Single vocab standard for each EHR reporting domain seen as 'momentous'

By Mary Mosquera
08:25 AM

The Health IT Standards Committee has endorsed a single set of vocabulary standards and a single guide for putting them in place for each area of quality reporting measures, an accomplishment that some individuals and groups have been working on for 10 years. The domains include medications, labs and allergies.

The committee will recommend to the Office of the National Coordinator for Health IT to incorporate the vocabulary standards and implementation guides in certification criteria for electronic health records (EHRs) for stage 2 of meaningful use. 

Standards provide the common technical methods that can be installed in EHRs to support functions that improve care and help physicians and hospitals meet meaningful use. 

ONC has offered choices of vocabulary standards associated with some quality measures in stage one, according to Dr. John Halamka, committee co-chair and CIO of Beth Israel Deaconess Medical Center. 

“Today we have achieved something that some of us have been working on for a decade. For the first time in history, we will be declaring a single set of standards for each domain with one set of implementation guides,” Halamka said at the Aug. 17 committee meeting. “This is truly a momentous event.”

In categories where more work is needed, the committee will suggest that pilots be the next step.

One criticism of stage one where vocabulary standards are involved is the availability of choice. “Every time we say ‘or,’ we really mean ‘and.’ It creates a dizzying amount of mapping because vendors must support every variation,” Halamka said.

Over the past month, the committee has fine-tuned the proposals of two of its work groups to require a minimal number of vocabulary standards, primarily SNOMED-CT, LOINC or RxNorm. 

“For every category of vocabulary, they have chosen one standard,” Halamka said.

The Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) is a standard medical vocabulary for use in electronic health records for sharing information across specialties and sites of care. The Logical Observation Identifiers Names and Codes (LOINC) is used for lab and clinical identifiers. And RxNorm is a standard for the names for clinical drugs and drug delivery devices produced by the National Library of Medicine.

For example, SNOMED will be used to describe condition or diagnosis, transactions in the patient and physician encounter, communications and the adverse effect caused by drugs, said Jamie Ferguson, chair of the vocabulary panel and vice president of Kaiser Permanente's health IT strategy and policy. RxNorm will identify the medication and SNOMED the non-medications that cause the adverse effects.

Throughout the recommendations, LOINC is frequently used to identify an instrument for survey or assessment, such as smoking status, and SNOMED for the answers to the questions or what is observed, Ferguson said. 

[See also: ONC wants comments about metadata standards for EHRs.]

Wes Rishel, committee member and vice president and distinguished analyst in Gartner's healthcare provider research practice, noted the “enormous progress” the industry has made in the past two years in agreeing on implementable standards measures. 

“You don’t know how complicated it is until you try to make it simple,” he said. The outcome will support the ability to aggregate the information about health care throughout the country. 

Rishel cautioned, however, that the difficult work is still ahead – providers using the standards to meet meaningful use. He suggested keeping the process of standards development public and inviting continued feedback on standards implementation for stage 1 when providers report quality measures.