U.S. patent application number 14/598076 was filed with the patent office on 2015-06-04 for method and system for concept-based terminology management.
This patent application is currently assigned to INTELLIGENT MEDICAL OBJECTS, INC.. The applicant listed for this patent is Intelligent Medical Objects, Inc.. Invention is credited to Gregory Richard Aldin, David Alvin, Aziz M. Bodal, Matthew Charles Cardwell, Regis JP. Charlot, Eric Nathan Frank, Andrew S. Kanter, Masayo Kobashi, Jose Antonio Maldonado, JR., Fred E. Masarie, JR., Frank Naeymi-Rad, Alina Oganesova, Amy Yunhsin Wang, Andre L. Young, JR..
Application Number | 20150154362 14/598076 |
Document ID | / |
Family ID | 50545200 |
Filed Date | 2015-06-04 |
United States Patent
Application |
20150154362 |
Kind Code |
A1 |
Masarie, JR.; Fred E. ; et
al. |
June 4, 2015 |
Method and System for Concept-Based Terminology Management
Abstract
A method for implementing an interface terminology is described,
the interface terminology comprising concepts and descriptions, a
description being an alternative way to express a concept. The
interface terminology also may include a plurality of domains,
wherein each concept is unique within a domain. The method may
include the steps of: storing a plurality of concepts in a
database; storing a plurality of descriptions in a database;
linking each description to a respective concept; storing an
external code set in a database, the external code set comprising a
plurality of external codes; and mapping an external code to a
concept. The steps may occur via database table mapping. The method
also may include deploying a front-end file, the front-end file
comprises a link between the descriptions and the external code
set.
Inventors: |
Masarie, JR.; Fred E.;
(Husum, WA) ; Aldin; Gregory Richard; (Oak Park,
IL) ; Alvin; David; (Glen Ellyn, IL) ; Bodal;
Aziz M.; (Skokie, IL) ; Cardwell; Matthew
Charles; (Oak Park, IL) ; Charlot; Regis JP.;
(Lake Bluff, IL) ; Frank; Eric Nathan; (Portland,
OR) ; Kanter; Andrew S.; (Highland Park, IL) ;
Kobashi; Masayo; (Long Grove, IL) ; Maldonado, JR.;
Jose Antonio; (Chicago, IL) ; Naeymi-Rad; Frank;
(Libertyville, IL) ; Oganesova; Alina; (Highland
Park, IL) ; Young, JR.; Andre L.; (Kenosha, WI)
; Wang; Amy Yunhsin; (Chicago, IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Intelligent Medical Objects, Inc. |
Northbrook |
IL |
US |
|
|
Assignee: |
INTELLIGENT MEDICAL OBJECTS,
INC.
Northbrook
IL
|
Family ID: |
50545200 |
Appl. No.: |
14/598076 |
Filed: |
January 15, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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13660512 |
Oct 25, 2012 |
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14598076 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G06Q 10/10 20130101;
G16H 70/20 20180101; G16H 10/60 20180101 |
International
Class: |
G06F 19/00 20060101
G06F019/00; G06Q 50/22 20060101 G06Q050/22 |
Claims
1. A method for concept-based medical terminology management,
comprising: receiving from a user a search request comprising a
description within a medical ontology; identifying, using a
computer, one or more concepts within the ontology that map to the
description; prompting the user to provide additional information
including at least one of: a clinical modifier, a non-clinical
modifier, a laterality, and a status modifier; determining, using a
computer, whether any of the identified one or more concepts also
map to the provided additional information; and identifying one or
more codes in a medical code set that correspond to the determined
concepts.
2. The method of claim 1, wherein the medical code set is one of an
administrative terminology, a reference terminology, and a clinical
terminology.
3. The method of claim 1, wherein the identifying step comprises:
identifying one or more codes of an interface terminology that
correspond to the determined concepts; and identifying one or more
codes of the medical code set that correspond to the identified
interface terminology codes.
4. The method of claim 1, wherein a description is an alternative
way to express a concept.
5. The method of claim 1, wherein a description is a synonym, a
vernacular term, a common term, an abbreviation, an acronym, an
eponym, a misspelling, or a patient-friendly term of a concept.
6. The method of claim 1, wherein a plurality of concepts are
stored in a database, a plurality of descriptions are stored in a
database, and a plurality of external codes from one or more code
sets are stored in a database, the method further comprising, prior
to any of the other steps: linking each description to a respective
concept; and mapping each concept to at least one external
code.
7. The method of claim 1, wherein a plurality of concepts are
stored in a database, a plurality of descriptions are stored in a
database, and a plurality of external codes from one or more code
sets are stored in a database, the method further comprising, prior
to any of the other steps: creating relationships between
concepts.
8. The method of claim 1, further comprising: populating, using a
computer, predetermined fields in a patient's electronic health
record in response to the determined concepts or the identified
codes.
9. The method of claim 1, further comprising: providing a summary
of each identified code corresponding to the determined concepts,
the summary including one or more of: the source of the code, a map
type, a number corresponding to the code, and a description of the
code.
10. A method for concept-based medical terminology management,
comprising: receiving from a user a search request comprising a
description within a medical ontology; identifying, using a
computer, one or more concepts within the ontology that map to the
description; prompting the user to provide additional information
including at least one of: a clinical modifier, a non-clinical
modifier, a laterality, and a status modifier; determining, using a
computer, whether any of the identified one or more concepts also
map to the provided additional information; presenting the
identified one or more concepts to the user; receiving a user
selection of a concept from among the presented one or more
concepts; and identifying one or more codes in a medical code set
that correspond to the user selected concept.
11. The method of claim 10, wherein a plurality of concepts are
stored in a database, a plurality of descriptions are stored in a
database, and a plurality of external codes from one or more code
sets are stored in a database, the method further comprising, prior
to any of the other steps: linking each description to a respective
concept; and mapping each concept to at least one external
code.
12. The method of claim 10, wherein a plurality of concepts are
stored in a database, a plurality of descriptions are stored in a
database, and a plurality of external codes from one or more code
sets are stored in a database, the method further comprising, prior
to any of the other steps: creating relationships between
concepts.
13. A system for concept-based medical terminology management,
comprising: one or more computers configured to: receive a user
search request comprising a description within a medical ontology;
identify one or more concepts within the ontology that map to the
description; prompt the user to provide additional information
including at least one of: a clinical modifier, a non-clinical
modifier, a laterality, and a status modifier; determine whether
any of the identified one or more concepts also map to the provided
additional information; and identify one or more codes in a medical
code set that correspond to the determined concepts.
14. The system of claim 13, wherein the system is separate from and
operates as an external service to an electronic medical
record.
15. The system of claim 13, wherein the system interfaces with the
electronic medical record to populate predetermined fields in the
electronic medical record in response to the determined concepts or
the identified codes.
16. The system of claim 13, further comprising: a database having a
table storing a plurality of concepts, a table storing a plurality
of descriptions, and a table storing a plurality of external codes
from one or more code sets; wherein the database further stores
mappings between two or more of the concepts, descriptions, and
external codes.
17. The system of claim 13, wherein the medical code set is one of
an administrative terminology, a reference terminology, and a
clinical terminology.
18. The system of claim 13, wherein the one or more computers is
configured to: identify one or more codes of an interface
terminology that correspond to the determined concepts; and
identify one or more codes of the medical code set that correspond
to the identified interface terminology codes.
19. The system of claim 13, wherein a description is a synonym, a
vernacular term, a common term, an abbreviation, an acronym, an
eponym, a misspelling, or a patient-friendly term of a concept.
20. The system of claim 13, wherein the one or more computers is
configured to: generate a search pane that receives user searches,
present search results, and refresh a display of medical codes in
response to a user selection from among the search results.
21. The system of claim 13, wherein the one or more concepts belong
to a plurality of domains, the system further configured to accept
a user input of a domain selection.
