Four students in the School of Nursing at Penn State University interviewed personnel from LOINC, NMDS, ABC, and ICNP. Their interviews are included in this edition of OJNI as an update. The Editors of OJNI would like to continue to monitor the terminologies and would welcome updates or interviews submitted to keep our readership aware of the progress being made in this vital area of nursing informatics.
Citations:
Saxion, E. (October, 2006). Interview: Multidisciplinary Terminology: Logical Observation Identifiers Names and Codes (LOINC). Online Journal of Nursing Informatics (OJNI), 10, (3) [Online]. Available at http://ojni.org/10_3/termint.htm
Hepler, A. (October, 2006). Interview: Data Element Set: Nursing Minimum Data Set (NMDS). Online Journal of Nursing Informatics (OJNI), 10, (3) [Online]. Available at http://ojni.org/10_3/termint.htm
Elawar, S. (October, 2006). Interview: Multidisciplinary Terminology: Alternative Billing Codes (ABC). Online Journal of Nursing Informatics (OJNI), 10, (3) [Online]. Available at http://ojni.org/10_3/termint.htm
Ryan, S. (October, 2006). Interview: Multidisciplinary Terminology: The International Classification for Nursing Practice (ICNP). Online Journal of Nursing Informatics (OJNI), 10, (3) [Online]. Available at http://ojni.org/10_3/termint.htm
Multidisciplinary Terminology: Logical Observation Identifiers Names and Codes (LOINC)
Susan Matney, RN, MS was interviewed by Erin Saxion, RN on September 28, 2006 at 1:30 p.m. EST.
1) When was your terminology recognized by the ANA?
September 2002 (December 8, 2002 per the website)
2) In what setting was your terminology developed?
LOINC was developed in nursing and other settings.
LOINC is supported by a grant from the National Library of Medicine. Regenstrief Institute maintains the database.
3) What is the content of your terminology?
Multidisciplinary Terminologies
Two categories:
1. Laboratory findings: there are about 30,000 observational terms
2. Clinical measurements: there are 10,000 terms
Looks at wound care assessment, cardiovascular assessment, skin assessment, ultrasound, radiology, clinical care classifications, Apgar, Pain scale, Braden scale.
“LOINC is the questions, it doesn’t have the answers. It is the ‘what’ of the question. It is what we are measuring.”
4) Any new developments - additions or changes?
ANA criteria requires ongoing development in this criteria. The Omaha Updated will be in the next release. There are ongoing additions in the LOINC database.
5) Could you give some examples of how your terminology is being implemented?
1. McKessen is using the Clinical LOINC.
2. The NCVHS (National Council Vital Health Statistics) mandated the use of
Lab LOINC.
6) Is your terminology being used internationally?
LOINC terminology is being used in countries such as Spain, China, Germany, France, Italy, and UK. The NHS (National Health System) in Canada is using SNOMED.
7) What would you like nurses to know about your terminology?
“It’s beyond lab. There are clinical observations that are recognized.”
8) What is the best way for someone to get additional information or provide you with input?
Contact me, Susan Matney, directly through the LOINC website www.loinc.org.
Data Element Set: Nursing Minimum Data Set (NMDS)
Connie Delaney, PhD, RN, FAAN, FACMI, was interviewed by Amy Hepler, RN, on October 10, 2006 at 7:15PM EST.
First let me note that the Nursing Minimum Data Set (NMDS) is for the profession. Developed through a consensus process involving numerous leaders in nursing and under the leadership of Harriet Werley and Norma Lang it was developed and published in 1988. It was submitted and consequently recognized by ANA in approximately 1999.
NMDS is not a terminology in the formal sense; it is a minimum data set which is an identification of key or core, essential elements of nursing knowledge. It was developed within nursing about nursing, relevant to all practice settings.
It is comprised of 3 categories and 16 elements listed below:
Nursing Care Elements
Patient Demographic Elements
Service Elements
No, the elements and definition of NMDS have remained unchanged since 1988. However, a national steering committee is in the process of organizing a review conference to discuss possible revisions of definitions and data collection regarding the NMDS.
NMDS has driven the vocabulary development as is evident in many classifications and terminologies. It is core in the design of nursing documentation systems as seen today as well as the design of the EHR (Electronic Health Record).
