Standard Nursing Terminologies:
A Landscape Analysis
MBL Technologies, Clinovations,
Contract # GS35F0475X
Task Order # HHSP2332015004726
May 15, 2017
,Table of Contents
I. Introduction ....................................................................................................... 4
II. Background ........................................................................................................ 4
III. Landscape Analysis Approach ............................................................................. 6
IV. Summary of Background Data ............................................................................ 7
V. Findings.............................................................................................................. 8
A. Reference Terminologies .....................................................................................................8
1. SNOMED CT................................................................................................................................... 8
2. Logical Observation Identifiers Names and Codes (LOINC) ........................................................ 10
B. Interface Terminologies .................................................................................................... 11
1. Clinical Care Classification (CCC) System .................................................................................... 11
2. International Classification for Nursing Practice (ICNP) ............................................................. 12
3. NANDA International (NANDA-I)................................................................................................. 14
4.
4. Nursing Interventions Classification System (NIC) and Nursing Outcomes
Classification (NOC) .................................................................................................................... 15
5. Omaha System ............................................................................................................................ 16
6. Perioperative Nursing Data Set (PNDS) ...................................................................................... 18
7. Alternative Billing Concepts (ABC) Codes ................................................................................... 19
C. Minimum Data Sets .......................................................................................................... 20
1. Nursing Minimum Data Set (NMDS) ........................................................................................... 20
2. Nursing Management Minimum Data Set (NMMDS) ................................................................. 22
VI. Health IT Developers - Perspective ................................................................... 23
VII. Emerging Issues in Using SNTs .......................................................................... 24
1. Lack of Alignment on Terminology Standards for Nursing Content Definition .......................... 24
2. Customized Development and Implementation of EHR Systems ............................................... 24
3. Resource-Intensive Mapping Requirements, Curation and Maintenance ................................. 24
4. Licensing Fees, Copyrights and Associated Pricing Challenges ................................................... 25
5. Incomplete Electronic Documentation of Nursing Care ............................................................. 25
Identifying Challenges and Opportunities within Standard Nursing Terminologies 2
,VIII. Conclusion ....................................................................................................... 26
Appendix A: Expanded Nursing Terminologies Timeline ............................................. 27
Appendix B: Pre-Determined Landscape Assessment Questionnaire .......................... 34
Appendix C: EHR Developer Assessment Questionnaire ............................................. 35
Appendix D: List of Abbreviations .............................................................................. 36
References ................................................................................................................. 38
Identifying Challenges and Opportunities within Standard Nursing Terminologies 3
, I. Introduction
With the rapid adoption of health IT and the promotion of interoperability to improve health, consistent
standards and common data elements are the foundation for the advancement of care models. This
advancement is based on objectives such as capturing sharable patient and care information across
disciplines and care settings, enabling more accurate and less burdensome measurement of the quality
of care delivered, and supporting ongoing research and analysis. Within this context, the nursing
profession can contribute an enormous amount of valuable data related to the care of the patient and
the nursing process. However, if nursing data are not stored in a standardized electronic format, or
easily translated to a vocabulary used by interdisciplinary care team members, the value and
contributions of nursing to patient outcomes may not be measurable or retrievable (Welton & Harper,
Measuring Nursing Care Value, 2016). With more than 3.6 million members, nurses constitute the
largest workforce in health care, and hospital-based nurses spend as much as 50 percent of their time in
direct patient care (Hurst) (Nursing Fact Sheet, 2011) (McMenamin, 2016). As we move forward with
innovative strategies to optimize the health of patients and communities, the omission of nursing data
due to a lack of agreement on a standardization strategy would be unfortunate.
To this end, the Office of the National Coordinator for Health IT (ONC) is working with MBL Technologies
and Clinovations Government + Health, Inc. (Clinovations GovHealth) (hereafter the project team) to
conduct a landscape assessment to better understand the current state and challenges associated with
using terminologies and classifications to support nursing practice within health information technology
(health IT) solutions. Through a literature review and interviews with terminology owners, this
assessment examines the current state of development and usage within the 12 Standard Nursing
Terminologies (SNT) recognized by the American Nurses Association (ANA).
This report:
Defines a brief history of the development of standard nursing terminologies and efforts to gain
consensus on a strategy for their use;
Includes the level of advancement and interoperability of individual terminologies with
electronic health records (EHRs); and
Identifies themes in the form of challenges and opportunities.
II. Background
Nursing terminologies and vocabulary structures first developed in 1973, and many have changed
significantly since their inceptions. Realizing that the standardization of nursing care documentation was
a critical component to support interoperable health information, the ANA in 1989 created a process to
recognize languages, vocabularies and terminologies that support the nursing practice (ANA, 2015).
Current action plans and guidelines, descending from the work of individuals such as James J. Cimino
and organizations such as the National Committee on Vital and Health Statistics (NCVHS) and the ANA,
continue to be refined (Cimino J. , 1998) (Cimino, Hripcsak, Johnson, & Clayton, 1989) (Sujansky, 2002).
