Controlled vocabularies: "@*%!!!" ?
Publication date: Sep 01, 2003
There is a marked increase in interest in coding by European healthcare provider organizations.
Instead of using free text, observations will have to be coded by
means of a code from a controlled vocabulary. I see two main reasons for the current increase in interest in coding:
by governments for the coding of diagnoses and procedures as a cost controlling mechanism, and the increased
cooperation between healthcare providers.
As a direct result of legislation healthcare provider organizations have a financial incentive to improve
their cost management,
i.e. to calculate -and lower- their costs
in relationship to diagnoses or treatment categories.
The impetus to decrease costs also leads to a desire to
increase efficiency by establishing ever closer cooperation with other healthcare providers.
The trend for cooperation between healthcare providers into healthcare provider networks is also driven by
various healthcare reform laws that mandate closer cooperation between providers
(e.g. The German 'Gesundheidsreform 2000').
The use of common coding standards is an essential prerequisite for close cooperation.
The change in attitude towards coding is mainly driven by a restructuring of the reimbursement process
towards the use of DRGs/DBCs. DRGs are used as a means of capturing diagnoses/procedures. Dutch DBCs are an identifier
/classification for clinical pathways.
DRGs/DBCs require the coding of diagnoses and procedures using coding standards such as ICD-10 and ICPC.
Once diagnoses and procedures have been coded they can be used for both financial as well as clinical purposes.
The coding requirements related to financial issues will lead to a higher acceptance of coding methods and technologies,
of coding standards such as LOINC, ICD-10 and SNOMED, and of
a new middleware product: the terminology server.
A terminology server is a product that contains all codes from a range of coding standards, and maintains
a database / expert system of the relationships between the individual concepts coded within these vocabularies.
If you use a DRG-grouper, you already have a terminology server: all DRG groupers have an embedded terminology server to
aid in the process of determining the correct diagnoses codes.
The interest in the area of coding is also shown by an increasing number of requests to healthcare related standardisation
organisations such as the HL7 Affiliates, CEN or NICTIZ, to assist with the
selection of coding standards.
In order to support the reimbursement process coding is gaining in popularity.
Even though most clinicians are rather resistant to the idea of having to do coding for purely financial reasons
(their reaction may very well be something like "@;$#*!!!"),
it will expose a large amount of clinicians to coding in general.
This will prove to be very beneficial to the chances of (regional) electronic patient record systems.
Money is a very powerful motivator when it comes to introducing new practices.
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Index of columns:
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- Next XDS Release (Oct 27, 2016)
- Five years of FHIR (Aug 11, 2016)
- Interoperability projects in Ireland - FHIReland (Mar 14, 2016)
- 2016 FHIR Jedi Calendar (Jan 06, 2016)
- Top 10 HL7 videos watched in 2015 (Dec 24, 2015)
- Update from the trenches on CDA R2.1/R3 and HL7v2. (Oct 15, 2015)
- FHIR DevDays - UK GP System APIs (Sep 16, 2015)
- IHE XDS - testing and implementation tools (Aug 25, 2015)
- Most often implemented IHE Profiles (Jun 08, 2015)
- Why we sponsor the HL7 WGM (May 10, 2015)
- FHIR in Paris (Apr 21, 2015)
- Mapping HL7v2 messages to FHIR. (Apr 13, 2015)
- Analysis of CDA R2 testing tools - most requirements are neither tested nor respected. (Feb 13, 2015)
- HL7 and IHE in Sweden (Feb 08, 2015)
