S&I Public Health Education Series formerly Wednesdays With PHRI… An Informational Webinar Series Session 8 September 3, or S&I = S TANDARDS AND I NTEROPERABILITY F RAMEWORK P UBLIC H EALTH E DUCATION S ERIES

Tools for Standardization of Public Health Reporting: MDHT, PHIN-VADS, USHIK, VSAC and other An Informational Webinar Series Session 8: 2

Agenda TopicTime Allotted Welcome/Introductions, Dan Chaput, Moderator Progression of Education Series, Dina Dickerson 4:00 – 4:05 PM ET PHINVADS, Sundak Ganesan4:05 – 4:15 PM ET VSAC, Rob McClure4:15 – 4:25 PM ET MDHT, Sean Muir4:25 – 4:35 PM ET USHIK, Robin A. Barnes4:35 – 4:45 PM ET Questions and Answers4:45 – 4:59 PM ET Adjourn5:00 PM ET 3

Sundak Ganesan, M.D. Centers for Disease Control and Prevention (CDC) Health Scientist, Lead CDC Vocabulary Specialist, CDC Platform (CDCP) – Message Processing, Validation and Data Provisioning System 4

Overview Overview of CDC Vocabulary Support Services PHIN VADS –Application –Content –Users 5

CDC Vocabulary Support Services Consult with CDC programs regarding value set development and distribution (e.g. Messaging guide) Collaboration with Federal agencies regarding the content development, distribution and support (e.g. NIST, FHA, FDA). Implementation support such as providing assistance in adopting the standard vocabulary (e.g. National Labs, Public Health Dept.) and data analysis (e.g. BioSense) Support various ONC / HHS initiatives (e.g. Meaningful Use, S&I) Integration of PHIN VADS API using web services with applications and systems (e.g. PHIN MQF, EpiInfo, NBS, etc..) 6

What is PHIN VADS? In 2004, CDC developed a web-based enterprise vocabulary system called the Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS) for accessing, searching, and distributing HL7 messaging value sets used within PHIN.PHIN VADS Provides all the vocabulary metadata needed for HL7 messaging. Promotes sharing and reusing of the value sets. Hosts multiple versions of value sets that allow implementers to have access to the current, past and the future versions of value sets and value set collections PHIN VADS can be accessed at a public web site PHIN VADS can also be accessed using web services such as HL7 Common Terminology Services (CTS) and IHE Sharing Value Set (SVS) 7

PHIN VADS Browser 8

Public Health Activities supported by PHIN VADS 9

VADS Content Authoring 10 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 – Users / Partners outside CDC

PHIN VADS – Users within CDC 12

Vocabulary Distribution Portals 13 NLM Unified Medical Language System (UMLS)UMLS –SDO vocabulary (RxNorm, SNOMED), mapping between standards, Metamorphosys, UTS, etc..SNOMEDMetamorphosysUTS Centers for Disease Control & Prevention (PHIN VADS)PHIN VADS –Public health & clinical care value sets, HL7 Messaging IG value sets distribution, web services,.. National Cancer Institute (NCI) – Enterprise Vocabulary Services (EVS)EVS –Cancer domain, NCI Metathesaurus, FDA vocabulary (SPL, UNII), Gene (HUGO, GO), etc.. Environment Protection Agency (EPA) – Substance Registry System (SRS)SRS –Substance (Chemical, Physical, Biological), Map to CAS #, vocabulary (Air, Water, Soil), etc… Agency for Healthcare Research & Quality – United States Health Information Knowledgebase (USHIK)USHIK –Metadata registry of healthcare data elements and information models of SDOs, HITSP, … Mayo Clinic - LexGrid, LexBig, LexWikiLexGridLexBigLexWiki –Distributed network of terminologies and ontologies using std. tools, web services (HL7 CTS), … Washington Publishing Company (WPC) – Taxonomy browser & file serverTaxonomy browser file server –Code lists supporting administrative data – X12, NUCC, HIPAA, etc… Commercial Terminology Distribution (Vendors) SDO Browsers

Questions? VADS Website –

NLM Value Set Authority Center Robert C. McClure, MD Terminology Consultant to NLM and ONC MD Partners, Inc. Originally presented by Maureen M. Madden Value Set Authority Center Coordinator National Library of Medicine National Institutes of Health U.S. Department of Health and Human Services September 3, 2014

U.S. National Library of Medicine World’s largest biomedical library Maintains vast print collection Produces electronic information resources Supports and conducts research, development, and training in biomedical informatics and health IT 16

Value Set Authority Center Since 2004, NLM is responsible as the central coordinating body for clinical terminology standards within HHS. With VSAC, NLM role is to provide a searchable repository of value sets and to assure the on-going validity and accuracy of these value sets.  This role will expand in future. VSAC is provided by NLM in collaboration with the ONC and CMS. 17

Value Set Authority Center Provides downloadable access to all official versions of vocabulary value sets contained in the 2014 Clinical Quality Measures (CQMs). Because many of the clinical terminologies used by value sets have copyright restrictions, VSAC users are required to agree to the terms of the UMLS License. 18

Value Set Developers and Consumers 19

What is a Value Set? A value set is a list of terms and their codes derived from single or multiple standard vocabularies used to unambiguously define clinical concepts (such as patients with diabetes, clinical visit, reportable diseases) used in clinical quality measures, and to support effective health information exchange, as well as other specific business purposes. 20

