Navigating the data maze: The significance of value sets in healthcare

Explore the importance of value sets in healthcare data. Learn how they improve patient care, drive interoperability, and ensure accurate reporting.
patient cohorting

Healthcare organizations generate and exchange vast amounts of data that impact clinical, operational, and financial plans. That data is also key to identifying patients who require unique care.

Given the abundance of data gathered from disparate sources, consistently grouping this information to segment patient populations into clearly defined cohorts can be challenging. From the outset, patient condition and treatment data must be accurately gathered to reflect the clinical concepts that define a group – and a high level of specificity is necessary for efforts like clinical trials, quality reporting, and tech stack interoperability.

Here’s where value sets come into play.

The what and why of value sets

A value set is a group of codes and corresponding terms that define clinical concepts. By combining specific data, value sets add context to the clinical narrative and help characterize groups of patients.

Value sets are among the fundamental building blocks supporting both day-to-day activities and strategic initiatives in healthcare. They help ensure that data is accurate, complete, and useful for many tasks, including:

  • Defining the data elements used for quality measurements. (For example, a value set that defines the different types of diabetes may be used for a particular quality measure.)
  • Helping coders assign the correct codes to patient records.
  • Identifying patients who meet the criteria for clinical trials or other research studies.

Value sets are becoming increasingly important

A number of industry trends are driving an increased need for organizations to create complete and accurate value sets.

  • Value-based care: Reimbursement models centered on quality and patient outcomes have brought greater attention to value sets, which help to define and capture the relevant clinical concepts necessary for measuring and evaluating performance.
  • Interoperability standards: The push for interoperability has been a driving force behind the increased use of value sets as they allow different systems and organizations to communicate and exchange data seamlessly. With the implementation of standards like Fast Healthcare Interoperability Resources (FHIR), value sets have become fundamental to achieving semantic interoperability.
  • Regulatory requirements: Agencies like the Centers for Medicare & Medicaid Services (CMS) require the use of value sets for reporting quality measures, clinical decision support, and other initiatives. Organizations must keep pace with evolving requirements to ensure compliance and accurate reporting.

Easier said than done

Creating and maintaining value sets is an intricate and time-consuming process. There are several challenges that an organization must address, like:

  • Defining complex clinical concepts
  • Obtaining the appropriate codes that represent the concepts
  • Standardizing and maintaining the value set beyond its initial creation

Each of these obstacles can create additional breakdowns in workflows across teams, whether it’s due to constant back-and-forth communication or the need to manually maintain data.

Let’s look at an example.

You want to identify all stage 3 breast cancer patients to ensure they receive appropriate follow-up. Defining this group using only ICD-10-CM is impossible as it does not have a representation for cancer stage. Or, if you were to use SNOMED CT®, two codes would be necessary to capture cancer stage.

Moving forward

Value sets play a vital role in standardizing healthcare data and enabling seamless interoperability, quality measurement, and improved patient care. As the healthcare landscape continues to evolve, it is crucial for organizations to recognize the importance of value sets and invest in robust processes and technologies for their creation and maintenance.

Stay tuned for more information from IMO as we help organizations like yours to improve their data quality while cutting down on the time and resources needed to maintain value sets.

Ready to learn how IMO’s solutions can improve the quality of your data?

SNOMED and SNOMED CT® are registered trademarks of SNOMED International

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