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Friday, April 22, 2011

Trouble Finding HL7 V3 Codes in NQF Quality Measures? I know why...

Are you having trouble finding the codes listed in the spreadsheets supplied by CMS for the NQF Quality Measures?  I was recently contacted by someone who was looking for immunization reason codes from the  spreadsheets in the second download.

The spreadsheet rows affected look something like this:
standard_taxonomy
standard_taxonomy_version
standard_code_list
HL7
3.0
21703, 21704, 21738, 21745, 21747, 21815, 21990, 22259, 22261, 22855
HL7
3.0
14880, 15985, 19729, 21708, 21710, 21741, 21743, 21746, 22260, 22851
HL7
3.0
19730 , 19731, 19733, 19734, 19735, 19736, 19987, 19988, 19989, 19990, 21408, 21493, 21568, 21706, 21707, 21709, 21728, 21729, 21730, 21731, 21732, 21733, 21734, 21735, 21744, 22023, 22024, 22165, 22166, 22167, 22168, 22169, 22857, 22858, 22859, 22865, 22866, 22867, 22907, 22909, 22911, 22912, 22913

Look all you want in HL7 Version 3 Vocabulary and you'll have trouble finding these code values.  Why?  Because those aren't the HL7 Code values nor is the code system correctly identified.  Yes, they do come from HL7 Version 3.0, but which of the umpteen code systems defined in V3?  (Note:  I'm using the HL7 Ballot web-site here for educational purposes, you should really be using an HL7 Normative Edition Publication to view the published codes).

The answer is that it can be found in the HL7 V3 ActReason Code System.

So, where did the numbers come from?  These are the Internal identifiers HL7 uses to maintain the vocabulary, found in the column titled "Definition, Properties and Relationships" rather than the appropriate codes found in the "Concept Code Column".  Look at 21703 for example.  That should actually be INEFFECT in the ActReason code set.

The Standard Taxonomy column should indicate that the vocabulary comes from HL7 ActReason so you know which code set it comes from.  While this is part of the HL7 Version 3.0 standard, the specific version of the code set is NOT 3.0.  I'm assuming that NQF is using the HL7 2010 Normative Edition.  If so, the version should probably be 2010 or something like that.

Now that you know how to do the mapping, there's something else that should also have been done.  The spreadsheets note the copyright for CPT®, LOINC® and SNOMED-CT®, but should also acknowledge the copyright of HL7 on the Version 3 codes that they report, and obtain appropriate permissions to use them.

4 comments:

  1. So where do you find the GROUPING Codes (e.g. Q_c157, Q_c158, etc.) This comes from the NQF0421 - Standard Code List for Pregnancy.

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  2. Grouping codes? Those are actually references to other rows in the table. Rather than repeating several code sets, they referred to them by the NQF table identifier.

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  3. First time I'm looking at this...sigh...these are not 'codes' as Keith correctly points out. And the only place that they appear is in the internal tooling (not even the release material) of HL7 v3, which in a matter of months will no longer be released or maintained (since it is only internal, and being changed). So I hope somebody having something to do with these spreadsheets wises up and fixes them. Soon.

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  4. Keith and Ted are 100% correct. The internal identifier is nothing more than an identifier used for the maintenance of the HL7 vocabulary.

    The internal identifier is essentially a primary key for one of the repository tables.

    ReplyDelete