The meaningful use program has provided a mixed bag of results in the terminology arena with widespread adoption of electronic health records. However, efforts to invoke sets of terminology standards for information systems haven’t achieved all the anticipated results.

With confusion over standards, and variability in the standards themselves, providers are having a hard time with systems that don’t speak the same language or require significant work to enable them to interact.

A recent roundtable discussion hosted by Health Data Management and sponsored by Health Language discussed terminology and standards challenges that now face all segments of the industry.

Moderated by Health Data Management editor Fred Bazzoli, the panel included:
* Ekta Agrawal, MD, healthcare informatics lead at Houston Methodist Hospital System
* Sheila Britney, manager of information systems, Spectrum Health, Grand Rapids, Mich.
* Jason Buckner, vice president of informatics for Healthbridge, Health Collaborative
* Steven Christoff, Executive director, Physician Health Partners, Ocala, Fla.
* Diane Christopherson, director of analytics, OptumCare, Eden Prairie, Minn.
* Amy Knopp, manager of enterprise information management, Mayo Clinic, Rochester, Minn.
* Brian Levy, MD, senior vice president and chief medical officer, Health Language, Wolters Kluwer Health
* Jean Narcisi, director of dental informatics, American Dental Association, Chicago, and chair of WEDI
* Paul Tuten, vice president of product development and management, RxAnte, Arlington, Va.
* Jason Wolfson, Vice President, Marketing and Product Management at Wolters Kluwer Health.

BAZZOLI: Has meaningful use helped or not in this arena?

PAUL TUTEN: There are only certain types of systems that meaningful use covers. You end up with an ecosystem that has a far greater number of actors on very different systems that don't have the same mandates. As a vendor that serves multiple enterprises, we face the same kind of challenges that providers face, only on a larger scale, especially if you're trying to do predictive analytics over a large enough population. We often get extracts of multiple years’ worth of data that comes out of an IT shop – they give you the data elements but don't necessarily understand the clinical significance of it. Then, you end up having to make sense of it.

DIANE CHRISTOPHERSON: That is probably one of the biggest challenges, keeping it up to date, with all of the different data sets for meaningful use and PQRS and HEDIS and core measures, as well as setting up your own registries.

JEAN NARCISI: Dentistry is a little bit different than medicine in that for dentistry uses procedure codes on the claims. Some Medicaid programs use ICD-9 codes, and then they’ll ask for ICD-10 if it ever rolls out. We have started working with some of the dental schools with our SNOMED CT subset. Dental students are just dying to be able to look at the data.

JASON BUCKNER: Standardization is fairly confusing, and federal regulations aren’t helping. ONC put out an interoperability standards document for 2015, and in that document, there is a terminology standards section. There are 15 different standard bodies, just in that, and that's just for general clinical usage. So if you really want to talk about anything to do with Medicaid, Medicare, all of your reporting, claims management, anything else, just magnify that list. We cannot treat terminology management in a departmental fashion; it needs to be an enterprise wide strategy, because it really spreads across so many areas, and it is complex.

EKTA AGRAWAL: In managing terminology, if there is an update to a HEDIS specification or core measure specification, we have to allocate resources and time updating the specifications and value sets. Then it changes in six months, and we have to go back and update again. Then there’s customization if an internal customer requests data to identify part of the patient population.

BRIAN LEVY: That’s the hardest part about using terminologies – it’s not to start using them, but to maintain them. In the UK, they were very proactive to adopt SNOMED years ago, and it was used to develop a system of “read” codes, which were procedure codes. They didn't have a good method to maintain them, and people even created their own read codes. So even though there was a standard, the standard began to drift away as people began to add codes to it. Pretty soon, you couldn't share read codes anymore because folks had added some codes, so you lost that ability for interoperability.

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