However, the inability to ensure the availability of sharable and comparable nursing data remains an
issue. Increased focus on longitudinal and interdisciplinary documentation, care quality and value
Identifying Challenges and Opportunities within Standard Nursing Terminologies 4
A Landscape Analysis
MBL Technologies, Clinovations,
Contract # GS35F0475X
Task Order # HHSP2332015004726
May 15, 2017
,Table of Contents
I. Introduction ....................................................................................................... 4
II. Background ........................................................................................................ 4
III. Landscape Analysis Approach ............................................................................. 6
IV. Summary of Background Data ............................................................................ 7
V. Findings.............................................................................................................. 8
A. Reference Terminologies .....................................................................................................8
1. SNOMED CT................................................................................................................................... 8
2. Logical Observation Identifiers Names and Codes (LOINC) ........................................................ 10
B. Interface Terminologies .................................................................................................... 11
1. Clinical Care Classification (CCC) System .................................................................................... 11
2. International Classification for Nursing Practice (ICNP) ............................................................. 12
3. NANDA International (NANDA-I)................................................................................................. 14
4.
4. Nursing Interventions Classification System (NIC) and Nursing Outcomes
Classification (NOC) .................................................................................................................... 15
5. Omaha System ............................................................................................................................ 16
6. Perioperative Nursing Data Set (PNDS) ...................................................................................... 18
7. Alternative Billing Concepts (ABC) Codes ................................................................................... 19
C. Minimum Data Sets .......................................................................................................... 20
1. Nursing Minimum Data Set (NMDS) ........................................................................................... 20
2. Nursing Management Minimum Data Set (NMMDS) ................................................................. 22
VI. Health IT Developers - Perspective ................................................................... 23
VII. Emerging Issues in Using SNTs .......................................................................... 24
1. Lack of Alignment on Terminology Standards for Nursing Content Definition .......................... 24
2. Customized Development and Implementation of EHR Systems ............................................... 24
3. Resource-Intensive Mapping Requirements, Curation and Maintenance ................................. 24
4. Licensing Fees, Copyrights and Associated Pricing Challenges ................................................... 25
5. Incomplete Electronic Documentation of Nursing Care ............................................................. 25
Identifying Challenges and Opportunities within Standard Nursing Terminologies 2
,VIII. Conclusion ....................................................................................................... 26
Appendix A: Expanded Nursing Terminologies Timeline ............................................. 27
Appendix B: Pre-Determined Landscape Assessment Questionnaire .......................... 34
Appendix C: EHR Developer Assessment Questionnaire ............................................. 35
Appendix D: List of Abbreviations .............................................................................. 36
References ................................................................................................................. 38
Identifying Challenges and Opportunities within Standard Nursing Terminologies 3
, I. Introduction
With the rapid adoption of health IT and the promotion of interoperability to improve health, consistent
standards and common data elements are the foundation for the advancement of care models. This
advancement is based on objectives such as capturing sharable patient and care information across
disciplines and care settings, enabling more accurate and less burdensome measurement of the quality
of care delivered, and supporting ongoing research and analysis. Within this context, the nursing
profession can contribute an enormous amount of valuable data related to the care of the patient and
the nursing process. However, if nursing data are not stored in a standardized electronic format, or
easily translated to a vocabulary used by interdisciplinary care team members, the value and
contributions of nursing to patient outcomes may not be measurable or retrievable (Welton & Harper,
Measuring Nursing Care Value, 2016). With more than 3.6 million members, nurses constitute the
largest workforce in health care, and hospital-based nurses spend as much as 50 percent of their time in
direct patient care (Hurst) (Nursing Fact Sheet, 2011) (McMenamin, 2016). As we move forward with
innovative strategies to optimize the health of patients and communities, the omission of nursing data
due to a lack of agreement on a standardization strategy would be unfortunate.
To this end, the Office of the National Coordinator for Health IT (ONC) is working with MBL Technologies
and Clinovations Government + Health, Inc. (Clinovations GovHealth) (hereafter the project team) to
conduct a landscape assessment to better understand the current state and challenges associated with
using terminologies and classifications to support nursing practice within health information technology
(health IT) solutions. Through a literature review and interviews with terminology owners, this
assessment examines the current state of development and usage within the 12 Standard Nursing
Terminologies (SNT) recognized by the American Nurses Association (ANA).
This report:
Defines a brief history of the development of standard nursing terminologies and efforts to gain
consensus on a strategy for their use;
Includes the level of advancement and interoperability of individual terminologies with
electronic health records (EHRs); and
Identifies themes in the form of challenges and opportunities.
II. Background
Nursing terminologies and vocabulary structures first developed in 1973, and many have changed
significantly since their inceptions. Realizing that the standardization of nursing care documentation was
a critical component to support interoperable health information, the ANA in 1989 created a process to
recognize languages, vocabularies and terminologies that support the nursing practice (ANA, 2015).
Current action plans and guidelines, descending from the work of individuals such as James J. Cimino
and organizations such as the National Committee on Vital and Health Statistics (NCVHS) and the ANA,
continue to be refined (Cimino J. , 1998) (Cimino, Hripcsak, Johnson, & Clayton, 1989) (Sujansky, 2002).
However, the inability to ensure the availability of sharable and comparable nursing data remains an
issue. Increased focus on longitudinal and interdisciplinary documentation, care quality and value
Identifying Challenges and Opportunities within Standard Nursing Terminologies 4
