1. Value Set Authority Center and VSAC Collaboration Tool
Maureen M. Madden
Value Set Authority Center Coordinator National Library of Medicine, National Institutes of Health
U.S. Department of Health and Human Services
Description: Although the Value Set Authority Center was initially created with an urgency to support the CMS eCQM initiative, NLM has always intended VSAC to support a broader audience. In this presentation of the general use and functionality of VSAC’s public value set repository, as well as the VSAC Authoring Tool and newly launched VSAC Collaboration Tool, we will also describe the additional stakeholders who have recently approached VSAC for support and distribution of their content.

2. AHIMA Content Standardization Survey 2016

3. What is a Value Set?
A list of codes and their terms derived from standard vocabularies and used to define clinical concepts (like diabetes, blood-sugar lab tests, smoking cessation, antibiotic prescriptions) to support effective and interoperable health information exchange.

4. Acute Pharyngitis Value Set
Name: Acute Pharyngitis Standard Vocabulary: SNOMED CT
Code
Description
Viral pharyngitis (disorder)
Acute gangrenous pharyngitis (disorder)
Acute phlegmonous pharyngitis (disorder)
Acute ulcerative pharyngitis (disorder)
Acute bacterial pharyngitis (disorder)
Acute pneumococcal pharyngitis (disorder)
Acute staphylococcal pharyngitis (disorder)
Acute viral pharyngitis (disorder)
Acute herpes simplex pharyngitis (disorder)
Acute herpes zoster pharyngitis (disorder)
Acute pharyngitis (disorder)

5. Antibiotic Meds Pharyngitis Value Set
Name: Antibiotic Medications for Pharyngitis Standard Vocabulary: RxNorm
Code
Description
24 HR Minocycline 105 MG Extended Release Tablet
24 HR Minocycline 55 MG Extended Release Tablet
24 HR Minocycline 80 MG Extended Release Tablet
Cefixime 100 MG Chewable Tablet
Cefixime 150 MG Chewable Tablet
Cefixime 200 MG Chewable Tablet
105152
Amoxicillin 60 MG/ML Oral Suspension
105170
Cefadroxil 25 MG/ML Oral Suspension
105171
Cefadroxil 100 MG/ML Oral Suspension
108449
Trimethoprim 10 MG/ML Oral Suspension

6. History and Purpose of VSAC
Value sets previously created manually in subject matter expert silos with minimal code validation
Centers for Medicare & Medicaid Services (CMS) urgent need to move clinical quality measures and value sets from paper to electronic format
2012: Health IT Standards Committee recommends NLM as single, central authority for value sets

7. Value Set Authority Center: NLM’s Role
NLM staff neither create nor govern the content of the value sets.
NLM VSAC tools validate the codes within value sets and hold the value sets in a searchable public repository.
VSAC implements most recent terminology updates and provides these for the value set authoring community.
NLM staff conducts frequent stakeholder engagement to know emergent needs and to respond with effective tooling.

8. Who Makes Value Sets? Federal Agency Programs
Standards Development Organizations (HL7)
Medical Specialty Organizations
Research Groups
Local Health Providers and Hospitals
Public Health Agencies

9. Current Value Set Contributors in VSAC
American Academy of Neurology American Nurses Association American Society of Clinical Oncology Austin Regional Clinic Centers for Medicare and Medicaid Services (67% of VSAC value sets) Children's Hospital of Philadelphia Emergency Care Research Institute Federal Health Interoperability Modeling and Standards Minnesota Community Measurement National Minority Quality Forum Pharmacy e-Health Information Technology Collaborative Council of State and Territorial Epidemiologists Vanderbilt University Electronic Medical Record and Genomics Network

10. What are Value Sets Used For?
Clinical Quality Measurement (67%)
Clinical Data Registries
Computable Clinical Phenotyping from EHRs
Public Health Reporting
Electronic Lab Reporting
EHR Structured Documents (C-CDA)
Reportable Conditions Alerts (RCKMS)
National and International EHR Patient Summary Exchange

11. Clinical Data Registries
“As medical specialty societies develop new measures
using standardized coding systems, they should strongly consider using the VSAC as a source for distributing and
standardizing these specifications.”2
2CMSS Primer for the Development and Maturation of
Specialty Society Clinical Data Registries January 2016
Clinical Data Registry (CDR) versus Clinical Quality Measure (CQM):
CQM:
-Electronically specified measures embedded in Certified Electronic Health Record Technology (CEHRT) systems
-Tools to measure and track quality of health care services provided by eligible professionals, eligible hospitals and critical access hospitals (CAHs) within health care system
-QCDRs can report eCQMs
CDR:
-collects clinical data for patient/disease tracking for quality improvement
-typically specialty society registries
-records information about the health status of patients and the health care they receive over varying periods of time (AMA)
-defines patient population, then recruits health care professionals who will submit data on a representative sample of these patients (AMA)

12. Who Makes Value Sets?
CMS creates the majority of current value sets as data elements for Clinical Quality Measures, per HITECH Meaningful Use Program.

