Intro to Value Sets

A value set is a list of specific values, terms, and codes used to describe clinical and administrative concepts in the healthcare system. Value sets provide groupings of unique values along with a standard description or definition from one or more standard vocabularies used to describe the same clinical concept, e.g., encounter status, medications, demographics, etc.

Organizations determine global standards for these value sets that can be used between healthcare organizations. Value sets support interoperable health information exchange, and provide a standardized way for defining terms in healthcare. Value sets are used in Electronic Health Records (EHRs) and in the Tendo system.

• The Office of the National Coordinator for Health Information and Technology creates and maintains the United States Core Data for Interoperability (USCDI) standard, a set of health data classes and constituent data elements for nationwide interoperable health information exchange.
• SNOMED International owns and manages SNOMED, the world’s most comprehensive clinical terminology. SNOMED covers all aspects of clinical care, and is used to code and classify medical concepts such as diseases, symptoms, procedures, and medications. SNOMED includes over 350,000 clinical concepts and over 1.5 million relationships between those concepts.
• RxNorm, produced by the National Library of Medicine, is a standardized nomenclature for clinical drugs and drug delivery devices. It contains over 100,000 concepts for drugs, including their active ingredients, brand names, and packaging. RXNorm also includes codes for drug-allergy interactions, which help prevent medication errors and adverse drug reactions. These codes can be used to indicate that a patient has an allergy to a specific medication or to flag potential drug interactions based on a patient's known allergies.

Most healthcare systems use SNOMED and RXNorm to code and classify medical concepts. They help healthcare providers communicate accurately and efficiently about medical topics. Tendo supports SNOMED and RXNorm as standard vocabulary value sets.

Custom value sets

When these standard Value Sets don’t meet a customer’s or Tendo’s needs, Tendo also creates its own custom Value Sets. For example, the term Comorbidity Impact is a custom Tendo Value Set used by Tendo Insights. It includes a set of terms specific to the work that Insights does with some CDI customers.

Tendo uses more than 50 different value sets. These value sets map to fields in the Tendo apps.

Value sets need to be viewed, created, edited, and deleted throughout the UI when a custom object is created or custom fields are added to a standard object.

There are three types of value sets:

• Tendo-managed - Value set and items are delivered and managed entirely by Tendo. These are read only.
• Configurable - Value set is delivered and managed by Tendo. Value set items can be changed if the customer requires it. These can be edited by a user with the right permissions.
• Custom - Value set and items are defined and managed by the customer. These can be created, edited, and deleted by a user with the right permissions.

Value Sets Curation

Tendo’s curation process for standard value sets and Tendo custom value sets involves identifying, selecting, and organizing the most relevant and useful concepts or codes from existing terminologies to create a standard value set that meets specific requirements.

This process involves:

1. Defining the scope and purpose of a value set, including the types of codes or concepts that should be included, intended use cases, and specific requirements or constraints.
2. Identifying candidate terminologies that contain codes or concepts related to the relevant usage or topic - standard terminologies such as SNOMED CT, ICD-10, LOINC, and RxNorm, and local or proprietary terminologies used within an organization or system.
3. Evaluating candidate codes or concepts to include in the value set. This involves reviewing the relevance, completeness, and specificity of each code or concept, and considering any issues related to data quality, consistency, or mapping.
4. Organizing and grouping codes or concepts into a logical hierarchy or structure. This may involve creating subsets or categories based on the clinical context, specialty, or other criteria, as well as defining relationships between codes or concepts.
5. Validating and testing the value set to ensure that it meets the defined requirements and is fit for the purpose. This may involve conducting user acceptance testing, verifying that the value set can be used in relevant systems and applications, and ensuring that it is consistent with other standards and guidelines.

Value set curation is a critical step in ensuring the quality and usefulness of terminology in healthcare. By following a systematic and rigorous process, organizations can develop and maintain value sets that support safe, effective, and efficient care delivery, while also promoting interoperability and data exchange across different systems and stakeholders.

Once terms have been identified, they are defined and organized into a taxonomy or hierarchy so that related terms are grouped together. As new terms emerge or existing terms change in meaning, value sets are updated to ensure that the terminology remains accurate and up to date.

Tendo has defined several value set definitions. Most of them are derived from an FHIR specification, while others are curated from different vocabulary sources provided by third-party systems. This example provides detailed steps about curation for the value set of allergy codes:

Allergy codes are used to capture information about a patient’s allergic reactions or sensitivities to specific substances or medications. Allergy codes standardize the way that allergy information is documented and communicated across healthcare settings such as hospitals, clinics, and pharmacies. By using a standardized set of codes, healthcare providers can more easily identify and track a patient's allergies and ensure that appropriate precautions are taken to prevent adverse reactions or interactions with medications or other substances.

Allergy codes include a wide range of substances and allergens that may cause allergic reactions, including foods, medications, environmental factors, and other substances.

Allergy codes also play an important role in healthcare analytics and research. By collecting data on allergy prevalence and trends over time, healthcare organizations can better understand the impact of allergies on patient outcomes and can identify opportunities for improved care and prevention.

There is no first-class data source to represent allergy codes in RXNorm and SNOMED code systems, so allergy codes must be manually curated from several different sources.

Most of Tendo’s value sets are imported during tenant provisioning in Tendo Cloud Configurator (TCC). They include industry standard value sets and Tendo’s custom value sets. Tendo-defined value sets are platform-specific and available to all tenants. Tenant custom definitions override the Tendo value on their tenant only.

After this import is completed, the value sets are visible in Atrium in the Tools app under Data > Value Sets.