1. PHIN VADS Webinar Series
Part 3 – Universal Authoring Framework (UAF)
December 3rd , 2010

2. Agenda Vocabulary Governance / Standards
Universal Authoring Framework Overview
Demonstration
Q&A
(1) Universal Authoring Framework (UAF) - Overview of CDC PHIN VADS value set authoring tool. (2) Vocabulary Governance (3) Vocabulary maintenance using UAF (versioning) (4) Publishing value sets in PHIN VADS (5) Brief demonstration of UAF (6) Q & A with Vocabulary Specialists and developers.
PHIN VADS
2010 Webinar Series

3. Vocabulary Definitions & Examples

4. Code System – SDO Vocabulary

5. Code System Concept Metadata
Synonyms
Legacy SNOMED concept code
Relationship
PHIN VADS
2010 Webinar Series

6. Value Set
PHIN VADS
2010 Webinar Series

7. Value Set Concept
PHIN VADS
2010 Webinar Series

8. Vocabulary View (Messaging Guides)
“Vocabulary View” refers to a collection of value sets associated with a HL7 messaging guide or CDA. View is also versioned and can be downloaded as a zip file. View can also be accessed using web services.
PHIN VADS
2010 Webinar Series

9. Vocabulary View Metadata
PHIN VADS
2010 Webinar Series

10. Vocabulary Group
PHIN VADS
2010 Webinar Series

11. Vocabulary Group Metadata
“Vocabulary Groups” includes only the latest version of a value set
PHIN VADS
2010 Webinar Series

12. Vocabulary Object Identifiers (OID)
Vocabulary OID Management & Publishing
PHIN VADS
2010 Webinar Series

13. Code System Concept – Standards overlap & Usage Context
Retired SNOMED Concepts
PHIN VADS
2010 Webinar Series

14. Standards adopted by PHIN VADS
White House E-Gov Consolidated Health Informatics (CHI):
Domain recommendations provided guidance regarding the selection of code system.
Health Information Technology Standards Panel (HITSP):
C80: Clinical Document and Message Terminology Component defines the vocabulary (value sets) for all the HITSP interoperability Specifications (IS).
Meaningful Use (MU): The Office of National Coordinator (ONC) for Health Information Technology - Standards and Certification Criteria for Electronic Health Records
ISO Metadata and HL7 Common Terminology Services (CTS)
HL7 Vocabulary Technical Committee

15. PHIN VADS Users CDC programs State and local health departments
HL7 Messaging Guide – Value set implementers
Epidemiologists
Healthcare Providers including labs and hospitals
Value set and quality measure developers
Standard Development Organization (SDO) – for SDO issues.
Standard harmonization and recommendations workgroups, Community of Practice (CRSWg, VMCoP, LMCoP)
EMR and public health application vendors
Public health applications (EpiInfo, PHIN MSS, PHIN MQF)
PHIN VADS
2010 Webinar Series

16. CDC Vocabulary & Messaging Governance Panel
CDC Vocabulary & Messaging Team
CDC Common Data Store Team (Data Storage)
Data Message Brokering team (Routing and Translation)
NNDSS team (Data Analysis)
CDC programs & Divisions including CDC NCHS (Content)
State Public Health Dept (Implementation issues)
SDO SME Rep (only to discuss SDO issues)
CDC Partners (APHL, PHDSC, etc..)
UMLS – to discuss about SDO issues (LOINC, SNOMED, etc..)
Other Federal Agencies (USHIK, VA, NCI, FDA, EPA, NLM, DoD) to discuss about collaboration.
PHIN VADS
2010 Webinar Series

17. Functions of CDC Vocabulary & Messaging Governance Panel
Content publishing schedule & prioritization issues
SDO standards related issues
Selection of a standard for value set
Users access to VADS value set authoring tool (UAF)
Implementation issues related to Vocabulary & Messaging
PHIN VADS application enhancements and its priority
PHIN VADS
2010 Webinar Series

