The Department of Defense (DoD) and the Department of Veterans Affairs (VA) are planning to use 3M's Health Data Dictionary (HDD) to normalize clinical terminology in their joint iEHR system, according to Government Health IT. The publication also reports that if this plan comes to fruition, the two departments will make the HDD freely available in the marketplace, much as the American College of Pathology made its Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) publicly available several years ago.
DoD and VA will do that by allowing their open source community, known as the Open Source Electronic Health Record Agent (OSEHRA), to use HDD. That would provide an incentive for software developers interested in creating applications for the iEHR to employ the 3M nomenclature.
Taken together, these moves could turn the HDD into a kind of lingua franca for health IT in the long run. Still, some serious obstacles remain.
For example, the article compares the DoD-VA plan to make HDD publicly available--if 3M agrees--to Kaiser Permanente's decision in 2010 to donate its Convergent Medical Technology (CMT) to the public domain. CMT is the basis of the Kaiser Permanente electronic health record, which was adapted from Epic's EHR. It is not clear, though, how HDD and CMT would fit together, or if there is any interest in making them compatible.
Also, according to the article, HDD will not compete with or replace other leading terminology standards, such as SNOMED, LOINC (lab data), and RxNORM (medication data). Stan Huff, M.D., CMIO of Intermountain Healthcare, told Government Health IT that "the HDD would have mappings from its codes to the standard codes."
So what is the advantage of having a terminology and underlying code set that differs from these standard vocabularies? According to Huff and Christopher Chute of Mayo Clinic's bioinformatics division, also quoted in the article, HDD organizes its terminology in ways that make it useful for quality measurement, clinical decision support, and "context-specific code lists."
In the end, of course, what really matters is whether health IT vendors embed a common vocabulary into their software. The DoD and VA, with 18 million combined patients, can exert a powerful influence. But vendors still would have to spend a lot of money to revise their databases and applications. That would be in addition to the investments they'll have to make to incorporate SNOMED, LOINC and RxNORM into their EHRs so they can be certified for Meaningful Use Stage 2.
The industry will continue moving toward greater interoperability, but probably won't leap to a common terminology anytime soon. For the foreseeable future, it's likely that firms like 3M, Apelon, and Health Language Inc. will continue to see robust demand for their terminology mapping services.