How to Use Standardized Healthcare Terminologies to Meet Your Quality Care Goals

This white paper is intended to help HIM professionals better understand the standard terminologies needed to meet the increasing need for semantic interoperability to cross the quality chasm. We discuss the common standard code sets used in the clinical setting, and the history, governing bodies, and maintenance of those standards as well as when you should use them (and when you shouldn’t) to help you organize and manage data throughout your organization.

The standards to be addressed cover administrative data, code sets used in revenue cycle management (ICD and CPT®), LOINC®, SNOMED CT, and RxNorm. Once you understand the basics of terminology, you will be well on your way to an understanding of semantic interoperability.

Addressing the Documentation Challenge for Clinicians: Provider Friendly Terminology

To support Meaningful Use, clinicians will need to create SNOMED CT®-encoded problem lists and ensure accurate ICD-9-CM and ICD- 10-CM diagnosis codes. The proper encoding of these problem lists would become a cumbersome endeavor if clinicians had to know the underlying complexity of SNOMED and ICD.

Clinicians should consider deploying a Provider Friendly Terminology solution that ensures problems, procedures, and diagnoses are properly documented and mapped to standards. This approach not only improves the quality of clinical documentation, but also increases clinician productivity and satisfaction – all critical goals when promoting the adoption of standards such as SNOMED CT, ICD-9 and soon ICD-10.

Terminology Requirements for Meaningful Use, Stages 1 through 3

This chart outlines electronic health record (EHR) requirements in the Meaningful Use program that necessitate consideration for healthcare terminologies. Although the Meaningful Use program is near its end, the Centers for Medicare & Medicaid Services (CMS) will continue to strengthen requirements for documenting, standardizing and sharing data within, and amongst, EHRs through other programs such as Hospital Value-Based Purchasing (VBP) payments, the Physician Quality Reporting System (PQRS), the Merit-Based Incentive Payment System (MIPS), Alternative Payment Models (APMs) – including accountable care programs – and others.

 

Data Normalization: Common Use Cases and Terminology Domain Challenges

The rapid evolution of health IT systems has resulted in significant interoperability problems, which stem from the presence of numerous local and standardized clinical terminologies.

A key ingredient for a data normalization solution should include mapping algorithms for labs, drugs, and problems and diagnoses that can translate disparate data to support the needs of data warehousing, ACOs, HIEs, analytics, and population health initiatives.

Managing Value Sets: The Building Blocks for Your Analytics Initiatives

Ensuring that patient information is accurately codified is critical to making informed decisions regarding care and utilization management, minimizing re-admissions, and ensuring medical adherence to treatment plans.

Code groups, also called value sets, are defined sets of codes that represent clinical concepts derived from one or more standard terminologies such as SNOMED CT®, LOINC®, ICD-10, ICD-9, and RxNorm. For example, a clinical concept may consist of a number of diagnoses and procedure codes spanning several terminologies that can be used to represent patients with myocardial infarction or diabetes.

Merging Claims and Clinical Data: CPT to LOINC Maps

Increasingly, payers are relying on laboratory data to support quality and reporting initiatives, analytics, and population health strategies. Maps between lab orders and lab results can assist health plans to identify and close gaps between claims from providers and lab results received from a variety of sources including hospitals, national lab providers, and HL7 messages.

With real-examples, you’ll see why combining claims and clinical data is important ensuring accuracy with your quality reporting programs.

Ensuring Clinical Accuracy During ICD-10 Medical Policy Remediation

95% of policies we have reviewed contained a key medical concept that was lost or assumed in translation from ICD-9 to ICD-10 using GEMs. Because of this, the medical intent is lost.

With real-world examples and analyses, you’ll see how to avoid claim rejections and payment losses when remediating your medical policies.

Achieving Advanced Interoperability and Analytics: The Importance of Data Quality and Governance

As federal regulatory initiatives continue to encourage information-sharing capabilities inside and outside a healthcare organization, the C-level is increasingly finding that an Enterprise Terminology Management strategy is critical to success.

Meaningful Use Stage 2 Certification: A Guide for EHR Product Managers

The federal government’s Meaningful Use program aims to boost the adoption of electronic health records, providing financial incentives to healthcare providers who adhere to the program’s standards. To qualify for those payments, healthcare providers must deploy “certified” EHR technology, yet the task of creating such a product is complex.

Data Normalization: The Foundation of Forward-Thinking Initiatives

Terminology is core to everything in healthcare. Unfortunately, the explosive growth in healthcare IT has resulted in patient data being scattered across an array of rapidly proliferating IT systems—each with their own way of representing clinical terms, creating an environment of data locked in silos. This terminology barrier must be overcome if we are to recognize the national effort around increased interoperability, transparency, and collaboration within our healthcare system.

Understanding the Health Language SNOMED CT® to ICD-10 Maps

THE PROBLEM: SNOMED CT® / ICD-10-CM MAPS.  As specified by Meaningful Use Stage 2, the 2014 edition of EHR certification will require problem list entries to have SNOMED CT® encoding. Further, on October 1, 2014, diagnoses must be encoded in ICD-10-CM for billing. After that time personnel and systems will need to convert problem list entries (in SNOMED CT®) to billing diagnoses (in ICD-10-CM). Sophisticated SNOMED CT® / ICD-10-CM mapping is required to allow this task to be done efficiently and accurately.

Meaningful Use Is Not the Finish Line

While earning financial incentives for achieving Meaningful Use is a worthy short-term goal, the increasingly interconnected nature of healthcare is making enterprise terminology management a new and essential part of long-term operations.

Mapping from ICD-9-CM/ICD-10-CM to SNOMED CT® for Meaningful Use Compliance

Achieving Meaningful Use (MU) with certified electronic health record (EHR) technology remains a top priority for healthcare organizations that want to qualify for federal incentive payments and avoid penalties for noncompliance. In order for disparate organizations to seamlessly exchange data, EHRs and other IT systems must first be able to communicate using common terminologies.

Meaningful Use and Terminology Compliance

Healthcare IT vendors are under increasing pressure to implement solutions that address complex vocabulary requirements in the Meaningful Use criteria. Health Language® is uniquely positioned to deliver advanced terminology management tools that help vendors manage, update, and distribute content sets and mappings to their clients.

Achieving SNOMED CT® Compliance for Better Care Delivery

The healthcare industry faces a critical question of semantics. As meaningful use (MU) converges with ICD-10 and the evolving performance-based revenue landscape, one important issue for health IT vendors and providers alike is the need for a common clinical vocabulary.