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The Notion of “Provider Friendly” in Healthcare IT

March 20, 2013

By: Charlie Harp

The point of a software application in a healthcare setting is essentially to (1) improve patient care (2) assist providers in providing care (3) make the processes involved in patient care more efficient, (4) leverage all of this to help manage costs over time and (5) make sure I am getting paid the for services I provide.

Now, behind closed doors it isn’t always prioritized in this way, but these are usually in the top-ten list of “whys”.

One of the main drivers of better software solutions is the notion of Clinical Decision Support or CDS.  This is the idea that a provider can’t keep everything in their head so we should augment them with extended clinical knowledge and the logic to apply it appropriately to their patient.  This is a good idea and we are slowly evolving in this direction.  We are still struggling today, primarily because the knowledge is too blunt and what the application knows about the patient is sketchy.  This is due to a number of issues, two of which are the lack of structured/coded information and also the absence of information from other care venues.   To address this we have “meaningful use” which promotes structured data and sharing across traditional information silos.

So to summarize, our goal is to capture and store clinically accurate structured terms so that our applications can leverage them for Clinical Decision Support.

If you are with me so far, then we need to ask a question.  Do the terminologies we are searching for, storing and exchanging provide a foundation for what logically comes next?  Are we strategically positioning ourselves for what is considered by many to be “the whole point” of an electronic medical record?

In order to provide good information in our patient records, we first have to find the term that most accurately describes our observations, diagnosis, treatments and procedure.  Finding the right term can be difficult because we humans are capricious.  We operate within our own contextual bias and want to describe something the way we think about it.  To accommodate this, for a given set of terms, we establish keywords, abbreviations, mnemonics and aliases.  In the informatics when you establish variants of a concept to enable searching or presentation this is commonly referred to as an ‘interface terminology’ and the concepts that they relate to are in a ‘reference terminology’.

Most people prefer an interface terminology because they are, by their very nature, more familiar. The problem with interface terminologies is that they can also serve to hide the actual reference terminologies that are, due to their conceptual nature, designed to drive what happens behind the scenes.

When you are working with an interface terminology you have to remember a few rules of thumb.

  • Good interface terms are in conceptual alignment with the concepts they relate to.

An interface term should not represent more or less information than their concept does.   For example a good interface term for ‘leg fracture’ would be ‘busted leg’ not ‘busted right leg’.

  • Good interface terms are complete
An interface term should be a complete term itself.  This means that they should avoid partial words abbreviated words or mnemonics.  These ‘lazy lexicals’, if tolerated, should be part of a search mechanism not an interface terminology.  You should assume that someone will store and present interface terms to a clinical user or a patient.  When this happens it should not look like ‘HX DMII w/o neph’.
  • Good interface terms indicate both language and purpose
If an interface term is in dutch, it should indicate as such.  If an interface term is an acronym, provider oriented or patient oriented, it should indicate that as well.  By providing this meta-information about an interface terms is allows for focused search as well as display filtering.
  • Good interface terms are stable
An interface term is a veneer on a concept that will be used to make decisions.  The relationship to that concept should be stable and managed appropriately.

A good rule of thumb is if you take a given interface term an put it in front of any member of the intended audience would they be able to (a) understand what the term means and (b) pick the concept behind the term out of a list?  If the answer is “yes” then the interface term is good. Remember that the concepts behind the “friendly” terms are the whole point and will be what truly matters in the next stage of our evolution as an industry.

Clinical Architecture’s Symedical® Server provides comprehensive support for interface terminologies and reference terminologies alike.  The search engine handles common mnemonics, partial words, acronyms and abbreviations for any terminology.  It also supports the creation of local keywords, aliases and even local terms without compromising terminology updates from the source.  Our mission is to help you prepare for the next logical evolutionary step while meeting your tactical objectives today.  Give us a call and let us show you a better way forward.

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