EMR Transition: It's all in the Words....

Seamless care through EMR requires establishing interoperability between different systems (i.e. organizations, hospitals, clinics, networks, etc.)  The starting point for achieving this interoperability is producing a controlled vocabulary to input within a database.  Naturally, over time development organizations have created such data sets in vocabulary for the specific aim to explain a specific arm of medicine.  Gradually, these organizations have broadened their purpose to encompass all medical terminology.  With this in mind, it is important to note that none of these initial data sets were ever intended to cover all of medicine and thus the reason we have overlap in terminologies, descriptions, etc.

If one were to simply take a look at a single term/data set and the variance in definitions of this term, it would be easy to see how the transition to EMR could effectively come to a grinding halt in its attempts to achieve complete interoperability.  A recent study examined the term myocardial infarction (MI). We all have our own conceptual model of MI and a respective qualitative/quantitative description to fit this model. The study I am referring to found 60 different scientific definitions of myocardial infarction.  Take this example one step further, and imagine the EMR interoperability nightmare if the records of one MI patient had to seek care or advice from a different institution. The flow of that data set from one institution to the next would immediately be severed simply because of the differing definitions and descriptors given. Now multiply this problem by every diagnosable disease.  The thought of standardization of language and disease description becomes a staggering one, and here lies the mountain of work we must climb to achieve seamless EMR interoperability.

To put this into further perspective, the following table elaborates the choices in terminology for specific recordable data sets and the respective organizations that are attempting to develop a controlled language.  While there may be overlap in some of the language in one or two of the systems, there is by no means a consensus language. 

 '+' represents the amount of use of a controlled terminology set within the U.S.; '$' represents a respective cost to the end user.

Having said this, clinicians cannot sit back and simply think that EMR transition will be done by IT people alone.  Definitions and vocabulary are the back bone of this system. Such terminology can only be given by clinicians.  Currently the Office of the National Coordinator estimates 50,000 people will be needed to assist in this effort over the next 4-5 years to reach our goal of 100% transition to EMR.  

I for one had no idea of the scale of the interoperability problems without having started the HITECH Workforce Program only a few weeks back.  I look forward to presenting many more of the big issues that we are facing during this EMR transition in the coming months.  

About the author:

Mehdi Rais is a physician, medical lecturer, medical writer, and self-proclaimed “tech nerd.” When Dr. Rais isn’t honing in on his trades, he spends his time scouring publications and the web for the latest trends in technology in the medical field, new applications in Health Information Technology, and emerging legislative & regulatory changes in medicine. 

Dr. Rais' interests are greatly focused in the realm of mobile computing and the use of cell phone technologies in the clinical setting.  He received his Medical Doctorate from St. Christopher’s College of Medicine after spending his undergraduate years at the University of Texas at Dallas.  

Dr. Rais can be reached on LinkedIn or followed at his blog here. Look for him on Twitter @DrMedBlog.