Types of value sets All VSAC value sets are restricted to a single code system Extensional – An enumerated list of concepts Intensional – A logical statement that selects concepts for inclusion in the set Grouping – Groups other value sets of any type –Technically the code system here is of type URI (OID) 21

Value set maintenance NLM will identify content changes due to code system updates and notify steward –VSAC will update version when membership changes –Intent is to do this with every code system version update Steward may modify content as a version update as long as membership is true to purpose –Change in purpose is a new value set No Intensional value sets yet 22

Value set collaborative review VSAC will be implementing “Crowd-source” forums – VSAC Share – For comment and review of value set content Goals are: –Open harmonization of value set content in support of clinical relevancy, completeness, consistency, and re-usability –Greater input and review of concepts selected, code systems used, identification of gaps –Enhanced stewardship in the face of intermittent participation of interested users 23

Use Cases for Value Sets Initial: “Meaningful Use” 2014 Clinical Quality Measures  Contribute to the unambiguous definition of the numerator and the denominator for a quality measure. Example: #diabetes patients/specific population Future/Phase 2: In collaboration with the field, support exchange and analysis of data within and between such diverse contexts as clinical and comparative effectiveness research, clinical decision support, performance measurement and public health. 24

Clinical Quality eMeasure Venous Thromboembolism Prophylaxis [This CQM has 40 Value Sets, one of which we show here]: Value Set OID: Value Set Name: Ischemic Stroke Ischemic Stroke ICD9 value set Ischemic Stroke ICD-10 value set Ischemic Stroke SNOMEDCT value set 25 Ischemic Stroke Grouping

Value sets can be re-used 26

Questions? VSAC Web site: Contact NLM: (888) FIND-NLM 27

Sean Muir Company Titles etc 28

Overview Model-Driven Health Tools (MDHT) open source project initiated by VA in 2008 at Open Health Tools (OHT) UML model-driven tools to create computable models Specialized support for healthcare standards Community Development Open standards Open source Toolkit that lowers the bar and accelerates development of innovative healthcare applications 29

MDHT Benefits 30

MDHT Workflow

Some Implementations in MDHT Continuity of Care Document (CCD) Health Story - Common Document Types (CDT) IHE Patient Care Coordination (PCC) HITSP Summary Documents using CCD and CDA Content Modules C32, C83, and C80 C32 Consolidated CDA Templates Certification /Meaningful Use, Stage 2

MDHT in Production NIST Certification for C-CDA as part of MU2 Mirth CDAPI Product Over Four Thousand Downloads in

Validation in XML Editor

MDHT Validation View(Entries)

MDHT Validation View(Issues)

MDHT Java API – Load and Validate

MDHT Java API – Generate CDA

MDHT Java API – OCL Queries

MDHT Future Activities Version 2.0 –Upgrade of eclipse, java, and UML Consolidated CDA R2 FHIR Support Support Meaningful Use stage 2 and beyond –Standards development and deployment Generalize common constraint-based modeling pattern for clinical information models: CIMI, CEM, SIM/LEGO (KBS) Expand terminology binding capabilities –CTS-2 and IHTSDO ISAAC integration –Design time discovery, post-coordination, and classification –Runtime deployment: validation, translation, and classification Model-Driven Message Interoperability (MDMI) 42

Web Sites MDHT Project Website – CDA Tools Website – 43

Questions? 44

Robin A. Barnes Nurse Informaticist/Lead Clinician United States Health Information Knowledgebase (USHIK) Agency for Healthcare Research and Quality (AHRQ) 45

United States Health Information Knowledgebase USHIK is an on-line, publicly accessible registry and repository of healthcare-related metadata, specifications, and standards USHIK is funded and directed by Agency for Healthcare Research and Quality (AHRQ) with management support and partnership from Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) 46

USHIK Portals Meaningful Use (MU): contains specifications, artifacts, downloads, search tools and other resources for MU including electronic Clinical Quality Measures, Value Sets and Objectives All-Payers Claims: offers a convenient set of tools for users to compare and download All- Payer Claims reporting specifications from states and the APCD council Draft Measures: provides a forum to solicit public feedback on draft Clinical Quality Measures and their associated Values Sets Child EHR Format: contains a set of child specific requirements provided by ARHQ and CMS that an EHR should meet to perform optimally for the health care needs of children Common Formats for Patient Safety: provides detailed information on the Data Elements required for Patient Safety Event reporting Standards: contains healthcare IT metadata from Standards Developing Organizations accredited by the American National Standards Institute such as ASC X12 and NCPDP HITSP: contains data for the health interoperability specifications and constructs such as C32, C80, C83 and C154 47

USHIK Portal Highlight: Meaningful Use The Meaningful Use home page contains links within the blue boxes at the top of the page to direct users to Clinical Quality Measures, Values Sets, API, Downloads and a Help menu. An information model allows users to select either Objectives or eCQMs for either Eligible Professionals or Eligible Hospitals by clicking the link inside the respective quadrant. 48

USHIK Portal Highlight: Meaningful Use 49 Users can select any number of measures to download in various formats, or select two or more measures to compare attributes and data elements. Users can also compare versions of the same eCQM by selecting the icon, in the Name column, that resembles two stacked pieces of paper.

Questions? 50