Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Toolkit Overview of MDS3.0 Rosetta Stone

12/01/2011

The Rosetta Stone spreadsheet was designed for the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) as a tool to assist long term care providers and clinicians in the transition to using Logical Object Identifiers Names and Codes (LOINC) and SNOMED CT as the terminology of choice for the documentation and conveyance of MDS 3.0 assessment content (based on CMS MDS3.0 data specifications v1.01.0, December 2010). The Rosetta Stone is a tool that can be used for various mapping scenarios:

  1. Map from MDS3.0 in CMS format to corresponding Model of Use LOINC representation: In this scenario, one uses the Rosetta Stone "Model of Use" tab. For each MDS3.0 question and answer, there is a corresponding LOINC question and answer code. In addition, the CDA pattern to be used when communicating the assessment items in CDA format is also listed.

  2. Map from MDS3.0 in CMS format to corresponding Model of Meaning representation: In this scenario, one uses the Rosetta Stone "Model of Meaning" tab. For each MDS3.0 question and answer, 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.

    MDS3.0 data elements were evaluated against other standard terminologies such as RxNorm however the terminologies were not compatible with the data captured in the CMS assessment instrument.

  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 can be used to help fill in the corresponding MDS question. (Note: Value sets were only created for MDS3.0 Section I data elements in this work product. Data elements for other sections of the MDS3.0 were not mapped to value sets.)

Rosetta Stone Context*
Tab 1   Overview This tab presents a description of the Rosetta Stone and its content.
Tab 2 Model of Use Using the MDS3.0 section and question ID as the primary sort order, this tab presents MDS3.0 Extract questions and answers (based on the CMS MDS2.0 data specification v1.01.0, December 2010) and corresponding:
  • LOINC representations and codes (provided by Indiana University of Regenstrief Institute, Inc.)
  • CDA pattern per HL7 Implementation Guide for CDA Release 2, CDA Framework for Questionnaire Assessments and CDA Representation of the Minimum Data Set Questionnaire Assessment (hereafter referred to as the MDS CDA Implementation Guide)

Content of this tab is listed below.

  • Columns A - D: MDS3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010

    Column A = CMS Section IDs for each MDS3.0 section
    Column B = CMS Question ID for each MDS3.0 data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS3.0 data item
    Column D = CMS Description for each MDS3.0 data item

  • Column E: Contains some general guidance related to data mapping.
  • Columns F - H: Contain relevant CDA mapping information per the HL7 Implementation Guide for CDA Release 2, CDA Framework for Questionnaire Assessments and CDA Representation of the Minimum Data Set Questionnaire Assessment

    Column F = Contains the Model of Use Question/Answer pattern for each MDS3.0 item in accordance with the MDS CDA Implementation Guide
    Column G = Contains the data type for each MDS3.0 item in accordance with the MDS CDA Implementation Guide
    Column H = Contains the type of unit the MDS3.0 question requires if the data type is Physical Quantity (PQ) in accordance with the MDS CDA Implementation Guide

  • Columns O - Q: Contain LOINC representation of MDS3.0 Extract data items.

    Column O = LOINC question code for each MDS3.0 data item
    Column P = LOINC answer code for each MDS3.0 data item
    Column Q = LOINC answer set object identifier (OID) for each MDS3.0 data item
    Note: LOINC codes were not assigned if the MDS CDA Implementation Guide required the data element be coded to another code sets (e.g. HL7 administrative codes for gender and marital status)

Tab 3 Model of Meaning Using the MDS3.0 section and question ID as the primary sort order, this tab presents MDS3.0 questions and answers (based on the CMS MDS2.0 data specification v1.01.0, December 2010) and corresponding:
  • SNOMED CT (version 20100731) representations and codes for semantically mappable MDS3.0 data items
  • ICD-9-CM (October 1, 2010 update) codes for MDS3.0 Section I (Active Diagnoses) data items
  • ICD-10-CM (2011 release) codes for MDS3.0 Section I (Active Diagnoses) data items
  • CVX (September 30, 2010 update) codes for MDS3.0 vaccination data items
  •  

Content of this tab is listed below.

Note: CAP SNOMED Terminology Solutions provided the SNOMED CT mapping of MDS3.0 data items.
The American Health Information Management Association (AHIMA) provided the ICD-9-CM, ICD-10-CM, and CVX mapping of MDS3.0 data items.

