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<div class="h1">VSAC Authoring Best Practices</div>
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<div class="tablet:grid-col-12"><!-- start column-->
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<p>The Value Set Authority Center (VSAC) serves as the authority and central repository for the Centers for
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Medicare &
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Medicaid (CMS) Electronic Clinical Quality Measure (eCQM) Value Sets, as well as value sets for use in other
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programs and within a wide range of data models. The VSAC provides search, retrieval and download
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capabilities
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through a <a href="https://vsac.nlm.nih.gov/">Web interface</a> and through an <a
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href="//www.nlm.nih.gov/vsac/support/usingvsac/vsacsvsapiv2.html">API</a>. A major function of the VSAC
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is the
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VSAC Authoring Tool for users to create value sets, as well as a VSAC Collaboration Tool for authors to
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collaborate
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on their VSAC content.</p>
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<p>These guidelines are intended for value set authors. The guidelines provide an overview and specific guidance
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on the
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best practices for authoring value sets for clinical quality measures and other healthcare applications. The
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main
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focus of these guidelines is to describe criteria that define a high quality value set.</p>
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<button class="usa-accordion__button" type="button" aria-expanded="false"
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aria-controls="bestpractices-section-1">
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Building High Quality Value Sets
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</button>
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</h4>
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<div id="bestpractices-section-1" class="usa-accordion__content">
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<p>A value set contains specific codes derived from a single code system or vocabulary, for example,
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RxNorm,
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ICD-10-CM, ICD-9-CM, SNOMED CT, LOINC, and CPT, although value sets can be grouped to combine code
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systems. In the CMS eCQMs program, value set codes populate an instance of a Quality Data Model
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(QDM)
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category of information in an electronic health record. The Health Information Technology Standards
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Committee (HITSC) Vocabulary Task Force and Clinical Quality Workgroups identified the primary code
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systems for use with each QDM category of information. The Clinical Quality community continues to
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work
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on these recommendations to assure they are more comprehensive and not too restrictive.</p>
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</div><!-- end accordion content-->
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<button class="usa-accordion__button" type="button" aria-expanded="false"
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aria-controls="bestpractices-section-2">
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Types of Value Sets
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</button>
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</h4>
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<div id="bestpractices-section-2" class="usa-accordion__content">
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<ul>
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<li><strong>Extensional:</strong> A set of concept codes and descriptors, in the form of an
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enumerated
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list, selected to serve a specific purpose. A simple enumeration of concepts is not always an
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||
ideal
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||
approach to define a value set, as a comprehensive approach to clinical quality measure
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development
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||
dictates examination of complete code hierarchies in a code system to define the levels of
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concept
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inclusion (see Intensional Value Sets below). An extensional value set contains codes from only
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one
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code system.
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||
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<br /><br /><img class="figure-img img-fluid img-thumbnail"
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||
src="//www.nlm.nih.gov/vsac/support/authorguidelines/valuesetext.jpg" id="extensional"
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alt="Extensional Value Set"><br /><br />
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</li>
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<li><strong>Grouping:</strong> A list of several value sets that share a common purpose and similar
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clinical concepts. For CMS eCQMs, specifically, members of a grouping value set must have the
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same
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Quality Data Model Category, but the value set members of the grouping do not need to share the
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||
same
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code system. For example, the "Wound Care" Grouping used in measure CMS71v10 uses three value
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||
sets,
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||
ICD-9-CM, ICD-10-CM, and SNOMED CT. All of these member value sets relate to wound care.
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||
|
||
<br /><br /><img class="figure-img img-fluid img-thumbnail"
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||
src="//www.nlm.nih.gov/vsac/support/authorguidelines/groupingex.jpg" id="Grouping"
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||
alt="Grouping Value Set"><br /><br />
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||
</li>
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||
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<li><strong>Intensional:</strong> A list of codes based on a logical statement that often has an
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algorithmic basis for selection of concepts. For example, "include all concepts that are
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children of
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a parent concept" in a hierarchical code system.
|
||
|
||
<br /><br /><img class="figure-img img-fluid img-thumbnail"
|
||
src="//www.nlm.nih.gov/vsac/support/authorguidelines/intensionalex.jpg" id="Intensional"
|
||
alt="Intensional Value Set"><br /><br />
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||
</li>
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|
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</ul>
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|
||
aria-controls="bestpractices-section-3">
|
||
|
||
Value Set Quality Criteria
|
||
|
||
|
||
</button>
|
||
</h4>
|
||
<div id="bestpractices-section-3" class="usa-accordion__content">
|
||
|
||
<p>Standardization of value sets is imperative, as it enables value set comparison across data sets.
