Clinical use of value sets to answer clinical questions

[drdavec]

Review multiple value sets that do not include concepts used in our sample data, where those concept codes appear to be valid and likely to encounter in practice.

Value Sets

• eGFR
• CKD
• Vitamin D
• ACEi / ARB Medication

eGFR Review the eGFR value set definition currently referenced from the IG. It seems to be incomplete. Our test data is not displaying and I see that the eGFR code is not in the value set, but appears OK in LOINC. https://loinc.org/69405-9/. Also I just looked at my own personal lab results from Quest Diagnostics taken a year ago (I have loaded these into Apple Health). And that code is also NOT is our value set. https://loinc.org/77147-7/

Vitamin D

• Does not include "Vitamin D 1000 UNT"

      {
        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "316894",
        "display": "Vitamin D 1000 UNT"
      }

CKD

• Does not include general concept from SNOMED or ICD

  "code": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "709044004",
        "display": "Chronic kidney disease (disorder)"
      },
      {
        "system": "http://hl7.org/fhir/sid/icd-10-cm",
        "code": "N18.9",
        "display": "Chronic kidney disease"
      }
    ],
    "text": "Chronic kidney disease"
  },

ACEi

• Does not include med from va-pat-dan example (works for different dosage in Patricia example)

        "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code": "314076",
        "display": "Lisinopril 10 MG Oral Tablet"

[emmanurse]

We need to understand why the value sets are so narrowly defined...