A Primer on the Vocabularies of Meaningful Use – Introduction

I recently had a request to create a post providing a primer on the vocabularies of meaningful use.  Let’s start with a review of the vocabularies that are named in the meaningful use criteria described on pages 21 and 22 of the January 13th release of the federal register located here:

http://edocket.access.gpo.gov/2010/pdf/e9-31216.pdf.

The “Chosen Ones”

The listed vocabularies and their purpose are as follows:

Terminology Stage Purpose(s)
ICD-9-CM Stage 1
Stage 1
Problems
Procedures
ICD-10-CM Stage 2 Problems
ICD-10-PCS Stage 2 Procedures
SNOMED-CT Stage 1
Stage 2
Stage 2
Problems
Problems
Lab Results (Submission Public Health)
CPT-4 Stage 1
Stage 2
Procedures
Procedures
Third Party Drug Vocabularies* Stage 1
Stage 1
Medications
Electronic Prescribing
RxNorm Stage 2
Stage 2
Medications
Electronic Prescribing
UNII Stage 2 Medication Allergies
CVX Stage 1
Stage 2
Immunization Registries
Immunization Registries
LOINC Stage 1
Stage 1
Stage 2
Stage 2
Lab Orders (from Reference labs)
Lab Results (from reference labs)
Lab Orders (All)
Lab Results (All)
UCUM Stage 2 Units of Measure
CDA template Stage 2 Vital Signs

* Third Party drug vocabularies that are listed as complete in RxNorm by the NLM

Meaningful Selection

What does it mean that a vocabulary is one of the chosen ones?  My understanding is that the meaningful use criteria (based on my reading of the federal register) defines that to be certified EHR technologies must provide patient summaries and interoperate (exchange data) using the listed vocabularies for their defined purposes.  In other words, the vocabulary standards are for interoperability not native persistence in the EHR application.
It is not reasonable to expect that every hospital / physicians office in the US will migrate their patient data to these standards (and then do it again for 2013).  As a good application architect, your objective is to determine how you will be able to express your client’s patient information in the anointed vocabularies.

Where to Learn More

There is a lot I can say about these vocabularies, both their suitability to the task that have been so capriciously assigned to them and the challenges associated in working with each of them.  This is not the post for that particular diatribe.  In this post, I will try to give you some high level information and some places to find out more.  So strap on your learning caps and practice your right click ‘open in new tab’ skills.

The next post will cover the problem vocabularies.

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