A few months ago I wrote a personal blog detailing the lack of interoperability for my data after a knee replacement. The most important observations that are measured after knee replacement are pain intensity and knee flexion angle. I would have loved to see my pain levels graphed out over time as it decreased while my knee flexion graph showed an increase. This meant that my measurements from hospital, home, physical therapy and the physician’s office all needed to be in the same system. So…what needs to be done to have my data where it needs to be to track my progress? Continue reading
Last month, the Office of the National Coordinator (ONC) released A Shared Nationwide Interoperability Roadmap. A recent blog written by Amy Sheide describes the contents of the document, but I want to discuss why it really matters. The vision outlined in the roadmap is the reason I work as a terminology leader in the standards industry. It answers a common question I frequently get: “Why do you do what you do and why does it matter?” I truly believe that human beings deserve the best healthcare they can get. This means that their information, such as past medical history, medications, labs, etc., should be at the fingertips of those who are providing care. Continue reading
Recently I attended the American Medical Informatics Association (AMIA) annual symposium in Washington, D.C. I focused mainly on sessions related to nursing, interoperability, or both. The keynote speaker for the nursing preconference session was Dr. Deborah Troutman, CEO of the American Association of Colleges of Nursing (AACN). Dr. Troutman spoke about the Institute for Healthcare Improvement’s (IHI) Triple Aim. This blog gives an overview of the Triple Aim, discusses how it pertains to informaticians, and ends with a discussion about where we need to focus in the future.
The Triple Aim is a framework for developing new designs to optimize health system performance and to capture social needs in healthcare. The three aims are experience of care, health of populations, and costs of health. Experience of care means that if a person gets sick, the perception of their care, including quality, effectiveness, timeliness, etc., should be high. Population health is focused on causes of illness, such as obesity, substance abuse, and heart disease. The final aim is to lower cost, not by decreasing what people receive in their care, but through process improvement and illness prevention. The desired state is person-centered and is not focusing on illness care but moving towards wellness. Continue reading
This summer, I attended a nursing informatics conference that inspired me to believe that interoperability of nursing data is achievable. The Nursing Knowledge: Big Data Science for Transforming Healthcare Conference, hosted by the University of Minnesota School of Nursing, brought together nursing thought leaders from nursing practice, education and informatics. The goal of the conference was to “Advance a national plan for capturing nursing information for big data research aimed at identifying effective care interventions and improving patient outcomes.” So the question I asked myself: “How far away are we and is nursing interoperability within reach?” This blog discusses the current state of nursing interoperability and an initiative in progress to support interoperable nursing data. Continue reading
In January, the International Health Terminology Standards Development Organization (IHTSDO) and the International Council of Nursing (ICN) announced the release of an equivalency table between the International Classification for Nursing Practice (ICNP) concepts and SNOMED CT concepts. What does this mean for nursing? In order to answer this I will describe the collaboration agreement between the ICN and IHTSDO, give an overview of ICNP, and discuss how this agreement impacts standardized nursing terminologies.
The IHTSDO has a formal Harmonization Agreement with ICN to “advance terminology harmonization and foster interoperability in health information systems.” ICN is a federation of more than 130 national nurse associations representing millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality nursing care for all and sound health policies globally. Continue reading
Healthcare data should be structured within a standardized information model so it can be easily and safely shared among patients, consumers, and providers. This structure would advance the vision of a transformed health system while enabling improved outcomes, quality of care, and lower costs. Standardized nursing assessment charting can enhance continuity of care yet research has demonstrated a lack of standardization in codified point-of care nursing assessment data. There is an international initiative in progress to develop guidelines for the creation detailed clinical models (DCMs) that can be used for standardized care. The goal of DCMs is to provide sharing of data, information, decision support, reports and knowledge to support evidence based practice and ultimately translates into a higher level of quality care. Continue reading
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. Continue reading
This summer, I attended two nursing informatics conferences, the 11th 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. Continue reading
Part 1 of this series introduced the role of standard terminologies in meaningful use (MU). Part 2 illustrates some of the challenges encountered to support the implementation of MU. This final installment illustrates the terminology challenges encountered when reporting clinical quality measures.
Reporting on Clinical Quality Measures (CQMs)
The Centers for Medicare and Medicaid Services (CMS) state, “In order to report clinical quality measures (CQMs) from an electronic health record (EHR), electronic specifications must be developed that include the data elements, and logic and definitions for each measure in a format that can be captured or stored in the EHR.” Data elements can be a one-coded item, such as “birth date,” or point to a value set (a list of codes).
To support the HITECH Act, the Department of Health and Human Services (HHS) tasked the National Quality Forum (NQF) to retool 113 NQF-endorsed CQMs from a paper-based format to electronic “eMeasures.” Forty-four eMeasures were included in Stage 1 of HHS’s MU EHR Incentive program. Continue reading
Part 1 of this series introduced the role of standard terminologies in meaningful use (MU). Part 2 illustrates some of the challenges encountered to support the implementation of MU.
Challenge #1: Many terminologies are needed to support the EHR and MU
Currently, no one terminology or classification system contains everything that is needed for the EHR, so encoding patient data for MU requires multiple standards. The Office of the National Coordinator for Health Information Technology (ONC) has adopted an initial set of vocabulary standards to support the proposed requirements of MU, shown in Table 1. Continue reading