Panel 1 The Role of Standard Vocabularies in Meaningful Use

The Role of Standard Vocabularies in Meaningful Use: LOINC
Clement J. McDonald, MD, FACMI
Director, NLM Lister Hill National Center for Biomedical Communications (LHNCBC)

  • average patients have 4 visits per year – 1/2 to primary care and 1/2 to specialists
  • LOINC – one of 3 NLM systems required in meaningful use (others are RxNorm and SNOMED)
    • has 6 major parts and can include up to 13 different parts
    • variables have synonyms, descriptions, links to references, data types, cardinality, and more
  • used in 157 countries, incl. national standard for 10 countries (Australia, Canada, France, Germany) and translated into 16 languages
  • has 2k most common items listed
  • web browser search/nav option
  • hospital labs must report individual lab tests and some clinical measurements with LOINC codes.  For example,
    • tests reported to public health
    • cancer tumor registry

SNOMED CT and Meaningful Use
James Case, DVM, PhD, FACMI – NLM – SNOMED

  • ID structure composed of extension item ID, namespace ID, partition ID, and check digit
  • 890k relationships
  • 777k descriptions
  • 297k concepts
  • IHTSDO – manages SNOMED and change request submissions

RxNorm and Meaningful Use
Patrick McLaughlin, MLIS – NLM

  • grew out of UMLS
  • followed HL7 drug model – based upon clinician prescribing rather than pharmacy ordering/fulfillment
  • two important driving factors: 1) improved interoperability 2) patient safety concerns
  • collection of commonly-used public and private drug vocabs (ex: Micromedex, Multum, Gold Standard, MeSH, SNOMED, VA National Drug File, FDA Structure Product Labels aka DailyMed, Anatomical Therapeutic Chemical Classification System, Medi-Span, First DataBank)
  • finding names is easy, but finding strengths is challenging
  • RXCUI (RxNorm concept unique identifier) – for what would be prescribed to the patient
  • How RxNorm is Structured
    • SCD – generic drug (~20k)
    • SBD – branded drugs (~10.5k)
    • GPCK – generic pack (multiple drugs in same pack) 333
    • BPCK – branded pack 410
  • medication standard for Stage 2 of meaningful use
    • medication reconciliation across multiple settings or care providers
    • MedlinePlus Connect – links EHR/PHR to MedlinePlus consumer health information via RXCUI match-up –> meets patient-specific information
  • need to register with UMLS for license but the license is free
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