Executives leading individual departments within a health system may hit upon the need for terminology management.
A hospital pharmacy, for example, may decide to move away from local drug terminologies toward the RxNorm standard to support an HIE initiative. A laboratory may abandon localized labs nomenclature and adopt LOINC to support an interoperability project with their EHR. Clinicians may drop hand-written patient documentation in favor of SNOMED-CT for problem lists in order to attest for Meaningful Use. Or perhaps two departments will agree upon the use of particular terminology standards to accurately represent their patients within their clinical quality measures.
All of those examples are steps in the right direction. Terminology management at the departmental level will help a healthcare organization begin to share and use data across clinical care processes, business functions and systems. But there are limitations to the departmental approach. As payers and providers adopt standard terminologies for multiple departmental business initiatives they are starting to recognize the need to align and govern terminology strategies at the enterprise level. An enterprise approach will help health systems address the following problems that arise from departmental terminology management:
1. Multiple Sources of “Truth”
There’s no single source of terminology truth when terminology standardization and management takes place at the departmental level. Organizations end up having to deal with the conflicts and inefficiencies that inevitably occur when there are multiple instances of “truth.” In contrast, an effective enterprise terminology management solution will include a single content database that provides a centralized and authoritative source of standards. Health Language’s Content Database, for example, manages more than 180 different terminology content sets.
2. No Overarching Governance
When organizations manage terminology on a department-by-department basis, they lack an overarching policy and governance structure. As a consequence, a health system can’t provide uniform, cross-domain guidance on terminology definitions, intended use, versioning and implementation.
3. Difficulty Updating Terminologies, Maps
Terminologies, maps for matching different terminologies, and code groups all need to be periodically updated as healthcare policies change and new versions of standards become available. A fragmented, departmental environment lacks a way to maintain consistency across the enterprise.
Departments that roll out individual terminology management solutions -- each with their own normalization, mapping and content database technology -- will incur the cost of acquiring and maintaining redundant platforms. With an enterprise-scale solution, in contrast, organizations can share a common platform across departmental boundaries, achieving economies of scale. In addition, health systems that single-source terminology management also stand to reduce the tension between coding and business teams in light of centralized operations and terminology governance.
5. Uncertain Scalability
A terminology management platform that fits one department or a couple of departments may provide an acceptable solution for the short term. But what happens when other departments see the value in standardized terminologies and management? Will the localized solution be able to support the entire healthcare enterprise? Will a solution that suits one department find acceptance in another part of the organization?
6. Interoperability Issues
Health systems that seek to share data with other organizations will benefit from a uniform approach to terminology management. An organization contending with a departmentalized approach to terminology will certainly find it harder to achieve interoperability with other parties. Communication with external groups will prove much easier for the organization that presents a united standards and terminology front.
Limitations of Departmental Systems
In summary, departmental terminology management solutions may provide some initial advantages for the healthcare organization, but will introduce limitations down the road. Those issues include the lack of a single source of trusted terminology, the absence of enterprise-wide governance and redundant technology investments. Organizations with departmental models may also experience difficulty with scalability and interoperability. An enterprise-scale platform addresses those concerns, providing consistency from a standards and terminology perspective.
Are you encountering problems with departmental approaches to terminology? Leave your comments below.