Big Data Research for Transforming USA Healthcare – LOINC Possible Road Map

Susan A. Matney, MSN, RN, FAAN1

Bonnie L. Westra, PhD, RN, FAAN, FACMI2

13M HIS, Murray, UT, USA;2University of Minnesota, Minneapolis, MN, USA

Clinical LOINC Fall 2014

2

Vision for Nursing Data in an Electronic Health Record Supported Clinical Data Warehouse

Continuum of Care

Nursing Clinicians

Students/Faculty

Researchers

Practice

Evaluation &

Quality

Health Policy

Professional

organization

s

Meaningful Use of EHR Requirements

• Standards & Interoperability (S&I) Framework• Consolidated Clinical Data Architecture (C-CDA)• Required and Optional data• Specifies terminologies

http://www.siframework.org/

Translation of Acronyms

• CCC – Clinical Care Classification• CPT – Current Procedural Terminology• HL7 – Health Level 7• ICD.x – International Classification of Diseases• ICNP – International Classification of Nursing Practice• LOINC – Logical Observation Identifiers Names & Codes• NANDA – North American Nursing Diagnosis Association• NIC – Nursing Intervention classification• NOC – Nursing Outcome Classification• PNDS – Perioperative Nursing Data Set• RxNorm – no translation • SNOMED CT – Systematized Nomenclature of Medicine — Clinical

Terms

Health Terminologies• Demographics – HL7, LOINC, OMB, CDC

• Encounter/ Enrollment – HL7 V3 ActEncounterCode

• Vital Signs – LOINC

• Problem – SNOMED CT, ICD-9, ICD-10

• Procedures – SNOMED-CT, ICD-10, CPT-4

• Medications – RxNorm

• Laboratory data – LOINC

• Clinical quality measures – – SNOMED CT for problems, interventions, outcomes, – LOINC - Assessments

Nursing Models & Terminologies

• Nursing has many terminologies/ data sets recognized by the American Nurses Association– Clinical data– Management data – context of care

• Interoperability– Requires common terminologies for exchange– USA

• SNOMED CT – problems, interventions, outcomes• LOINC for Assessments

– International• ICNP/ SNOMED CT

Interoperability

Nursing Interoperability State

25.4%

3.2%

http://www.himssanalytics.org/stagesGraph.asp

Continue the Vision, Teamwork, Collaboration

2nd Annual BIG DATA Conference

June 2014

Purpose

Advance a national plan to effectively capture nursing information for big data research and improved health outcomes

More than 70 leaders from government organizations, national associations, health systems, academia and the software industry

Conference Attendees

Action Plan - 2014

Education1. Develop standard curriculum for nursing informatics faculty/students

(Tom Clancy, Daniel Pesut)

2. Certification, credentialing, and accreditation in nursing informatics programs. (Judy Warren)

Practice3. Transform nursing documentation. (Ann O’Brien/Charlotte Weaver)

4. Develop strategies to measure value of nursing. (Ellen Harper/ John Welton)

Action Plan - 2014Policies/Incentives5. Advancing the NDNQI Pressure Ulcer eMeasure work (Judy

Warren/Nancy Dunton)

6. Coordinate efforts to engage nurses in Health IT policy. (Gail Latimer/Joyce Sensmeier)

7. Build an infrastructure for the collection and dissemination of standardized workforce data (Amy Garcia)

Research8. Develop and disseminate a framework and standards for integration of

LOINC/SNOMED CT coding into EHRs for interoperability. (Susan Matney)

9. Promote harmonization and standardization of nursing data and model. (Laura Heermann-Langford/Judy Murphy)

10. Nursing and the science of big data. (Connie Delaney/Bonnie Westra)

Group 8 Goals

1. To identify the common assessment measures used in nursing, map them to LOINC, place them in a framework and publish in a public location.

2. To identify the values associated with the common enumerated assessment measures and map them to SNOMED CT.

Process

• Top-down– Bonnie Westra, Jung In Park, Susan Matney

evaluating current LOINC nursing alignment using the following framework

• Bottom-up– Identify the top 50 physiologic nursing assessment

questions. – Determine LOINC mappings.– Submit those without mapping to LOINC.– Align with the proposed framework.

LOINC® Nursing Framework

Adapted from Clinical Care Classification SystemWestra, B.L., Matney, S.A. (2014). LOINC® and Nursing Assessments. Presentation at Big Data Conference, Minneapolis, MN.

Request from LOINC

• Nursing Web Page– Illustrating framework– Framework developed to browse hierarchically LOINC

codes under the framework

• RELMA– Use framework as a class hierarchy within RELMA

Questions?