The State of the Lexicon Shipped in FOIA

For years, the VA has hollowed out the CPT and HCPCS code maps of the Lexicon before releasing it to FOIA. They now take the same approach with SNOMED and even some older Lexicon-supported schemes:

  1. they don't cleanly remove proprietary code maps (file 757.02). Instead they kill two FileMan-mandatory fields (code and classification) in each map entry, leaving skeleton maps behind. Rather than ship schema-breaking code files, it would be preferable to separate these maps into "only if you license" KIDs builds, to have a CPT-map KIDS, a HCPCS-map KIDS etc.
  2. even where an expression has only one license-restricted code, it is left in the FOIA Lexicon. The VA is not removing the label of a code, just the code itself. I presume the argument is that removing code support == removing the code number and that keeping code labels doesn't violate the letter of a license.

Note: This report is one of a series prepared to aid hosting the VA schemes on C3, Caregraf's Semantic Web-based Concept Management service. Its peer - The reusable parts of the VA Lexicon - details which parts of the Lexicon appear in C3.

Summary of numbers in FOIA, WorldVistA, OpenVistA and an intact VA VistA

TypeFOIAWVOVVA VISTA
total48005347098065956475372
purged4441031981114271335

Interpretation ...

  1. While FOIA has the most entries (480053), most (444103) are purged. This is because most of the latest Lexicon is SNOMED entries.
  2. WorldVistA has an older FOIA-released Lexicon which had SNOMED but did not purge the entries. OpenVistA's much smaller number (65956) is the Lexicon's size before the addition of SNOMED.
  3. The 335 purged entries of VAVISTA counts bad FileMan records (all {}). FMQLv1.0a will skip this corruption and not count records with corrupt entries. In other words, a VA system has NO valid purged entries.

Details

The following shows the number of valid maps for each Lexicon-supported scheme in each of FOIA, WorldVistA (WV), OpenVistA (OV), a VA VISTA.

  1. Per VistA it records the number of valid (unpurged) entries per scheme against how many of these are marked inactive.
  2. The VA VistA column gives the rough number expected in any up to date, unpurged Lexicon. Even this Lexicon is empty for some schemes, even the common such as MeSH (28)
  3. Older schemes such as Classification of Nursing Diagnosis went unredacted until recently. Now the VA treats them as it treats CPTs.
  4. Logical Observation Identifier Names and Codes - LOINC - (LNC/757_03-51) is empty in the current Lexicon. Once populated, it along with SNOMED should dominate the Lexicon.

Note: While SNOMED dominates a full and new Lexicon in quantity, its entries are completely separate from those used in VistA. We don't believe this is an effective method for including SNOMED in the Lexicon for reasons detailed in The reusable parts of the VA Lexicon

#TypeFOIAWVOVVA VISTA
1DoD Military Treating Facilities (MTF/757_03-54)0/00/00/00/0
2Problem List Code Set (PRB/757_03-55)0/00/00/00/0
3SNOMED Clinical Terms (SCT/757_03-56)0/0400787/810980/0403795/107614
4Breast Imaging Reporting and Data Sys, Assessments (BIR/757_03-57)0/00/00/014/0
5Undefined Code/Coding System (Code = "None") (UND/757_03-50)0/00/00/00/0
6Logical Observation Identifier Names and Codes (LNC/757_03-51)0/00/00/00/0
7Reason for Visit Classification for Amb Care (RVC/757_03-52)0/00/00/00/0
8DoD DMIS ID's (DMI/757_03-53)3713/4883664/4883433/4883713/488
9Classification of Nursing Diagnosis (NAN/757_03-11)0/0111/0111/0111/0
10Nursing Intervention Classifications (NIC/757_03-12)0/0341/0341/0341/0
11Nursing Outcomes Classifications (NOC/757_03-13)0/00/00/00/0
12Home Health Care Component, Diagnosis/Interventions (HHC/757_03-14)0/0115/0115/0115/0
13Omaha Nursing Diagnosis and Interventions (OMA/757_03-15)80/080/080/080/0
14Service Connected Disabilities (SCC/757_03-17)758/40812/2714/2718/0
15Index for Radiological Diagnosis (ACR/757_03-19)0/0119/0119/0119/0
16International Classification of Diseases, Diagnosis (10D ICD/757_03-30)0/0108/0108/0108/0
17International Classification of Diseases, Procedures (10P ICD/757_03-31)0/00/00/00/0
18Systematized Nomenclature of Medicine (SNM2/757_03-8)0/011109/211106/211105/2
19International Classification of Diseases, Procedures (ICP9/757_03-2)1021/2161021/2151021/2101021/215
20Current Procedural Terminology (CPT4/757_03-3)0/00/0879/29312105/2673
21International Classification of Diseases, Diagnosis (ICD9/757_03-1)22833/165022130/140621273/107822617/1460
22Diagnostic & Statistical Manual of Mental Disorders (DS4/757_03-6)0/0404/4404/1404/5
23Current Procedural Codes (CPC/757_03-4)0/00/01616/6298311/2985
24Diagnostic & Statistical Manual of Mental Disorders (DS3/757_03-5)0/0247/2247/2247/2
25Dorland's Medical Dictionary (DOR/757_03-49)0/00/00/00/0
26Unified Medical Language System Metathesaurus (MTH/757_03-48)0/00/00/00/0
27Subject Headings (LCH/757_03-47)0/00/00/00/0
28Medical Subject Headings (MSH/757_03-46)0/00/00/00/0
29Computer Stored Ambulatory Records Term File (COS/757_03-21)0/01396/01395/01393/0
30Disease/Findings Knowledge Base (AIR/757_03-20)755/0756/0757/0756/0
31Computer Retrieval of Info. on Scientific Projects (CSP/757_03-23)5121/05123/05123/05122/0
32Coding Symbols Thesaurus for Adverse Reaction Terms (CST/757_03-22)1669/01674/01671/01670/0
33Glossary of Epidemiology Terms (MCM/757_03-25)0/018/018/018/0
34Diagnostic Prompting System (DXP/757_03-24)0/0490/1490/1490/1
35Glossary of Neuronames (UWA92/757_03-27)0/0586/0586/0586/0
36Universal Medical Device Nomenclature System (UMD/757_03-26)0/078/078/078/0