Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. 3. Rosetta Stone

12/01/2011

The Rosetta Stone spreadsheet was designed as a tool to assist health IT vendors of long-term care EHR products in the transition to using LOINC, SNOMED CT and other standard vocabularies as the terminology of choice for the documentation and conveyance of MDS 3.0 (based on CMS MDS3.0 data specifications v1.01.0, December 2010) and OASIS-C (based on CMS OASIS-C data specifications v2.00, Revision 3, October 2009) assessment content. The use of these healthIT standards should be transparent to the end user and the assessment content they are accustomed to seeing would remain unchanged. However, the software application would be enhanced to map the assessment content to standard vocabularies to support interoperable exchange and reuse of the assessment content. The Rosetta Stone is a tool that can be used for various mapping scenarios:

CMS Data Specifications:

Several updates to the CMS MDS3.0 Data Specifications were released over the course of this project. It was out of scope for this project to revise deliverables based on data specification updates released following completion of a tool. Such updates will need to be addressed in the future.

MDS tools created for this study are based on the CMS data specifications as listed below:

  • MDS CDA Implementation Guide Update Release 2: used CMS MDS3.0 data specifications v1.00.0, October 2009
  • MDS Rosetta Stone: used CMS MDS3.0 data specifications v1.01.0 December 2010
  • OASIS Rosetta Stone: used CMS OASIS-C data specifications v2.00, Revision 3, October 2009
  1. Map from MDS3.0 or OASIS-C in CMS format to corresponding Model of Use LOINC representation: In this scenario, for each MDS3.0 or OASIS-C question and answer, there is a corresponding LOINC question and answer code, respectively. For MDS3.0 questions and answers, the CDA pattern to be used when communicating the assessment items in CDA format is also listed. For this scenario, see the Rosetta Stone "Model of Use" tab in the attached Excel spreadsheet.

  2. Map from MDS3.0 or OASIS-C in CMS format to corresponding Model of Meaning representation: In this scenario, for each MDS3.0 question and answer mappable to a standard terminology, there is a corresponding semantically complete representation, based on a complete modeling of the question against the HL7 Reference Information Model, coupled with codes from a standard terminology such as SNOMED CT or code sets such as ICD-9-CM or CVX. For OASIS-C questions and answers, there is a corresponding code from a standard terminology such as SNOMED CT or code set such as CVX.

    MDS3.0 and OASIS-C data elements were also evaluated against other standard terminologies such as RxNorm. However, these other terminologies were not compatible with the data captured in these CMS standardized assessment instruments.

    For this scenario, see the Rosetta Stone “Model of Meaning” tab in the attached Excel spreadsheet for the semantic representation of MDS or OASIS questions and answers.

  3. Map from EHR data element to MDS3.0 element to facilitate semi-automated population of assessments from EHR data: In this scenario, one uses the Rosetta Stone "Supporting EHR Observation" tab and corresponding Access database of "Value Set Members". Where a SNOMED-encoded finding, ICD-9-CM code or ICD-10-CM code in the EHR maps into one of the value sets, it suggests the presence of EHR data that could be used to help fill in the corresponding MDS question.

    Note: Under this scope of work, value sets were only created for MDS3.0 Section I (Active Diagnoses) data elements. Additional work is needed to identify value sets for OASIS-C data elements and data elements for other sections of the MDS3.0.

A separate “Rosetta Stone” has been created for the MDS3.0 and the OASIS-C assessment instruments. Each Rosetta Stone is a spreadsheet with an Overview describing the content of the spreadsheet, and separate tabs for Model of Use and Model of Meaning content. The Rosetta Stone for the MDS3.0 also has a “Supporting EHR Observations” tab for Section I (Active Diagnoses) value sets as described above.

 

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