The healthcare sector lacks a common clinical vocabulary that spans the rapidly growing population of IT systems.
The problem has both local and cross-industry dimensions. At the local level, a given health delivery organization may manage 40 or more separate systems, each of which has its own clinical terminology infrastructure. The disparate terminologies make it difficult for such an organization to leverage the data in a meaningful and consistent way. The problem becomes magnified at the inter-organizational level when two or more health systems attempt to share and analyze data.
The resulting fragmentation is a key obstacle for national initiatives to boost interoperability, transparency, and collaboration within the healthcare system. Enterprise terminology management, however, aims to help healthcare organizations overcome the interoperability issues associated with differing clinical terminologies. This type of solution lets healthcare organizations deploy a single trusted source of terminology truth across an enterprise.
Here are a few reasons why enterprise terminology management will be particularly relevant in 2015:
Healthcare providers are working toward a government-imposed October 1, 2015 deadline for transitioning from ICD-9 to ICD-10 code sets used for reporting medical diagnoses and inpatient procedures. The task is a big mapping project, with many payers and providers turning to the General Equivalence Mappings or GEMs as a tool for the conversion of data from ICD-9-CM to ICD-10-CM and ICD-10-PCS and vice versa. GEMs however, has been found to be inconsistent and incomplete. As a result, many healthcare organizations are turning to terminology vendors to provide terminology mapping services to take into account their business rules and the proper clinical context into account versus attempting the GEMs one-size-fits-all approach. In the first half of 2015, we expect many organizations to continue to refresh their remediation plans in order to prepare for the upcoming transition late next year. In addition to remediating transactional systems, payers and providers need to utilize purpose built forward and backward mappings between ICD-9 and ICD-10 for their longitudinal reporting needs.
Enterprise Terminology Management solutions are also being used to model DRG shifts as a result of the transition. The modeling enables payers and providers to understand shift magnitude, root cause, and perform ‘what if’ analysis to assess the impacts of remediation strategies.
Finally, Enterprise Terminology Management solutions help ensure clinical governance and ongoing management of remediation strategies – ensuring full line of sight into compliance issues and early warning signs of new problem areas.
The IT infrastructure required to support accountable care organizations (ACOs) is dependent on accurate quality reporting and the identification of patient populations for target outreach.
An Enterprise Terminology Management platform can help ACOs meet quality reporting requirements and increase cohort identification rules. ACOs need to aggregate both claims and clinical data for comprehensive reporting and terminology management’s mapping and code group capabilities can help them accomplish that. Enterprise Terminology Management solutions can rationalize the differences between claims and clinical data, providing the ability to match and group vastly different terminologies to a system of shared meaning. For example, an ACO trying to identify all patients that had heart blocks, would need to pull the ICD-10-CM code of Other specified heart block (I45.5) and the SNOMED-CT code for sinoauricular block along with many other SNOMED-CT codes. The ability to map between SNOMED-CT and ICD enables the aggregation of both claims and clinical data sources.
In addition to mapping and grouping among terminology standards, as ACOs begin to add data sources to their networks, they are wrestling with an influx of poorly maintained data that, for example, may result in having several hundreds of ways to represent hemoglobin A1C tests. Such an environment makes accurate analytics impossible. Enterprise Terminology Management solutions are being utilized to normalize all of this data to standards, effectively un-locking the data and enabling insights.
Meaningful Use Targets
Healthcare providers who embarked on the government’s Meaningful Use program in 2013 stand to gain thousands of dollars in incentive payments if they demonstrate a full year of Stage 2 compliance in 2015. However, terminology complexity requirements are hindering semantic interoperability, physician adoption, and stage 2 attestation.
Enterprise Terminology Management solutions help automate the management and integration of codified terminologies (classification systems, reference terminologies, and code groups) through automated content management and update processes.
Enterprise Terminology Management solutions can further be used to map between terminologies or from proprietary code sets to standards to ensure non-certified systems who may be using local codesets interoperate with the EMR – ensuring attestation and accurate quality measure computation. For example, a map from NDC/RxNorm to CVX makes it easy to capture all of the vocabularies used to encode libraries and local lab codes to LOINC mappings. As another example, Stage 2 makes RxNorm a required vocabulary for communicating medication data. Many health systems will need to map their current pharmacy management codes to RxNorm. Enterprise Terminology Management solutions provide automation, making the mapping process much faster than manual methods.
Finally, Enterprise Terminology Management solutions can be deployed to support clinician’s workflow at the intersection of ICD-10 and Meaningful use by enabling problems (SNOMED CT) and diagnoses (ICD-9/10) search based on provider friendly terms.
Is your organization confronting a pressing business or regulatory deadline in 2015? Would terminology management alleviate the pain and speed up compliance? Leave your comments below.