  • Columns A - D: MDS3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010

    Column A = CMS Section IDs for each MDS3.0 section
    Column B = CMS Question ID for each MDS3.0 data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS3.0 data item
    Column D = CMS Description for each MDS3.0 data item

  • Column E: Contains some general guidance related to data mapping.
  • Column F: Contains the pattern used for mapping the SNOMED CT representation of the MDS3.0 data items. SNOMED mapping was based on either an "assertion pattern" or "question & answer pattern".
  • Columns G - H: Contain SNOMED CT representation of semantically mappable MDS3.0 data items

    Column G = SNOMED CT code for each mapped MDS3.0 data item
    Column H = SNOMED CT Fully Specified Name (FSN) for each assigned SNOMED code

  • Column I: Contains ICD-9-CM codes for the MDS3.0 active diagnoses (selected from MDS3.0 Section I data items)
  • Column J: Contains ICD-10-CM codes for the MDS3.0 active diagnoses (selected from MDS3.0 Section I data items)
  • Column K: Contains CDC Race and Ethnicity Codes for the MDS3.0 race/ethnicity data items
  • Column L: Contains Codes for Vaccines Administered (CVX) for the MDS3.0 vaccination data items
Tab 4 Supporting EHR Observation Using the MDS3.0 section and question ID as the primary sort order, this tab presents MDS3.0 Section I questions and answers for Active Diagnoses (data items I0100 thru I8000 based on the CMS MDS3.0 data specification v1.01.0, December 2010) and corresponding:
  • SNOMED CT (version 20100731) value set identifiers
  • ICD-9-CM (October 1, 2010 update) value sets
  • ICD-10-CM (2011 release) value sets

    Notes:

    1. CAP SNOMED Terminology Solutions provided the SNOMED CT value sets for the MDS3.0 Section I (Active Diagnoses) data items. The value set for each Section I data item, found in a separate file named MDS_Value_Set.zip, contains the CMS ID and description of the data item and the corresponding SNOMED CT concept ID (CID) and the Fully Specified Name (FSN) for the members of the value set.
    2. The American Health Information Management Association (AHIMA) provided the ICD-9-CM and ICD-10-CM value sets for the MDS3.0 Section I (Active Diagnoses) data items.
  • Columns A - D: MDS3.0 question and answer ID numbers and descriptions based on CMS data specifications v1.01.0, December 2010

    Column A = CMS Section ID
    Column B = CMS Question ID for each MDS3.0 Section I data item (This column is the primary sort order for the tab.)
    Column C = CMS Answer ID for each MDS3.0 Section I data item
    Column D = CMS Description for each MDS3.0 Section I data item

  • Column E: Contains some general guidance related to data mapping.
  • Columns F - G: Contain the identifiers for the SNOMED CT value sets compiled by CAP SNOMED Terminology Solutions

    Column F = Value Set ID for each Section I data item
    Column G = Value Set name for each Section I data item

  • Column H: Contains the ICD-9-CM codes comprising the value set for each data item in MDS3.0 Section I (Active Diagnoses)
  • Column I: Contains the ICD-10-CM codes comprising the value set for each data item in MDS3.0 Section I (Active Diagnoses)
Tabs correspond to Excel file available at http://aspe.hhs.gov/daltcp/reports/2011/StratEng-D1.xlsx.

 

Rosetta Stone Resources
CMS Minimum Data Set 3.0 (MDS3.0) MDS3.0:
Codes for Vaccine Administered (CVX) CVX codes:
International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) ICD-9-CM codes:
  • Are maintained by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services
  • Are updated in October (yearly) and April (if needed)
  • Can be accessed at http://www.cdc.gov/nchs/icd/icd9cm.htm
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) ICD-10-CM codes:
  • Are maintained by the National Center for Health Statistics (NCHS)
  • Are not valid for any purpose or use until October 1, 2013 (effective date per HIPAA requirements)
  • Can be accessed at http://www.cdc.gov/nchs/icd/icd10cm.htm
Logical Object Identifiers Names and Codes (LOINC) LOINC codes:
  • Are maintained by Regenstrief Institute, Inc.
  • Are updated as needed
  • Can be accessed through the Regenstrief LOINC Mapping Assistant (RELMA) at http://loinc.org/relma
Standardized Nomenclature of Medicine - Clinical Terms (SNOMED CT) SNOMED CT codes:
  • Are maintained by the International Health Terminology Standards Development Organisation (IHTSDO)
  • Are updated twice a year in January and July
  • Can be accessed through a variety of free browsers listed by the Unified Medical Language System (UMLS) at http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html

 

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