By: Charlie Harp
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:
https://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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