- 2015 FHIR Chiefs Calendar (Jan 07, 2015)
- The Merry FHIR Choir caroling the 12 Days of Christmas (Dec 09, 2014)
- Chicago FHIR Update (Oct 13, 2014)
- Internationalization of HL7 (Sep 25, 2014)
- New XDS Advanced training course on offer by IHE Services and IHE Academy (Jul 14, 2014)
- Recent and Future developments of the DICOM standard (Mar 06, 2014)
- Top 10 HL7 videos watched in 2013 (Jan 02, 2014)
- Report from the HL7 WGM in Cambridge (Oct 16, 2013)
- Documenting the history of HL7 (Sep 03, 2013)
- Histology Lab Device Automation using HL7 version 2 (Jul 23, 2013)
- HL7 FHIR Elevator Pitch (Jul 15, 2013)
- Interoperability Standards - the no-sales pitch (Jul 09, 2013)
- HL7 UK - new landscape, new opportunities (Jun 26, 2013)
- Validation and error correction at the IHE Connectathon (Apr 25, 2013)
- CDA Implementation Guides - (not) invented here (Apr 17, 2013)
- Usage of IHE Profiles (Feb 25, 2013)
- 10 year anniversary - Dutch Ringholm HL7 v2 training courses. (Feb 19, 2013)
- About IHE Academy and new IHE training courses (Jan 12, 2013)
- CDA implementation experiences in the UK (Dec 04, 2012)
- Musings on free HL7 IP (Oct 01, 2012)
- HL7 Connectathons (Sep 09, 2012)
- Renovate HL7 version 3 (Aug 03, 2012)
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- Lighting the FHIR, HL7s new major interoperability standard (Jun 15, 2012)
- Reflections on the HL7 membership model - the affiliate life cycle (Dec 28, 2011)
- Thinking like an OWL reasoner (Sep 17, 2011)
- RFH (Resources for Health): HL7 version 3 taken to the next step (Aug 18, 2011)
- What's so great about the HL7 organization? (Aug 04, 2011)
- Kerndossier: een Nederlandse versie van CCD (Dutch, May 03, 2011)
- A HL7 RIMBAA update (Apr 21, 2011)
- Timezone Hotel (Mar 29, 2011)
- HL7 and openEHR are cooperating (finally) (Jan 21, 2011)
- Increasing demand for IHE training courses (Dec 18, 2010)
- Context issues with the IHE QED profile (Dec 15, 2010)
- The changing role of HL7 country organizations (Jul 16, 2010)
- Implementing HL7 version 3 - the book (May 06, 2010)
- Adding openness to a closed world (Feb 09, 2010)
- How to lower the hurdle for HL7 v3 implementers (Jan 21, 2010)
- HL7 v3 deployment statistics (Dec 17, 2009)
- There's Trouble in Paradigm (Sep 25, 2009)
- Internationalization of HL7 (Sep 24, 2009)
- HL7 UK signs deal with Ringholm to deliver HL7 v2/v3 training courses in London (Sep 17, 2009)
- The use of HL7 in South Africa (Aug 20, 2009)
- The Next Web Conference in Amsterdam (Apr 17, 2009)
- The HL7 UK AGM and RIMBAA (Apr 16, 2009)
- The HL7 Wiki reaches 2000 pages (Mar 02, 2009)
- The HL7 roadmap for CDA R3 and the CCD (Jan 17, 2009)
- HL7 Affiliates Meeting in Orlando (Jan 11, 2009)
- Swiss and Dutch HL7 News (Dec 31, 2008)
- Devices and Prizes (Nov 22, 2008)
- HL7 in Norway: a situation report (Sep 02, 2008)
- Russian whitepaper (Jul 09, 2008)
- The HL7 Interoperability Conference - IHIC 2008 (May 30, 2008)
- HL7 creates a RIM Based Application Architecture (RIMBAA) group (May 18, 2008)
- Notes from the HL7 WGM in Phoenix (May 08, 2008)
- Germany embraces CDA eReferral document specification (May 02, 2008)
- HL7 v3 RIM based applications: an unintended side effect (Jan 19, 2008)
- Collaborative Tools (Jun 21, 2007)
- HL7 ist Pflicht in der deutschen Telematikinfrastruktur (German, Mar 16, 2007)
- HL7 based Tree inventory system (Jan 30, 2007)
- The link between HL7 and Open Source Software (Jan 06, 2007)
- Workflow Bribery (Sep 15, 2006)
- Timezones in HL7 (Jan 23, 2004)
- Controlled vocabularies: "@*%!!!" ? (Sep 01, 2003)
- Trusting the other Party (Nov 01, 2002)
About Ringholm bv
Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT.
We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
See http://www.ringholm.com or call +31 33 7 630 636 for additional information.
Rene is the Tutor-in-chief of Ringholm.