Kaiser Permanente's Convergent Medical Terminology.

This paper describes Kaiser Permanente's (KP) enterprise-wide medical terminology solution, referred to as our Convergent Medical Terminology (CMT). Initially developed to serve the needs of a regional electronic health record, CMT has evolved into a core KP asset, serving as the common terminology across all applications. CMT serves as the definitive source of concept definitions for the organization, provides a consistent structure and access method to all codes used by the organization, and is KP's language of interoperability, with cross-mappings to regional ancillary systems and administrative billing codes. The core of CMT is comprised of SNOMED CT, laboratory LOINC, and First DataBank drug terminology. These are integrated into a single poly-hierarchically structured knowledge base. Cross map sets provide bi-directional translations between CMT and ancillary applications and administrative billing codes. Context sets provide subsets of CMT for use in specific contexts. Our experience with CMT has lead us to conclude that a successful terminology solution requires that: (1) usability considerations are an organizational priority; (2) "interface" terminology is differentiated from "reference" terminology; (3) it be easy for clinicians to find the concepts they need; (4) the immediate value of coded data be apparent to clinician user; (5) there be a well defined approach to terminology extensions. Over the past several years, there has been substantial progress made in the domain coverage and standardization of medical terminology. KP has learned to exploit that terminology in ways that are clinician-acceptable and that provide powerful options for data analysis and reporting.

Modeling nursing interventions in the act class of HL7 RIM Version 3.

The proposed Health Level 7 Reference Information Model (HL7 RIM) Version 3 is the foundation for expressing data to be communicated across health care information systems. The general objective of this analysis was to examine whether the RIM supports the expression of nursing interventions, considering both terminological and structural perspectives. The Nursing Terminology Summit Interventions Group focused on patient education about breast cancer, an intervention that differs sufficiently from other medical processes already considered by HL7 and represents issues surrounding both definition and execution of nursing process. Relevant actors, actions, and action relationships were culled from use cases and modeled into the proposed RIM structure and attributes by using modified instance diagrams. This method was effective and reproducible, and the RIM proved to be an adequate model for supporting breast cancer education. Additional interventions must be studied to fully assess the adequacy of the model to support all aspects of nursing process and terminology.