22. The system of claim 13, the one or more computers configured
to: provide a summary of each identified code corresponding to the
determined concepts, the summary including one or more of: the
source of the code, a map type, a number corresponding to the code,
and a description of the code.
Description
[0001] This application is a continuation of U.S. patent
application Ser. No. 13/660,512, filed Oct. 25, 2012 and
incorporates that application by reference in its entirety.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present application is direct to a method and system for
managing and implementing one or more external code sets using an
interface terminology.
[0004] 2. Description of the Related Art
[0005] One of the challenges facing healthcare computing is the
representation of patient data in a usable form. The typical
approach is to encode the information using terms taken from a
controlled vocabulary. Applications such as CPR's (computer-based
patient records), order entry, summary reporting, automated
decision support and data aggregation for clinical research all
require data to be represented in standard ways if there is to be
any meaningful understanding of the data. Understandably, health
care providers, educators, researchers, medical and scientific
software developers and policy makers often take for granted the
existence of an appropriate standard terminology and assume that it
is in routine use. In reality, the lack of a standard for
representing patient data is one of the today's greatest
impediments to medical computing.
[0006] The coding of patient information has been carried out long
before the advent of computers. This coding typically has been
directed at simplifying the data and converting it to a general
form that is easier to manipulate and understand. For example,
while a patient may have pneumonia that may have been caused by a
variety of organisms, involved in different sites in the lung,
accompanied by differing symptoms, and of varying levels of
severity, coding a patient's diagnosis simply as "bacterial
pneumonia" allows it to be aggregated with other cases for
statistical purposes, although this coding may lack sufficient
specificity for meaningful analysis and treatment.
[0007] If finer granularity is needed, more specific terms can be
added to the coding scheme (such as gram negative bacterial
pneumonia and lobar bacterial pneumonia). A set of patient records
can be classified with such codes and then retrieved when cases of
certain types are needed. Since this coding represents only a
simplified synopsis of information extracted from the record, it
may be referred to as abstraction. Record abstraction may be used,
e.g., to allow the assessment of incidence of a disease, mortality
of a surgical procedure, or cost for a hospital stay.
[0008] Documents in a medical field may contain information to
which clinical descriptions may be attached, see, e.g., co-owned
U.S. publication 2012/0179696, titled "System and Process for
Concept Tagging and Content Retrieval."
[0009] As computer use has become more prevalent, electronic health
records or electronic medical records (EHRs or EMRs) have become
the industry standard for documenting patient care. Industry
initiatives and government legislation have facilitated EHR
implementation and use. Most notable among them is the Health
Information Technology for Economic and Clinical Health Act (HIT
ECH), which gives incentives to providers toward implementation and
demonstration of meaningful EHR use.
[0010] An aspect of reliable and accurate information is ensuring
that providers have the ability to capture their clinical
intentions regarding patient care through terminologies. Healthcare
terminology has long been called "the language of medicine," but,
in the electronic age, this language has to be readable by both
humans and computers. Various terminologies are used in defining
associated terms.
[0011] Terminology
[0012] Terminology is a set of descriptions used to represent
concepts specific to a particular discipline. It also is the
foundation of EHR data. For example, the terms "heart attack" and
"MI" describe the same concept of myocardial infarction. The
concept in turn may be associated with codes that are used for a
variety of purposes.
[0013] Different healthcare terminologies may have their own unique
features and purposes. For example, one set of terminologies,
RxNorm, encodes medications, while another set of terminologies,
e.g., Logical Observation Identifiers Names and Codes (referred to
under the trademark "LOINC"), is used for laboratory results.
[0014] Terms related to terminology include: Administrative code
sets; Clinical code sets; and Reference terminologies.
[0015] Administrative code sets may be designed to support
administrative functions of healthcare, such as reimbursement and
other secondary data aggregation. Common examples are the
International Classification of Disease (ICD) and the Current
Procedural Terminology, which is referred to via the trademark CPT.
Each system may be different, e.g., ICD's purpose is to aggregate,
group, and classify conditions, whereas CPT is used for reporting
medical services and procedures.
[0016] Clinical code sets have been developed to encode specific
clinical entities involved in clinical work flow, such as LOINC and
RxNorm. Clinical code sets have been developed to allow for
meaningful electronic exchange and aggregation of clinical data for
better patient care. For example, sending a laboratory test result
using LOINC facilitates the receiving facility's ability to
understand the result sent and make appropriate treatment choices
based upon the laboratory result.
[0017] A reference terminology may be considered a "concept-based,
controlled medical terminology." The Systematized Nomenclature of
Medicine Clinical Terms (referred to under the trademark "SNOMED
CT") is an example of this kind of terminology. It maintains a
common reference point in the healthcare industry. Reference
terminologies also identify relationships between their concepts.
Relationships can be hierarchically defined, such as a parent/child
relationship. The reference terminology contains concept A and
concept B, with a defined relationship of B as a child of A. SNOMED
CT includes concepts such as heart disease and heart valve
disorder, and their defined relationship identifies heart valve
disorder as a child of heart disease.
[0018] Reference terminology may allow healthcare systems to get
value from clinical data coded at the point of care. In general,
reference terms may be useful for decision support and aggregate
reporting and may be more general than the highly detailed
descriptions of actual patient conditions. For example, one patient
may have severe calcific aortic stenosis and another might have
mild aortic insufficiency; however, a healthcare enterprise might
be interested in finding all patients with aortic valve disease.
The reference terminology creates links between "medical concepts"
that allow these types of data queries.
[0019] An important aspect of a well-constructed terminology is
concept orientation, typically granular by nature and defined as "a
unit of knowledge or thought created by a unique combination of
characteristics." An example of a SNOMED CT concept is aortic valve
disorder. A concept may have multiple subconcepts arranged in a
hierarchical relationship.
[0020] Many clinicians are required to use administrative coding
sets (CPT, HCPCS, and ICD-9-CM code sets, etc.) to capture clinical
data. However, administrative code sets were designed either to
group diagnoses and procedures or to contain broad categories with
administrative technical terms with complex rules and guidelines.
Examples of this are time durations or vascular branch orders
directly stated in various terms.
[0021] Administrative codes and terms typically use language that
is not natural or familiar for clinicians. For example, in
ICD-10-PCS the root operation term "extirpation" is not routinely
stated by surgeons. Administrative codes and descriptors also do
not contain the different clinical, administrative, and colloquial
terms used in healthcare, making it difficult for clinicians,
information management professionals, and patients to find the
terms they need when performing simple text searches. This
disconnect between clinician language and coding sets creates
concern over losing clinical intent in the documentation. In
addition, forcing a physician to document in administrative terms
is uncomfortable and disruptive.
[0022] EHR solutions incorporating these terminologies may be
limited in providing full value to hospitals and physicians, which
may include not delivering meaningful use and full reimbursement
levels. These problems may present themselves in various ways. For
example, when charting, doctors may be unable to find the correct
diagnosis and instead may use free text or may give-up and omit the
problem altogether. In turn, this may lead to incomplete and
incorrect patient documentation as well as the loss of ability to
analyze and report on this information. Lost time and money may
result due to under-coding or rejected claims, and the captured
information may be useless for meaningful communications with
patients and other care providers.
[0023] What is needed is a system and method that addresses one or
more of the issues and shortcomings presented above.
BRIEF SUMMARY
[0024] In one aspect, a method for implementing an interface
terminology is described, the interface terminology comprising
concepts and descriptions, a description being an alternative way
to express a concept. The interface terminology also may include a
plurality of domains, wherein each concept is unique within a
domain. The method may include the steps of: storing a plurality of
concepts in a database; storing a plurality of descriptions in a
database; linking each description to a respective concept; storing
an external code set in a database, the external code set
comprising a plurality of external codes; and mapping an external
code to a concept. The method also may include the step of
assigning a unique numerical identifier to each concept. The method
further may include storing patient data in an electronic health
record using the interface terminology.
