In another case, an orthopedic surgeon is seeing a man who was diagnosed with bilateral carpal tunnel syndrome in 2015. When he tries to schedule surgery for the patient, he finds that he is unable to do so. The diagnosis of bilateral carpal tunnel syndrome, represented by two ICD codes in 2015, is now represented by a single ICD code and this causes a problem with preauthorization for the surgery. Delaying or rescheduling a surgery causes great emotional and physical stress for the patient.
In each of these scenarios, important data was lost—in one case putting the patient at risk and in the other, adding to the workload for the physician. How did this happen?
In both cases, data was lost or changed because clinical vocabularies and mappings to standard code sets were not maintained across the various settings critical to the patients’ care. When the woman’s cardiologist’s EHR translated the data from the oncologist’s EHR, only the preferred SNOMED® code was included, the additional codes were not and important diagnostic data was lost, negatively effecting her treatment. When the orthopedic surgeon tried to schedule surgery, he was unable to do so because the ICD codes were obsolete, affecting his workflow.
Both cases illustrate the need to have comprehensive clinical dictionaries and codes that are maintained and up-to-date in the ever-changing world of healthcare. “We need to be able to follow the patient through all phases of care,” says Frank Naeymi-Rad, PhD, MBA, Chairman, and CEO of Intelligent Medical Objects, Inc (IMO). “We need to be sure that the narrative captured in the first patient visit is accurately communicated down the line to all stakeholders along the continuum of care. And we need to be sure that clinical intent is captured and preserved, and not changed as a result of changes in clinical codes.” The patient’s story matters.
Healthcare Is About More Than Billing
IMO understood from the very beginning that health care was ultimately about caring for patients and solving clinical problems. While billing and reimbursement are necessary, separating clinical documentation from the downstream administrative processes would allow providers to focus on what was important—providing care to patients.
“What we find in practice is that each use case requires different sets of administrative and reference terminologies to be mapped to the same concept,” explains Naeymi-Rad. “We saw that the traditional coding market was ripe for disruption,” he adds. “We had been at this a long time. As early as 1994, we had developed care management tools to enable the capture of codified data for analysis of HIV therapy. So we understood the complexity of the process and underlying ecosystem.”
IMO went on to develop a patented, concept-oriented terminology management system and service that today has over 800,000 clinical concepts, millions of different display terms, all mapped to over 100 code systems. This comprehensive platform allowed IMO to pave what Naeymi- Rad likes to refer to as “the Semantic Highway” for multiple healthcare applications, ensuring that exactly the right information is available for the right patient at the right time, regardless of use case.
IMO maintains both concept-to-code and concept-to-concept relationships in a proprietary database that is served in context-specific services within multiple points in the health information ecosystem. Once clinical intent is documented within the information system using IMO’s Clinical Interface Terminology (CIT), the multiple relationships can be used to ensure that proper coding is available to drive reimbursement, clinical decision support, cohort generation, and population health. In addition, links between problems and procedures, including labs and medications, can drive other workflows like automatic summarization of patient status, problem list management/reconciliation, and advanced analytics.
This patented approach of focusing on clinical concepts, which are stable over time, while managing the changing relationships to codes and other concepts driven by regulatory changes and gains in medical knowledge, places IMO at the foundation of successful health information ecosystems.
IMO maintains both Concept-to-Code and Concept-to-Concept relationships in a proprietary database that is served in context-specific services within multiple points in the Health Information Ecosystem
Paving the Semantic Highway, One Concept at a Time
Clinical interface terminologies capture the clinical intent of the care provider as highly granular and specific findings. In the case of the woman with breast cancer in the opening scenario, the oncologist identified three clinical concepts relating to his patient, each potentially having its own SNOMED CT® code: carcinoma of breast, stage 1, estrogen receptor positive. Each concept describes important clinical information about the diagnosis. IMO makes it easy for the clinician to find and document the combined clinical concept, assigns a single, unique lexical ID to the detailed diagnosis, and maps this to the three individual SNOMED CT terms, in addition to the two ICD-10-CM codes required for reimbursement. The clinical intent is maintained and the detailed mapping is never lost.
The problem arises when information moves around the health information ecosystem and loses its specificity as terminology is translated to a single administrative or reference code. In the breast cancer scenario, the cardiologist’s EHR only stored the preferred primary code for “carcinoma of the breast,” losing other important details about the diagnosis. The patient’s story is lost. If IMO’s interface terminology was used, the data would not have been lost because it is all contained in the single IMO lexical ID and mappings.
“The Semantic Highway reflects the idea that terminology is a key foundational component of all clinical information systems,” explains Naeymi-Rad. “It is IMO’s mission to ensure that the semantic content, or meaning, of the patient data persists as it moves around the ecosystem. This is critical to ensuring efficient and quality care and commerce.”
Paving the Semantic Highway refers to IMO’s ability to exchange patient information across information system boundaries without losing resolution or fidelity. IMO’s accurate and comprehensive clinical data can drive all sorts of downstream workflows including efficient ordering, quality improvement, clinical decision support, high-risk patient identification and reimbursement optimization. Without the Semantic Highway, there can be no efficient transfer of information, and no effective and scalable commerce.
