Variance in the English language is harming patients and hospitals’ bottom lines. Is healthcare IT the solution?
Since the onset of the firestorm sparked by the Institute of Medicine (IOM) reports “To Err is Human” and “Crossing the Quality Chasm,” there have been extensive debates, volumes of text and countless presentations focused upon patient safety and reducing medical errors. There is consensus among all healthcare stakeholders–physicians, nurses, patients, hospitals, clinics, payers and government–that patient safety is of paramount concern and warrants enhanced scrutiny from within the healthcare system, as well as from the public. There is even consensus that healthcare information technology (IT) will be the linchpin in reducing medical errors and avoiding future adverse and sentinel events.
Variance in the English language is harming patients and hospitals’ bottom lines. Is healthcare IT the solution?
“But no language is perfect, no vocabulary is adequate to the wealth of the given universe, no pattern of words and sentences, however rich, however subtle, can do justice to the interconnected gestalts with which experience presents us.” –Aldous Huxley
Since the onset of the firestorm sparked by the Institute of Medicine (IOM) reports “To Err is Human” and “Crossing the Quality Chasm,” there have been extensive debates, volumes of text and countless presentations focused upon patient safety and reducing medical errors. There is consensus among all healthcare stakeholders–physicians, nurses, patients, hospitals, clinics, payers and government–that patient safety is of paramount concern and warrants enhanced scrutiny from within the healthcare system, as well as from the public. There is even consensus that healthcare information technology (IT) will be the linchpin in reducing medical errors and avoiding future adverse and sentinel events.
However, what we have learned in the ensuing years since the IOM reports is that while IT is a critical component to patient safety management and error reporting, there is no panacea, no quick fix to achieve these noble goals.
Patient safety is usually defined as the prevention of harm to patients, where harm can occur through errors of commission and omission. According to the National Committee on Vital and Health Statistics, approximately 1 in 25 hospital admissions results in an injury to a patient. Additionally, preventable medical errors account for about 12 to 15 percent of total hospital costs. Healthcare entities generally develop standards against a broad spectrum of error types including medication, biologic, device, clinical decision making, nursing or procedural. Quite clearly, patients would benefit if all stakeholders not only committed to a culture of safety, but also spoke the same healthcare safety language.
Although desirable, and certainly valuable, it is not sufficient for healthcare entities to identify and implement standardized terminologies and patient safety taxonomy in an effort to avoid medical errors. Healthcare executives should initiate steps to further improve patient safety by: optimizing the ability of systems to share critical information; mitigating the ambiguity of using words; and, exploiting the robust classification scheme or hierarchy of terminology for enhanced data aggregation and rule triggering.
What’s in a Word?
Dessert or sweets, soda or pop, elevator or lift, flashlight or torch? When comparing American English and British English, George Bernard Shaw noted that the United States and the United Kingdom were “two countries divided by a common language.” Nuances in the English language, such as regionalism, culture and linguistics, can be both challenging and amusing, however, when variants in language impact treatment, safety and billing, it is all challenge and no humor.
Although English contains a reasonable degree of conformity, divergence in phrasing and meaning can compound comprehension problems and impact patient safety. These language “woes” (such as words with overlapping meanings; words with similar concepts that are expressed using different terms; and, words with the same meanings but different connotations) can be minimized through the use of sophisticated healthcare IT systems with terminology management services.
The following abbreviated list of patient safety terms (which uses accepted patient safety taxonomy) exemplifies the language challenges associated with medical error reporting: incident, near miss, slip, error, unexpected or unplanned clinical occurrence, medical mishap, hospital-acquired complication, no-harm event, failure, iatrogenic complication or injury, adverse event, root-cause term and sentinel event.
Despite the emphasis on patient safety measures, there is no doubt why healthcare organizations find reporting and analyzing patient safety data convoluted, as well as challenging.
Healthcare organizations, IT vendors and government agencies must work collaboratively to implement measures to effectively localize, update and disseminate healthcare terminologies, mappings and other terminology-related content currently issued by national and international standards bodies. Realizing that this undertaking is akin to a herculean labor, some experts support combining these variant terminologies to “simplify” healthcare language. Others, who recognize the value that each terminology adds to the greater body of medical knowledge, strongly advocate leveraging language engine technology to provide common terminology services, as well as managing terminology changes over time, as a reliable means to better capture, report and analyze data.
Beyond Words to Concepts
Despite efforts to standardize healthcare language and current technological strides to facilitate mappings from disparate terminologies and terminology-related content, there is considerable discord and extensive debate within the healthcare arena regarding which standards should be implemented.
A controlled medical vocabulary such as Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), maps words to a coded idea or concept that drives the complex use of rules and decision support to shape today’s healthcare decisions, implementing best practice standards.
Although sophisticated healthcare IT systems are not panaceas, they can act as a communication conduit to facilitate shared access to critical clinical and decision-support data.
Disparate national and international standards and terminologies can be problematic, delaying proper diagnoses and treatment protocols, placing patients at increased risk and impeding prompt payment. It’s essential, therefore, for healthcare facilities to implement healthcare IT with terminology management services to alleviate these potentially harmful situations. In the long-term, healthcare stakeholders should focus upon mitigating the ambiguity of words in medical data collection. Clinicians should harness concept-based data entry and non-semantic codes to support consistency in data entry and retrieval.
Any time that health data are created, used, updated or reviewed there is an opportunity for misinterpretation. The ambiguities of language among clinicians in the same specialty, as well as from those with different areas of medical expertise and experience, are suspect and can represent unreliable data. To reduce the chance of medical error or misinterpretation, computerized patient record implementation should include concept-based vocabularies, modeling tools and application programming interface support. Additionally, there should be available mappings to facilitate conversion of documented clinical concepts to appropriate billing codes.
Reporting, Analysis and Best Practice
All medical data–clinical, administrative and billing–have real value to healthcare organizations and to the medical community at large. Concept-based healthcare IT applications enhance enterprisewide terminology management, empower the healthcare organization’s data aggregation capability, and improve its outcomes data analysis functionality. A key benefit to a terminology management services-enabled healthcare IT is its ability to leverage the robust classification scheme or hierarchy of terminology for enhanced data aggregation and rule triggering.
The foundation of today’s evidence-based medicine is decades of aggregated healthcare data. Rules, business logic and custom mappings can facilitate the interpretation of these data to drive a broad range of functions, such as patient safety initiatives, best practice protocols and pay-for-performance metrics.
Where’s the Hero?
Because healthcare organizations are likely to be mired in terminology conflicts for years to come, healthcare executives are seeking a “Hercules” to make their terminology problems disappear. Isn’t this the ideal time for Hercules to enter the healthcare arena and re-route the rivers to clean out the Augean stables in a single day? If only this were possible!
What is possible, however, is the implementation of sophisticated healthcare IT–augmented by terminology management services functionality–to support medical data entry and retrieval, enhance reporting, tracking and analysis capabilities and, initiate and evaluate patient safety measures. As the medical community moves closer to assimilating core terminology standards, what is evident is that healthcare terminology is constantly evolving–each terminology standard complementing the total body of medical knowledge. The “problem” is here to stay, but the solution, as expected, will be underpinned by advanced healthcare IT.