[0025] The external code set may be one or more of an
administrative terminology, a clinical terminology, and a reference
terminology.
[0026] The mapping step may include indicating a type of
relationship between the external code and the concept, the
relationship being, e.g.: same-as, broader-than, or
narrower-than.
[0027] At least one concept may include a preferred clinician term
and a preferred patient term linked as descriptions of that
concept.
[0028] The method also may include abstracting similar descriptions
for two concepts, such that the descriptions are different.
[0029] In addition, the method may include deploying a front-end
file of the result of the mapping step, the front-end file
comprising a link between the descriptions and the external code
set. The front-end file may have a comma-separated-value ASCII
format, a tab-delimited ASCII format, a database export format, or
a binary flat file format. Additionally or alternatively, the
deploying step may involve a cloud deployment that relies upon a
stateless, in-memory database.
[0030] In another aspect, a method for implementing an interface
terminology in at least one database is described in which the
interface terminology may include a plurality of concepts and a
plurality of descriptions, a description being an alternative way
to express a concept. The method may include the steps of:
generating a concept table including a column storing a plurality
of concept identifiers; generating a description table including a
column storing a plurality of description identifiers; linking the
concept table to the description table; generating an external
vocabulary table including a column storing a plurality of external
vocabulary identifiers; and linking the concept table to the
external vocabulary table.
[0031] The step of linking the concept table to the external
vocabulary table may include: generating a mapping table; linking
the concept table to the mapping table; and linking the external
vocabulary table to the mapping table. The mapping table may
include mappings between multiple concepts in the concept table and
one external vocabulary identifier in the external vocabulary
table. Additionally or alternatively, the mapping table may include
mappings between one concept in the concept table and a plurality
of external vocabulary identifiers in the external vocabulary
table.
[0032] The step of linking the concept table to the description
table may include: generating a mapping table; linking the concept
table to the mapping table; and linking the description table to
the mapping table. The method further may include generating a
description-external vocabulary mapping table, linking the mapping
table to the description-external vocabulary mapping table; and
linking the external vocabulary table to the description-external
vocabulary mapping table. The description-external vocabulary
mapping table includes at least one column from the mapping table
and at least one column from the external vocabulary table.
[0033] The method further may include the step of: generating a
deployment file, the generating step comprising: referencing the
description-external vocabulary mapping table; and populating the
deployment file with a plurality of entries, wherein each entry
links a description with an external vocabulary identifier.
[0034] In still another aspect, a method for implementing an
interface terminology is described, wherein the interface
terminology comprises a plurality of concepts and a plurality of
descriptions, a description being an alternative way to express a
concept. The method may include the steps of: linking, in a
database, each description to a respective concept; storing, in a
database, an external code set comprising a plurality of external
codes; mapping each concept to a respective external code; and
deploying a front-end file, the front-end file comprises a link
between the descriptions and the external code set.
[0035] The method also may include: adding a new description for
one of the concepts; linking the new description to the concept;
and re-deploying the front-end file, the front-end file comprises a
link between the new description and a code in the external code
set. The re-deploying step may occur without the need to re-map the
concept to its respective external code.
[0036] Additionally or alternatively, the method may include:
adding a new external code; mapping at least one concept to the new
external code; and re-deploying the front-end file, the front-end
file comprising a link between at least one description and the new
external code. This mapping step may occur without the need to
re-link the at least one description to the at least one
concept.
[0037] Each concept resides in a domain, and each external code in
the external code set may maps to concepts in one or more domains.
In addition, each concept may include a description that is the
same as that concept.
[0038] As part of implementing the interface terminology, patient
data may be stored in an electronic health record using the
interface terminology.
[0039] These and other features and advantages are described in the
following description, with reference to the accompanying
drawings.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0040] FIG. 1 is a depiction of the medical business processes
linking interface terminology and data flow in a medical
environment.
[0041] FIG. 2 is a representation illustrating one example of the
relationship between concepts and descriptions within an interface
terminology and external codes linked to the terminology.
[0042] FIGS. 3A-3E (collectively "FIG. 3") are a conceptual
database schema diagram depicting the relationship between elements
of an interface terminology and the mapping to elements of an
external code set or vocabulary.
[0043] FIGS. 4A-4C (collectively "FIG. 4") are a database entity
relationship diagram illustrating one example of interface
terminology including an external code set.
[0044] FIG. 5 is a screenshot of multiple drop-down menus for
receiving user input when mapping concepts.
[0045] FIG. 6 is an example of a plurality of interface terminology
concepts mapping to one or more respective external codes.
DETAILED DESCRIPTION
[0046] Many terminologies are required in today's healthcare
environment, including one or more administrative code sets, one or
more clinical code sets, and one or more reference terminologies.
This may result in multiple coding systems being used in a single
patient's electronic record and may create an environment where the
disparate systems must exchange as well as understand information
to provide an effective, integrated healthcare system. Over the
life of the patient, modifications or updates may be made to one or
more of the terminology groups, further compounding the complexity
and need for a comprehensive system configured to recognize
multiple terminologies and to communicate those to other
terminologies.
[0047] In order to provide patient-centered care, providers should
be able to document patient care with sufficient clinical
specificity. Sound EHR practices allow providers to engage in a
patient's care delivery effectively because electronic
documentation supports patient-centered care in multiple fashions,
most notably for decision-support capabilities and the exchange of
data across providers and settings. An important aspect of
patient-centered care is having access to dependable data in order
to make sound decisions. Accurate and reliable information in an
electronic format requires all stakeholders to be engaged with the
record. However, forcing a physician to document in administrative
terms may be uncomfortable and disruptive.
[0048] As described herein, interface terminology may bridge the
gap between information that is in the clinical user's mind, i.e.,
the clinical intent, and information that can be interpreted by
computer applications. Interface terminology may help clinicians
find the right diagnosis and procedure terms to document and code
more comprehensively and accurately within their normal
workflow.
[0049] As shown in FIG. 1, a clinician's intent may be entered into
a system. Via external links to the interface terminology 10, that
clinical intent may be linked to one or more external codes sets,
e.g., administrative terminologies 20 such as ICD-9-CM, reference
terminologies 30 such as SNOMED CT, and clinical terminologies (not
shown). Linking to the administrative terminologies may allow for
more efficient and accurate completion of various administrative
tasks, such as billing. Linking to a reference terminology may
allow for meaningful use, such as patient data aggregation and
analysis. In addition, via the interface terminology, the patient's
EHR 50 may be populated with an entry reflecting the clinician's
intent, which may lead to more accurate and thorough treatment,
proper billing codes for more precise billing, and clinical data
for improved research and analysis.
[0050] Terminology is important in many fields, particularly in the
medical field, where very specific information may be required to
provide a proper diagnosis for evaluation and treatment or a
complete medical record for accurate analysis of a patient's
history. To this end, medical records are faced with two competing
problems: without sufficient specificity, the user may not be able
to record accurately what is needed for quality patient care and
may be "forced" to say something that is not quite correct.
Conversely, the higher the degree of granularity or specificity,
i.e., the greater the number of concepts, the larger and more
unwieldy the system may become. This also may lead to unnecessary
variation, where multiple concept entries exist for what fairly
should be considered the same concept.
[0051] The method and system of applying the interface terminology
10 described herein may manage these competing interests by
employing a set of clinically relevant terms mapped to one or more
other code sets, which may include internal or external code sets
and further may include industry standard administrative and
clinical code sets and reference terminologies. Clinically relevant
terms capture granularity and clinical intent in the
documentation.
[0052] Interface terminology may include multiple components,
including: Domains, Concepts, Descriptions, and Words. As discussed
below, there may be relationships among elements within each of
these components, as well as between elements within each
component, which may be described as granularity. More information
about interface terminology may be found in the co-owned U.S.
publication 2012/0179696, titled "System and Process for Concept
Tagging and Content Retrieval," which is referenced in the
Background above, and the contents of which are incorporated herein
by reference.
