Robert Emmons Haskell

Evaluation of the Clinical LOINC (Logical Observation Identifiers, Names, and Codes) Semantic Structure as a Terminology Model for Standardized Assessment Measures

OBJECTIVE The purpose of this study was to test the adequacy of the Clinical LOINC (Logical Observation Identifiers, Names, and Codes) semantic structure as a terminology model for standardized assessment measures. METHODS After extension of the definitions, 1, 096 items from 35 standardized assessment instruments were dissected into the elements of the Clinical LOINC semantic structure. An additional coder dissected at least one randomly selected item from each instrument. When multiple scale types occurred in a single instrument, a second coder dissected one randomly selected item representative of each scale type. RESULTS The results support the adequacy of the Clinical LOINC semantic structure as a terminology model for standardized assessments. Using the revised definitions, the coders were able to dissect into the elements of Clinical LOINC all the standardized assessment items in the sample instruments. Percentage agreement for each element was as follows: component, 100 percent; property, 87.8 percent; timing, 82.9 percent; system/sample, 100 percent; scale, 92.6 percent; and method, 97.6 percent. DISCUSSION This evaluation was an initial step toward the representation of standardized assessment items in a manner that facilitates data sharing and re-use. Further clarification of the definitions, especially those related to time and property, is required to improve inter-rater reliability and to harmonize the representations with similar items already in LOINC.

Translation and Integration of CCC Nursing Diagnoses into ICNP

The purpose of this study was to translate and integrate nursing diagnosis concepts from the Clinical Care Classification (CCC) System Version 2.0 to DiagnosticPhenomenon or nursing diagnostic statements in the International Classification for Nursing Practice (ICNP) Version 1.0. Source concepts for CCC were mapped by the project team, where possible, to pre-coordinated ICNP terms. The manual decomposition of source concepts according to the ICNP 7-Axis Model served to validate the mappings. A total of 62% of the CCC Nursing Diagnoses were a pre-coordinated match to an ICNP concept, 35% were a post-coordinated match and only 3% had no match. During the mapping process, missing CCC concepts were submitted to the ICNP Programme, with a recommendation for inclusion in future releases.

Modeling nursing interventions in the act class of HL7 RIM Version 3

The proposed Health Level 7 Reference Information Model (HL7 RIM) Version 3 is the foundation for expressing data to be communicated across health care information systems. The general objective of this analysis was to examine whether the RIM supports the expression of nursing interventions, considering both terminological and structural perspectives. The Nursing Terminology Summit Interventions Group focused on patient education about breast cancer, an intervention that differs sufficiently from other medical processes already considered by HL7 and represents issues surrounding both definition and execution of nursing process. Relevant actors, actions, and action relationships were culled from use cases and modeled into the proposed RIM structure and attributes by using modified instance diagrams. This method was effective and reproducible, and the RIM proved to be an adequate model for supporting breast cancer education. Additional interventions must be studied to fully assess the adequacy of the model to support all aspects of nursing process and terminology.