Enterprise Terminology Management

Terminology is core to everything in healthcare – from diagnoses to procedures to outcomes, healthcare IT systems represent clinical concepts in coded terminologies or free text. The lack of a common clinical vocabulary across disparate systems is currently a primary roadblock to the national efforts to increase interoperability, transparency and collaboration within our healthcare system.

As federal regulatory initiatives continue to encourage information-sharing capabilities inside and outside a healthcare organization, the C-Suite is increasingly finding that an enterprise terminology management strategy is critical to success. Forward-thinking initiatives such as Accountable Care Organizations, quality improvement, health information exchange, analytics, and population health management all require that terminology content be standardized to eliminate semantic ambiguity.

Enterprise Terminology Management
From adopting major reference terminologies and classification systems such as SNOMED CT and ICD-10 to the aligning of problem lists or quality measures across EMRs, payers and providers who once relied on their point solution vendors to manage terminologies are increasingly realizing that terminology management is no longer confined to departmental solutions. These organizations realize that terminology must be managed centrally, and ambiguity of meaning must be removed from data to enable the exchange, comparison and aggregation of information across disparate systems. A strategy that creates a single source of terminology truth supported by advanced clinical terminology tools and automation is foundational.

The value of leveraging economies of scale by single-sourcing standard terminologies and ensuring that clinical data is properly encoded into standards is evident in its impressive returns – for example, a recent study shows a nearly $4 million saving for one payer alone covering three million lives after implementation of enterprise-wide terminology management.

Meeting Healthcare’s Terminology Challenge
In today’s healthcare ecosystem, it’s not uncommon for a health delivery organization to manage 40 or more separate IT systems, each with its own clinical terminology infrastructure. Ensuring enterprise compliance with industry standards across such a vast landscape often requires a combination of spreadsheets and error-prone manual processes involving numerous interdepartmental coordination meetings between informaticists and individual business owners.

Furthermore, these processes need to be continually repeated each time a local business rule or standard code set is updated.

Without an enterprise terminology management strategy, conflicts regarding terminology intake, management, and distribution are inevitable.

Establishing a Center of Excellence
Healthcare organizations seeking to take the first steps toward an effective enterprise terminology strategy should consider deployment of an Enterprise Terminology Management platform alongside a centralized governance model. These steps establish the infrastructure for integrating structured clinical terminologies on an enterprise scale.

The deployment of an Enterprise Terminology Management platform helps organizations overcome the burden of coordinating terminology use by leveraging 1) standard and enhanced terminologies, mappings, value sets, and synonym libraries; 2) software for terminology access, management, and distribution; and 3) project-based workflow tools for the import, modeling, mapping, customization, grouping, and publishing of terminologies.

When establishing the governance model for a terminology center of excellence, five critical domain responsibilities should be considered:
• Policy and Governance
Govern how terminologies are utilized through the alignment of terminology definitions, intended use, versioning, and implementation across business domains.

• Acquisition and Promotion
Validate and prioritize the promotion of standard and custom content by understanding the business use of terminologies across enterprise systems.

• Integration and Distribution
Ensure the implementation of terminologies within defined SLAs, supported by change notifications and auditing processes.

• Content Authoring
Establish the consistent creation of local content by implementing a common information model that defines content structure and import requirements for modeling, mapping, and loading local terminologies.

• Code Group Management
Identify enterprise-wide business rules and align those through the management of code groups that represent concepts such as benefit policies, cohort identification rules, quality measures, and other classifications of clinical data used within analytic methodologies.

Enterprise Terminology Management in the Healthcare IT Landscape
Evolving our health IT landscape toward greater information sharing, transparency, and interoperability will require an enterprise terminology management strategy. Such a strategy should include implementation of solid governance alongside an Enterprise Terminology Management technological platform. The end result is the enterprise-wide use of approved and up-to-date standard and local terminologies, maps, and value sets – all prerequisites for the exchange, comparison, and aggregation of data across disparate systems.

Jason Wolfson is Vice President of Marketing & Product Management, Health Language, Wolters Kluwer Health Clinical Solutions. He can be reached at Jason.Wolfson@wolterskluwer.com.

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