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A Meaningful Scavenger Hunt

Written by Charlie Harp

August 6, 2015 at 7:21 PM

Meaningful Use Scavenger Hunt
In order to comply with the many of the requirements for meaningful use and other state and federal programs we are required to interoperate or report using specified terminologies or "standards".  Here are a few examples from the Standards Advisory from
Purpose Standard
Allergy Reactions SNOMED-CT
Care Team Member National Provider ID (NPI)
Ethnicity OMB
Encounter Diagnosis SNOMED-CT / ICD-10-CM
Family Health History SNOMED-CT
Gender Identity SNOMED-CT
Immunizations CVX/MVX
Lab Tests LOINC
Medications RxNorm
Medication Allergies RxNorm
Numerical References and Values The Unified Code of Units and Measures (UCUM)
Patient Conditions SNOMED-CT
Preferred Language ISO 639-1 / ISO 639-2 / ISO 639-3 / RFC 5646
Dental Procedures Code on Dental Procedures and Nomenclature (CDT)
Medical Procedures CPT-4 / HCPCS / ICD-10-PCS
Race OMB
Radiology RadLex
Sex HL7 Administrative Gender
Sexual Orientation SNOMED-CT
Smoking Status SNOMED-CT
Unique Device Identification FDA Unique Device Identifier
Vital Signs LOINC

While the above is a list that provides “guidance”, it is a little vague.  For example:

  • There are over 400,000 concepts in SNOMED-CT.  Which ones do I use for ‘sexual orientation’, which do I use for ‘gender identity’?  Why do we use a totally different terminology, HL7, for ‘sex’?
  • How can there be more than one "standard" for interoperating with medical procedures and  Encounter Diagnosis?  Do I have to support both to comply?
  • Can I post-coordinate RadLex?  Is there a specific way that should be done?
  • UCUM is not a terminology… it is a grammar.  How do I use it as a “standard”?
  • The NPI is less of a standard and more of a giant spreadsheet in the sky.  How can I be sure I have the right identifier for the provider?

Beyond the ambiguity, there is additional complexity.  The listed standards are all released with different schedules and all come from different sources.  They all have different formats and varying levels of complexity.

These are just the standards required for Meaningful Use.  Terminologies required by other regulatory initiatives, like the CMS Health Services Delivery specialty codes, are only made available in PDF documents.

Anyone working with these standards should also know that they change over time.  That means that in order to use them effectively you not only need to find them and understand them, you need to keep them current as well.

Great! You've killed the invisible swordsman.

In the 1986 movie “The Three Amigos!” there is a scene where the amigos (Steve Martin, Chevy Chase and Martin Short) need to find the way to the lair of the villain, El Guapo, to save the damsel in distress.  They are given the following guidance:

“We go east...through the desert until we come to the singing bush.  When we find the singing bush...we say the magic chant, each fire one shot in the air...and that will summon the invisible swordsman...and he will then show us the way to El Guapo's”.

Whenever I think about standard terminologies it reminds me of this scene (and click the YouTube link above for the full effect).  As an industry we need to do something that should be fairly straight forward, use the required standards.  What we end up with is a vague scavenger hunt that requires us to become terminologist and experts on not one but twenty terminologies.

To do this properly you could probably occupy a team of four to eight full time resources finding, loading, updating and verifying all that content.  But you don’t have to…

For several years now, our Symedical® platform has provided our clients with access to over 300 content assets, including standard terminologies, delivered in a standard format and updated automatically.  I am delighted to let you know that very soon we will be making this service, complete with automated delivery, available as a standalone offering.

We are calling it the Clinical Architecture Content Cloud and it will give you what you need in a format you can use.  Watch this space for a press release that will provide more details.

Have a great weekend!  Next week I will post the first in a series of articles on managing data in healthcare.