[0053] Domains
[0054] A domain may be the uppermost level of the hierarchy. Each
domain may be a container for one or more concepts.
[0055] Domains may include, e.g., problems, procedures, diagnoses,
medications, allergies, family history, observations, etc.
[0056] Concepts
[0057] Concepts may be one step down from domains and may be
considered containers for descriptions. A concept may define a
clinical finding and may be a fully, well-defined expression of
clinical intent. It may be unambiguously defined and may reside
within a single domain.
[0058] A concept may be a coded entity with unique semantics. While
concepts may reside higher up in the order of terminology
specificity, concepts preferably are specific enough to provide
accurate, unique terminology for a user.
[0059] Adding a concept may require creating a concept description
(more specific) and domain (more general) for the concept. The
concept description may be added as a default description for the
new concept. Each concept description preferably is unique for the
domain to which the concept pertains, although a single concept may
appear in multiple domains.
[0060] The existence and status of concepts preferably is fluid and
subject to change or user modification. For example, while not
limited to or necessarily encompassing each of these options,
concepts may be added, updated, deleted, retired, or merged.
[0061] When updating or otherwise modifying the status of a
concept, the system may establish an audit trail of all
modifications.
[0062] Deleting a concept may require deleting all maps associated
with the concept.
[0063] Retiring a concept may include removing relationships to
that concept and affecting the status for that concept. The status
may be modified to reflect the retired status. This status may
occupy a row in a table listing each of the concepts.
[0064] Instead of deleting or retiring a concept, it may be
desirable to merge one or more concepts together. In the event of
merging an older concept with a newer concept, the user preferably
is able to search for the newer concept. In addition, data
associated with the older concept may be re-mapped to the newer
concept ID. A row in the concept table for the older concept may be
flagged as retired, and a comment may be inserted to reflect that
the older concept has been merged with the newer concept.
[0065] Conversely, instead of merging concepts, it may be desirable
to keep one or more concepts distinct from one another but create a
relationship between the concepts. For example, a single concept
may be split into one or more additional concepts, and it may be
desirable to indicate that the multiple concepts are related. This
is achieved by creating and maintaining qualified
concept-to-concept relationships, e.g., "is a child of," "is a
parent of," etc.
[0066] In order to keep track of concepts, each concept may be
assigned a unique numerical identifier. This identifier may be
generated randomly. Alternatively, multiple related concepts may
share some commonality in identifiers, e.g., each having the same
first three numbers.
[0067] Each concept may map to one or more external codes (e.g., a
reference, clinical, or administrative terminology), where each
mapping indicates both: a) a preferred status and b) a type of
relationship in comparison to the external code, e.g., same-as,
broader-than, or narrower-than. For example, the concept "acute
mastoid sinusitis" may have a preferred map to a SNOMED concept of
"acute sinusitis" with a relationship type of "narrower-than,"
meaning that the concept being mapped is "narrower-than," i.e.,
more specific than, the SNOMED concept. It may be desirable to map
the new concept to a reference terminology or to one or more other
concepts, either at the time of creation or otherwise.
[0068] Clinical interface terminology may use a reference
terminology to create or supplement ontology, i.e., relationship
among concepts.
[0069] Categories
[0070] The system may allow for the creation of categories, which
may not be related hierarchically to the other system components.
Each category may have one or more concepts mapped to it.
Categories may be a sub-domain, e.g., laboratory procedures within
a "procedures" domain, or a collection of concepts across
sub-domains.
[0071] It may be possible to add new categories, delete an existing
category, or edit the name of an existing category. New categories
may have unique names and may have associated comments. In one
embodiment, only the user that creates a category may be allowed to
delete that category. In another embodiment, either that user or a
user with higher access privileges may be able to delete the
category. Deleting a category may result in the deletion of all
concepts mapped to that category.
[0072] Within a category, the user may be able to add one or more
concepts to the category. Conversely, the user may be able to add
one or more categories to a concept or to delete a category from a
concept.
[0073] The system also may allow for the copying of one or more
concepts of an existing category to another category or a new
category.
[0074] The user also may be able to able to add one or more flags
to a concept and/or the concept-description mapping. With respect
to that mapping, flags may be used to associate the concept with,
e.g., a default description, preferred descriptions, consumer
descriptions, secondary descriptions, etc. In addition, a flag may
be used to indicate whether the concept or one of its descriptions
is a lingual variant, e.g., and English/British variant. Flags also
may be used to establish search filters and/or display result
filters, e.g., only displaying terms relevant to one or more groups
of users.
[0075] Descriptions
[0076] Descriptions may be a collection of text strings or terms
and may represent alternative ways to express a concept, which may
allow the system to capture concepts in the terms that various,
varied practitioners may use. Multiple descriptions may map to a
concept, but each description preferably has the same meaning. For
each concept, there may be one or more preferred descriptions. For
example, there may be at least one of a preferred clinician and a
preferred patient term, in order to capture both clinical intent
and an explanation understandable by the lay patient. As discussed
above, preferred terms may be called out with the use of flags to
the respective entries.
[0077] It may become necessary to determine whether a new term is a
description within an existing concept or whether it merits the
creation of a new concept. This determination may be driven by an
iterative, editorial process. Preferably, the determination is
based on an understanding of clinical science, such that creation
of a new concept results from a clinical understanding of its
difference as compared to existing concepts.
[0078] Each concept may include a default description, and the
system may include an editing module in order facilitate changing
this description. A default description may be selected, e.g., by
receiving a user selection, and it may be the description that is
mapped to a concept and has a CONTEXT_ID equal to some
predetermined value, e.g., 1. While descriptions may be deleted,
the system may prevent the deletion of a default description, at
least until a new default description has been established.
[0079] As seen in FIG. 2, multiple descriptions 16 may be
associated with each concept 14. Descriptions 16 are associated
with lists of words (discussed below). (FIG. 2 further illustrates
that each concept may map to one or more external codes, such as an
administrative term code 20, a clinical term code 30, and/or a
reference terminology code 40.) These words may include the words
that map to descriptions 16 from a table such as the
DESCRIPTION_WORD_MAP table. They also may include words that map to
words in one or more other tables, such as a WORD_GROUP table,
which may include other variations around the word, e.g., plural
forms and misspellings.
[0080] Concepts are unique within a domain, and the same
description is not used more than once across all concepts. Thus,
the system may allow the user to leverage existing descriptions to
form the basis for new descriptions. For example, the system may
include a graphical user interface that allows the user to select
an existing description within a separate concept and to populate
fields relating to the description in the new concept with those
from the existing descriptions. Similarly, selecting an existing
description within the same concept or a different concept may
generate a list of suggested descriptions to be added based on word
equivalence. Moreover, instead of copying a description from one
concept to another, the system may allow the user to move a
description between concepts.
[0081] Without context, a description may not provide the user with
full understanding of what it represents since the description may
be related to multiple concepts. For example, acronyms may be
included as descriptions, and while the acronym MI may refer to
myocardial infarction or mitral insufficiency, descriptions may be
"MI (myocardial infarction)" and "MI (mitral insufficiency)," which
may be referred to as disambiguation. Even if the same description
is used in multiple concepts, preferably the system includes a
separate instance of that description for each concept. For
example, two of the concepts shown in FIG. 2 may include the
description "MI," but those descriptions 16 are linked to their own
concepts 14, i.e., there is no description that shows a
relationship with two separate concepts.
[0082] Words
[0083] Words may be a subset within descriptions. Words may reflect
variations of the descriptions such as misspellings, alternative
spellings, abbreviations, variations in parts of speech (the
adjective of a noun description, e.g.), etc.
[0084] Words also may include items that are related to, but are
not variations of, the descriptions to which they are attached. For
example, "heart" may be a word under the description "myocardial
infarction."
