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All original work IN TEXT CITAITON AND REFERENCES
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400 words
Controlled Terminologies
Find Web sites that make use of terminologies (standard or not) in health care and other
industries. Post the URLs and a brief description to the discussion board. Do you feel that the
terminologies you located work well? Why or why not?
Reading material
Terminology
A terminology is a group of terms used in a particular profession. Terminologies can vary in
terms of scope and purpose and can be found in many industries including healthcare.
Industrial Engineers (IE) terminology set (Links to an external site.) was created to establish
standardization of terms that are currently used in industrial engineering. The terms were
created in collaboration with the Institute of Industrial Engineers (Links to an external site.) and
the ANSI Z94 Committee on Industrial Engineering terminology (Links to an external site.). The IE
topics that were included in the terminology included planning, operations, inventory planning,
and control.
The North American Industry Classification System (NAICS) (Links to an external site.) is the
standard used by Federal statistical agencies in classifying business establishments for the
purpose of collecting, analyzing, and publishing statistical data related to the U.S. business
economy. NAICS was developed under the auspices of the Office of Management and Budget
(OMB) (Links to an external site.), and adopted in 1997 to replace the Standard Industrial
Classification (SIC) (Links to an external site.)system. It was developed jointly by the U.S.
Economic Classification Policy Committee (ECPC) (Links to an external site.), Statistics
Canada (Links to an external site.), and Mexico’s Instituto Nacional de Estadística y Geografía
(INEGI) (Links to an external site.), to allow for a high level of comparability in business statistics
among the North American countries.
Standards are used to create consistent terminology by using a data dictionary or a common
language such as the Unified Medical Language System (UMLS) (Links to an external site.).
Coding systems such as International Classification of Diseases (ICD) (Links to an external
site.) or Current Procedural Terminology (CPT) (Links to an external site.) are used to standardize
billing information for transmission to third party payers. The Systemized Nomenclature of
Medicine (SNOMED) (Links to an external site.) combines the information from both of these
systems and is able to represent symptoms of a disease as well as procedures and diagnoses.
A healthcare field that utilizes standard terminology is that of
pharmaceuticals. MedlinePlus (Links to an external site.) does a good job of listing the
medications, but the main benefit is that once the link for the medication is clicked, it leads to
another page with details about the medication such as; why its prescribed, how it should be
used, the side effects etc.
RxNorm (Links to an external site.) is maintained by the U.S. National Library of Medicine (Links
to an external site.) as is MedlinePlus. The major pro of this system is that it normalized drug
names. The unique identifiers assigned to the drug facilitates easier electronic sharing across
dissimilar systems. It shows the standard name but also the ingredients, strengths, and dose
forms that are available in the USA from different vendors.
The RxNorm uses a structured approach to naming the drugs.
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Step 1 is to create groups for a medication. A medication can come in different names and
forms. RxNorm creates a group of synonyms that mean the same thing.
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Step 2 is to create the normalized name.
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Step 3 is to assign a unique identifier.
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Step 4 is to define attributes and relationship to other drugs. This includes items such as
manufactures, pill size, and ingredients.
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Step 5 is related to the RxNorm name and the relationships.
Logical Observation Identifiers Names and Codes (LOINC) (Links to an external site.) is a
recognized reference terminology for classifying and electronically exchanging information
regarding lab tests, measurements, and clinical observations.
The terminology works well because it has the attributes of a reference terminology standard:
LOINC is a set of concepts and structured data; it provides a terminology of universal codes and
names that allow the exchange of data between multiple systems without requiring each system
to map to external systems unique internal code system; LOINC has been identified
by HL7 (Links to an external site.) as a preferred code set for laboratory test names in
transactions between health care facilities, laboratories, laboratory testing devices, and public
health authorities; and LOINC has been designated as a standard for the exchange of health care
information by the Federal government.
SNOMED and ICD-10
SNOMED is the most comprehensive, clinically expressive, and logically sound clinical care
terminology but it is not designed for public health reporting. ICD-10 is the global health
information standard for mortality and morbidity reports but it was developed for use in
epidemiology and not primarily for clinical care record keeping.
