Nomenclature vs. Classification – Part 1

When our esteemed Medical Director is about to make a pronouncement about something outside his vast area of expertise, he usually starts by saying, “I’m just a country doctor, but …”

Well, I’m just a country computer programmer, but I think we should discuss the difference between a nomenclature and a classification. “Nomenclature” is the “N” in SNOMED. “Classification” is the “C” in ICD-9 or -10.

Why am I wandering into such dangerous waters, swarming with medical informaticists and other academic denizens capable of biting my head off, or at least splitting all my hairs? Because many people, in their desire to have an easy ICD-9 to ICD-10 transition, are setting their expectations of the GEMs too high. This manifests itself as requests for otherworldly extensions to software that I helped write. And though I’d do almost anything to keep my customers satisfied, I’m not a magician.

Hiking the Path to Interoperability

Interoperability is one of the leading goals in the healthcare industry, but how can we get there? In spite of decades of experience with electronic health records, the lack of semantic interoperability in healthcare has prevented sharing of healthcare data. Often, health data is not comparable, cannot be aggregated, and  cannot be used to accurately automate or augment clinical decision making. The Health Information Technology Standards Committee has recommended Logical Observations, Identifiers, Names and Codes (LOINC) as the standard for structured coded assessment instruments and Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) for appropriate responses (“answers”). This implies that point-of-care measures should be codified using LOINC and SNOMED CT.

An Insider’s Look at the HIMSS13 Interoperability Showcase

Last week, 3M Health Information Systems participated in the 2013 HIMSS Interoperability Showcase with the 3M Healthcare Data Dictionary (HDD). It was our first time participating in the Showcase with the HDD. The Showcase was organized into several different use cases of hypothetical clinical scenarios. Each use case had its own pod on the Showcase floor. Within each pod each vendor had its own kiosk.  We were one of the vendors in Use Case #3:  Biosurveillance Monitoring and Detection. The Saturday and Sunday before HIMSS were spent setting up our systems, testing, and rehearsing our presentations, with t. he Showcase itself running Monday through Wednesday of HIMSS.  I like to think of the Showcase as a place where vendors come to “walk the walk,” not just “talk the talk” about interoperability.  Vendors there were able to demonstrate the fruits of their collaboration efforts with each other to get their various systems to work together based on standard specifications.

Building Walls vs. Building Doors

A book came out several years ago that has continued to resonate with me and that I still reference in conversations and discussions.  The book, What Would Google Do?, by Jeff Jarvis, delves into how the Internet has evolved, and continues to evolve, and why some companies like Yahoo and AOL became has-beens while Google has flourished.

If you think about how Google operates, they focus on giving their users control, while other internet companies focus on trying to control users.  The example that illustrates Google’s strategy most clearly is to just go to www.google.com and look at what you see, and then go to www.yahoo.com or www.aol.com and compare these two to Google.

Go ahead, check it out.

Moving Forward: Three Ways to Drive Data Innovation

Remember those wish lists you came up with over the holidays, those resolutions you swore you were going to do in the New Year? Well, it’s February, which means if you haven’t already, it’s time to put those New Year’s resolutions to work. The same thing goes for the healthcare IT industry. Last month, Healthcare IT News asked me what I would most like to see happen in healthcare IT in 2013—my wish list for the industry. If I had time and space, my full list would probably stretch out the door, but for now, here are the top three changes I hope to see put in motion this year:

Healthcare Executives Sound Off on Data Challenges

Last week, we hosted one of our Executive Council meetings up in Park City, Utah. These meetings bring together executives from many of our client sites to discuss the challenges they’re facing and ways in which 3M Health Information Systems can help them achieve their goals. It wasn’t always easy keeping the group focused on the topics instead of the view of the snow-covered mountains through the window behind me, but when the subject of analytical needs came up, I had their attention. The discussion quickly turned to the challenges they face in getting the data needed to manage regulatory requirements, reduce costs, and improve quality of care. The client executives participating voiced a number of concerns, including:

- Difficulty in getting longitudinal data across the healthcare continuum
- Inability to get data from unstructured text within their EMR
- Limitations of claims data only
- Use of data to identify “avoidable care” so they can reduce costs and improve outcomes
- Data needed to manage compliance risk

Free the Data!

Anyone heard of ING Direct (just acquired by Capital One and soon to become Capital One 360) and their Orange online banking and savings accounts? Ever used PayPal? These two disparate organizations are connected by one shared characteristic: there aren’t any physical locations for these companies—you interact with them completely online. If you want to ditch your local bank and move your money to an online bank, all you need is an internet connection and your account numbers. If you want to send money to someone, or pay for online purchases through PayPal, all you have to do is link PayPal to your credit card or bank account.

Today, you can easily get access from just about anywhere to your online banking and financial information. You can move your money where you choose, switch banks, open new accounts, invest in stocks, or blow your savings on new shoes and online poker—all without having to ask anyone for permission or build a new interface to allow your money to go where you want it to. The banking, financial, and what I’ll call the online commerce/credit card markets are all secure (or as secure as the internet can be) and fairly open to allow interfacing or communication with other systems.

Data Integration: Going with the Flow

Just as the flame of a small candle, if mishandled, can go from beautiful to a disaster very quickly, the information we share as we go about our daily lives has the potential to be of great help, but also great harm if not handled correctly.

These days, data is shared everywhere in health care organizations.  Patient and provider data flows in and out of transcription as documents are created.  From the transcription system to the EHR and other clinical repositories, the patient’s record is available for further care, coding, billing, research, and so on.  Integration is wonderful when it works well.

Computer-Assisted Healthcare: Making the Right Moves

A couple of years ago, I read a news article about an unusual kind of chess competition. This competition allowed teams of up to two competitors to use any chess computer software they chose in order to play against other teams of two with their own chess software. This may sound like an unusual competition, and it was, but the goal was interesting: to see which team of humans could best utilize technology to their advantage.

Most teams bought off-the-shelf software and just plugged their opponents’ moves into their chess program and then made the moves that their own program churned out. The winning team, however, actually developed their own software, leveraging machine learning and feeding their program the moves and results of thousands of games in order to “teach” it different strategies and moves. The really interesting part was that in some crucial situations this team actually made moves that went against their program’s suggested moves. They let the machine guide their overall strategy but were not afraid to make their own moves when they felt it was to their advantage. In the end, they walked away champions, with man-plus-machine being superior to just machine alone.

Nursing Terminology Use within an EHR

This summer, I attended two nursing informatics conferences, the 11^th International Congress on Nursing Informatics (NI2012) and the Summer Institute of Nursing Informatics (SINI).  At the conferences and in anticipation of the final rule of Meaningful Use Stage 2, there was a lot of discussion surrounding the topic of standard terminologies. As someone who lives and breathes terminologies, I am often asked about implementing nursing terminologies and which “one” to use. Before answering that question, let’s review the status and use of nursing terminologies in relation to national standards. 

The Office of the National Coordinator (ONC) has proposed standard terminologies for multiple domains and designated certain terminologies for Stage 1 and Stage 2 of Meaningful Use.¹  However, the ONC has not designated one standard terminology in the area of nursing documentation.