[0085] The left half of FIG. 3 illustrates one example of the
relationships between the domain 112, concept 114, description 116,
and word 118 component tables of an interface terminology schema
110. The arrowheads in this figure represent the degree of
relationship; thus a line with one arrowhead pointing to one table
at one end and two arrowheads pointing to a second table at a
second end depicts a one-to-many relationship.
[0086] As seen in FIG. 3, each concept table 114 may include an
entry in columns representing the concept code 114a, title 114b,
and domain code 114c. The concept additionally may include entries
in the Status Dict ID and Note columns.
[0087] Concept table 114 may link to one or more additional
concept-related tables 120, 122, 124, 126, 128. One or more of
these tables may include a column containing the unique identifiers
for each concept, e.g., "Concept Code" column 130. Concept code
column 130 may be identical to or relate back to concept code
column 114a, e.g., via the use of one or more foreign keys to refer
back to the parent concept table 114.
[0088] Similarly, each description in description table 116 may
include entries in at least a description code column 116a and a
title column 116b. The schema shown in FIG. 3 indicates that there
may be a table linking the concepts to the descriptions, e.g., the
"Concept Description Map" table 128. Within this table, there may
be columns for concept codes 130 and description codes 132, as well
as a column for a code indicating a map 128a between concepts and
descriptions. Because multiple descriptions may map to a single
column, entries in the description column preferably are unique,
whereas entries in the concept column may be repeated.
Alternatively, entries in each of the concept description map code,
concept code, and description code columns may be unique, and for
each map code entry, there may be pointers to the respective
entries in the concept code and description code columns.
[0089] Staying with FIG. 3, similar relationships exist between the
description 116 and word 118 tables, with both linking to a
Description Word Map table 140 that includes both description code
columns 140a and word code columns 140b.
[0090] Interface Terminology
[0091] Within this framework, an interface terminology 10 may be
created. An interface terminology may be the link between what the
clinician wants to say and what the terminology can capture.
[0092] Unlike administrative code sets and reference terminologies,
which often are stored in the back-end functions like billing,
reporting, decision support, research, and interoperability between
applications, an interface terminology may operate at the front-end
of a clinical information system, i.e., in the "presentation
layer."
[0093] The interface terminology may be a suite of vocabulary
products that help institutions capture clinical patient
information. This interface terminology subsequently may provide
access to standardized vocabularies, such as ICD, CPT, SNOMED.RTM.
CT, MeSH, & UMLS, in order to connect providers and patients
with the patient record, administrative information, academic
references, and consumer information. As such, an interface
terminology may serve multiple ends, including, e.g., capturing a
clinician's intent, driving financial aspects including billing,
and driving analytical functions.
[0094] In one embodiment, an interface terminology may include
mappings between concepts and code sets that are configured not to
change over time. Alternatively, the mappings between an interface
terminology concept and a reference, interface, or other standard
code set may be subject to change, e.g., in light of regulatory
changes or modifications to those code sets.
[0095] A key feature in establishing an effective terminology may
be the inclusion of a comprehensive set of descriptions for each
concept. Descriptions preferably include both clinician-friendly
terms, e.g., vernacular, common terms, abbreviations, acronyms,
eponyms, or common misspellings, and patient-friendly-terms.
[0096] Relationship to Electronic Medical Record
[0097] The present system may be integrated within an EMR, see,
e.g., commonly owned U.S. Publication 2008/0065452, titled
"Longitudinal Electronic Record System and Method," the contents of
which are incorporated by reference, such as by linking external
codes with interface terminology related to data in the various
instances within a medical record.
[0098] The system also may be separate from the EMR, and the EMR
may access the terminology as an external service.
[0099] A patient's medical record may include multiple domains of
terminology, including, e.g., problems, plans, procedures,
observations, histories, allergies, medications, etc. Each of these
domains will include sets of concepts that may be mapped internally
to other concepts and externally to other codes or source
vocabularies.
[0100] Unique concepts may belong to, at most, one domain. Domains
may be divided into sub-domains. In one embodiment, concepts map to
external code sets. For example, problem concepts may map to
administrative code sets, such as: ICD-9-CM, ICD-10-CM, ICD-10-WHO,
ICD-10-CA. Procedure concepts may map to administrative code sets,
such as: CPT, ICD procedures, and HCPCS. Observation concepts
(including, e.g., lab results) may map to LOINC. Other external
source vocabularies for mapping may include, but not be limited to,
e.g., UMLS Metathesaurus, NCI Thesaurus, NDC or other drug
terminologies or codes, nursing terminologies such as NIC, NOC,
NANDA, CCC (previously known as HHCC), and PNDS.
[0101] Alternatively, it may be possible to map concepts in
multiple domains to one external code set. For example, all
interface terminology concepts across multiple domains may map to
respective SNOMED concepts.
[0102] Concepts may include work flow aspects. For example,
concepts may be orderable, performable, resultable, chargeable,
and/or historical. (Concepts are flagged as one or more of these
aspects, e.g., procedure terms may be used in multiple contexts.)
Each of these aspects may relate to external coding or terminology,
and the present system and method may link this coding or
terminology together.
[0103] External Code Mapping
[0104] In the past, descriptions may have been mapped to respective
codes in external code sets individually. Multiple descriptions may
have mapped to a single external code, but those descriptions may
not have had the same meaning.
[0105] Here, conversely, each description 16 in the interface
terminology 10 preferably maps to a concept 14, and that concept 14
is mapped once to the respective codes in the external code sets
20, 30, 40, as seen in FIG. 2. As such, the underlying descriptions
may be subject to additions, deletions, or other modifications,
while the higher-level concept linking remains intact.
[0106] In addition to user-generated matches between system
concepts and external codes, the system may populate a list of
potential match candidates, e.g., based on word equivalency that
meets or exceeds a predetermined or user-defined threshold.
[0107] Concepts are related to external code sets using qualified
relationships--a relationship type--including: exact match, broader
than, narrower than, related to, equivalent to, has-location,
has-severity, has-laterality, etc. Other relationship types may
include: "due to," "associated with," "has morphology," "has
causative agent," "has associated finding," "has laterality," "has
associated procedure," "has location," "has direct evidence," "has
direct substance," "has focus," "has interpretation," and
"interprets." This relationship coding may provide more granular
and complete relationships, which may provide a more accurate
mapping.
[0108] Preferably, the interface terminology concepts are at least
as specific as the external codes. In the event that an interface
terminology concept is broader than a more-specific external code,
that interface concept may map to one or more of the more specific
external codes. Alternatively, a newer, more specific interface
terminology code may be created, in order to respond to clinical
care use cases
[0109] In a significant majority of cases, the interface
terminology concepts may be more specific (more granular) than
those of the external code sets. In that case, those concepts may
map to the next highest, most accurate external code.
[0110] Multiple external code set codes further may be related to a
distinct concept according to varying degrees of preference, e.g.,
primary preferred, primary non-preferred, secondary preferred, or
secondary non-preferred.
[0111] One concept may map to multiple external codes.
Additionally, multiple concepts may map to a single external code.
The system may include a preferred base code mapping flag that
indicate the optimal external code for a given description and,
conversely, a preferred description code mapping flag that
indicates which description is preferred for display of a given
external concept.
[0112] One or more descriptions may be copied from a first concept
to a second concept that is part of a different domain. Similarly,
code mappings from one concept may be cloned to pertain to a second
concept, and the system may permit the user to select which codes
to copy.
[0113] The system and method may allow for a large degree of
flexibility in mapping. For example, it may be possible to map to
external codes that include laterality (e.g., one code for a
problem relating to the right kidney and a second code for a
problem relating to the left kidney). Additionally, the system and
method may map to codes that reflect combinations (e.g., Crohn's
disease of small intestine with fistula) and codes that reflect a
recordation of the episode of care (initial visit vs. follow-up,
etc.).