|
||
Adherence to these quality criteria facilitates reuse of well-defined value sets to advance clinical
|
||
research studies and interoperability of health informatics analysis systems. Value set authors
|
||
should
|
||
clearly understand major principles that define high quality value sets:</p>
|
||
|
||
<ul>
|
||
|
||
<li><strong>Clinical Validity:</strong> Value set authors should assure that all included codes
|
||
correspond to the intent and purpose from a clinical perspective. For example, a code defining
|
||
breast malignancies might be considered clinically irrelevant in a value set that defines eye
|
||
disease. However, there might be more subtle nuances in clinical meaning one may need to
|
||
consider.
|
||
</li>
|
||
|
||
<li><strong>Metadata Completeness:</strong> Authors must provide correct and complete metadata, using English language and English characters only. Authors need to
|
||
add
|
||
any missing metadata as defined by the data model they use or program under which the authors
|
||
work.
|
||
Value sets defined by different clinical data models will have specific sets of metadata. The
|
||
VSAC
|
||
Authoring Tool indicates which metadata elements are mandatory. Authors should not populate
|
||
free-text fields with meaningless information, as this will hinder the collaborative process of
|
||
eliminating value set redundancy and harmonization efforts of the value set user community.</li>
|
||
|
||
<li><strong>Non-redundancy:</strong> Ideally, a given data element should be presented by one and
|
||
only
|
||
one value set for a given code system. Multiple value sets with the same codes should be
|
||
eliminated
|
||
to facilitate maintenance and prevent inconsistency over time. For example, duplicate value sets
|
||
should be avoided, and value sets that share a majority of codes should be considered for
|
||
merging or
|
||
revision to assure the value sets are as complete as possible.</li>
|
||
|
||
<li><strong>All Value Set Codes Are Active in the Code System:</strong> The authors should consider
|
||
only
|
||
currently active codes for inclusion into a value set, unless inactive codes have been
|
||
intentionally
|
||
included in the value set to facilitate a look back period. This assures proper maintenance of
|
||
the
|
||
value sets.</li>
|
||
|
||
<li><strong>Descriptors Match Code System Descriptors:</strong> Authors should make sure any
|
||
descriptors
|
||
they add manually to value sets match the descriptors in the code system to which the codes
|
||
belong.
|
||
The VSAC Authoring Tool provides a descriptor match check as a built in function. The VSAC
|
||
Authoring
|
||
Tool performs this validation during batch import of codes into a value set, and during manual
|
||
insertions of codes and descriptors.</li>
|
||
|
||
<li><strong>Code List Completeness:</strong> A value set should contain all the relevant codes for a
|
||
particular data element. The coverage of codes should be correct. Authors should make sure the
|
||
lists
|
||
are lean and they should scrutinize large value sets. You should devise working rules and
|
||
quality
|
||
assessment tests to determine whether or not a concept or code is a proper member of a value
|
||
set.
|
||
Authors should describe such rules and tests in the required value set Purpose statement.</li>
|
||
|
||
<li><strong>Logical Correctness:</strong> A value set should contain only the relevant codes for a
|
||
particular data element and the codes contained in the value set should strictly align with the
|
||
described Purpose.</li>
|
||
|
||
<li><strong>Proper Terminological Hierarchies (terminological correctness):</strong> Only root codes
|
||
and
|
||
their descendants should be present in the value set. Presence of codes rooted at a different
|
||
concept normally indicates incorrect choice of codes. In complex cases, value set authors should
|
||
consult terminology experts.</li>
|
||
|
||
<li><strong>Concept Property Similarity:</strong> Value set member concepts should not vary in
|
||
respect
|
||
to their properties and attributes, such as semantic type, term type, etc. For example, a value
|
||
set
|
||
intended for prescribable drugs should contain only drugs with the property, "Prescribable."
