(Editor’s Note: The is article is part 2 in a two-part series on healthcare terminology. Click here to read part 1.)
Every organization that has implemented an electronic clinical system – such as electronic health records (EHRs), clinician order entry, lab or radiology management – has had to implement standardized terminology. That terminology is in use every single day to support structured data entry and summary data reporting. Unfortunately, despite its widespread use and necessity, terminology has not been given much strategic consideration.
But that’s changing. Healthcare executives and administrators increasingly recognize that appropriate use of terminology systems is integral to the success of HIT systems. These investments, coupled with those by large federal healthcare agencies, portend recognizable change for healthcare terminology in 2012 and beyond.
Terminology: Not Just a Requirement
As clinicians and administrators look at the near-term landscape, it is clear that the requirements to support meaningful use, ICD-10, and a host of other broad scale initiatives center on doing terminology right. By the end of 2012 and beyond, all those clinicians that have been ushered into the EHR age will come to view terminology not just as a requirement to be fulfilled for a single implementation, but as a key asset deserving of greater consideration and long-term management because of the impact it can have on results and quality of care. In doing so, they will begin to see terminology management as an enterprise-wide priority that demands ongoing monitoring, evaluation and a commitment of resources.
One must remember that patient care is driven by clinicians’ direct interaction with patients, and their assessment and recording of unique elements about each individual patient in order to determine the best course of action. While not all information needs to be encoded electronically, there is tremendous value in capturing some representation of that information using standardized terminology so that it can be acted upon by computerized systems, something akin to recording significant baseball events for summary statistics. Our healthcare systems are now at a point where we can benefit from such encoded information and the terminologies (and systems that support them) are a key strategic element of long-term healthcare systems.
The result of improved EHRs with better managed terminology will be felt by every healthcare organization, from small physician practices to large integrated delivery networks (IDNs), and from data collection firms to home care agencies. Some large integrated healthcare delivery organizations have recognized this for years, even decades. Systems such as the Veteran’s Health Administration integrated clinical record system, Intermountain Health Care and its Clinical Element Model for recording of patient care, and the clinical record used by Kaiser Permanente Health Systems have been built using sophisticated terminology components to support direct patient care. While such large and costly approaches need not be replicated by most healthcare systems, they illustrate the importance of consistent use and management of standardized terminologies.
As we noted in Part 1, useful terminologies are being identified and value sets are being defined that provide directed sets of concepts that should be collected for particular activities (such as NQF meaningful use eMeasures). Governmental and international entities are working to make this terminology data more available, although at perhaps a slower pace than some would like.
Rise of Terminology Managers
Organizations can begin to build upon this body of work and should recruit terminology managers to manage and support accurate, usable, standardized terminology that clinicians, healthcare administrators, and clinical researchers can utilize for everything from patient care to data reporting. Terminology managers will need to understand healthcare data use and have a basic understanding of the clinical issues involved.
Where will they come from? For many organizations, existing health information management professionals who have been traditionally charged with managing the coding and billing activities will be challenged to better understand standardized terminology in the context of terminology-enhanced systems.
Using the current conversion to ICD-10 as an example, facilities will ask their professionals to draw upon other data sources to turn an ICD-9-CM code into an ICD-10-CM based upon retrieval of the additional information needed. Organizations that see these tasks as a core element of the implementation and maintenance of the EHR to directly support the delivery of patient care and will look for clinically savvy EHR informaticists to integrate persistent terminology into the growing list of sophisticated EHR functions.
By identifying terminology managers who can fully grasp data standardization in the context of patient data exchange and reporting mandates, forward-thinking organizations will build an infrastructure that will support the more specific – and more useful – requirements that arrive with stage ii meaningful use. This same methodological approach will also be required for moving from ICD-10 to ICD-11, given that ICD-11 is built upon an approach very similar to the building blocks found in SNOMED CT.
It is also important to keep in mind that while historically much of the work of enabling terminology has been focused on enhancing the clinician experience and enabling healthcare professional documentation and support, beginning in 2012 we need to include the patient perspective, too. Given the push toward patient engagement and an enhanced patient experience, vendors, providers and payers are likely to pay more attention to how well patients understand their care, including how they’re able to describe and discuss their risk factors, signs and symptoms, diagnoses, treatments, medications and follow-up care.
So how should hospitals and health systems respond to the need to standardize terminology as they move to meet the needs of meaningful use and ICD-10 in 2012? Among the most critical steps are the following:
- Understand that even with potential changes in deadlines for meeting stage II meaningful use requirements and ICD-10 implementations, organizations cannot delay the need to embrace standardized terminology as a health care information asset requiring ongoing management. This means a commitment to a permanent terminology asset management program, staffed by experienced informaticists and operating with best-practice processes, to ensure patient data is stored using standard terminology that supports clinical and business users’ needs.
- Make sure clinical information is tailored for usability. Demand that vendors provide useful terminology based on vetted, constrained value sets drawn from national and international standards during implementation that will support organizational terminology management into the future.
- Watch for the Department of Health and Human Services, likely via the Office of the National Coordinator (ONC), to identify an organization or agency that will make discrete value sets available to implementers and providers, further reducing the cost of implementation for users and vendors alike.
As our clinical systems mature in into 2012, the importance of standardized healthcare terminology that supports both direct patient care and summary clinical analysis is increasingly important. Organizations that focus on terminology as a critical asset in 2012 and beyond will be well positioned for the future.
Robert McClure is the CMO of Apelon Inc. and former U.S. representative to the IHTSDO Implementation and Innovation Committee.