[0114] External code sets may be updated or modified fairly
regularly, e.g., one or more times a year for most sets and up to
weekly or even daily for drug vendor data. This system and method
may process these updates in a back-end environment, such that
users may continue to use the same terminology, unaffected by these
updates.
[0115] Data may be stored in one or more databases, e.g.,
object-oriented or relational databases. Mapping, as well as the
ultimate packaging of the mapped relationships into an end-user
format as described below, may occur on one or more computers via
one or more processors. In addition, while the data structure
described herein reflects entries in columns within one or more
tables, this should be understood to encompass a data structure
with the categories entered in rows.
[0116] Returning to FIG. 3, this external mapping may be
represented by the creation of a Mapping Data 150 table that links
the Concept table 114 on the Interface Terminology side and the
Ext. Vocab table 162 on the External Vocabulary side 160. As with
the mappings between concepts 114 and descriptions 116, described
above, where there is a column for concept codes and description
codes, the Mapping Data table 150 may include columns for a "From
Code" 150a and a "To Code" 150b, e.g., an interface terminology
code and an external vocabulary code, respectively. In addition,
because there may be multiple domains storing concepts and multiple
external code sources, the table also may include columns with
entries identifying a "From Source" 150c and a "To Source" 150d.
The mapping table also may include a Map Type column 150e, which
may provide additional information regarding the mapping, e.g.,
whether the mapping is primary preferred, primary non-preferred,
secondary preferred, or secondary non-preferred.
[0117] FIG. 4 shows a distribution entity relationship diagram 200
illustrating the relationship between one external code set (here,
ICD-9) and the interface terminology. FIG. 4 may not represent a
true back-end data structure, such as the one shown in FIG. 3, but
instead may reflect how the data may be presented or perceived as a
result of a software build from FIG. 3.
[0118] Table ICD9_BASE_TEXT 210 may contain the codes and full
textual descriptions of the ICD-9 external code. It also may
contain a plurality of entries and/or flags for additional
information that may be useful with the external code, e.g.,
ability to bill, code specificity, ability of code to be used as
primary diagnosis, gender indicator/flag, and age
indicator/flag.
[0119] Table ICD9_LEXICALS_TEXT_IMO 220 may include codes and
related textual entries for interface terminology
descriptions/lexicals.
[0120] Linking these tables, table ICD9_IMO 230 may map the
interface codes and texts to the external codes and texts in a
many-to-many relationship. This table also may include flags to
determine preferred codes for each relationship. It also may
include flags for the following entries: a match to the external
code full description; a truncated short description; a patient
translation flag (flagging a preferred patient description); a
clinician translation flag (indicated preferred physician
description for a given external code); a preferred base code
mapping, which indicates an optimal external code for a given
description; and a preferred lexical/description code mapping.
[0121] In order to manage data, a system and method such as
disclosed in the co-owned U.S. Pat. No. 6,904,432, titled "Adaptive
Data Manager," and/or U.S. Pat. No. 7,693,917, titled "Method for
Adaptive Data Management," may be useful, the contents of both of
which are incorporated by reference. For example, elements of the
interface terminology and their relationships, as well as
relationships with the external code sets, can be captured and
managed using a directed graph data structure in a back-end
information storage infrastructure.
[0122] Other tables in this structure may include a hierarchy table
such as ICD9_HIERARCHY_IMO 240, which contains clinical
hierarchical designation of each code. There may be multiple levels
of designation indicated by the HIERARCHY_LEVEL column in the
table. Each external code may have at least one entry in this
entity. In one aspect, the actual text for this table may be stored
in a separate, linked table, such as ICD9_HIERARCHY_TEXT_IMO
250.
[0123] Another significant table may be represented by the
ICD9_SNOMEDCT_IMO table 260 of FIG. 4. This table may contain a
mapping between interface terminology description terms and
external code concept terms. Each description may have one or more
maps, although the table may include preferred flags and
relationship flags to allow for a one-to-one mapping, if
necessary.
[0124] IMO Terminology Management Tool
[0125] Code mapping may be implemented using a terminology
management tool. This tool may be web-based and include a secure
login with role-based access privileges. The system may permit
users to have more than one role and also to support multiple
simultaneous users.
[0126] The terminology management tool may include a series of
separate panes to perform various tasks or analysis. A jobs pane
may allow a back-end user to see if there are any pending jobs that
require action, e.g., determining whether a new description
warrants its own concept or whether an existing concept should be
split into a plurality of concepts. A categories tab may enable the
user to add, delete, modify, or otherwise edit one or more
sub-domains. A history pane may provide the user with a trail of
all changes and all users responsible for those changes.
[0127] In addition, the tool may include a search pane in which the
user may enter all or a portion of a search phrase. The system may
search the database of interface terminologies and also may search
the external concepts to determine and display the closest matches
to the search term. Preferably, the system may prompt the user to
select a relevant domain for searching, so as to narrow the scope
of the search.
[0128] The system may highlight the top search result and display
relevant information about it in the rest of the terminology
management tool. This display may be refreshed upon receiving a
user selection from among the search results. Because the search
results may represent descriptions, the data displayed in one or
more of the additional task panes may be related to the selected
description's parent concept. Alternatively, the search results may
be concept entries, and the displayed data relates directly to the
selected concept.
[0129] The terminology management tool may allow for the addition,
merging, moving, copying, or deleting of a concept, e.g., via the
selection of one or more radio buttons.
[0130] If the user chooses to add a new concept, the system may
prompt the user to enter the new concept name, select the relevant
domain, and enter the relevant external code to which the new
concept maps. The system may permit the user to search for and
select a desired code, e.g., through various search techniques
known to those of ordinary skill in the art. The system also may
receive a user selection of the mapping type, e.g., "same as,"
"broader than," or "narrower than." When the new concept is
created, the system may generate a first description for that
concept that has the same name as that concept. This description
may be marked as the default or preferred description, although
those designations may be changed once one or more additional
descriptions are added.
[0131] Continuing with the terminology management tool, the system
may display the various descriptions mapped to the selected
concept, along with the flags applied to each of those
descriptions. Each concept may have a preferred description, which
may or may not have the same name as the concept itself. For
example, a selected concept of "myocardial infarction" also may
include a "myocardial infarction" description, and that description
may include a PF context flag to indicate that this description is
the preferred choice and a default flag to indicate that it is the
default choice.
[0132] As discussed above, each interface terminology concept
preferably also includes a preferred consumer term in order to
communicate the meaning behind the concept to the patient in an
effective, less technical manner. The mapping tool may display and
permit modifications to this term.
[0133] The terminology management tool further may provide a
summary of each external code mapped to that concept. The summary
may include the source of the external code, the map type
(broader-than, narrower-than, etc.), the number corresponding to
the external code, and a description of that code. More than one
external code may include a preferred designation, although
preferably only a single code within each external code set
includes such a designation. For example, a concept may map to one
ICD-9-CM external code and multiple SNOMED CT external codes. The
system may apply a preferred designation to both the ICD-9-CM and
one of the SNOMED CT code, while not designating the other SNOMED
CT concept as preferred.
[0134] The system may include an auditing subsystem to track
creations and edits to the data. For example, created and edited
data may include a date and/or time stamp, as well as a record
entry corresponding to the user ID of the user that made the
additions or modifications. In addition, the system may include the
ability to rollback changes to one or more previous states.
[0135] Internal Concept Mapping
[0136] Returning to FIG. 2, multiple concepts may be related to one
another and should be linked to reflect these relationships. A
simple form of relationship may be, e.g., a parent-child
relationship between two concepts. Other, more complex
relationships, e.g., broader than, narrower than, has-location,
has-severity, and has-laterality, also may exist amount various
concepts.
[0137] Additionally, code mapping may support clinical and
non-clinical modifiers. Clinical modifiers may relate to the
substance of the term being coded, e.g., when coding a fracture,
clinical modifiers may include "open," "closed," "compound," etc.
