electronic public health messages based on National Standards The primary objective of PHIN VADS is to be the distribution source for public health vocabularies based on the White House’s Consolidated Health Informatics initiative (CHI) Allows for distribution of public health subset of HITSP C80 and Meaningful Use Vocabulary Standard coding systems (LOINC, SNOMED-CT, ICD-10) (and related value sets) are kept up to date with their annual or semi-annual updates based on SOP Others updated as needed to address needs of users, e.g., new value sets based on newer HL7 tables, RXNorm concepts not in the VADS subset Cannot distribute code systems – many have copyright laws

VADS Content Object Organization PHIN VADS consists of concepts The concepts are contained in Code Systems and are grouped together to form value sets. The same way concepts are grouped to form value sets, value sets can be grouped to form views. Views can be used to provide the collection of value sets used in an Implementation Guide or MMG Provides value set based distribution system, which can provide multiple standards under the same value set. Code Systems PHIN VS Local CS LOINC ICD-10-CM Concept 1 Concept 3 Concept 2 concept Concept 5 Concept 4 Concept 7 Concept 8 Concept 9 Concept 6 Example VS 2 Views Example VS 1 Example View 1 Value Sets Concept 1 Hosts multiple versions of value sets which allow implementers to have access to the current, past and the future versions of value sets/views Provides detailed code system metadata for value set concepts such as context, hierarchy, synonyms and alternate codes Subscription capabilities

Universal Authoring Framework (UAF) – PHIN VADS The Universal Authoring Framework (UAF) is a Web based, thin client vocabulary authoring tool. CDC uses UAF to import SDO vocabulary as well as to author and publish its own vocabulary for use in case notification and lab reporting.

6 5 4 3 1 2 High Level Flow of Content in PHIN VADS PHIN VADS Browser Published DB Content viewable in Browser 6 Web Services 5 PHIN VADS Browser Deployment Review DB Publish 4 3 Review UAF Web Services Publish Authoring DB Deployment Publish 1 Authoring UAF 2 Web Services Create or import Content

PHIN VADS Demo

Q & A

1600 Clifton Road NE, Atlanta, GA 30333 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: http://www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or http://www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Center for Surveillance, Epidemiology, and Laboratory Services Division of Health Informatics and Surveillance