CPRI Phrasing Exercises Legacy, Lessons, and Point of view.

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CPRI Wording Exercises Legacy, Lessons, and Point of view CG Chute, MD DrPH Mayo Establishment SP Cohn, MD MPH Kaiser Permanente NCVHS May, 1999 Inspiration and Connection: A Quality Suggestion
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CPRI Terminology Activities Heritage, Lessons, and Perspective CG Chute, MD DrPH Mayo Foundation SP Cohn, MD MPH Kaiser Permanente NCVHS May, 1999 1

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Motivation and Context: A Value Proposition “Those with more nitty gritty, dependable and practically identical information for expense and result thinks about, ID of best practices, rules advancement, and administration will be more fruitful in the marketplace.” SP Cohn; Kaiser Permanente 2

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Clinical Database Observational Data Medical Knowledge Clinical Guidelines Expert Systems Heritage of Continuous Improvement Central Role of Terminology Patient Encounters 3

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Terminology as Crucial Requirement Without Terminology Standards... Wellbeing Data is non-equivalent Health Systems can\'t Interchange Data Secondary Uses (Research, Quality) are impractical Linkage to Decision Support Resources unrealistic 4

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Weights and Measures Public Health Metrics “The classification is of as much significance in [health], as weights and measures in the physical sciences, and ought to be settled without delay.” William Farr, First Annual Report of the Registrar-General of Births,Deaths, and Marriages in England. London: 1839 p. 99. 5

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Long Heritage of CPRI Involvement with Terminology Questions Chute CG, Cohn SP, Campbell KE, Oliver DE, Campbell JR, and the Computer-Based Patient Record Institute\'s Work Group on Codes & Structures. The substance scope of clinical groupings . JAMIA 1996;3(3):224-33. Campbell JR, Carpenter P, Sneiderman C, Cohn SP, Chute CG, Warren J. Stage II Evaluation of Clinic Coding Schemes: Completeness, Taxonomy, Mapping, Definitions, and Clarity. JAMIA 1997;4(3):238-251. Chute CG, Cohn SP, Campbell JR. A Framework for Comprehensive Health Terminology Systems in the United States: Development Guidelines, Criteria for Selection, and Public Policy Implications. JAMIA 1998;5:503-510. 6

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CPRI Coding Study Conclusions - 1996 (1994) Most coding frameworks lose data Some lose more than others ICD, even with CPT, loses over 50% of the clinical point of interest Misclassification predisposition is likely in studies which utilize managerial coding frameworks 7

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Joint CPRI ANSI/HISB Terminology Framework ( JAIMIA Dec ‘98 ) Characteristics Comprehensive, Coherent, Interlocking ... Structure of the Terminology Model Atomic, Compositional, A-cyclic,... Support Identifiers, Version Control,... Organization 8

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National Summit on Health Information Solutions CPRI Summit: November, 1996 Agreed to: Convene A National Conference Terminology and Dataset Developers Health Care Providers CPR System Vendors Health Care Payers Government 9

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History of Conference Fora Focusing Upon Health Terminology National Conference on Terminology for Clinical Patient Description November 12-14, 1997, Arlington, VA Joint Conference on Lexical Solutions for the Government CPR (GCPR) Co-Hosted by Health Level-7 (HL7) Arlington, Virginia August 3-4, 1998 Terminology II: Establishing the Consensus Lessons for a fact April 27-29, 1999, Tysons Corner, VA 10

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Single Web Entry Point All Presentation Slides Substantial Summaries Average 50 page outlines References to Published Work www.cpri.org/phrasing 11

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National Conference on Terminology for Clinical Patient Description Nov 12-14 1997; Arlington, VA Industry Defined Terminology Requirements Agree Upon Framework for Progress Prioritize Requirements Knowledgeable Input Into National Deliberations 12

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What is Clinical Terminology Tentative Definition Standardized terms and their equivalent words which record persistent discoveries, circumstances, occasions, and mediations with adequate subtle element to bolster clinical consideration, choice bolster, results exploration, and quality change; and can be productively mapped to more extensive arrangements for managerial, administrative, oversight, and monetary necessities. 13

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Continuum from Nomenclature to Classification Patient Data is Highly Detailed Modifiers: Anatomy, Stage, Severity, Extent Qualifiers: Probability, Temporal Status Aggregate Uses Require Categorization Granularity of Classifiers Focused Groups and Strata for CQI/Outcomes Broad Statistical/Fiscal Groups 14

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Terminology Systems Relationships Engineering Map ...Classifications Entry Terminology Reference Terminology Nomenclatures... Total and Administrative Terminology 15

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Classifications Emerging from a Nomenclature Summary Nomenclature Granular 16

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Consensus Point Recognition that Fair Recovery of Development and Ongoing Maintenance Costs are Justifiable and Necessary 17

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CPRI II: April 1999 Case Studies and Practical Examples Positing “Interlocking Solutions” Not Enough Examine Case Studies of Bilateral Coordination or Cooperation Generalize from Experiences as Examples to Proceed toward Common Goal 18

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Backdrop of Recent Coordination Understated yet Spectacular Success NLM’s Facilitation of: CPT, ICD, SNOMED Bilateral Mappings LOINC-SNOMED Cooperation “Inclusion” by Reference Lexical-Ontyx “Letter of Intent” to Merge Terminology Component Vendors Merger of SNOMED - NHS “Read” Clinical Terms Create a New, Common, Hybrid Product 19

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Centers of Gravity Emergent Since “Terminology I” ISO WG on Terminologies Newly Merged Public and Private Efforts HL/7 Vocabulary Working Group Intention to Register Terminology Systems NCVHS 20

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Detailed Updates on Major Systems CPT-5: Karen Borman MD ICD-10-PCS: Pat Brooks RRA SNOMED-RT: Kent Spackman MD PhD LOINC: Patricia Maloney ICD-10-CM: David Berglund MD 21

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Major Points: Terminology II  Business Relevance Clinical Nomenclatures and Reference Terminologies Are Now Broadly Recognized As Crucial to the Optimal Practice of Health Care, Enabling Quality Improvement, Outcomes Analysis, and Treatment Efficacy Studies. They Can Enhance Clinical Efficiency and Provide Reliable Linkages for Decision Support. 22

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Major Points: Terminology II  Demonstrated Coordination There Has Emerged a Spirit of Cooperation and Many Case Examples of Fruitful Coordination and Collaboration Among Terminology Developers and Supporters. A Positive Consolidation in the Field Is Escalating. 23

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Major Points: Terminology II  From Nomenclatures to Classifications The Importance of Mapping or Linking the Detailed Descriptions of Patients Using Clinical Nomenclatures Against Categorical Classifications (Such as the ICDs) Is Well Recognized and Proactively Adopted by Terminology Developers Across the Continuum From Nomenclatures to Classifications. 24

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Major Points: Terminology II  Public Funding The Principle of Government Support for Terminology Development and Maintenance As an Infrastructure for the Public Good , With an Aim Toward Reducing the Costs for End Users, Is Welcomed and Encouraged. 25

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Remaining Tasks Fully Engage Payers and Providers “Customer Demand” for Vendors Reconcile: Terminology Structures Reference Information Models Complete Transition from Esoteric Interest to Crucial

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