Watch SNOMED CT Basics – Part 1 (Links to an external site.) (8 minutes).
The SNOMED CT components, including Concepts, Descriptions, and Relationships.
Watch SNOMED CT Basics – Part 2 (Links to an external site.) (8 minutes).
Covers special hierarchies, directed acyclic graphs, and subsumption relationships.
Campbell (2013) calls the Systematized Nomenclature of Medicine (SNOMED) (Links to an
external site.) “the most comprehensive, clinically expressive, and logically sound clinical care
terminology available.” He then goes on to emphasize the importance of an expressive
terminology in clinical care documentation.
SNOMED is a standard medical terminology that captures and stores clinical information in an
EHR to ensure consistent expression of similar concepts that can be leverage for decision
support, reporting, and analytics. ICD is a classification system that captures diagnoses but is
used mostly for medical billing.
SNOMED facilitates electronic data collection at the point of care; retrieval of relevant data,
clinical concepts, information, and knowledge and use of data for surveillance, clinical decision
support and quality and cost monitoring. ICD is an abstraction and combinations of clinical
concepts that are designed to support non-clinical documentation needs, such as reimbursement
or regulatory reporting. ICD codes do not work well as an interface or reference terminology
because they lack granularity, fail to define individual concepts, and their relationships, and have
complex rules for code selection.
SNOMED-CT is a terminology that is too detailed to be used for reporting; it is designed for
input (Bowman, 2014). ICD is a classification designed for output. It aggregates the details being
input into codes designed for reporting (Bowman, 2014). SNOMED-CT is designed to be
managed by computer. It’s not just a flat list of numbers and corresponding terms. It’s a
complex relationship of concepts.
The common themes in support of the use of SNOMED over ICD-10 include level of detail,
clinical focus (vs statistical focus), point of care focused (vs after care), user friendliness, more
flexible data retrieval, and disease specific.
The new ICD-11 model revised by the World Health Organization (WHO) (Links to an external
site.) is intended to have a shared ontology with SNOMED CT. It might create the push we need
to develop a blended model of the two terminology systems that will benefit both physicians
and administrators. Blending of the systems will also support semantic interoperability in the
eHealth systems which is a huge benefit in terms of the ability to exchange information quickly
and adequately.
However, there is still work to be done. ICD needs to be restructured so that it has an
ontological core which follows the requirements for classifications. SNOMED must develop a
subset of self that will serve as the ontological core of the ICD foundation. These are not easy
tasks and agreements would need to be reached from multiple sides (Rodrigues, 2013).
UMLS
The advances throughout the years in the development of the Unified Medical Language System
(UMLS) Metathesaurus (Links to an external site.) are an important part in the development of a
clinical ontology that can be used as the basis for multiple coding terminologies.
Interesting to note that the UMLS research project was carried out in a disciplined and
communicated manner. Many fields of study, including medicine, biomedical science, medical
informatics, computer science, library and information science, and linguistics contributed.
The NLM UMLS chose a “task-order” research contract as the means to fund external research
collaborators. This gave the flexibility of having research tasks that were defined but also
negotiable throughout the life of the contract. The biggest advantage of this mechanism was
that it allowed NLM and their collaborators to adjust research questions and methods as
improved understanding of both the problems involved and the changes in health information
environment occurred.
Works Cited
Bowman, S. (2014). SNOMED, ICD-11 Not Feasible Alternatives to ICD-10-CM/PCS
Implementation (Links to an external site.). Journal of Ahima.
Campbell, J. R., Brear, H., Scichilone, R., White, S., Giannangelo, K., Carlsen, B., & Fung, K. W.
(2013). Semantic interoperation and electronic health records: Context sensitive mapping from
SNOMED CT to ICD-10. MedInfo, 192, 603–607.
Rodrigues, J. M., Schulz, S., Rector, A., Spackman, K., Üstün, B., Chute, C. G. & Persson, K. B.
(2013). Sharing ontology between ICD 11 and SNOMED CT will enable seamless re-use and
semantic interoperability. Studies in Health Technology and Informatics, 192, 343.
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