ANIA: VA harnesses standardized terminology to 'free the data'
BOSTON--The Office of Nursing Services (ONS) at the Department of Veterans Affairs is developing an inter-agency standards-based catalog of terms to drive data use, re-use and sharing. And now this effort is at the tipping point, said Murielle Beene, MBA, RN, chief nursing informatics officer at the ONS; and Diane Bedecarre, MS, RN-BC, during a session at the recent ANIA/CARING conference.
Compiling standards-based terms is no easy task at a single hospital, much less at a federal organization that employs more than more than 75,000 nurses in facilities nationwide and serves 5.77 million patients, Beene said.
Although the VA has had an EHR since the mid-1990s, a useful data retrieval platform has been elusive, she said. Some of the challenges to standardization include a lack of communication across disciplines and providers within the VA. In addition, local-level customization has occurred, the agency has multiple application development processes “and some people buy COTS [commercial off-the-shelf software] products. When they do that, there’s no meeting of the minds to pull these systems together,” Beene said.
“We have non-computable nursing data, inefficiencies that impact workflow and data silos. As a result, we have an inability to use, reuse or share data within our organization,” she said.
“Nursing has been in the unique role of actually figuring out all this stuff, all the diagramming at the other end. Not that we asked for it, it’s just a perfect storm for us to tell our organization where and how to do what they probably need to do better. We can’t have data locked away in various files and applications, we have to leverage the strength of our EHR in order to provide the service for our patients and our staff,” said Beene.
“Our new mantra needs to be ‘free the data.’ ”
“Two-thirds of our veterans healthcare is performed outside the VA system, through contracted services or individuals seeking out care,” she said. “For us to maintain the integrity of our EHR, it is imperative for us to be able to exchange clinical data within the VA and outside the VA.”
The ONS needs to ensure that semantically consistent terminology persists throughout VA applications. “It’s nursing that’s led the way in how we’ll capture and store data within the VA,” said Bedecarre. “The ONS’ standardized catalog of clinical observation terms will be used by all applications, all disciplines and across care settings. SNOMED and LOINC are embedded into current apps and those that are being developed, she said.
About a year ago, three documentation systems were ready to be deployed. All three would directly affect nursing. However, “none of these applications spoke to each other: Rollout and development was in parallel, not harmonized,” Bedecarre said.
The VA began sorting things out by creating a content development group and compiling a set of terms from the flow sheet and assessment software. The focus was on clinical observation terms, including assessment data, in inpatient settings, said Bedecarre. The group was interdisciplinary and interagency. The content development team held weekly calls with clinician subject matter experts.
The ONS measured the group’s progress using Web-based conference tools–Microsoft Sharepoint Services and Microsoft Live Meeting. Document management tools have also been pressed into service, as have spreadsheets for data listing. The office also tapped the CliniClue browser to search SNOMED CT, she said.
“Terminology alone is not enough,” so the group used FreeMind’s “mind mapping” software to develop a graphical display for each domain, including cardiology, functional IV, mental health and others, Bedecarre said. “Domain by domain, we put them on the mind maps to show associations and relationships in a hierarchical view (UML model).”
The ONS is working with clinical LOINC to validate the models. The formal notation effort translates clinical knowledge into UML diagrams, creates models to drive product development, to enable sharing with standards organizations and external partners, including HL7 and the Department of Defense, Bedecarre said.
Compiling standards-based terms is no easy task at a single hospital, much less at a federal organization that employs more than more than 75,000 nurses in facilities nationwide and serves 5.77 million patients, Beene said.
Although the VA has had an EHR since the mid-1990s, a useful data retrieval platform has been elusive, she said. Some of the challenges to standardization include a lack of communication across disciplines and providers within the VA. In addition, local-level customization has occurred, the agency has multiple application development processes “and some people buy COTS [commercial off-the-shelf software] products. When they do that, there’s no meeting of the minds to pull these systems together,” Beene said.
“We have non-computable nursing data, inefficiencies that impact workflow and data silos. As a result, we have an inability to use, reuse or share data within our organization,” she said.
“Nursing has been in the unique role of actually figuring out all this stuff, all the diagramming at the other end. Not that we asked for it, it’s just a perfect storm for us to tell our organization where and how to do what they probably need to do better. We can’t have data locked away in various files and applications, we have to leverage the strength of our EHR in order to provide the service for our patients and our staff,” said Beene.
“Our new mantra needs to be ‘free the data.’ ”
“Two-thirds of our veterans healthcare is performed outside the VA system, through contracted services or individuals seeking out care,” she said. “For us to maintain the integrity of our EHR, it is imperative for us to be able to exchange clinical data within the VA and outside the VA.”
The ONS needs to ensure that semantically consistent terminology persists throughout VA applications. “It’s nursing that’s led the way in how we’ll capture and store data within the VA,” said Bedecarre. “The ONS’ standardized catalog of clinical observation terms will be used by all applications, all disciplines and across care settings. SNOMED and LOINC are embedded into current apps and those that are being developed, she said.
About a year ago, three documentation systems were ready to be deployed. All three would directly affect nursing. However, “none of these applications spoke to each other: Rollout and development was in parallel, not harmonized,” Bedecarre said.
The VA began sorting things out by creating a content development group and compiling a set of terms from the flow sheet and assessment software. The focus was on clinical observation terms, including assessment data, in inpatient settings, said Bedecarre. The group was interdisciplinary and interagency. The content development team held weekly calls with clinician subject matter experts.
The ONS measured the group’s progress using Web-based conference tools–Microsoft Sharepoint Services and Microsoft Live Meeting. Document management tools have also been pressed into service, as have spreadsheets for data listing. The office also tapped the CliniClue browser to search SNOMED CT, she said.
“Terminology alone is not enough,” so the group used FreeMind’s “mind mapping” software to develop a graphical display for each domain, including cardiology, functional IV, mental health and others, Bedecarre said. “Domain by domain, we put them on the mind maps to show associations and relationships in a hierarchical view (UML model).”
The ONS is working with clinical LOINC to validate the models. The formal notation effort translates clinical knowledge into UML diagrams, creates models to drive product development, to enable sharing with standards organizations and external partners, including HL7 and the Department of Defense, Bedecarre said.