1. HIT Standards Committee Clinical Operations Workgroup Update on Vocabulary Task Force Jamie Ferguson Kaiser Permanente Betsy Humphreys National Library of Medicine December 18, 2009

2. 2 Vocabulary Task Force Kick-off The Vocabulary TF held its first meeting 11/19/2009 to begin consideration of the gaps and issues identified by the HIT Standards Committee. Task Force Charge: Identify gaps, issues and needs for clinical and administrative vocabulary solutions within the scope of the HIT Standards Committee. Develop recommendations to ONC for methods, actions, standards and/or programs to mitigate, manage or solve these vocabulary concerns. Task Force Scope: Vocabulary needed for Meaningful Use and other purposes under ARRA within the scope of the Standards Committee.

3. 3 Vocabulary Task Force Membership Chair Jamie FergusonKaiser Permanente Co-Chair Betsy HumphreysNational Library of Medicine Members Clem McDonaldNational Library of Medicine John HalamkaHarvard Medical School Stan HuffIntermountain Healthcare Christopher ChuteMayo Clinic Marc OverhageRegenstrief Institute Dan VreemanRegenstrief Institute Andy WiesenthalIHTSDO Stuart NelsonRxNorm/NLM John KlimekNCPDP Floyd EisenbergNational Quality Forum Amy GruberCMS Donald BechtelASC X12 Patricia GreimVeterans Affairs Jim WalkerGeisinger Greg DowningHHS Doug FridsmaHHS/ONC Chris BrancatoHHS/ONC Bob DolinHL7 ONC Jodi Daniel Carol Bean

4. 4 Input from Standards Committee Implementation Workgroup –Create publicly available vocabularies and code sets –Ensure they are easily accessible with straightforward updates –Noted licensing issues, e.g., for CPT and medication cross- maps Clinical Operations Workgroup –Noted gaps in cross-maps, subsets and value sets –Noted gaps in governance, management and maintenance –Noted gaps in value set binding to content exchange standards Quality Workgroup –Noted needs for value set determination and processes –Coordination with quality measure stewards

5. 5 Vocabulary Process Gaps & Issues for Task Force Governance: requirements and recommendations Infrastructure: requirements and recommendations Licensing: requirements and recommendations Education/communications: requirements and recommendations Specific value set and subset processes –Requirements determination and definition process for value sets –Coordination of releases, e.g. RxNorm and SPL –Dissemination and publication of value sets –Maintenance of value sets

6. 6 Vocabulary Standards Gaps & Issues for Task Force Cross-maps SNOMED CT frequently used to ICD and CPT RxNorm and proprietary medication codesets Testing and Implementation guidance UCUM, RxNorm Tooling for implementers SNOMED CT Subsets and value sets SNOMED CT, LOINC, RxNorm Binding value sets to content exchange standards CDA Regulatory FDA requirements for UCUM in devices and labs

7. 7 Task Force Approach and Priorities Goals and guidelines for discussion: TF Approach should include public input and invited expert testimony TF Approach should result in recommendations to ONC on identified gaps and issues TF Approach should address all identified issues in 2010  Group discussion to identify TF approach alternatives  Group discussion to identify priorities and immediate next steps

8. 8 Schedule and Structure of Task Force Meetings Monthly meetings proposed, the day before each meeting of the HIT Standards Committee –In-person in Washington DC with teleconference capability Likely meeting structure –Background Paper – with Issues, Questions to be addressed One vocabulary process topic, plus, One vocabulary standards gap or issue –Invited testimony as appropriate –Workgroup discussion –At least one task force phone call between meetings