|
||
This is
|
||
applicable for concepts that have such properties. The properties should be more similar than
|
||
dissimilar. For complex cases, value set authors should seek guidance on the matter from
|
||
terminology
|
||
experts.</li>
|
||
|
||
<li><strong>Code System Alignment to Standards:</strong> Value set authors should base their value
|
||
set
|
||
on the code system recommended by the standards depending on the purpose of their value set and
|
||
the
|
||
data model (such as the National Quality Forum Quality Data Model) to which the value set
|
||
authors
|
||
may be adhering. Please refer to the Quality Data Model Categories with Office of the National
|
||
Coordinator (ONC) Health Information Technology (HIT) Standards Committee Recommended
|
||
Vocabularies,
|
||
in the most recent version of the <a
|
||
href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MeasuresManagementSystemBlueprint.html">CMS
|
||
Measures Management System Blueprint</a>.</li>
|
||
|
||
</ul>
|
||
|
||
|
||
</div><!-- end accordion content-->
|
||
|
||
<h4 class="usa-accordion__heading">
|
||
<button class="usa-accordion__button" type="button" aria-expanded="false"
|
||
aria-controls="bestpractices-section-4">
|
||
|
||
Value Set Name
|
||
</button>
|
||
|
||
|
||
</h4>
|
||
|
||
<div id="bestpractices-section-4" class="usa-accordion__content">
|
||
|
||
<p>The name of a value set is a crucially important and descriptive metadata element. Value set authors
|
||
should adhere to specific naming guidelines to assure value sets can be found manually and through
|
||
automated processing, to encourage reuse of the value sets and to discourage their redundancy. The
|
||
following guidelines will help you create concise, descriptive value set names that capture the
|
||
purpose
|
||
of each value set.</p>
|
||
|
||
<p><strong>Do's:</strong></p>
|
||
|
||
<ul>
|
||
|
||
<li>Write the value set name to convey the specific distinguishing characteristics of the member
|
||
concepts.</li>
|
||
|
||
<li>Name the value set exactly for what it is, not what you wanted it to be. Avoid including
|
||
descriptions of the content that was intended but not achieved. Correct the name accordingly if
|
||
during the course of the work you discovered you were not able to align the value set content
|
||
with
|
||
the initial name given to the value set. For example, if you initially named the value set "Oral
|
||
Anticoagulants" when the intent was to capture only oral anticoagulants for chronic atrial
|
||
fibrillation, change the name to "Oral Anticoagulants for Chronic Atrial Fibrillation" to align
|
||
it
|
||
with the intended purpose.</li>
|
||
|
||
|
||
|
||
<li>Use sufficiently descriptive names. Using the example above, the value set name "Oral
|
||
Anticoagulants" is not sufficiently descriptive because it does not describe the scope of the
|
||
value
|
||
set. The value set name "Oral Anticoagulants for Chronic Atrial Fibrillation" is a better name
|
||
because it effectively describes the scope of the value set.</li>
|
||
<li>Use correct spelling and grammar</li>
|
||
|
||
<li>Separate multi-word terms by spaces and not by any other characters.</li>
|
||
|
||
<li>Capitalize first letters of all words, except prepositions, as in a title.</li>
|
||
|
||
<li>Make unique value set names. Due to the uniqueness of the value set purpose and content, name
|
||
redundancy ought to be a very rare occurrence.</li>
|
||
|
||
<li>Limit the value set name to as few words as possible, and no more than 128 characters.</li>
|
||
|
||
</ul>
|
||
|
||
<p><strong>Don'ts:</strong></p>
|
||
|
||
<ul>
|
||
|
||
<li>The following characters are technically prohibited and you will get a system warning if they
|
||
are
|
||
used: + * ? : - | ! " %</li>
|
||
|
||
<li>Avoid abbreviations, unless they are widely accepted in the medical literature.</li>
|
||
|
||
<li>Do not include the name of the steward responsible for the value set. The steward name is
|
||
separate
|
||
metadata bound to the value set and captured in the VSAC database.</li>
|
||
|
||
<li>Avoid including the name of the Quality Data Model data element to which the value set will be
|
||
linked if the value set is to be referenced as part of a Clinical Quality Measure.</li>
|
||
|
||
<li>Do not include the name of the program that sponsors the value set, unless the program name
|
||
describes a primary distinguishing characteristic of the value set.</li>
|
||
|
||
<li>Do not include the name of the code system used to obtain the concepts, unless it describes a
|
||
primary distinguishing characteristic of the value set. For example, extensional value sets that
|
||
belong to a grouping value set might be an appropriate case in which you would include the code
|
||
system name.</li>
|
||
|
||
<li>Do not include the concept category that characterizes the context of use, unless it describes a
|
||
primary distinguishing characteristic of the value set requirements. For example, only include