18. Public Health Meaningful Use Measures Vocabulary
Vocabulary & Messaging Community of Practice (VMCoP) webinars related to Meaningful Use (stage 1) can be found at VMCoP online forum (phConnect):
1) Syndromic Surveillance (October 28th 2010)
2) Electronic Laboratory Reporting (September 21st, 2010)
3) Immunization (August 17th , 2010)
PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary:
MU Stage 1- Immunization HL IG Vocabulary
MU Stage 1- ELR HL IG Vocabulary
MU Stage 1 – Value sets related to Syndromic Surveillance are available in PHIN VADS and the vocabulary view would be created in Dec 2010
PHIN VADS
2010 Webinar Series

19. 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
PHIN VADS
2010 Webinar Series

20. Vocabulary Distribution Portals
NLM Unified Medical Language System (UMLS)
SDO vocabulary (RxNorm, SNOMED), mapping between standards, Metamorphosys, UTS, etc..
Centers for Disease Control & Prevention (PHIN VADS)
Public health & clinical care value sets, HL7 Messaging IG value sets distribution, web services, ..
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)
PHIN VADS
2010 Webinar Series

21. 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 the PHIN and NHIN.
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
Provides web services (API) that allows HL7 interface engines, medical and public health applications to obtain the value sets as well as validate the vocabulary present in HL7 messages.
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.
PHIN VADS can be accessed at a public web site -
CDC Vocabulary and Messaging team manages the PHIN VADS.
PHIN VADS
2010 Webinar Series

22. Purpose and Usage of VADS
Distributes the value sets associated with the public health HL7 messaging (V2.x, V3) & CDA implementation guides.
CDC as SDO maintains and distributes the code system such as Vaccine names (CVX), Vaccine manufacturers (MVX), Race & Ethnicity, Healthcare Service Locations and Nationally Notifiable Disease/Conditions (NND) using VADS.
Facilitates the routing and filtering of HL7 messages and can be easily integrated with any medical or public health applications using VADS web services (API)
Develops & distributes HL7 messaging value sets associated with:
Electronic Laboratory Reporting (ELR)*
Immunization*
Syndromic Surveillance*
Public Health Case Reporting
Public Health Case Notification (infectious & non-infectious)
NHSN Healthcare Associated Infections (HAI)
Cancer Registry (Anatomic Pathology Reports)
Clinical Quality Measures reportable to public health* (e.g. Diabetes control) * Meaningful Use Stage 1 measure
PHIN VADS
2010 Webinar Series

23. PHIN VADS Content
Currently, PHIN VADS has 592 value sets supporting 60 HL7 and CDA message implementation guides. The PHIN VADS hosts both the intrinsic and extrinsic value sets.
PHIN VADS also hosts 149 SDO code systems that are used by HL7 messaging value sets. Many of the code systems (~ 120) belong to HL7 v2.x or V3.
PHIN VADS updates the value sets often based upon SDO code system updates.
PHIN VADS Hyperlinks for Meaningful Use (MU) Stage 1 Vocabulary:
MU Stage 1- Immunization HL IG Vocabulary
MU Stage 1- ELR HL IG Vocabulary
MU Stage 1 – Value sets related to Syndromic Surveillance
PHIN VADS
2010 Webinar Series

24. PHIN VADS Content Access
PHIN VADS can be accessed using one of the following methods:
PHIN VADS Web Browser.
PHIN VADS Web Service – System to System exchange of vocabulary data.
PHIN VADS Lite – Local instance of VADS web services and database
PHIN VADS
2010 Webinar Series

25. PHIN VADS Framework
PHIN VADS
2010 Webinar Series

26. PHIN VADS Web User Interface
PHIN VADS web browser is the most commonly used method for browsing, searching and downloading the public health value sets.
PHIN VADS web site –
Users have an option to download PHIN VADS value sets using Microsoft Excel or tab-delimited text format. PHIN VADS web user interface is complaint with web accessibility section 508.  
PHIN VADS allows the users to bookmark the value sets, code systems, concepts, vocabulary views and groups. PHIN VADS vocabulary view bookmarks are usually included in the HL7 message implementation guide that allows the implementers to access the messaging vocabulary associated with implementation guide easily.
Browser compatibility
Internet Explorer 7 and above
FireFox version 3.0 and above
PHIN VADS
2010 Webinar Series

27. 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).
Sample code and a detailed API are available in the PHIN VADS Developer’s Toolkit -

