We have been hearing from patients that clinicians spend a lot of time trying to find information in their EHRs, only to often give up rather than search through other sections of the chart to find a lab result, view past encounter notes, or try to correlate medications with problems or the course of a condition. This situation will only get worse once the healthcare data interoperability floodgates are opened, making it even more challenging for clinical users to find what they need.
However, it’s not all bad news. The effects of the 21st Century Cures Act and TEFCA will make it easier for systems to send and receive information. Additionally, the establishment of terminology standards and the use of common codes such as ICD-10, SNOMED, LOINC, RxNorm, CPT, DSM5, CTCAE, UNII, CVX, and others will provide a basis for what is often called “semantic interoperability.” Meanwhile, the performance of natural language processing (NLP) is improving and provides a means to identify terminologies and codes within free-text notes.
More coded data must be a good thing, right?
Not necessarily––unless users can quickly find the information they need for managing, assessing, evaluating, and treating the patient and each of their clinical problems. With the growing focus on chronic condition management driven by widespread adoption of risk-based reimbursement through Medicare Advantage and similar programs, it will be increasingly critical for clinicians to see a diagnostically focused view for each patient and each of their medical problems. And they must be able to do so instantly, without searching through disparate sections of the EHR.
Yes, semantic interoperability through the common use of standard terminologies and code sets is a great start and is necessary for sharing of clinical information between systems. It will also drive better analytics and population health insights. However, what it will not do is make it easier for a clinician to find what they need for the patient at the point of care (whether that patient is in-office or on a screen).
Most existing EHRs, and the terminologies and codes for semantic interoperability, are separated into distinct “domains.” In the EHR, this commonly shows up as separate sections or tabs: a problem list, medication list, laboratory orders and results, procedures, encounter notes, discharge summaries, etc. Problems have ICD-10 and SNOMED codes, labs have CPT and LOINC codes, medications have RxNorm or NDC codes, and other domains use other code sets. These codes were designed for their specific domain, and not designed to work together for the clinical user.
The key to usability is to tie all these together by linking them to the problem list, enabling a user to click on a problem and instantly see the clinically related medications, labs, procedures, therapies, co-morbidities, and specific findings in encounter notes that are related to the problem. In other words, a diagnostically filtered presentation that can be viewed longitudinally, supported by millions of mappings from standard terminologies and code sets into a unique diagnostic relevancy engine that provides both semantic, and diagnostic, interoperability.
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