In Iceland, NMDS drives all data collection related to nursing. NMDS is also being utilized in Belgium, Switzerland, Thailand and Canada just to name a few countries.
NMDS can be shared and used to provide quality patient care with the help of national collaboration of the nursing population.
Weaver, C., Delaney, C., Weber, P., & Carr, R. (2006). Nursing and Informatics for the 21st Century: An International Look at Cases, Practice, and the Future, First Edition. Healthcare Information and Management Systems Society (HIMSS). Chicago, IL: HIMSS.
Goossen, W., Delaney, C., Coenen, A., Saba, V., Park, H., Casey, A., & Oyri, K. (2006). Towards the International Nursing Minimum Data Set. In Nursing and Informatics for the 21st Century: An International Look at Cases, Practice, and the Future, First Edition. Weaver, C., Delaney, C., Weber, P., & Carr, R. (Editors). (In press). Healthcare Information and Management Systems Society (HIMSS). Chicago, IL: HIMSS.
Delaney, C. (2006). Nursing Minimum Data Set (NMDS) Systems. In V. Saba & K. McCormick (Eds.), Essentials of Nursing Informatics, 4th Edition. (pp.249-261) New York: McGraw-Hill.
Multidisciplinary Terminology: Alternative Billing Codes (ABC)
Melanie Giannini was interviewed by Sherrie Elawar, RN on September 26, 2006 at 4:00 P.M. EST.
1. When was your terminology developed?
October, 2000. In 1996, we began developing terminology for alternative medicine.
2. What types of care does your terminology now cover?
The types of terminology we now cover are nursing, behavioral health, midwifery, spiritual and many others.
3. What is the content of your terminology?
Codes that describe interventions used to process healthcare claims.
4. Any new developments- additions or changes?
Each year we refine existing codes based on user input and add new codes based on requests from practitioners and others who process healthcare claims. For example, we developed 450 codes for the military this year. They will be used to measure chaplaincy care being delivered in military settings, for disaster relief and in prisons and hospitals.
5. Could you give some examples of how your terminology is being implemented?
Alaska Medicaid began using ABC codes two years ago to support care for mentally ill patients in bush and rural communities. The state was able to improve the efficiency and effectiveness of its healthcare system by allowing paraprofessionals to bill for services they provided in areas where professional care was not available. Without codes, the state would not have been able to manage this care. This led to savings of about 50%. The use of ABC codes for electronic health care transactions also had the research benefit of being able to compare costs to professional care.
6. Is your terminology being used internationally?
I do not know. The system was purchased outside the U.S., but we do not know if it is being implemented.
7. What would you like nurses to know about your terminology?
Our development process draws on established nursing terminologies that are created by nurses and other non-physicians. The other major code set used for billing healthcare services is managed by the AMA.
8. What is the best way for someone to get additional information or provide you with input?
ABC codes’ website and under various links such as www.eclaim.biz.
Multidisciplinary Terminology: The International Classification for Nursing Practice (ICNP)
Amy Coenen was interviewed by Susan Ryan on September 26, 2006 at 10:30 EST.
1) When was your terminology recognized by the ANA?
It was recognized by the ANA, then reviewed again 2 years ago. The ANA has an accreditation process that has 15-20 criteria for information systems to meet.
2) In what setting was your terminology developed?
It includes all nursing areas and specialties. Eighty countries are currently using ICNP. It is a software modeling program.
3) What is the content of your terminology?
It includes diagnosis, intervention and outcome.
4) Any new developments - additions or changes?
The terminology is always continuing to change, it is very dynamic. There are updates every year. Version 1.1 update is planned for 2007.
5) Could you give some examples of how your terminology is being implemented?
Electronic health systems, documentation of nursing diagnosis and outcomes, data warehousing, and analysis of practice are a few of the ways.
6) How and where is your terminology being used internationally?
The main countries using the terminology are Korea, Portugal, and Germany. There are 3 accredited centres. Not used much in the United States, but is used somewhat in Canada.
7) What would you like nurses to know about your terminology?
It can bring together other languages and cultures that can all map into one.
8) What is the best way for someone to get additional information or provide you with input?
The world wide web or e-mail :mailto:coenena@uwm.edu