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

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

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 3.2% 25.4% 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 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)

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)

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.

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.

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.

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

Questions?