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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 Motivation and Context: A Value Proposition

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cpri terminology activities heritage lessons and perspective

CPRI Terminology ActivitiesHeritage, Lessons, and Perspective

CG Chute, MD DrPH

Mayo Foundation


Kaiser Permanente


May, 1999


motivation and context a value proposition
Motivation and Context:A Value Proposition

“Those with more detailed, reliable and comparable data for cost and outcome studies, identification of best practices, guidelines development, and management will be more successful in the marketplace.”

SP Cohn; Kaiser Permanente


heritage of continuous improvement





Medical Knowledge





Heritage of Continuous Improvement

Central Role of Terminology





terminology as crucial requirement
Terminology as Crucial Requirement

Without Terminology Standards...

  • Health Data is non-comparable
  • Health Systems cannot Interchange Data
  • Secondary Uses (Research, Quality) are not possible
  • Linkage to Decision Support Resources not Possible


weights and measures public health metrics
Weights and MeasuresPublic Health Metrics

“The nomenclature is of as much importance in [health], as weights and measures in the physical sciences, and should be settled without delay.”

William Farr, First Annual Report of the Registrar-General of Births,Deaths, and Marriages in England. London: 1839 p. 99.


long heritage of cpri involvement with terminology questions
Long Heritage of CPRI Involvement withTerminology 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 content coverage of clinical classifications. JAMIA 1996;3(3):224-33.
  • Campbell JR, Carpenter P, Sneiderman C, Cohn SP, Chute CG, Warren J. Phase 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.


cpri coding study conclusions 1996 1994
CPRI Coding StudyConclusions - 1996 (1994)
  • Most coding systems lose information
  • Some lose more than others
  • ICD, even with CPT, loses over half of the clinical detail
  • Misclassification bias is probable in studies which use administrative coding systems


joint cpri ansi hisb terminology framework jaimia dec 98
Joint CPRI ANSI/HISBTerminology Framework (JAIMIA Dec ‘98)
  • Characteristics
    • Comprehensive, Coherent, Interlocking ...
  • Structure of the Terminology Model
    • Atomic, Compositional, A-cyclic,...
  • Maintenance
    • Identifiers, Version Control,...
  • Administration


cpri summit november 1996

National Summit onHealth 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


history of conference fora focusing upon health terminology
History of Conference ForaFocusing 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 from Experience

    • April 27-29, 1999, Tysons Corner, VA


single web entry point
Single Web Entry Point
  • All Presentation Slides
  • Substantial Summaries
    • Average 50 page synopses
  • References to Published Work



national conference on terminology for clinical patient description
National Conference on Terminology forClinical Patient Description

Nov 12-14 1997; Arlington, VA

  • Industry Defined Terminology Requirements
  • Agree Upon Framework for Progress
  • Prioritize Requirements
  • Knowledgeable Input Into National Deliberations


what is clinical terminology tentative definition
What is Clinical Terminology Tentative Definition

Standardized terms and their synonyms which record patient findings, circumstances, events, and interventions with sufficient detail to support clinical care, decision support, outcomes research, and quality improvement; and can be efficiently mapped to broader classifications for administrative, regulatory, oversight, and fiscal requirements.


continuum from nomenclature to classification
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


terminology systems relationships engineering map
Terminology Systems RelationshipsEngineering Map


Entry Terminology

Reference Terminology


Aggregate and Administrative Terminology


consensus point
Consensus Point
  • Recognition that Fair Recovery of Development and Ongoing Maintenance Costs are Justifiable and Necessary


cpri ii april 1999 case studies and practical examples
CPRI II: April 1999Case 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


backdrop of recent coordination understated but spectacular success
Backdrop of Recent CoordinationUnderstated but 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


centers of gravity emergent since terminology i
Centers of GravityEmergent Since “Terminology I”
  • ISO WG on Terminologies
  • Newly Merged Public and Private Efforts
  • HL/7 Vocabulary Working Group
    • Intention to Register Terminology Systems


detailed updates on major systems
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


major points terminology ii business relevance
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.


major points terminology ii demonstrated coordination
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.


major points terminology ii from nomenclatures to classifications
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.


major points terminology ii public funding
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.


remaining tasks
Remaining Tasks
  • Fully Engage Payers and Providers
    • “Customer Demand” for Vendors
  • Reconcile:
    • Terminology Structures
    • Reference Information Models
  • Complete Transition from Esoteric Interest to Crucial Infrastructure for the Public Good