Modifiers may be maintained as concept qualifiers, which may be
deployed in run time. Conversely, non-clinical modifiers may
provide additional important information, but that information may
be less related to the substance of the term. For example, the
system may include non-clinical modifiers for the type of encounter
during which the code is captured, e.g., "initial," "subsequent,"
"etc."
[0138] The system may present the user with variations on the entry
point concept to select, e.g., displaying "fracture of surgical
neck of right humerus," "open fracture of surgical neck of right
humerus," and "compound fracture of surgical neck of right humerus"
on the same screen. The system then may receive a user selection of
the desired concept.
[0139] Alternatively, the system may display the base concept to
the user and then provide the user with one or more menus from
which to select the desired modifiers. For example, once the user
enters his or her clinical intent, the system may display various
possibilities for the user to select. Using the example in the
preceding paragraph, the user may select "fracture of surgical neck
of right humerus." Turning to FIG. 5, at that point, the system may
display one or more drop-down-type menus, e.g., one for a clinical
modifier (e.g., fracture type), a second one for encounter type,
and a third for a status (e.g., sequela). The system then may
receive the user's selections of the desired modifiers, building
the complete entry in that manner.
[0140] Clinical Workflow
[0141] Clinicians interact with interface terminology when
documenting diagnoses and procedures in the patient's electronic
record. The user, e.g. a physician, may perform searches using a
search functionality in designated locations in an EHR. The search
terms may be compared against words and descriptions within a
particular domain. One standard algorithm may be to proceed to a
search using the words that are part of a description, as well as
synonyms or other words classified within or linked to that
description. The resulting descriptions may be organized according
to a heuristic or term ordering. Search results may include direct
matches and approximate matches, the level of approximation
equating to a display-worthy result being calculated by one or more
different algorithms, examples of which may be generally known to
those of skill in the art.
[0142] Additionally or alternatively, a search algorithm may make
use of one or more terminology indices to determine whether an
exact match to the user's query exists. In the event that the
indices fail to yield a result, additional algorithms may be used
to suggest possibilities to the user, e.g., "Do You Mean
(DYM)"-type results. In addition, a search may yield a plurality of
potential results, and result ranking heuristics may be used to
address the particular field of use, e.g., one type of heuristic
may be used to address medical informatics needs, while a second
heuristic may be used in another field of use.
[0143] One or more terms may be returned to the user as a result of
the search, and the user may be able to review the possible results
to select the appropriate concept, e.g., the appropriate problem or
procedure. The physician selects the appropriate term to capture
the clinical intent, and the term(s) populates predetermined fields
in the electronic record.
[0144] The selected term also contains mappings to one or more
external codes, e.g., industry standard terminologies, such as ICD
or SNO MED CT. Thus, the user's selection of the desired interface
terminology automatically may provide necessary maps to those
codes, allowing the physician to focus on patient care while at the
same time capturing the necessary administrative and reference
codes.
[0145] Implementation
[0146] Workflow may be straightforward. First, a host application
may make a search request for terminology. Second, a response may
be consumed by a service client, and the response may be in XML
format. Third, the request may be fulfilled, and an XML response
may be sent back to the service client.
[0147] Implementing this workflow may be accomplished using various
languages. For example, the XML output implementation may occur via
coding in a C, dot.Net C#, Java, Javascript, COBOL, PHP, or MUMPS
environment.
[0148] By storing the interface terminology code in a patient's
record, an EHR may be able to retrieve the most up-to-date
administrative, clinical, and reference codes in the future. With
interface terminology in place within an EHR, physicians find a
number of beneficial impacts to their clinical workflow,
including:
[0149] Improved diagnostic search results for physicians to locate
problems;
[0150] More clinically meaningful physician documentation;
[0151] Creation of better and more complete problem lists; and
[0152] Improved coding accuracy and reliability.
[0153] Importance of Interface Terminology
[0154] Interface terminology provides a stable and constant pivot
point to meet the changing coding requirements of the healthcare
industry. Depending upon the EHR functionality, organizations can
extract the terms and associated codes for analysis.
[0155] Interface terminology in the EHR may provide several
benefits to health information management (HIM) professionals.
Knowing how the terminology works in the EHR may help to ensure
that an organization is reaping all the benefits of the system. The
interface terminology may affect how information is managed, from
impacting the revenue cycle to the design of the physician's search
experience and preservation of the clinical intent within the
longitudinal EHR.
[0156] One goal of interface terminology may be to facilitate
clinical documentation while streamlining other administrative
functions of healthcare. Clinician-friendly terms with associated
industry standard terminologies facilitate this goal. Interface
terminology also may support a "capture once, use many times"
philosophy of electronic health information. For example, if the
term "CHF (congestive heart failure)" is captured with an
associated ICD-9-CM code (428.0) or ICD-10-CM code (150.9) and
SNOMED CT code (42343007), the ICD code is routed to the financial
system for review and claims generation, while the SNOMED CT code
is available for other reporting. FIG. 6 illustrates how other
descriptions (through their respective concepts) may be mapped to
one or more external coding systems.
[0157] Clinical interface terminology may be used across multiple
domains, e.g., problems, procedures (surgical, lab, imaging,
medical), etc. By implementing interface terminology at the point
of documentation, clinicians may be able to more easily focus on
patient care while being able to capture clinical intent (e.g.,
capturing "left knee pain," even though the most appropriate
external code may correspond to "knee pain" in SNOMED CT and "pain
in joint, lower leg" in ICD-9). They also may be able to
provide--indirectly--more accurate external codes for billing,
decision support, and reporting, i.e., the system may provide for
meaningful use.
[0158] Interface terminologies are important for problem lists. In
practice, clinicians use many different synonyms, acronyms,
eponyms, abbreviations, and other terms to describe the same
diseases and problems. In terms of an interface terminology, each
of these alternative terms may be a description under a common
concept.
[0159] These alternate forms may be more familiar and frequently
used in the clinical domain rather than ICD-9-CM, ICD-10-CM terms,
or other external codes. Interface terminology provides an
interface to the standard ICD-9-CM (or other code)-driven
terminology in the EHR search. If the diagnosis was in standard ICD
language, billing or other administrative tasks may be easier, but
the clinician might have to alter the description or, depending
upon the term, might even be unable to initially locate the
diagnosis for selection. Additionally, the clinician then might
have to work with an incomplete ICD description. Similarly, while
billing or other administrative tasks may be simplified, the EHR
may face significant issues capturing the visit diagnosis.
[0160] Instead, in this system and method, the physician selects an
interface terminology diagnosis. The selected diagnosis populates
the patient's problem list and other parts of the EHR. The selected
interface terminology concept may be mapped to a preferred billable
administrative code by administrative code sets, and that code may
be used to populate the organization's billing system for review
and claims generation to increase efficiency and accuracy in the
revenue cycle.
[0161] Similarly, the selected interface terminology concept may
map to one or more clinical and/or reference terminology terms.
This mapping may allow the clinician or another user to research
and retrieve information on all patients whose records include a
reference to the concept.
[0162] In another example, once a problem has been diagnosed and/or
coded, the user may order or engage in a course of treatment. This
process may add additional complexity, in terms of both workflow
and the implication of sub-domains. For example, the user may be a
physician who orders a test, such as a "PSA Ultra." An
"Ultrasensitive Prostate Antigen (PSA) Measurement" test, i.e., a
performable procedure, may be performed. The user may select this
test, which may have mappings to one or more administrative,
clinical, and reference codes, which may result in a specific
procedure (here, e.g., "CPT Code 84152 Prostate Specific Antigen
(PSA); complexed (direct measurement)" being chargeable and billed.
Resultables, which preferably correlate with the orderable, may be
sent back from the lab and the results may be recorded in the
EHR.
