Agreeing on terminology will grow in importance as different entities in healthcare see the need to share information frequently and seamlessly.

Information transfer has been limited in past years, either between healthcare organizations or between providers and payers. Now, providers are working together to better coordinate care and share risks in population health initiatives. Payers are working more closely with providers and want a better understanding of the care that their covered lives are receiving.

As a result, the need to improve communication, via standardized terminologies, is expected to grow rapidly.

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 HDM 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.


BRIAN LEVY: Standards are important for all participants in healthcare. They can't be interoperable if both sides are not using the same sets of standards.

EKTA AGRAWAL: Our organization is going toward using an integrated EHR system. But it’s going to be another challenging task when we start getting claims data. When it comes to integrating the claims data for accountable care measures, how will we handle that situation, and how will the EHM vendor or other vendors assist in that process?

LEVY: Payers are also starting to ask the opposite question – how can we handle EHR data? They're beginning to recognize there's a treasure trove of data that's much more powerful than claims data. Providers have SNOMED codes and IC-10 CM codes, and then for labs, you might have SNOMED codes and CPT codes. One of the common problems that payers are asking us to help to solve is that they are getting laboratory kinds of data being reported using CPT for the order and LOINC for the result, and they want to be able to reconcile them.

JASON BUCKNER: Will the number of accrediting standards bodies defining terminologies shrink?

LEVY: I think we're going to see a proliferation of smaller standards groups working on subsets of the standards. We're commonly asked, “Can you give us a list of SNOMED codes that relate to diabetes?” We say, “What do you mean by ‘the list?’ Does this include Type 1 or Type 2 diabetes; does that include the patients who have gestational diabetes? The next big wave of challenges is how to make sure that we're at least using the same subsets of definitions of these codes. I think we're going to see a really vast proliferation of the subsets across terminologies.

JASON WOLFSON: Standards have different purposes. Classifications are different for reference systems. One is good for one thing, one is good for another. I don't think you can join them. There's that mediation in between where you have vendors and maps.

PAUL TUTEN: This has been discussed widely within ONC. The problem is not going to go away any time soon. Even when rational actors would look at it and say really you and you should work together – this would make a lot of sense. We've tried to broker those types of discussions; it's a hard job trying to coordinate with only a certain degree of regulatory leverage. It certainly isn't going to get any better.

AMY KNOPP: I think the other challenge is version. Not only do we have lots of standards, but which version is the standard pointing to? You want the standards to evolve, so you want to use newer versions, but then you're also stuck trying to support multiple versions of standards for different regulatory purposes.

WOLFSON: Speaking of the update challenge, right? You have all of these versions, you have all of these different systems using different versions. Maybe they want to use a different version. If I’m doing a HEDIS program, I'm doing this version. If you do research, you use that version. Then you have maps between these, and all of those have versions.

LEVY: If we care about the questions we want to ask about the data, and we recognize that they're sometimes not going to be easy to effectively answer these questions, at least we're going after the questions that we haven't in the past. It's not about SNOMED codes; it's about what you do with those SNOMED codes.

DIANE CHRISTOPHERSON: In some cases, bringing those subsets together has a lot of value. So keeping your type one and type two diabetes patients separate from the others, and then bringing together – which of those subsets give you the most meaningful answer? And that really goes back to governance. Having a team that can communicate effectively what each of those sets are and can do, and what is the value proposition, is golden. It's absolutely golden.

BUCKNER: In my HIE world, it gets really fuzzy. For our terminology services that we provide, probably half of the constituents are doing it so they can check the box on a regulatory or an incentive-based requirement, so they're going to do the bare minimum. And then the other half actually wants to take value out of that data. And so when you've got a mix of those two environments together, it does complicate things.

CHRISTOPHERSON: The combination of all these different data sources – the data from disparate EMR systems, with claims data, with data coming from the national labs or from local labs, pharmacy – being able to pull that together and reconcile it is an amazing challenge. If we can do that effectively, we have improved the healthcare system. From what I'm hearing here, that's a lot of our passion.

AGRAWAL: If we can set some standards to utilize the data that we collect, other than just for reimbursement purposes, and if we can utilize that in a meaningful format, that would be a good step towards analytics.

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