Code groups and analytics initiatives—the two go hand-in-hand. Healthcare organizations are increasingly realizing that effective management of code groups (also known as value sets) is imperative for aligning with healthcare’s Triple Aim and positioning within the value based landscape.
The necessity of this function within a healthcare organization’s greater terminology management strategy was recently underscored in a webinar hosted by the Workgroup for Electronic Data Interchange (WEDI). Dan Exley, executive director of data strategy and reporting at California-based MemorialCare, was joined by Health Language executives Barbara Antuna, medical informatics specialist, and myself, for an in depth look at the challenges of managing code groups in today’s healthcare environments and how an enterprise terminology management solution can provide the much-sought-after single source of terminology truth.
While standardization of local content and maps are critical first steps to addressing semantic interoperability between disparate systems, they don’t address broader terminology management issues that exist with population health and analytics initiatives. When managing patient populations, healthcare organizations often need to build code groups, or lists of codified terminologies to construct quality measures, decision support rules or population cohorts.
Encompassing six nationally recognized hospitals, California-based MemorialCare faced the same interoperability challenges common in most health systems today: inter-departmental and intra-organization data silos and challenges with master data management. In preparation of the health systems strategies for population health management, bundled payment initiatives and research optimization, the organization realized that the first step is getting everyone on the same “terminology” page.
Exley highlighted the complexities of managing information across a system of multiple hospitals, outpatient centers and peripheral clinics, all operating with their own technology platforms and proprietary terminology codes. For instance, consider defining a population cohort for heart failure. Such an initiative would require use of several groups of codes:
- diagnoses (claims-ICD9/10 OR clinical SNOMED)
- test results (LOINC)
When this cohort can be defined by a group of codes with common definitions, a common criteria for measuring the population can be established across a health system to a lay foundation for accuracy and efficiency. The value of code sets also extends to meeting and reporting quality measures by allowing providers to determine appropriate criteria for what constitutes a particular measure.
In essence, code groups provide an additional layer to help abstract the complexity related to the underlying standardized terminologies of a particular population cohort, ensuring greater accuracy with any subsequent reporting, analytics or clinical initiative. When this layer does not exist, we explained the potential negative downstream impact:
- Increase in patient readmissions – by not utilizing the valuable data contained within problem lists, care or disease management programs become less effective.
- Lower payments in performance-based programs – through skewed quality measures that do not accurately represent patient populations.
- Patient safety issues – resulting from lack of normalized data and use of local lab and drug proprietary codes within decision support rules.
The Power of Single Source of Terminology Truth
The webinar also highlighted the power of leveraging a terminology management platform to create a single, integrated and trusted source of truth for all local and standard code groups across your organization. Antuna and I explained the advantages of laying the right infrastructure to support terminology management:
- Terminology Governance
- Reduce operational overhead by aligning terminology and code group definitions, intended use, and versioning across business domains and all your clinical applications.
- Always Up To Date
- Stay current with content updates from the world’s leading terminology standard bodies.
- Systems Integration
Integrate seamlessly within your current environment
Leveraging a terminology management platform can be an important step toward aligning with national quality initiatives. When a platform of software, content and consulting solutions exists to map, translate, update and manage standard and enhanced clinical terminology, the guess work can be removed from complex terminology management processes.
For more information, watch the webinar here.