[0163] Each of these elements, i.e., the orderable, performable,
resultable, and chargeable, may be recorded as data elements and/or
data objects spanning one or more visits, within the patient's
electronic medical record. Additionally, once completed, the
procedure may be added to a list of historical procedures. One
process of capturing and generating historical linkages for these
data elements may be described in the commonly-assigned U.S. patent
application Ser. No. 11/858,241, titled "Longitudinal Electronic
Record and System." Additionally, the data elements may be coded
with the appropriate interface terminology codes, which then may be
linked to the appropriate external codes as described herein.
[0164] This method and system may have several benefits, e.g., it
may:
[0165] Use familiar medical terms, which may reduce search time and
increase precision;
[0166] Improve charge capture as a result of accurate diagnostic
codes, resulting in quicker and more accurate billing;
[0167] Minimize maintenance, which may save the expense of creating
and maintaining a term dictionary and complicated term-to-code
mappings;
[0168] Provide meaningful use compliance;
[0169] Enable accurate data capture at the point of care; and
[0170] Increase patient safety through clarity of diagnosis,
problem, and procedure descriptions.
[0171] Interface Terminology and Patient-Centered Care
[0172] Patients are the heart of healthcare. Today there is a
renewed focus on patients as the driving force behind their
received care, as the industry is striving for a holistic,
patient-centered approach to providing care. Recent government
regulations, such as accountable care organizations (ACOs), support
and reinforce this idea. The ACO is a new care delivery model
focused on a provider team to coordinate and manage healthcare
services for a defined patient population. This coordinated care
team is the designed point of contact to ensure that all of the
patient's healthcare needs are being addressed regardless of
setting or specialty. Accurate information is critical to managing
patient populations effectively. This drives the need for
longitudinal data sharing, which has been a challenge for the
healthcare industry.
[0173] Interface terminologies can play a large role in the ability
to store and share data across provider settings. They have the
ability to capture clinical intent and create historical data to be
available for longitudinal records. The needed level of clinical
granularity is captured, which is important for continuity of care
between providers. Having all associated maps for the terms also
allows providers to know and manage their patient population. This
robust data enables sound business practices for providers in
addition to making the best decisions for their patients.
[0174] Interface terminology is vital to healthcare today and
tomorrow as terminology is the foundation of documentation. The
role of documentation does not change as records progress from
paper to electronic format, i.e., the saying "if it is not
documented, it was not done" still applies. But how the
documentation is accomplished does change in the electronic
environment, and efficiencies are gained by using an interface
terminology.
[0175] Maintenance
[0176] Maintaining up to date and accurate information may be just
as vital as the implementation and design of the EHR. As industry
standard terminologies are updated, organizations engage in a
maintenance process. Interface terminology eases the maintenance
process for organizations.
[0177] For example, what happens if a diagnosis appears in a
medical record, but the ICD code for that diagnosis is replaced?
Interface terminology remains indefinitely in effect while the
associated ICD code is updated to reflect the new code, i.e., the
map to a code may change, while the record remains unchanged. This
may be accomplished by redirecting the administrative code set
maps. Alternatively, the original flag may remain pointed to the
old code, and a new flag may be created to point between the
interface terminology concept and the new code, e.g., in the case
of secondary or less used codes and lexicals. In either event, the
historical tags between the term and the prior ICD code may stay
intact for historical purposes.
[0178] This updating may occur within an implementation workflow.
For example, on day/visit one, the patient may present with "knee
pain." The doctor may propose a treatment regimen, and the visit
may be billed according to the "knee pain" ICD-9 external code,
after which the visit may be closed. Later, a new ICD-9 external
code may be assigned to "knee pain," by the Center for Medicare
Services. This new external code then is mapped to that concept.
Upon reopening the medical record for that patient and re-exploring
that "knee pain" problem, the system will recognize that the
concept of "knee pain" is mapped to a different ICD-9 external
code, e.g., and will create a new revision of that problem with the
updated external code map.
[0179] This process may eliminate physicians selecting diagnoses
linked to out-of-date, incorrect, or non-billable codes, which in
turn may help reduce the amount of needless communication and time
spent between billing departments and clinicians to determine
clinical intent and adjudicate coding discrepancies.
[0180] Deployment
[0181] The concept architecture for creation and maintenance of
terminology described above preferably exists in a back-end
environment. Conversely, the system may deploy a description- or
lexical-based view on the data in the front end. This view may be
more useful to the end users, as descriptions or lexical may more
accurately reflect clinical intent and may comprise the terms most
frequently used by the end users.
[0182] This front end deployment may include compiling and
transmitting a lexical file, e.g., a text file, of all descriptions
with flags indicating how the description might be used in the user
interface. FIG. 4 may represent how the data for one domain--here,
the problem domain--is presented to and is consumable by end users.
Transformation processes take data from the tables of FIG. 3 to
create FIG. 4 types of information. There are other domains that
may be produced from FIG. 3, which may resemble FIG. 4, but for
other domains, e.g., medications, procedures, etc.
[0183] This transformation may be aided by generating a table
linking to and drawing from elements of both the table linking the
concepts to the descriptions, e.g., the "Concept Description Map"
table 128 and the external vocabulary table 162. This table may be
considered a description-external vocabulary mapping table 170 and
may include a column 170a listing codes between the multiple
concepts and descriptions. This table also may include one or more
columns 170b, 170c listing the external vocabulary codes or
external codes. These columns may be generated specifically for
this table, but preferably entries in the concept description map
code column 170a may be derived from the concept description map
code column 128a in the concept description map table 128.
Similarly, entries in the external vocabulary code column 170b and
external code columns 170c may be derived from the external
vocabulary code column 162a and external code column 162b in
external vocabulary table 162. (The external code column may
include an entry indicating the code set, e.g., SNOMED CT, ICD-9,
etc., from which the code values in the external vocabulary code
column come.)
[0184] Deployment from FIG. 3 to FIG. 4 may occur in various ways,
e.g., running a series of SQL statements to obtain and arrange the
required information in the desired format. This information may be
obtained by referencing the description-external vocabulary mapping
table, and populating the deployment file with a plurality of
entries, where each entry links a description with an external
vocabulary identifier.
[0185] The lexical file that is deployed may include mappings
between descriptions and the external codes to which they relate,
which may support billing, reporting, or decision support
workflows. While the actual mapping may occur at the concept level,
the file presented to the user may not include mappings to
interface terminology concepts, so the end users may not be aware
of the number of concepts or the exact details of those concepts.
With these mappings in place, the process of determining the
external concepts to apply may become tantamount to a table
lookup.
[0186] The deployment file may be available in multiple formats,
including, but not limited to: comma-separated-value (CSV) ASCII
format, tab-delimited ASCII format, database export formats, or
other binary flat file formats. Described another way, the
deployment file may be a distributable, computerized relational
data source file. This deployment method also may rely upon a
stateless, in-memory, software as a service (SAAS), for cloud
deployment.
[0187] Deployment may occur in one or more fashions, e.g., via flat
files in a relational database format or as part of a portal or web
service.
[0188] The deployment method also may provide one or more of the
following benefits:
[0189] Providing users with extensive alternative word choices and
natural clinical language grammar, increasing the chance that the
most accurate or most desirable concept is selected;
[0190] Presenting the user with one or more options that may
reflect the user's clinical intent;
[0191] Presenting users with several linguistic versions such as
synonyms, acronyms, abbreviations and alternate lexical
variants;
[0192] Enabling enhanced granularity, e.g., adding specific disease
and syndrome coding rather than broad, non-specific terms such as
"other" or "unspecified;" and
[0193] Insulating the user from translations between coding,
clinical, and patient terminology, providing the user with an
easier-to-use environment.
[0194] While the foregoing written description of the invention
enables one of ordinary skill to make and use what is considered
presently to be the best mode thereof, those of ordinary skill will
understand and appreciate the existence of variations,
combinations, and equivalents of the specific exemplary embodiment
and method herein. The invention should therefore not be limited by
the above described embodiment and method, but by all embodiments
and methods within the scope and spirit of the invention as
claimed.
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