28. PHIN VADS Lite
Allows any individual or organization to implement a local instance of the VADS service and database.
The VADS Lite deployment is available for Oracle and Microsoft SQL Server.
VADS Lite is not deployed with a User Interface
The deployment model requires the users to download, install, and maintain a local installation on their hardware. Vocabulary Server with Application Programming Interface (API) may allow the vendors or implementers to integrate the vocabulary server with their application.
E.g. NEDSS Messaging Subscription Service application includes PHIN VADS vocabulary server and Orion Rhapsody that will help validate HL7 messages and assist mapping between local and standard terminology.
PHIN VADS
2010 Webinar Series

29. Custom Downloader Example
PHIN VADS custom downloader can be used like a shopping cart for downloading the VADS content.
Useful tool especially for generating custom reports and queries from PHIN VADS database.
Can be easily executed by non-technical people (Epidemiologist, Clinicians, Quality Measure Developers, Value set creators, etc..)
Allows to download several value sets into a single file. This helps the implementers to import value set collections into a database.
Uses VADS web services to query the VADS database.
Value set and quality developers can use this tool to develop the intrinsic value sets using the hierarchical relationships from SDO vocabulary such as SNOMED.
Download this tool from VADS online forum (phConnect)
PHIN VADS
2010 Webinar Series

30. Value Set Authoring – 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
2010 Webinar Series

31. UAF Usage
UAF is currently available to CDC partners, value set creator and quality measure developers who are involved in the development and management of the value sets present in PHIN VADS.
UAF has most of the code systems suggested by Consolidated Health Informatics (CHI) for various domains.
Allows vocabulary specialists to either enumerate the value set concepts or provide the logic for creating the intrinsic value set.
Allows programs to select a particular version of the value set to be associated with the messaging vocabulary view.
Allows programs to create / import code systems which include the concepts, relationships, alternate designations, and extended properties.
Allows authoring the local code systems as well as CDC code systems that has been adopted by standards such as HL7. (E.g. CVX, MVX, Nationally Notifiable Disease).
PHIN VADS
2010 Webinar Series

32. Value Set Maintenance (Versioning)
Change Event Model:
PHIN VADS maintains the past, current and future versions of a value set.
Provides a historical record of all changes made to an object over time.
Each change is stored as a delta from prior version to proposed version. .
PHIN VADS
2010 Webinar Series

33. UAF Security & Role
PHIN VADS
2010 Webinar Series

34. UAF Security & Role
PHIN VADS
2010 Webinar Series

35. How to request UAF access?
Request access along with access level desired by sending an to the CDC Vocabulary & Messaging team at
Please note that desired access level cannot be guaranteed for the user. Vocabulary & Messaging Governance Panel will carefully analyze each request to determine level of access
Once approved, user will be sent instructions to complete formalities to have a SAMS account created
An id will also be created for the user in the UAF application
Once SAMS account is created and approved for the user, they will be notified by . The user will also be notified of the appropriate access level approved for them by the CDC Vocabulary & Messaging Governance Panel.
PHIN VADS
2010 Webinar Series

36. UAF Training & Orientation
Standards Selection Guidance
CDC Vocabulary & Messaging Team Support
New SDO concept request process
Communication about timeline for publishing in PHIN VADS
CDC Vocabulary & Messaging Team Governance Meetings (optional)
PHIN VADS
2010 Webinar Series

37. PHIN VADS Vocabulary Updates
Notification about VADS, UAF update
List Serv (VMCoP, HL7 PHER, PHIN)
VADS Online Forum
VMCoP monthly meetings
Frequency
Quarterly
On-demand (e.g. Outbreak or Natural disasters)
Code System Update in UAF (LOINC, SNOMED)
PHIN VADS
2010 Webinar Series

38. PHIN VADS Support - phConnect
PHIN VADS online forum URL:
PHIN VADS
2010 Webinar Series

39. Demonstration

40. Demonstration
Code System Representation in VADS and standard selection guidance (Web site link)
OID Registry
CDC Local Coding System Usage
UAF Help Navigation
UAF Editor
- Change Arboviral Value Set
- Create a new value set (Flu Activity Code)
- Create Code System (USDA Subject Descriptor)
UAF Publish Module

