HIT Standards Committee Clinical Operations Workgroup, Vocabulary Task Force Update on Vocabulary For Stage 2 Jamie Ferguson, Kaiser Permanente Betsy Humphreys, National Library of Medicine 18 May, 2011

2 Vocabulary Task Force – Current Priority ONC Requested Vocabulary Standards for Stage II/III –Medications for e-prescribing and medication allergies –Lab tests for results reporting and test orders –Problems for problem list documentation Assess Previous HITSC Vocabulary Recommendations –Whether Recommendation still valid –Readiness of Vocabulary and supporting technology –Feasibility of Industry-wide Implementation by 2013/2015 precedeGeneral question: Can an EHR certification requirement precede a meaningful use requirement in order to facilitate adoption?

3 Medications for e-prescribing (1 of 2) RxNorm –RxNorm vocabulary is ready for adoption Coverage for prescription drugs nearly complete (CMS/Rand study) Distribution now includes NDF-RT Upcoming enhancements will aid implementers/data entry –June 1 st draft subset of approximation of prescription drugs currently marketed in US »Will seek sources of data on frequently prescribed non- prescription drugs so these can be added –Sept. 11 inclusion of RxTerms view, will allow grouping by general dose forms (e.g., Oral) in RxNorm –Task Force Recommendation: Include four key elements of RxNorm in eRx (aligns with NCPDP recommendation): Semantic Clinical Drug (SCD); Semantic Branded Drug (SBD) Generic Package (GPCK); Branded Package (BPCK)

4 Medications for e-prescribing (2 of 2) Task Force Still Developing Recommendation on Timing and Industry Readiness for RxNorm –NCPDP members – expecting it and working toward it –Drug information providers – expecting it, mapping done or mostly done –Surescripts – getting ready to accept it, per recent conversation –Need more information on readiness of stakeholders: EHR vendors Medium and Large provider organizations Other relevant stakeholders Current use of “Proxy” NDCs very undesirable Addition of frequently prescribed OTC meds needed NLM RxNorm eRx subset – piloting, evaluation?

5 Medication Allergies Task Force Recommendations Under Development, Discussions To Date: RxNorm –Specific components: Ingredient (active), SCD, SBD, GPCK, BPCK UNII –Inactive ingredients used in medications

6 Lab Results and Orders Task Force Will Consider Lab Recommendations Next After Medications LOINC recommended previously for results –Recommendations also included SNOMED CT e.g. organisms Lab Order vocabulary will require significant input, analysis and coordination –Coordination w/ future standardization of order messaging –Clarification of objectives is needed: Standardized messaging representation of current mixed codes vs. Standard order codes –Key issue for lab orders: Industry migration to unique test orders

7 Problem List Task Force To Review And Develop Problem List Recommendations After Lab Recommendations Previous HITSC Recommendations for Problem List –SNOMED CT or ICD-9 for Stage 1 –SNOMED CT or ICD-10 for Stage 2 (timing per HIPAA) –SNOMED CT alone for Stage 3 Key Issue For Problem List Subsets: –Problem List For Problems (e.g. Findings and Disorders) –vs. Problem List As A Catch-All (e.g. Procedures, Medications, Other Orders, Regimes/ Therapies, Etc.)