POSTED : August 10, 2016
BY : ProKarma

Most of us are familiar with the Biblical story of the Tower of Babel.  In trying to reach the heavens, a group of people began erection of a massive tower.  Unfortunately they became arrogant about the endeavor and were cursed by God with the affliction of each speaking a different language.  Unable to communicate with one another; the builders abandoned the project and scattered to the ends of the earth.

The same can be said for healthcare as we build our own Tower of Accountable Care.  We are attempting to reach a heaven filled with higher quality and lower costs; yet we are still plagued with the fact that we speak different languages.

Regardless of your role in healthcare, the use of information technology and how well it leverages clinical and administrative terminologies affects you.  This holds true for providers, health information exchanges, payers, and Accountable Care Organizations.

The expectation for healthcare applications to pass, interpret and act upon medical record information continues to rise and simply having an interface connection between two systems is not enough. The information passed between systems must be “machine readable” and accurately represent the original clinical context.

In other words, it’s not enough to map which fields correlate between systems (allergy → allergy). The actual data received must be translated into the terminology code sets used by the receiving system (allergy A → allergy A). Otherwise, it is like having a conversation with someone in a language you do not understand.

Given the vast amounts of data and unstructured information stored in existing applications the industry cannot continue to manage terminologies as it has to date. It helps that a number of terminology sets have been designated as required communication “standards”, but they are not easily integrated into existing software solutions or helpful in understanding historical records. The industry needs a solution that enables everyone in healthcare to take control of terminologies and achieve semantic interoperability between any system that can contribute information valuable to patient care and business operations.

Providers – The way hospitals, health systems and physicians deliver care and manage their businesses is being molded by a variety of incentives, penalties and expanded reporting requirements. Much, if not all of these initiatives require unprecedented use and interpretation of the patient data stored in disparate software applications using a mix of standard, proprietary and home-grown terminologies. Increasingly success is defined by those who take control of how they use terminologies to capture, transmit, aggregate and understand patient data.

  • The expected benefits of common terminology include:
  •  Establishing and Maintaining Semantic Interoperability
  • Improvement in Quality Reporting Processes
  • Increased Operational Efficiency
  • Understanding Aggregated Clinical and Administrative Data

HIEs – Health Information Exchanges play a crucial role in supplying access to medical record information. Initially a portal solution for displaying referential patient information, HIEs are increasingly being asked to deliver actionable data to a wide variety of clinical applications. While HIEs make an ideal “central switch” for patient record data, there are significant challenges to maintaining semantic continuity as data passes to and from various software applications, each using a mix of standard, proprietary and local home-grown terminologies, or free text. Overcoming these challenges allows HIEs to deliver enhanced value, create new offerings and generate sustainable revenue.

The expected benefits of common terminology include:

  •  Delivery of Semantic Interoperability
  • Improved Operational Efficiency
  • Added Value to Quality Reporting
  • Interpretation of Aggregated Claims and Clinical Data
  • Establishment of Sustainability

Payers and ACOs – Improving care, controlling cost, and assessing risk requires access to accurate and normalized information.  There is no lack of data and more is becoming available as electronic medical record systems, all payer claims databases, and health information exchanges come online. For payers and accountable care organizations, success moving forward will be defined by their ability to make sense of the vast amount of data available.

The expected benefits of common terminology include:

  • Interpret Aggregated Clinical and Claims Data for Improved Analytics
  • Improve Operational Efficiency
  • Make Informed Decisions from Trusted Insights

Recap – As we can see, regardless of which side of the healthcare continuum you reside in; there is quantifiable benefit to the use of terminology services.  Standardization and normalization are your foundation for trusted data, which in turn leads to trusted analytics.  Maybe there is still hope for the Tower of Accountable Care!