|
||
the
|
||
word "Procedure" when the context of the main focus is ambiguous.</li>
|
||
|
||
<li>Do not use the word "Other" as an alternative to another value set. Each value set name must be
|
||
understandable independent of any other value set. For example: Do not name a value set "Other
|
||
Endophthalmitis" just because a value set named "Purulent Endophthalmitis" already exists. Be as
|
||
specific as possible. "Other Endophthalmitis" lacks adequate information that value set
|
||
consumers
|
||
need.</li>
|
||
|
||
<li>Do not include "CamelCase" or other composite and delimited words or phrases.</li>
|
||
|
||
<li>Avoid using code descriptors within the value set name.</li>
|
||
|
||
<li>Do not use names of measure types for which the value set is intended. For example, do not
|
||
include
|
||
"hospital measure," "patient measure," etc. Include this information in the value set Purpose
|
||
Statements.</li>
|
||
|
||
</ul>
|
||
|
||
|
||
</div><!-- end accordion content-->
|
||
|
||
<h4 class="usa-accordion__heading">
|
||
<button class="usa-accordion__button" type="button" aria-expanded="false"
|
||
aria-controls="bestpractices-section-5">
|
||
|
||
Value Set Purpose
|
||
|
||
|
||
</button>
|
||
</h4>
|
||
<div id="bestpractices-section-5" class="usa-accordion__content">
|
||
|
||
<p>The <strong>Purpose Statement</strong> is a multi-part free-text mandatory entry. It is designed to
|
||
provide a clear and comprehensive description of the membership of the value set. This important
|
||
metadata element must describe how to use the concept in a clinical measure or in any other intended
|
||
application. The Purpose Statement cannot be validated automatically, so authors should spend time
|
||
to
|
||
make this text as informative as possible for human readers to understand the intent of the value
|
||
set,
|
||
and how the value set is put together. To avoid redundancy, there should be only one value set for a
|
||
given purpose. <strong>Authors must add Purpose Statements to value sets if they are not
|
||
present.</strong></p><br />
|
||
|
||
<p>The Purpose Statement includes <strong>four</strong> separate fields that the value set author needs
|
||
to
|
||
complete:</p>
|
||
|
||
<ol>
|
||
|
||
<li><strong>Clinical Focus -</strong> A free text statement describing the general focus of the
|
||
value
|
||
set including a description of the intended constituent concepts. This can include information
|
||
about
|
||
clinical relevancy or a statement about the general focus of the value set, such as a
|
||
description of
|
||
types of messages, payment options, geographic locations, etc. Note that over the course of a
|
||
value
|
||
set’s lifecycle value set authors should not change the clinical focus in any meaningful way.
|
||
|
||
<div style="margin-left:35px"><strong>Example</strong> (from the CMS eCQM program): The purpose
|
||
of
|
||
this value set is to represent concepts for conjugated estrogen/medroxyprogesterone
|
||
combination
|
||
medications.</div><br />
|
||
|
||
|
||
<li><strong>Data Element Scope -</strong> A free text statement describing how the data element
|
||
relates
|
||
to the value set it is bound to. This context of usage often constrains the semantic type of the
|
||
allowed constituent concepts. <br />
|
||
|
||
<div style="margin-left:35px"><strong>Example</strong> (from the CMS eCQM program): This value
|
||
set
|
||
may use a model element in the QDM category of Medication.</div><br />
|
||
|
||
|
||
<li><strong>Inclusion Criteria -</strong> A free text statement that describes what specific concept
|
||
or
|
||
code criteria are included and why.<br />
|
||
|
||
<div style="margin-left:35px"><strong>Example</strong> (from the CMS eCQM program) Includes
|
||
concepts
|
||
that describe a medication specific to generic, prescribable esterified estrogen medication.
|
||
</div><br />
|
||
|
||
|
||
<li><strong>Exclusion Criteria -</strong> A free text statement that describes what specific concept
|
||
or
|
||
code criteria would normally be included, but are specifically excluded by the value set author,
|
||
including their rationale for exclusions. If the value set author determines there are no
|
||
identified
|
||
exclusions, they should populate this field with the text “No exclusions."<br/>
|
||
|
||
<div style="margin-left:35px"><strong>Example</strong> (from the CMS eCQM program): Excludes
|
||
concepts that describe branded and non-prescribable esterified estrogen medications in
|
||
combination with other medication. </div><br />
|
||
|
||
|
||
</ol>
|
||
|
||
|
||
</div><!-- end accordion content-->
|
||
</div><!-- end accordion-->
|
||
|
||
</div><!-- end column-->
|
||
</div><!-- end row-->
|
||
|
||
|
||
|
||
|
||
<p class=”margin-top-5”><small>Last Reviewed: December 30, 2024</small></p>
|
||
|
||
</div>
|
||
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