Standardization of Health Care Terminologies

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Please address a 1 -1.5 page(s) discussion citing the references below including references page in APA format. Note: Please use only references that have been provided and if you must w/in the last 5 years relevant to topic. Please address it from an informatics nursing view.

Desiderata is a Latin word that translates to “something that is wanted or needed.” It is obvious that James Cimino had this translation in mind when he created his “Desiderata for Controlled Medical Vocabularies.” In his work, Cimino outlines 12 desiderata he believes the health care community should consider when constructing medical vocabularies. He also highlights the need to control the vocabulary used within terminology sets, as well as the requirements for doing so.

For electronic health records (EHR) and clinical decision support systems (CDS) to truly be successful, Cimino, along with many other health care professionals, expresses the vital need to standardize and control the terminology being used in health care settings.

For this Discussion, you will use one of Cimino’s desiderata (or themes) to critically appraise a nursing terminology set:

Cimino’s 12 themes for the 21st century:

  • Vocabulary content
  • Concept orientation
  • Concept permanence
  • Nonsemantic concept identifiers
  • Polyhierarchy
  • Formal definitions
  • Reject NEC “Not Elsewhere Classified”
  • Multiple granularities
  • Multiple consistent views
  • Representing context
  • Graceful evolution
  • Recognize redundancy

 

To prepare:

  • Review the article “Desiderata for Controlled Medical Vocabularies in the Twenty-First Century”. Consider how each theme aims to control the vocabulary used by nursing terminologies.
  • Reflect on prominent standardized nursing terminologies sets, such as NIC, SNOMED, SABA, NANDA, and NOC. How might these terminologies compare to the requirements outlined in Cimino’s 12 themes?
  • Select one nursing terminology set and one of Cimino’s themes to further examine. Does the terminology align with the requirements of this theme? Why or why not?

 

References

Cimino, J. J. (1998). Desiderata for controlled medical vocabularies in the twenty-first century. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415631/

Scherb, C. A., & Weydt, A. P. (2009). Work complexity assessment, nursing interventions classification, and nursing outcomes classification: Making connections. Creative Nursing, 15(1), 16-22.

***The authors of this article discuss the Work Complexity Assessment (WCA), a process that allows nurses to better understand interventions for patient care. The connection between the WCA, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) are also discussed.

Truran, D., Saad, P., Zhang, M., & Innes, K. (2010). SNOMED CT and its place in health information management practice. Health Information Management Journal, 39(2), 37–39. .

***This article focuses on the Systemized Nomenclature of Medicine – Clinical Terminology (SNOMED CT) and how it can be used to support electronic health records (EHRs). The authors describe how SNOMED CT can contribute to EHR improvement with regard to patient safety, quality care delivery, and decision support functionality.

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