One of the biggest obstacles to true interoperability among clinical information systems is the multiplicity of medical terms used to describe the same concept. In an effort to promote "semantic interoperability" among systems, the Health IT Standards Committee, a governmental advisory body, has endorsed the use of certain standard vocabularies in electronic health records (EHRs).
The committee is expected to recommend that the Office of the National Coordinator for Health IT (ONC) incorporate the terminology standards into Stage 2 of the Meaningful Use requirements.
The selected vocabularies apply to three areas that will be required to report quality data electronically: medications, lab results and allergies.
The chosen terminologies include:
- The Systematized Nomenclature-Clinical Terms (SNOMED-CT), a standardized medical vocabulary to which other terminologies often are mapped.
- The Logical Observation Identifiers Names and Codes (LOINC). Most often used for lab results, LOINC also identifies concepts such as smoking status.
- RxNORM, the National Library of Medicine classification system for drugs and drug delivery devices.
Jamie Ferguson, a Kaiser Permanente executive who chairs a subgroup of the IT Standards Committee, told Government Health IT that SNOMED-CT will be used to describe diagnoses, encounter data and adverse drug effects, among other things.
Even if ONC accepts the committee recommendations, and support for semantic interoperability is built into EHRs, it will not be easy to get providers to use standard vocabularies, noted Wes Rishel, a committee member and Gartner executive.
A Presidential commission on health IT recently recommended the development of a "universal exchange language." To the extent that semantic interoperability becomes a reality, it will help achieve that objective.