1. 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
Practice Evaluation & Quality
Students/
Faculty
Clinical Data
NMDS
Management Data
NMMDS
Other Data Sets
Professional organizations
Researchers
Nursing Clinicians
Health Policy
Assumption today is that clinical data = medical data
UHDDS captures some of the NMDS, but missing nursing care elements
Management data - missing
Environment, Nursing resources, Financial resources
Continuum of Care 2 2

3. Meaningful Use of EHR Requirements
Standards & Interoperability (S&I) Framework
Consolidated Clinical Data Architecture (C-CDA)
Required and Optional data
Specifies terminologies

4. 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

5. 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

6. 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

7. Interoperability

8. Nursing Interoperability State
3.2%
25.4%

9. 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

10. Conference Attendees

11. Action Plan - 2014 Education Practice
Develop standard curriculum for nursing informatics faculty/students (Tom Clancy, Daniel Pesut)
Certification, credentialing, and accreditation in nursing informatics programs. (Judy Warren)
Practice
Transform nursing documentation. (Ann O’Brien/Charlotte Weaver)
Develop strategies to measure value of nursing. (Ellen Harper/ John Welton)

12. Action Plan - 2014 Policies/Incentives Research
Advancing the NDNQI Pressure Ulcer eMeasure work (Judy Warren/Nancy Dunton)
Coordinate efforts to engage nurses in Health IT policy. (Gail Latimer/Joyce Sensmeier)
Build an infrastructure for the collection and dissemination of standardized workforce data (Amy Garcia)
Research
Develop and disseminate a framework and standards for integration of LOINC/SNOMED CT coding into EHRs for interoperability. (Susan Matney)
Promote harmonization and standardization of nursing data and model. (Laura Heermann-Langford/Judy Murphy)
Nursing and the science of big data. (Connie Delaney/Bonnie Westra)

13. Group 8 Goals
To identify the common assessment measures used in nursing, map them to LOINC, place them in a framework and publish in a public location.
To identify the values associated with the common enumerated assessment measures and map them to SNOMED CT.

14. Process Top-down Bottom-up
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.

15. LOINC® Nursing Framework
Developed an organizing framework comparing nursing diagnoses categories
Examined diagnoses within the framework
Compared 4 EHRs to identify assessments that might represent panels or surveys within LOINC® (adult, non-critical care, includes community)
Blue = some assessments in LOINC®
Pink – need to add to CCC for a framework – we used LOINC®
However, EHRs use the framework at the bottom
Adapted from Clinical Care Classification System
Westra, B.L., Matney, S.A. (2014). LOINC® and Nursing Assessments. Presentation at Big Data Conference, Minneapolis, MN.

16. Request from LOINC Nursing Web Page RELMA Illustrating framework
Framework developed to browse hierarchically LOINC codes under the framework
RELMA
Use framework as a class hierarchy within RELMA

17. Questions?