13. VSAC Downloadable Resources Table

14. VSAC Downloadable Resources Table

15. Example API Call and Resulting XML
Use Case
Retrieve all value sets and metadata for CMS eMeasure ID CMS100v3
API Code
GET eMeasure ID &tagValue=CMS100v3&ticket=ST X0nKrEe0fYel07mqtKMs-cas
Resulting XML
…truncated

16. Value Set Authority Center

17. VSAC Authoring Tool

18. VSAC Authoring Tool3 – Query for Codes

19. Available Code Systems in VSAC
(not shown: 23 code systems from HL7)

20. VSAC Authoring Tool – Validation/Remapping

22. Purpose of VSAC Collaboration:
VSAC stakeholders need tooling that supports interactive and centralized collaboration among VSAC authors and collaborators, as well as notification of changes.

23. VSAC Collaboration Tool
VSAC Collaboration provides a central content management site for teams to:
Share threaded discussions about value sets
View posted value set expansions
Organize value sets by team’s workflow
Receive VSAC Collaboration activity s

24. VSAC Collaboration Tool

25. Recent Developments
CDC: Zika Virus CDC is leveraging NLM terminology expertise and value set code validation tools and the VSAC Collaboration Tool to support CDC and subject matter expert collaboration on Zika value sets that will support interoperable electronic exchange of clinical and epidemiological information.
RCKMS: Reportable Conditions Division of Council of State and Territorial Epidemiologists (CSTE) who partner with CDC. Using Value Set Authoring and Collaboration Tools to electronically develop all 80 reportable disease conditions in support of a notifiable public health disease alert system under development by CSTE.

26. Future VSAC Development
Logical Value Set Definitions
Terminology Validation
Fast Healthcare Interoperability Resources (FHIR) for Value Set Query and Exchange

27. AHIMA Content Standardization Survey 2016

28. VSAC Support Center

29. References
Winnenburg R, Bodenreider O. Issues in creating and maintaining value sets for clinical quality measures. AMIA Annu Symp Proc 2012:
CMSS Primer for the Development and Maturation of Specialty Society Clinical Data Registries (V.1) January 2016
Khatipov E, Madden M, Chiang P, Chuang P, Nguyen D, D’Souza I, Winnenburg R, Bodenreider O, Skapik J, McClure R, Emrick S. Creating, maintaining and publishing value sets in the VSAC. [poster] AMIA Annu Symp Proc 2014:1459.

30. Acknowledgments Aleksandr Aliyev Soheil Alemansour Vivian Auld
National Library of Medicine
Aleksandr Aliyev
Soheil Alemansour
Vivian Auld
Pishing Chiang
Philip Chuang
Andrea Demsey
Steve Emrick
Andrew Gurung
Stanley Jia
Rama Khanal
Mikyung Lee
Maureen Madden
Duc Nguyen
Rob McClure, M.D. -- NLM and ONC Terminology and Standards Consultant
Centers for Medicare and Medicaid Services
Office of the National Coordinator for Health Information Technology

31. Maureen M. Madden Value Set Authority Center Coordinator
Questions?
Maureen M. Madden Value Set Authority Center Coordinator

32. CMS Clinical Quality Measures (eCQMs)
93 Measures -mandated by CMS electronic health record incentives program
8-10 Value Sets per Measure (average) -data elements that define patient populations
Example Measure Titles: -Appropriate Testing for Children with Pharyngitis -Controlling High Blood Pressure -Thrombolytic Therapy -Exclusive Breast Milk Feeding

33. Clinical Quality Measure (implementation)
Hemoglobin A1c Test for Pediatric Patients
List of LOINC codes
Tests for HbA1c
Numerator: # diabetic patients [age 5-17] tested for HbA1c
Denominator: # diabetic patients [age 5-17]
MAUREEN:
Data Element
Type 1 or Type 2 diabetes
[Excludes gestational diabetes]
Requires date of birth
List of SNOMED CT or ICD-10-CM codes