Healthcare Is About Managing Change
“The ability to manage change is a significant and sustainable competitive advantage in healthcare,” says Naeymi-Rad. “But managing change requires the ability to understand and manage the complexity of the process. You need a semantic architecture that can adapt to changes very quickly.”
Where today we rely on the clinician to make decisions, tomorrow decisions will be aided by artificial intelligence (AI) and machine learning. But these systems are only as good as their underlying knowledge. This is why the codified data and rules that serve as the foundation for this knowledge are so critical.
Expert systems need to account for changes to data inputs in real time, especially as machine learning becomes more prevalent in healthcare. But many of today’s algorithms are static. They must be reprogrammed at every instance of alteration. They cannot easily adapt to new rules and new data streams. If we are to manage the complexity of healthcare, we need transformative technology that can adapt to a rapidly changing world.
“Which brings us to our latest disruptive technology,” says Naeymi-Rad. “IMO 2.0—an enterprise terminology platform for change management at the application level and at the data level, as well as at the point of care.” In a logical layered application design, all layers need to communicate with one another and understand changes in other layers. “The presentation layer and how it calls the dictionary is as important as the business rules layer and data layer,” he says. “They all work together in a supportive infrastructure. So many applications on the EHR become obsolete almost immediately because the underlying terminology changes. Coding changes should not change the patient’s history—mapping should be managed in the background.”
“Think of it this way,” says Naeymi-Rad. “IMO 2.0 sits in the middle of machine communications and reporting requirements. I like to call it a universal code translator,” he says. “It allows you to validate and communicate data for further analysis even if a machine becomes outdated. Once you have a trusted semantic foundation, you can really begin to innovate.”
IMO 2.0 clinical interface terms have up to 100 reference maps—for example, SNOMED®, ICD, RxNorm®, or LOINC® — to ensure that all terms are maintained at the highest level of integrity as information moves through the healthcare ecosystem. It is a single solution to streamline operations and overcome quality care and reimbursement challenges.
"With IMO 2.0, all electronic medical records, AI, and expert systems are continuously up-to-date with regulatory, policy, and coding changes"
IMO 2.0 includes features that maintain and manage the terminology silently and automatically, with product updates throughout the year. IMO also provide services to compare and “clean up” customer dictionaries so they are in compliance with the IMO terms and code mappings. There are also tools to compare dictionaries against value sets required by healthcare reporting agencies for reporting on quality measures. With new APIs like the Fast Healthcare Interoperability Resource (FHIR)® to transact patient instance data and share IMO’s aggregation layer like IMO’s Clinical and revenue cycle groupers (i.e. DRG, HCC, and Quality Measure groups).
In the opening scenario describing the patient with carpel tunnel syndrome, the orthopedic surgeon was unable to schedule surgery because the ICD codes in his EHR were out of date. Bilateral carpal tunnel syndrome went from two ICD codes (one for right and one for left) to a single ICD code (for bilateral) in October 2016. Had he been using IMO’s terminology, this would not have happened because IMO’s unique lexical ID retains all relevant code maps, regardless of code changes.2.0 ETP gives organizations confidence that their data accurately represents their patients and the care delivered.
Healthcare Is About Managing and Understanding Data
The world of healthcare is fuelled by data, with more and more of it being generated every day. It’s in every breath and heartbeat, every step we take. Machine learning, AI, sensors, and wearables are changing the way we experience and deliver care. Healthcare data is growing at an annual rate of 48 percent, making it one of the fastest growing data segments in the world. One report estimates healthcare data will reach 2,314 exabytes by 2020. To bring this into perspective, a single Exabyte could store about 500 billion volumes of War and Peace. Think about the potential value and insight, and all its challenges, posed by these numbers.
In order to be able to use this data effectively while working efficiently, we need technology that is smart, works seamlessly, and updates and integrates multiple data streams automatically. We need to have confidence that the data collected truly preserves the patient’s story and the clinician’s intent in the most accurate, specific way possible.
“This is really at the core of IMO’s value proposition,” says Naeymi-Rad. “We give healthcare organizations the ability to manage change and derive value from data that is growing exponentially in order to stay competitive and deliver quality care. IMO was founded in 1994 and we have spent the last 20 years making sure that the clinical intent is captured at the point of care and maintained as an IMO term as information moves around the healthcare ecosystem.”
The end result is semantic interoperability without loss of data fidelity. You get the whole story, the big picture, in full color.
The IMO Team is fully engaged and totally committed to “pave the Semantic Highway” each step of the way to support client initiatives for innovation, transparency in decision support, and accountable care.
LOINC is a registered trademark of the Regenstrief Institute, Inc.
SNOMED and SNOMED CT are registered trademarks of the International Health Terminology Standards Development Organisation.
FHIR is a registered trademark of Health Level Seven International.
RxNorm® is a registered trademark of the National Library of Medicine.
Intelligent Medical Objects, Inc. and IMO are registered trademarks of Intelligent Medical Objects, Inc. @ 2017 Intelligent Medical Objects, Inc. All rights reserved.