41. Questions

42. Acknowledgments Sundak Ganesan – Lead Vocabulary Specialist
Sheila Abner – Vocabulary Specialist
Steve Eady – Tech Lead
Prosenjit Dutta – Developer
Scott Keller – Database Analyst
Cathy Lester – Quality Assurance/Tester
Vanessa Fernandez – Business Analyst
Michael Pray – Project Manager
Mark Winarsky & Gautam Kesarinath
– CDC FTE Program Managers
Nikolay Lipskiy – CDC FTE lead for SDO standards
PHIN VADS
2010 Webinar Series

43. Appendix
2010 Webinar Series
PHIN VADS

44. Vocabulary Basics - Resources
PHIN VADS Help – FAQ and Glossary
HL7 Vocabulary TC
Good Vocabulary Practice Guide (May 2000)
Core principles and properties of V3 (Sept 2010 Ballot)
HL7 OID Registry
Federal Health IT - Vocabulary Task Force
Health Information Technology Standards Panel (HITSP) – C80 Messaging Terminology
PHIN VADS
2010 Webinar Series

45. HIT VTF Testimony (Sept 1st and 2nd 2010) - One Stop Shopping Theme
Web site links
Meeting Audio for September 1, 2010 [MP MB]
Meeting Transcript for September 1, 2010 [PDF KB]
Meeting Audio for September 2, 2010 [MP MB]
Meeting Transcript for September 2, 2010 [PDF KB]
PHIN VADS
2010 Webinar Series

46. VTF Testimony (March 23rd 2010) - Governance of Value Sets (Govt
VTF Testimony (March 23rd 2010) - Governance of Value Sets (Govt. Agencies)
Web site links
Meeting Audio [MP MB]
Meeting Transcript [PDF KB]
PHIN VADS
2010 Webinar Series

47. VTF Testimony (February 23rd 2010) - Governance of Value Sets (Vendors & SDO)
Web site links
Meeting Audio [MP MB]
Meeting Transcript [PDF KB]
PHIN VADS
2010 Webinar Series

48. CDC Interoperability Tools (Case Notification)
PHIN VADS
2010 Webinar Series

49. OID Request
CDC is plan on publishing all the vocabulary OID’s in HL7 OID registry.

50. PHIN VADS Change Control Model
Allows locking of a subset of the data model to be edited.
Change Control Model provides a mechanism for governance of edits to VADS data.
Organizes edits to subsets of the data structure, such as Code System, Value Set, Vocabulary Views, etc.
Edits to VADS are checked against business rules, then applied as a group to the actual tables
Completed edits are moved via XML as a Change Control Package to the Review and Production environments.
Each change control package contains the original vocabulary item as well as its changes. This can be used for reports later.
The Change Control Package provides an audit trail.
PHIN VADS
2010 Webinar Series

51. Lessons learned in the management of value sets
Collaborating with the stakeholders, Standard Development Organizations (SDO), Community of Practice and implementers during the process of developing messaging guide and value sets helps in the adoption of standard vocabulary.
Most of the HL7 implementation guides require at least 25 to 30 value sets that were developed from various coding systems. CDC programs and implementers found it easier to download a specific version of the value set or vocabulary view from such single for PH location as PHIN VADS.
PHIN VADS value set download includes all the metadata that are needed for implementing HL7 message coded data types (CE, CWE) which makes it easier for implementing the value set concepts in HL7 message or CDA.
Implementers and CDC programs can access the previous, current and future versions of value sets and vocabulary views from PHIN VADS as they become available. This makes it easier for implementers to implement a particular release of the HL7 messaging or CDA implementation guide.
PHIN VADS
2010 Webinar Series

52. Value set management issues
The biggest challenge in creating value sets is the timeliness of getting the new standard vocabulary concepts from SDO.
An notification process is not an optimal solution for notifying implementers about the updates in a timely manner. We believe that a subscription mechanism (e.g. RSS Feeds) would work better for getting updates to vocabulary views or value sets.
Many implementers have not adopted the SNOMED numeric codes. They are still using the SNOMED alphanumeric codes. PHIN VADS include the value set concepts with the preferred concept codes as well as the alternate codes which allows the implementers to map their local vocabulary to standard vocabulary.
PHIN VADS
2010 Webinar Series